**7. Conclusion**

### **7.1 Overview of purpose and major findings**

The purpose of this chapter was to explore patterns of sexual abuse over the life-course among incarcerated older adult offenders and the relationship to sexual offense histories, and their temporal subjective experiences of trauma. This study corroborates prior results that find high prevalence rates of trauma among juvenile and adult prisoners (Abram et al., 2007). However, this study makes a number of significant contributions to the field. Firstly, it focuses in on traumatic experiences specific to sexual victimization. Secondly, it not only examines the objective occurrence of such experiences, but also examines incarcerated older adults' past year subjective impressions of these events, indicating significant present distress from past sexual abuse experiences. Thirdly, it examined and found support for a positive and significant relationship between having committed a sexual offense and experiences of sexual victimization.

### **7.2 Implications**

Currently, the sexual abuse victimization experiences of older adults who also are incarcerated offenders have been largely ignored. This is a serious oversight since prison systems are known for being highly stressful environments in which older adults are at greater risk for the onset or resurfacing of post traumatic stress symptoms (Maschi, Gibson, Zgoba, & Morgen, 2011). In court or prison intake assessment and pre-parole evaluations, subjective experiences, especially psychological distress related to past events, and sexual victimization, are not assessed. Without proper assessment, can older adults in prison access the types of services to help process unresolved sexual abuse experiences and take responsibility for their offenses?

In addition to adjustment to prison, about half of the incarcerated older adults are expected to be released to the community. There is potential for new federal proposals to aid in improving both advancing the discourse about these issues and improving practices for older adults in prison facilities. For example, in America, the Substance Abuse and Mental Health Services Administration (SAMHSA, 2011) recently created eight new initiatives (2011-2014), including trauma and justice. Programs that provide sexual abuse and sex offender specific treatment are warranted. Treatment options should be available from the point of entry into the correctional system, in preparation for re-entry into the community, and care after release.

As the findings suggest, significant differences were found between objective and subjective experiences of sexual abuse in this population. Understanding these differences and the more significant role that subjective experience plays for these participants, are essential in understanding, developing, and refining, effective screening instruments and implementing appropriate, trauma-informed interventions. This study supports the notion that assessing for objective and subjective distress related to these events also may be essential.

Along the same lines, evidence-based assessment and interventions must be in line with the finding of how significant the subjective impressions of sexual assault are for incarcerated older adults in treatment. A promising intervention that is being piloted in the criminal justice system with younger age groups is Eye Movement Desensitization and Reprocessing (EMDR). EMDR specifically targets change in subjective units of distress among trauma survivors, particularly sexual abuse survivors, which in turn reduces post traumatic stress symptoms (Kitchiner, 2000). Moreover, previous research with incarcerated juvenile offenders shows that EMDR can work in reducing post traumatic stress reactivity resulting in less violent behavior and conduct problems among samples. Its utility for older adults, especially those with histories of sexual assault victimization and perpetration is perhaps a promising intervention. The use of evidence-based practices suggests that untreated trauma and grief are related to increased adult recidivism rates (Leach et al., 2008). Therefore, treating psychological distress and untreated symptoms effectively, which involves both screening and treatment that captures subjective experiences, may help to break the cycle of recidivism and in some case sexual offending.

#### **7.3 Limitations and future research directions**

28 Sexual Abuse – Breaking the Silence

The results from the series of chi square tests that were run indicate that there is a significant relationship between having a sexual offense history and each of the sexual victimization variables (sexual touch before age 16 (*X*2 = 26.32, *df* =1, *p* = .001), sexual assault before age 16 (*X*2 = 8.16, *df* =1, *p* = .001), sexual touch after age 16 (*X*2 = 6.0, *df* =1, *p* = .02), sexual assault after age 16 (*X*2 = 7.9, *df* =1, *p* = .01), and sexual harassment (*X*2 = 10.5, *df* =1, *p* = .001). These findings suggest that there is a relationship between prior sexual victimization and sexual offending.

The purpose of this chapter was to explore patterns of sexual abuse over the life-course among incarcerated older adult offenders and the relationship to sexual offense histories, and their temporal subjective experiences of trauma. This study corroborates prior results that find high prevalence rates of trauma among juvenile and adult prisoners (Abram et al., 2007). However, this study makes a number of significant contributions to the field. Firstly, it focuses in on traumatic experiences specific to sexual victimization. Secondly, it not only examines the objective occurrence of such experiences, but also examines incarcerated older adults' past year subjective impressions of these events, indicating significant present distress from past sexual abuse experiences. Thirdly, it examined and found support for a positive and significant relationship between having committed a sexual offense and

Currently, the sexual abuse victimization experiences of older adults who also are incarcerated offenders have been largely ignored. This is a serious oversight since prison systems are known for being highly stressful environments in which older adults are at greater risk for the onset or resurfacing of post traumatic stress symptoms (Maschi, Gibson, Zgoba, & Morgen, 2011). In court or prison intake assessment and pre-parole evaluations, subjective experiences, especially psychological distress related to past events, and sexual victimization, are not assessed. Without proper assessment, can older adults in prison access the types of services to help process unresolved sexual abuse experiences and take

In addition to adjustment to prison, about half of the incarcerated older adults are expected to be released to the community. There is potential for new federal proposals to aid in improving both advancing the discourse about these issues and improving practices for older adults in prison facilities. For example, in America, the Substance Abuse and Mental Health Services Administration (SAMHSA, 2011) recently created eight new initiatives (2011-2014), including trauma and justice. Programs that provide sexual abuse and sex offender specific treatment are warranted. Treatment options should be available from the point of entry into the correctional system, in preparation for re-entry into the community, and care after release. As the findings suggest, significant differences were found between objective and subjective experiences of sexual abuse in this population. Understanding these differences and the more significant role that subjective experience plays for these participants, are essential in understanding, developing, and refining, effective screening instruments and implementing

**6.3 Chi square results** 

**7. Conclusion** 

**7.2 Implications** 

**7.1 Overview of purpose and major findings** 

experiences of sexual victimization.

responsibility for their offenses?

This study has notable limitations. First, the study used a cross-sectional design thus precluding causal inferences about the relationship between sexual victimization and sexual offending. The study sample from a northeast state prison system may not be representative of and generalizable to prisoners in other geographic locations and non-English speaking participants. Using a mailed self-administered survey may be another limitation because of possible low response rates and possible limited literacy levels.

Perhaps most importantly, while the data found in this study related to sexual abuse are slightly higher than in the general public, it is imperative to consider that these numbers are still not representative of the actual rates of sexual victimization in older prisoners. Offenders often do not endorse a history of sexual abuse even if it is present. For instance, research shows that 40% of randomly selected male inmates met the criteria for being a victim of sexual abuse. However, 41% of those people did not consider themselves to have been sexually abused (Fondacaro, Holt & Powell, 1999). Similarly, results from a large study by the Alaska Department of Corrections (1998) of prisoners in Alaska reveal that while 70% of respondents endorsed a history of sexual acts prior to the age of 12, all of which would indicate sexual abuse, only 12% of them considered the experiences to be sexual abuse (Langworthy, Barnes, & Curtis, 1998). As a result, it must be considered a possibility that these numbers are lower than actuality.

The findings of this study support the need for future research to examine the relationship between sexual offending and sexual victimization among incarcerated older offenders. This includes studies that examine a broad range of sexual victimization and how these experiences influence subjective physical and mental well-being and criminal offending, including sexual offending. A longitudinal study examining reactivity among ex-offenders after reentry would greatly benefit the field and provide evidence for policy makers to implement such trauma-informed treatments within the prison system and community correctional programs.

Sexual Abuse Histories Among Incarcerated Older Adult Offenders: A Descriptive Study 31

Gagnon, M., & Hersen, M. (2000). Unresolved childhood sexual abuse and older adults: Late-life vulnerabilities. *Journal of Clinical Geropsychology, 6*(3), 187-198. Glaze, L.E. (2009). Correctional population in the US, 2009. (NCJ Publication No. 231681).

Goff, A., Rose, E., Rose, S., & Purves, D. (2007). Does PTSD occur in sentenced prison

Harlow, C. W. (1999). Prior abuse reported by inmates and probationers. (NCJ Publication

Haugebrook, S., Zgoba, K., Maschi, T., Morgen, K., & Brown, D. (2010). Trauma, stress,

Hiskey, S., Luckie, M., Davies, S., & Brewin, C. (2008). The phenomenology of reactivated

Hochstetler, A., Murphy, D. S., & Simons, R. L. (2004). Damaged goods: Exploring predictors of distress in prison inmates. *Crime & Delinquency, 50(3*), 436–457. James, D. J., & Glaze, L. E. (2006). Mental health problems of prison and jail inmates. (NCJ Publication No. 213600). Rockville, MD: U.S. Department of Justice. Kitchiner, N. J. (2000, February). Using EMDR to treat post-traumatic stress disorder in a

Krause, N. (2004). Lifetime trauma, emotional support, and life satisfaction among older

Lamet, A., Szuchman, L., Perkel, L., & Walsh, S. (2009). Risk factors, resilience, and

Langworthy, H., Barnes, R, & Curtis, R. (1998). Results From the Long-Term Inmate Survey:

Maruschak, L. M. (2008). Medical problems of offenders. (NCJ Publication No. 221740).

Maschi, T. (2006). Exploring the link between trauma and delinquency: The cumulative

Maschi, T., Dennis, K., Gibson, S., MacMillan, T., Sternberg, S., & Hom, M. (2011). Trauma

Maschi, T., Gibson, S., Zgoba, K.M., & Morgen, K. (2011). Trauma and life event stressors among young and older offenders, *Journal of Correctional Healthcare, 17*(2), 160-172. Maschi, T., Morgen, K., Zgoba, K., Courtney, D., & Ristow, J. (2011). Trauma, stressful life

McDaniels Wilson, C. & Belknap, J. (2008). The extensive sexual violation and sexual abuse histories of incarcerated women. *Violence Against Women, 14,* 1090-1127.

psychological distress among holocaust and nonholocaust surviviors in the post-

Focus on Child Abuse Histories. Report prepared for the Alaska Department of Corrections. Anchorage, AK: Justice Center, University of Alaska Anchorage. Leach, R.M., Burgess, T., & Holmwood, C. (2008) Could recidivism in prisoners be linked to

traumatic grief? A review of the evidence. *International Journal of Prisoner Health,* 

and stress among older adults in the criminal justice system: A review of the literature with implications for social work. *Journal of Gerontological Social Work, 54*,

events, and post traumatic stress symptoms: Do subjective experiences matter? *The* 

prison setting. *British Journal of Community Nursing, 5*(1), 26-31.

9/11 environment. *Educational Gerontology, 35*(1), 32-46.

populations? A systematic literature review. *Criminal Behavior & Mental Health,* 

health, and mental health issues among ethnically diverse older adult prisoners.

trauma memories in older adults: A preliminary study. *Aging & Mental Health,* 

Washington, DC: US Department of Justice.

No. 172879). Rockville, MD: U.S. Department of Justice.

*Journal of Correctional Health Care, 16*(3), 220-229.

adults. *The Gerontologist, 44*(5), 615-623.

Rockville, MD: U.S. Department of Justice.

*Gerontologist.* doi:10.1093/geront/gnr074

versus differential risks. *Social Work, 1,* 59–75.

*17(3*), 152–162.

*12*(4), 494-498.

*4*(2), 104-119.

347-360.

#### **7.4 Conclusion**

In conclusion, this study attempted to fill a gap in the literature about earlier sexual abuse victimization experiences among incarcerated older adults and the relationship to sexual offending histories. Overall, the plight of older adults in the criminal justice system has largely been ignored. Continuing to neglect the later life aftermath of earlier life sexual abuse experiences may have detrimental effects on the individual experiencing them then and now.

#### **8. Acknowledgment**

The project was part of the Hartford Geriatric Social Work Faculty Scholars Program Award, which is funded by the Gerontological Society of America and the John A. Hartford Foundation.

#### **9. References**


In conclusion, this study attempted to fill a gap in the literature about earlier sexual abuse victimization experiences among incarcerated older adults and the relationship to sexual offending histories. Overall, the plight of older adults in the criminal justice system has largely been ignored. Continuing to neglect the later life aftermath of earlier life sexual abuse experiences may have detrimental effects on the individual experiencing them then and now.

The project was part of the Hartford Geriatric Social Work Faculty Scholars Program Award, which is funded by the Gerontological Society of America and the John A. Hartford

Abram, K. M., Washburn, J. J., Teplin, L. A., Emanuel, K. M., Romero, E. G., & McClelland,

Acierno, R, Hernandez, M.A., Amstadter, A.B., Resnick, H.S, Steve, K; Muzzy, W; &

Acierno, R, Lawyer, S.R, Rheingold, A, Kilpatrick, D.G, Resnick, H.S; & Saunders, B.E.

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental

Cauffman, E., Feldman, S., Waterman, J & Stiener, H. (1998). Posttraumatic stress disorder

Cox, J. F. & Lawrence, J.E. (August 2010). *Planning services for elderly inmates with mental* 

Dawes, J. (2009). Ageing Prisoners: Issues for social work. *Australian Social Work, 62*(2), 258-

Draper, B., Pfaff, J., Pirkis, J., Snowdon, J., Lautenschlager, N., Wilson, I., et al. (2008). Long-

Falter, R.G. (2006). Elderly inmates: An emerging correctional population. *Correctional Health* 

Fondacaro, K., Holt, J. & Powell, T. (1999). Psychological impact of childhood sexual abuse on male inmates: The importance of perception. *Child Abuse and Neglect, 23,* 361 – 369. Ford, J. D., Hartman, K., Hawke, J., & Chapman, J. F. (2008). Traumatic victimization,

*illness.* (Library ID. 024489.) National Institute of Corrections.

project. *Journal of the American Geriatrics Society, 56*(2), 262-271.

Aday, R. H. (2003). *Aging prisoners: Crisis in American corrections.* Westport, CT: Praeger. Aday, R. H. (2006). Aging offenders' concerns toward dying in prison. *OMEGA: Journal of* 

detained youths. *Psychiatric Services, 58(10)*, 1311–1316.

*Interpersonal Violence, 22*(2), 250-258.

disorders (TR). Washington, DC: Author. Brown*, Governor of California, et al. v. Plata et al.,* 2011.

*Death and Dying, 52(3*), 199–216.

*Adolescent Psychiatry 37*: 1209-216.

G. M. (2007). Posttraumatic stress disorder and psychiatric comorbidity among

Kilpatrick, D. (2010). Financial abuse and potential neglect in the united states: The national elder mistreatment study. *American Journal of Public Health, 100*(2),292-297.

(2007). Current psychopathology in previously assaulted older adults. *Journal of* 

among female juvenile offenders. *Journal of the American Academy of Child and* 

term effects of childhood abuse on the quality of life and health of older people: Results from the depression and early prevention of suicide in general practice

posttraumatic stress disorder, suicidal ideation, and substance abuse risk among juvenile justice-involved youth. *Journal of Child and Adolescent Trauma, 1,* 75-92.

**7.4 Conclusion** 

**8. Acknowledgment** 

Foundation.

**9. References** 

271.

*Journal, 1*, 52-69.


**3** 

*Australia* 

**A Salutogenic Approach to** 

Sheryle Vilenica and Jane Shakespeare-Finch

*Queensland University of Technology, Brisbane,* 

**Healing Following Child Sexual Assault** 

*School of Psychology and Counselling, Institute of Health and Biomedical Innovation,* 

Decades of research has now produced a rich description of the destruction child sexual assault (CSA) can cause in an individual's life. Post-Traumatic Stress Disorder (PTSD), Dissociative Identity Disorder, Borderline Personality Disorder, depression, anxiety, Panic Disorder, intimacy issues, substance abuse, self-harm, and suicidal ideation and attempts, are some of the negative outcomes that have been attributed to this type of traumatic experience. Psychology's tendency to dwell within a pathological paradigm, along with popular media who espouse a similar rhetoric, would lead to the belief that once exposed to CSA, an individual is forever at the mercy of dealing with a massive array of accompanying negative effects. While the possibility of these outcomes in those who have experienced CSA is not at all denied, it is also timely to consider an alternative paradigm that up until now has received a paucity of attention in the sexual assault literature. That is to say, not only do people have the ability to work through the painful and personal impacts of CSA, but for some people the process of recovery may provide a catalyst for positive life changes that

To begin with in this chapter, the negative sequale' of childhood sexual assault it discussed. Inherent to this discussion are questions of measurement and definitions of sexual assault. The chapter highlights ways in which the term CSA has been defined and hence operationalised in research, and the myriad problems, confusions, and inconclusive findings that have plagued the sexual assault literature. Following this is a review of the sparse literature that has conceptualised CSA from a more salutogenic (Antonovsky, 1979) theoretical orientation. It is argued that a salutogenic approach to intervention and to research in this area, provides a more useful way of promoting healing and the gaining of wisdom, but importantly does not negate the very real distress that may accompany growth. This chapter will then present a case study to elucidate the theoretical and empirical literature discussed using the words of a survivor. Finally, the chapter concludes with implications for therapeutic practice, which includes some practical ways in which to promote adaptation to life within the context of having survived this insidious crime.

**1.1 The impact of child sexual abuse: An overview of the pathological paradigm** 

For those who work therapeutically with individuals who have a history of child sexual abuse (CSA) there is no difficulty in understanding just how impactful this particular type

have been termed post-traumatic growth (Tedeschi & Calhoun, 1995).

**1. Introduction** 


http://www.ncchc.org/pubs/CC/aging\_inmates.html

