Child sexual abuse: A marker or magnifying glass for family dysfunction?

A report of child sexual abuse leads to a multi-agency investigation that often reveals other maltreatment and dysfunctional behaviors within the family. Due to recent developments in this field, the emphasis of the investigation has shifted to the child's history rather than information from the parent or accused, or the presence of injuries. In the last 10 years Children's Advocacy Centers have become a central component to the investigation of child sexual abuse and provide a means for long-term follow-up of referred families. The idiosyncrasies of this investigative and advocacy system have provided an in-depth view of the families of sexually abused children. Four family types emerge: safe and secure, safe and insecure, unsafe and enmeshed, and unsafe and insecure. The characteristics of child sexual abuse, the response to the child's disclosure of abuse, and the prognosis for the child victim vary among the different family types. An innovative long-term program of wrap-around services for sexually abused children and their families provides counseling, peer activities, family mentoring, and child mentoring while tracking the symptoms and behaviors of the child victims. The identification of a child victim of sexual abuse can be a tragic crisis and an opportunity for intensive and timely intervention.