eAppendix. Frequencies of Individual JVQ Items Used to Assess Lifetime Victimization by YSO Perpetrator.
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Shattuck A, Finkelhor D, Turner H, Hamby S. Children Exposed to Abuse in Youth-Serving OrganizationsResults From National Sample Surveys. JAMA Pediatr. 2016;170(2):e154493. doi:10.1001/jamapediatrics.2015.4493
Copyright 2016 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.
Protecting children in youth-serving organizations is a national concern.
To provide clinicians, policymakers, and parents with estimates of children’s exposure to abuse in youth-serving organizations.
Design, Setting, and Participants
Telephone survey data from the 3 National Surveys of Children's Exposure to Violence (2008, 2011, and 2014) were combined to create a sample of 13 052 children and youths aged 0 to 17 years. The survey participants included youths aged 10 to 17 years and caregivers of children aged 0 to 9 years.
Main Outcomes and Measures
Items from the Juvenile Victimization Questionnaire.
In the combined sample of 13 052 children and youths aged 0 to 17 years, the rate of abuse by persons in youth-serving organizations was 0.4% (95% CI, 0.2-0.7) for the past year and 0.8% (95% CI, 0.5-1.1) over the lifetime. Most of the maltreatment (63.2%) was verbal abuse and only 6.4% was any form of sexual violence or assault.
Conclusions and Relevance
Abuse in youth-serving organizations was a relatively rare form of abuse, dwarfed by abuse by family members and other adults.
Child abuse in youth-serving organizations (YSOs) has received considerable attention in the wake of extensive news coverage of cases involving teachers, coaches, day care staff, clergy, and scout leaders.1-3 Lawsuits have sometimes painted a picture of YSO environments as posing a particular risk for abuse because they have inadequate supervision and may serve as magnets for those with abusive inclinations.4 Although efforts have been made to quantify the rate of abuse in some specific environments, such as the Catholic Church5-7 and schools,8,9 most of these studies apply to earlier generations. Counts in the United States within the last 10 years are hampered by the fact that in key data sources, such as the National Child Abuse and Neglect Data System and the Federal Bureau of Investigation’s National Incidence-Based Reporting System, perpetrators who are youth-serving workers are not specifically categorized as such, leaving a vacuum of information about this problem.
Population surveys offer another way to develop information on the epidemiology of abuse in YSOs; however, because these offenses may be less common than abuse by family members, large samples may be required to estimate their incidence. This study uses combined population surveys to calculate prevalence rates for YSO abuse and compare them with family and other nonfamily, non-YSO abuse.
Question: How many children and youths are abused by staff associated with youth-serving organizations such as schools and religious/recreational groups?
Findings: The rate of abuse by persons in youth-serving organizations was 0.4% for the past year and 0.8% over the lifetime. Most of the maltreatment (63.2%) was verbal abuse, and only 6.4% was any form of sexual violence or assault.
Meaning: Additional attention should be put on psychological maltreatment of children in youth-serving organizations.
The data for this analysis came from the aggregation of 3 representative samples of US children: the National Surveys of Children’s Exposure to Violence, carried out in 2008, 2011, and 2014. All 3 were telephone surveys conducted about the abuse, crime, and violence experiences of children and youths aged 1 month to 17 years. Youths aged 10 to 17 years were interviewed directly about their experiences, while information about the experiences of children aged 0 to 9 years was obtained through interviews with a caregiver. Details of the methodology are provided elsewhere.10-12 All procedures were authorized by the institutional review board of the University of New Hampshire. Oral consent was obtained from caregivers and youths aged 10 to 17 years. The 3 samples were combined into a single sample, totaling 13 052 children and youths.
In each survey, information on children's exposure to violence was collected using the Juvenile Victimization Questionnaire,13-15 which contains questions on more than 40 forms of offenses against youth, covering 6 general areas: conventional crime, child maltreatment, peer and sibling abuse, sexual assault, witnessing and indirect violence, and internet abuse. For each type of abuse that a respondent reported experiencing in his or her lifetime, a series of follow-up questions gathered additional information about the most recent exposure, including whether it occurred in the past year, who the perpetrator was, and where the abuse occurred. The questionnaire items used in this analysis were identical across all 3 survey administrations except for 2 items that were not present in 2008 because they were added to the survey in 2011.
For this analysis, only items representing physical assault, sexual abuse, verbal aggression, and neglect were included and only if they were committed by an adult from a YSO. Twenty Juvenile Victimization Questionnaire items were used to assess these abuse types (eAppendix in the Supplement). Although cases of YSO abuse could come to attention in response to any of the 20 questions, the main questions eliciting these cases asked: “At any time in your life, did a grown-up you know touch your private parts when they shouldn't have or make you touch their private parts?” and “Did a grown-up you know force you to have sex?” (sexual abuse); “did a grown-up in your life hit, beat, kick, or physically hurt you in any way?” (physical abuse); or “did you get scared or feel really bad because grown-ups in your life called you names, said mean things to you, or said they didn’t want you?” (verbal abuse). Follow-up questions asked who the perpetrator was. The survey definition of YSO worker was “a grown-up (your child/you) know(s) from some organization, such as a teacher, coach, or youth group leader.” The adult’s role was not broken down into any more specific categories.
The proportion of children and youths with exposure to any type of YSO maltreatment was 0.8% (95% CI, 0.5-1.1) over their lifetime and 0.4% (95% CI, 0.2-0.7) in the past year (Table). This compares with rates of abuse by any family adult of 11.4% (95% CI, 10.4-12.4) over the lifetime and 5.9% (95% CI, 5.2-6.6) in the past year. The total rate for nonfamily adult, excluding YSO adults, was 5.9% (95% CI, 5.2-6.6) for lifetime and 3.3% (95% CI, 2.8-3.9) for past year.
Breaking down the lifetime exposures into categories, sexual abuse was one of the least frequent categories, occurring in 6.4% of YSO survivors. Verbal abuse was most frequent, experienced by more than half (63.2%) of YSO survivors. Physical abuse was reported by 34.6% of survivors.
Most episodes (67%) occurred at school or daycare. They were spread across the developmental spectrum, occurring even among preschool children. Rates were somewhat higher among older than younger children. The experience of a YSO abuse in general was not disproportionate by sex, racial group, or family type, but children who had experienced such abuse had also experienced a higher mean number of adverse events in their lifetime (3.3 for YSO survivors compared with 2.0 for non-YSO survivors) (Table). Lifetime adversity was assessed using 15 questions that asked about major adverse events (eg, serious unintentional injuries or illnesses involving the child or a family member, parent imprisonment, family drug or alcohol problem, and/or parent unemployment).
This analysis of national survey data on maltreatment exposure suggests that the overall rate of YSO maltreatment is modest; YSO maltreatment is dwarfed by family maltreatment and other categories of nonfamily adult abuse, which are comparatively much more common; and sexual abuse in YSOs is a small proportion of all YSO abuse and also of all sexual abuse. These conclusions are not that surprising given that most interactions in YSOs occur in the presence of multiple children and often the proximity of other adults. In addition, many YSOs have made efforts in recent years to improve training, staff selection, and implement abuse-prevention programs.
However, low comparative rates of exposures to YSO sexual abuse in this survey should not be interpreted to mean that such events are rare in absolute numbers. The rate found in this analysis could translate to a population estimate of 36 000 (95% CI, 10 000-125 000) cases among the population of children and youths younger than 18 years, certainly worthy of additional prevention efforts. Levels of exposure of this magnitude are difficult to measure precisely, even with large samples like the one aggregated for this analysis. More targeted studies using cases coming to professional attention, such as the National Incidence Study of Child Abuse and Neglect, may be needed to assess change over time.
Another important finding from the study was the degree to which verbal abuse predominated in reports about YSO abuse. The fact that most abuse in YSOs was categorized as verbal abuse in this survey is a reminder that this kind of maltreatment can occur in contexts other than the home and school. Much of the current prevention training and screening within YSOs is oriented toward sexual abuse,16 but YSOs may also benefit from training staff about how to recognize and prevent verbal abuse. This should include outbursts of anger, shaming, and rejecting that can cause psychological harm.
In many of the cases of YSO abuse coming to public attention, disclosure of abuse has been delayed by dozens of years, possibly suggesting that those experiencing abuse are not yet willing to reveal abuse to interviewers or parents who would pass it on to interviewers. However, it is noteworthy that the rates of abuse by family members, another difficult to disclose form of exposure, were substantially more numerous in this survey.
One other limitation of this survey was that it did not have any screening questions that specifically asked about abuse by YSO staff. Instead, YSO abuse was were identified using more general abuse questions, including some on abuse by adults and caregivers, and a follow-up question asking for more specifics on perpetrator identity. A more targeted YSO question may have elicited more episodes. Narrative descriptions of episodes might have also identified more offenders who could have been classified as YSO connected. In addition, perpetrator identity in our protocol only asked about the most recent experience for children who had more than 1 of that type of episode. This could also mean that some YSO experiences were not counted. This would be less true, however, for the less frequent kinds of episodes, such as sexual abuse, that tended not to have happened with multiple perpetrators.
This analysis suggests that maltreatment of children and youth in YSOs is a problem, but not nearly as much as maltreatment in the family. It is important that publicity about cases that come to media attention not give an exaggerated sense of frequency that creates unnecessary anxiety or deters families from making the resources of these organizations available to their children. It is also important that the statistics on family maltreatment be widely and regularly disseminated so that this reality is not obscured.
Corresponding Author: David Finkelhor, PhD, Crimes Against Children Research Center, University of New Hampshire, 125 McConnell, 15 Academic Way, Durham, NH 03824 (email@example.com).
Published Online: February 1, 2016. doi:10.1001/jamapediatrics.2015.4493.
Author Contributions: Dr Shattuck had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Study concept and design: All authors.
Acquisition, analysis, or interpretation of data: All authors.
Drafting of the manuscript: Shattuck, Finkelhor.
Critical revision of the manuscript for important intellectual content: All authors.
Statistical analysis: Shattuck.
Obtained funding: Finkelhor, Turner.
Administrative, technical, or material support: Finkelhor.
Study supervision: Finkelhor, Turner.
Conflict of Interest Disclosures: None reported.
Funding/Support: This project was supported by grants 2006-JW-BX-0003 and 2009-JW-BX-0018 awarded by the Office of Juvenile Justice and Delinquency Prevention, Office of Justice Programs, US Department of Justice.
Role of the Funder/Sponsor: The funder had no direct role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or the decision to submit the manuscript for publication.
Disclaimer: The points of view or opinions in this document are those of the authors and do not necessarily represent the official position or policies of the US Department of Justice.
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