Wekerle CIHR Team - W2A Ottawa 2017 Child sexual abuse, adolescent health risks, and adolescent rights

1. "Child sexual abuse,
adolescent health risks, and
adolescent rights”
Sexual Violence: What’s Going On?
Dr. Christine Wekerle, McMaster University
@DrWekerle on Twitter
wekerce@mcmaster.ca & www.in-car.ca

2. Difficult, But Important Conversations

3. #CIHRTeamSV – Research and Social Media Project
ResilienceinYouth (Youtube; Twitter; Instagram)
• See Project on Researchgate:
https://www.researchgate.net/project/Understanding-health-
risks-and-promoting-resilience-in-male-youth-with-sexual-
violence-experience-CIHR-Team-Grant-TE3-138302
• Special Issue – Child Abuse & Neglect – Guest Edited by
Delphine Collin-Vézina & Edward Garrido – free access articles
• Special Issue: - Journal of Child and Adolescent Trauma –
Guest Edited by Patricia Kerig & Christine Wekerle – free access
articles
• Sexual and Non-Sexual Violence Against Children and Youth:
• Current Issues in Gender, Trauma and Resilience
• Wekerle, C. & Kerig, P.K. doi:10.1007/s40653-017-0130-7
• https://goo.gl/x51nde
•
DEFINITION:
SEXUAL
VIOLENCE
Sexual activity
without consent
#consentculture vs.
#rapeculture

4. UN Convention on the Rights of the Child (UN CRC)
• Article 3: The best interests of the child must be a primary consideration in all
• actions
• Article 4: Governments must do all they can to fulfil the rights of every child
• Article 12: Every child has the right to say what they think in all matters affecting
• them, and to have their views taken seriously
• Article 34: Governments should protect children from all forms of sexual exploitation and
abuse.
• Maps onto the 2030 Sustainable Development Goals (SDGs) for Gender Equality;
Education; Health & Wellbeing; Peace & Justice

5. • Overall: Cdn Population Survey: CSA only (6.6% women; 1.7% men; OR for CPS 2.2); CSA + CPA (3.8%%, 2.6%; OR for CPS 5.4), CSA+CPA+IPV (3.2%, 1.5%; OR for CPS, 15.8) (Afifi,
MacMillan, Tallieu, Cheung, Turner, Tonmyr, Hovdestad, 2015)
• Cdn Population Survey: CSA Hx – 66.3% “flourishing,” 30. 15% “moderate,” 3.5% “languishing” (Afifi, MacMillan, Tallieu et al., & Boyle, 2016)
• US survey, 28.9% women and 12% men reported CSA (Dube & Rishi, 2017); YRBS 6.7% “forced sex” (Kahn et al., 2016); 4% attempted/completed rape (Ybarra & Mitchell, 2013)
• US population survey, 5.3% of males w/ CSA (1.3% CSA only) with significantly higher mental health risk for: major depression, dysthymia, mania, panic, specific phobia, generalized anxiety,
drug use disorders; paranoid, schizotypal, antisocial, borderline, histrionic, narcissistic, avoidant, obsessive-compulsive personality disorders; and suicide attempts (Turner, Tallieu, Cheung, &
Afifi, 2017)
• Most youth victims (82.7%) of contact peer-to-peer SV did not report to anyone (Radford et al., 2011)
• Indigenous: Younger Cdn population, M age=27 vs. 40 with higher CSA, sexual assault, sex trafficking (Scrimm, 2016; Native Women’s Association of Canada, 2014)
• Physical/sexual abuse (25.4% vs. non-Indigenous, 19.4%) (Brownridge, Tallieu, Afifi, & Elgar, 2016)
• On-line: Risks for (1) grooming of the child and possibly their family; (2) informal indecent image production and distribution amongst offender networks; (3) live streaming of abuse via
webcams (where families/carers are complicit); (4) trolling/bullying
• Girls and boys exhibit similar levels of electronic, verbal, and social bullying (PrevNET)
• Technology-only or Mixed SV (verbal/text) Incidents: 2+ perpetrators (31%, 46%); same gender (73%, 69%); physical violence/threat (22%, 30%); mainly in-home or in-school; social networking
site > texting > instant messaging (Mitchell, Jones, Turner, Shattack, & Wolak, 2016)
• On public transport: 15% (HIC; UK) to 95% (LMIC) rates of sexual harassment & assault towards girls/women (Gekoski, Gray, Adler & Horvath, 2017)
• Child Protection: Similar low CSA rates < 5% Canada - OIS/CIS; UK
• Youth Justice: 51% girls; 9.2% boys CSA (Chaplo, Kerig, Modrowski, & Bennett, 2017)
• In youth gangs: 36.2% gang membership, no gender diffs.; CSA in 58.1% girls (*higher than non-gang), 8.7% boys(Kerig, Chaplo, Bennett & Modrowski, 2015)
• Young Age CSA: Preschoolers experiencing CSA showed lower caregiver ratings on initiative (”act persistent”), self-control (“handle frustration well”) , and attachment-related behaviour
(“respond positively to adult comforting when upset”) over 1 year follow-up (*Langevin & Hébert, 2016
Sexual Violence Victimization: Childhood Sexual Abuse (CSA), Sexual Exploitation,
Sexual Assault, Sexual Coercion/Dating Violence, Sexual Cyber-bullying, Sexual
Harassment – Are we detecting these experiences?

6. Trauma Experiences are stress events that are emotionally difficult to deal with
TRAUMATIC
EXPERIENCES
TRAUMATIC
REACTIONS RESILIENCE
COMMUNITY DIVERSITY VITALITY

7. Resilience, Depression, and Alcohol Problems
• *Goldstein, Zhu, Kofler & Wekerle (2016) (N=277, internet survey)
• Median age of onset of depression in 20s with increasing levels of depression in adolescent
females
• 18-24 year olds have highest rate of past year drinking, binge drinking, and risk for alcohol-related
problems
• The child maltreatment – young adult depression symptoms relationship was mediated by self-
identity (“wishing you were understood better” “believing what someone told you, even though it
didn’t makes sense”) and affect control problems (”moods change quickly” “throwing/hitting
things as a way to get out anger”)
• Further, resilience was a moderator: the above effect was highest at low scores on resilience
• The child maltreatment – young adult alcohol problems relationship was mediated by affect
control problems
• Resilience was a moderator: at high maltreatment and low resilience, depression symptoms were
highest
• - Need to target altered self-capacities and unhealthy coping (alcohol drinking)
• Adolescence and young Adulthood critical developmental windows of opportunity to support
identity exploration

8. Relationships as context for resilience in youth
Social Self-Efficacy: Belief in ability to make connections
Mattering: Felt sense of being important, feeling significant
Optimism: Positive expectancies for future, hopeful
Approach Style: Move towards people and connecting
Adaptability: Capacity to shift when in novel/challenge situations
Adaptive Disengagement: Negative feedback does not impact self-
worth appraisal
Growth mindset: Framing negatives as learning opportunities to
develop skills from a developmental/process vies
Self-Compassion: Responding mindfully to self with kindness, self-
acceptance, not over-personalizing
Adapted from: *Flett, Flett & Wekerle (2015). www.in-car.ca

9. Where there is trauma, there is resilience
• Internet survey, about 50%
perpetrator outside of home
• N=191, M age of onset=7.68
years, SD-3.36
• 6/10 physical threat/violence
• For most, CSA spanned years
• Self-compassion mediated the
CSA -PTSD score relationship.
Emotional abuse still significant
(*Romano, Lyons & St. John, 2015)

10. The Maltreatment and Adolescent Pathways
(MAP) Research Study
• Self-compassion as a resilience
skill and daily practice
• https://www.youtube.com/wat
ch?v=3Zes-PJi2OY
• A minority of youth endorsing
CSA items endorsed “I was
sexually abused” (47% of girls
and 41% of boys)
• (*Wekerle et al., 2017)

11. Indigenous Conceptualization of Resilience
• *Toombs, Kowatch & Mushquash (2016) & Drawson, Houlding, Braunberger, Sawula,
Wekerle & Mushquash (2016)
• Definition: Dynamic process, including ability to use available resources, belief in oneself and
spirituality
• Community resilience : ability to remain autonomous, resistant, meaningful action,
relationships that foster connectedness
• Land-based: sense of place, collective identity, ecological and social interconnectedness
• Actions: Land-based activities, language, having positive experiences of social justice,
engagement with school, participating in community/cultural programs; success of CBT-based
models
• Barriers: restricted travel, challenge to engage with traditional activities, access to resources

12. Peace River Rising Documentary
• “Disclosure” refers to the process whereby a victim of sexual assault confides in
someone, whether a friend or family member or a formal source of support, about a
situation that he or she has experienced Source: https://www.inspq.qc.ca/en/sexual-assault/understanding-sexual-
assault/victims
• https://www.youtube.com/watch?v=6GbGL7dmEwA 9:36 in total
• 4:34-7:40 (resilience journey of sexual violence survivors)
• Helen Knott, a Dane-Zaa/Nehiyaw social worker, poet and activist, explores the
connection between violence against Indigenous women and violence against the land.
• 24/7 Toll-free hotline: First Nations and Inuit Hope for Wellness Help Line at 1-855-
242-3310.

13. Motives for Behaviours: Links to Adolecent Health Risks
(Wekerle et al., 2017) – Importance of Sex for Coping w/
Negative Affect
CopingEnhancement
Social Conformity
Source
Valence
Positive Negative
External
Internal
Cooper, 1994

14. Preventure Model (Conrod, 2016)
• Personality-targeted school-based CBT intervention for substance use/misuse, depression, peer-to-peer
victimization by targeting thinking styles and matching intervention to personality style (i.e., challenging
personality-specific cognitive distortions that lead to health risk behaviours)
• Among undergraduates: missing class due to hangover (19%), unplanned sex (14%), unsafe sex (6%),
being assaulted (10%) or sexually harassed (10%)
• SURPS (Woicik, Stwart, Pihl, & Conrod): (1) impulsivity (stimulants), (2) sensation-seeking (alcohol,
cannabis); (3) anxiety sensitivity and (4) depressive/hopeless (alcohol, sedatives, opiods) (translated
Cantonese, Mandarin)
• Grouped by personality, 2-90 min. sessions, manualized, trained facilitators, 1 week between sessions;
also, have used phone/email coach with intervention manual to client working from home
• Successful adaptation to First Nations youth
• Most adolescents report that learning the CBT strategies were the most valuable component
• 8 randomized trails in Canada, UK, Australia, Netherlands); Effect size, .2 to ..36 (binge drinking), .68
(alcohol use) to .8 (Cocaine use) to 2 years follow-up; average effect size across all studies and
outcomes, d=.47
• IMPLEMENTATION TEAM application for China and Indigenous Youth

15. China-Canada GACD Team grant Call
• Sub-population experiencing relationship loss (parental or community separations; caregiver absence, caregiver death,
cultural disconnection)
• Targeting prevention of adolescent depression and substance use disorders
• Implementation research: assessment/training – smaller trial/fidelity – full-scale implementation
• China – Rural/Town – “Left-Behind Children and Youth (LBCY)” – Relationship loss; Limited Resources
• By 2010, 61 million LBCY (54% boys; 45.9% girls). About 33% living w/ grandparents, 11% with others, 3% left alone;
accounting for 50% of total children in school
• In 2016, 9.02 million LBCY (about 89% grandparents; 3% others; 4% no guardian, largest group, 6-13 age range
• Canada – Rural/Remote Indigenous Youth – Relationship loss; Limited Resources
• Currently in China, 3-session Life Skills program
• Add 2-Session Preventure program (“Train-the-trainer: model)
• Peer-to-Peer Mentoring Network (Year 1, 2 Targets) “youth expert” model
• Add ResilienceInYouth App for maintenance of gains
• Plan to go to 4000 schools in China by Year 3, of 5-year grant
• Indigenous implementation trajectory begins in Year 3 in keeping with Tri-Council Guidelines

16. Thank you for listening!
Questions or
Comments?