Supporting Adolescent & Young Adult Health

1. 1
Sexual violence
prevention and
resilience promotion
Building international collaborations
Presentations to: University of Worcester, University of
West England
October, 2016
Editor-in-Chief, Child Abuse & Neglect
Supporting Adolescent &
Young Adult Health:
Christine Wekerle, Ph.D.
Pediatrics, McMaster University
Hamilton, ON, Canada
wekerc@mcmaster.ca
@DrWekerle

2. Presenter Conflicts of Interest Disclosure
• Presently: Dr. Christine Wekerle
• Relationships with commercial interests: NONE

5. Definition of child maltreatment (CM)
• “Child maltreatment, sometimes referred to as child
abuse and neglect, includes all forms of physical and
emotional ill-treatment, sexual abuse, neglect, and
exploitation that results in actual or potential harm to
the child's health, development or dignity”
• WHO | Child maltreatment www.who.int/topics/child_abuse/en/
– Public Health – Prevention of premature mortality, directly and indirectly
– Humanitarian – Use of children during conflict (sex, labor, shielding)
– Human Rights – Basic rights to non-violence and well-being; Disability
prevention (14% >likely to be unemployed in adulthood; Currie & Widom,
2010; open access article:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3571659/)
– Legal – Mandatory Reporting – for US States reporting numbers and
information
https://www.childwelfare.gov/organizations/?CWIGFunctionsaction=rols:mai
n.dspROL&rolType=custom&rs_id=5

6. Child Maltreatment
Harm and Resilience Potential
Artwork in the 2016 McMaster Museum of Art: “Picturing Wellness” Exhibit
https://museum.mcmaster.ca/exhibitions/past-archive/ #art=#resilience

7. Outline: #SGDs #GlobalGoals #ENDviolence
#malehealthmatters #violenceprevention #resilienceinyouth
#picturingwellness
7
I. Child Maltreatment
Connecting to Global Partnership to End Violence Against Children
Keeping adolescents and emerging adults in mind
Connecting to developmentally-timed task
II. Canadian Institutes of Health Research
(Institute of Gender & Health, Public Health Agency of
Canada) Team Grant in Boys’ and Men’s Health
Range of studies from epidemiology to social media-based Kmb
Targets for Prevention in Vulnerable Populations (hand-out)
III. Discussion

8. Global Partnership to End Violence Against
Children (http://www.end-violence.org/)
• SAFE, STABLE, NURTURING CARE
– (1) Teach positive parenting skills;
– (2) Help children develop life skills and
stay in school;
– (3) Raise access to treatment and support
services;
– (4) Implement and enforce laws to protect
children;
– (5) Value social norms that protect
children;
– (6) Empower families economically;
– (7) Sustain safe environments for children

9. Global Partnership to End Violence
• https://sustainabledevelopment.un.org/partnership/?p=9061
• 2017 Deliverable: Build political will to end violence
against children - make violence prevention a
global policy priority
• Goal 4: Build and upgrade education facilities that
are child, disability and gender sensitive and
provide safe, non-violent, inclusive and effective
learning environments for all
• Target 16.2 End all forms of violence against
children
• What about adolescents?
9

10. Trauma Experiences are high-impact events that are
emotionally difficult to deal with and cause stress
TRAUMATIC
EXPERIENCES
TRAUMATIC
REACTIONS RESILIENCE
COMMUNITY DIVERSITY VITALITY
UNICEF 2016 plan
12% of budget in youth protection
http://www.unicef.org/publications/files/HAC_2016_Overview_
ENG.pdf

11. Terms used in Elsevier’s Child Abuse & Neglect articles
published 2010-2014
Citation impact:
Note: Elsevier analyses of common terms from Child Abuse & Neglect articles; Used with permission, 2016

12. Global research priorities for interpersonal violence
prevention: a modified Delphi study (Mikton et al., 2016)
12
• Interpersonal violence=
child maltreatment,
intimate partner violence,
sexual violence, youth
violence, armed violence,
elder abuse (lifespan)
• Findings:
• International expert
research priority ratings on
1 (most)-6 (least)Likert
scale:
• Child Maltreatment
(2.05);
• Sexual Violence (4.07).

13. Reviews of the global literature,
including population surveys…
• 363/1000 children (emotional abuse);
• 226/1000 children (physical abuse)
• 163-184/1000 children (neglect)
• 127/1000 children (sexual abuse)
• Unique impact of sexual abuse (e.g., Dion et al., 2016)
• An increasing recognition that male youth may feel
greater stigmatization and may under-report
• Issue of sexual violence exposure among vulnerable
populations (child welfare, juvenile justice, military,
street-involved, LBGT+, Indigenous etc.)

14. 4-D (dimensions) Model of Trauma:
(time; thought; body; emotion)
Frewen & Lanius (2014) https://www.researchgate.net/publication/260994367_Trauma-
Related_Altered_States_of_Consciousness_TRASC_Exploring_the_4-D_Model14

15. 4-D Model of Trauma: Sense-of-Self
I am in the
past . . .
I am outside my
body, and my
body does not
belong to me . . .
My thoughts
and voices take
control . . .
I can’t feel,
I don’t know
what I’m feeling,
I feel too much,
I too little . . .
SELF
TRAUMATIZED
I am in the
present . . .
I am in my body
and it belongs to
me . . .
I own and am in
control of my
thoughts . . .
I can feel, and
know what I’m
feeling . . .
SELF
RECOVERED

16. Traumatic Responses – Male victim
• “Major isolation, major depression, major
anger, sadness, shame, guilt, scared – I always
felt I was to blame. I suffer from PTSD, serious
sleep deprivation, struggled with a lot of
depression, anxiety, suicidal ideations, difficult
to relate to peers, socially isolated, withdrawn,
introverted, extreme mistrust of people,
extreme amount of guilt, disassociation – -
no safe place. “
• From: http://www.justice.gc.ca/eng/rp-pr/cj-
jp/victim/rr13_8/rr13_8.pdf

17. CSA &Gender Rates
STUDY CSA Rape/Sodomy Sexual
Harassment
Internet Sex
Talk
Sexual
Dating
Violence
US Juvenile Offenders and
Victims 2014 National Report
5.1%
12.9%
3.4%
20.5%
5.6%
13.9%
US NatSCEV (2011) 4.0%
17.0%
0.4%
3.6%
US CDC Youth Risk Behavior
Survey (YRBS) 2013
6.2%
14.4%
US National Incidence -
Based Reporting System
Law Enforcement
Modal Age Boys=
4 years old
Modal Age Females=
14 years old
62.0%
55.0%
(Fondling)
5.0%/30.0%
35.0%/ 5.0%
Global Rates
Stoltenborgh et al. (2011)
Systematic Review
7.6%
18.0%

18. Maltreated youth tend to function day-to-day
(adaptation)
• Order of Canada, ex-NHL’er Sheldon Kennedy
adolescent interview YouTube
• Documentary: “Swift Current”
• CLIP: https://www.youtube.com/watch?v=sP3z8KVttro
(1.03 minutes)
• “Graham asked me questions about my life that nobody ever
asked me. He asked me how I got along with my father, how I
liked playing on my team, how I felt about school. I opened up
to him immediately, especially…I wasn’t used to being asked
about my feelings and opinions about things, and I sure wasn’t
used to being listened to with so much interest and attention.”
(p.33, Why I didn’t Say Anything, 2011)

19. MAP Study Research Team & Funders
Multi-disciplinary Co-Investigator Team (alphabetical order):
Dr. Michael Boyle, McMaster University
Dr. Deborah Goodman, University of Toronto; Child Welfare Institute, Children’s Aid Society of
Toronto
Mr. Bruce Leslie, Catholic Children’s Aid Society of Toronto (retired)
Dr. Eman Leung, City University of Hong Kong
Dr. Harriet MacMillan, McMaster University
Dr. Nico Trocmé, McGill University
Dr. Randall Waechter, St. George’s University
MAP Advisory Board – child welfare agency representatives and researchers
Partner Supporters: Child Welfare Research Portal (cwrp.ca), Child Welfare League of Canada,
First Nations Child and Family Caring Society of Canada, Ontario Association of Children’s Aid
Societies
Collaborating MAP Scientists
CIHR Team grant – male CSA – secondary analyses

20. Maltreatment and Adolescent
Pathways (MAP) Research Study
• Random case selection of active caseload
• Across types of status – 62% Crown Wards
• Repeated assessments every 6 mo. – 2 years
• Some findings overview:
• https://www.youtube.com/watch?v=3Zes-
PJi2OY
20

21. Maltreatment and Adolescent Pathways (MAP)
Research Study - Child Sexual Abuse Experiences
• From initial assessment (N=561) – Grouping into CSA experiences using youth self-
report (CTQ/CEVQ) and Caseworker Report
» Females (n=145; 49%) Males (n=70; 27%)
Using CTQ
Fondling 54% 45%
Molested 47% 38%
“I was sexually abused.” 55% 41%
http://www.nspcc.org.uk/globalassets/documents/research-reports/social-
workers-knowledge-confidence-child-sexual-abuse.pdf
2014 Brady et al. NSPCC report – challenges of workforce in specific trauma
assessment areas like CSA

22. Motives for Sex &:
Sexual Health Risks (n=297)
CopingEnhancement
Social Conformity
Source
Valence
Positive/Approach Negative/ Avoid
External/
Other-focus
Internal/
Self-focus
Cooper, 1994

23. • For child welfare-involved male youth, direct (c’) and indirect
significant (PA, PM)
• CSA+ males > CSA- males and CSA+ females to use alcohol
before sex
23
Childhood Sexual Abuse
Coping Motives
Partner Approval
Motives
Peer Approval Motives
Risky Sexual Behaviour
a1
a3
a2
b1
b2
b3
c´
• Early age of
intercourse;
• 4+partners, lack of
protection, sex w/
not well-known
person past 6 mo.
• Use alcohol/drugs
before sex

24. Youth are more challenged in normative
adolescent risk-taking: Drinking & Sex
• Teaching consent helps w/ what not-to do, but not
what to-do (strategies for peer pressure)
• Adolescent and young adults, including collegiates,
at risk of sexual violence
• Audrie & Daisy 2016 documentary trailer
• https://www.youtube.com/watch?v=29Dr4ChJUBc
• Interview with male youth:
• https://www.youtube.com/watch?v=S4eOS-
TvVmA 24

25. College as a Resilience Hub
• Colleges and universities are service providers across a
spectrum: food security, learning, organization, career
planning, physical health, mental health, sexual violence
prevention, special needs
• Recognized time of risk-taking within a structured
environment - safe schools are required
• Research study within The Caring Campus Project, funded
by Movember Canada (http://caringcampus.ca) on sexual
violence and drinking
• Kehayes, I. L, Hudson, A., Thompson, K., Wekerle, C., & Stewart, S. H. (2017). Alcohol-Involved Sexual
Victimization in College Men and Women: Anxiety and Depression Outcomes. Poster submitted to the
Anxiety and Depression Association of America (ADAA) Annual Anxiety and Depression Conference,
San Francisco, California, April.
• Kehayes, I. L, Hudson, A., Thompson, K., Wekerle, C., & Stewart, S. H. (in preparation). The
consequences of alcohol use and sexual victimization in men and women college students.
25

26. Collegiates as a Resilience Population
• Collegiates experience adversity and local service access and
resources may be a context of resilience
• Young adulthood more developed executive function to support
reaching for positives under challenge (school stress, connectedness,
growth mindset)
• Key adverse event: Collegiate sexual assault
– 20% women experience assault
– 1-14% men experience assault
• Sexual victimization and alcohol use often co-occur
– 50-70% of sexual assaults involve alcohol use1
• Heavy drinking may increase risk of sexual assault as victims may be targeted by
perpetrators1
• Alcohol intoxication may interfere with a victim's ability to keep themselves safe
– Women who drink regularly once a week, more likely to experience a sexual assault than
women who don’t drink regularly2
– 1Abbey et al., 2004; 2Testa & Livingston, 2000 26

27. Alcohol and Sexual Assault
• Alcohol first acts as an anxiolytic (inhibits anxiety)
• Alcohol influences higher-order processing (planning, problem-
solving and inhibition)1
–  cues that would inhibit behaviour (empathy, concern) less
salient than feelings of sexual arousal when drinking
• Alcohol as synergistic
– Predisposed to sexual perpetration  more likely to act on
desire when intoxicated
• Beliefs about alcohol also important
– College men who thought they were drinking  more aroused
by consensual and forced sex2
1Chermack & Giancola, 1997; 2George et al., 2000

28. • Longitudinal (5 waves)
– 1,475 participants
• Present study utilizes wave 3 only
– 819 first-year students (512 who drink)
– M age = 18.34 (1.88)
– 69.1% female, 30.9% male
• Victimized while drinking
– How often have you experienced the following as a result of using alcohol this
term?
• Was taken advantage of sexually
• Never, Once or twice, 3-5 times, 6-9 times, More than 10 times
• Victimized by someone who was drinking
– How many times this term has another student (i.e., friend, roommate,
classmate, or other student) who had been drinking or using drugs…
• Sexually harassed or sexually assaulted you
• Never, One or twice, 3 or 4 times, 5 or more times
• Anxiety and depression
– Mood and Anxiety Symptom Questionnaire
– (MASQ; Watson & Clark, 1991)

29. Model
Victimized by
Someone Drinking
A)
B)
Anxiety
Depression
Victim of Sexual
Assault When
Drinking
Anxiety
Depression
.14* (F = .08, M = .28**)
.03 (F = .-.04, M = .17†)
.21*** (F = .15*, M = .38**)
.06 (F = .02, M = .01)
∆χ²(9) = 49.472, p < .001
∆χ²(9) = 48..974, p < .001
† p = marginal, * p < .05, ** p < .01, *** p < .001

30. Affective Issues involved in trauma: Anhedonia
(Frewen et al. work)
HEDONIC DEFICIT (HD) NEGATIVE AFFECTIVE INTERFERENCE (NAI)
POSITIVE
AFFECT
NEGATIVEAFFECT
Trauma Theory: Child maltreatment challenges affect regulation, given the experience of
competing emotions e.g., attachment feelings with fear of attachment figure; experiencing pain
and positives from the same parent or attachment figure. Association of positives with
negatives and visa versa.

31. Childhood Maltreatment & Anhedonia
(Frewen et al. studies)
EMOTIONAL ABUSE
0
1
2
3
4
5
6
HD NAI
EA (n=20)
No-EA
(n=79)
SEXUAL ABUSE
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
HD NAI
SA (n=14)
No-SA
(n=85)
*
***
*
*

32. Mindfulness Mindset
Mindfulness:
• A resilience process to de-
couple positives from
negatives and reduce
emotion over- or under-
reactivity
• Building the observational
self (versus the victimized or
victimizer self-concept) to
provide self-scaffolding to
emotional experiences (in
maltreatment, parental lack
of scaffolding child’s
experiences

33. Frewen & Lanius, 2014 Mindfulness
Intervention: In the PALM of your hand...
Presence
• I am in the
Present,
not the
Past
• Recognize
influence
of past on
my
responses
in the
present
Awareness
• Being
Aware of
my senses,
body, and
emotions
• Labeling
and under-
standing
my
experience Letting-Go
• Letting-go
of
distressing
experience
• Non-
attach-
ment to
harmful
impulses
or desires
Metta
• Being
Kind &
Compass-
ionate to
Self &
Trusted
Others

34. Crafting A Daily Resilience Practice
(1) Reducing everyday experience/perception of
overwhelming stress (rumination);
(2) Increasing positives and regulation actions
•Sleep Quality
•Social Connectedness
•Self-compassion
•Exercise/Fitness
•Healthy Fun

35. Thank you for your time and attention!
35
Youtube = ResilienceInYouth
Instagram = ResilienceinYouh
Twitter = @ResilienceinYouth @Team_Resilience @DrWekerle
Email: wekerc@mcmaster.ca for CIHR Team Twitter Chart
Researchgate: Follow Project @
https://www.researchgate.net/project/Understanding-health-risks-
and-promoting-resilience-in-male-youth-with-sexual-violence-
experience-CIHR-Team-Grant-TE3-138302