| I. |
TYPE OF SEXUAL ABUSE |
| 1. |
Sexual Talk
Comments: |
| 2. |
Exposure/Voyeurism
Comments: |
| 3. |
Fondle Outside Clothing
Comments: |
| 4. |
Fondle Under Clothing/Digital
Comments: |
| 5. |
Oral Sex/Genital/Anal Penetration
Comments: |
| 6. |
Pornography/Prostitution/Exploitation
Comments: |
| II. |
CHARACTERISTICS OF THE ABUSE SITUATION |
| A. |
Duration
1. Short = 1 month
2. Long = more than 1 month
Comments: |
| B. |
Number of Times
1. Few = 5 or fewer
2. Many = more than 5
Comments: |
| C. |
Use of Force (absent versus present)
1. No force
2. Force
Comments: |
| D. |
Threats Regarding Disclosure
0. No threats
1. Mild threats
2. Severe threats
Comments: |
| III. |
VICTIM AGE
1. 14-16 years
2. 11-13 years
3. 8-10 years
4. 5-7 years
5. 3-4 years
6. 0-2 years
Comments: |
| IV. |
SUSPECT-VICTIM RELATIONSHIP
1. Out-of-house, unrelated
2. Out-of-house, related
3. In-house child/teen
4. In-house unrelated male, unrelated female
5. In-house uncle, grandfather, aunt, grandmother, cousin
6. In-house father, stepfather, adoptive father, foster father
7. In-house mother, stepmother, adoptive mother, foster mother
Comments: |
| V. |
NUMBER OF VICTIMS
Comments: |
| VI. |
NUMBER OF PERPETRATORS
Comments: |
| VII. |
FUNCTIONING OF THE NON-OFFENDING PARENT |
| A. |
Reaction to Knowledge About the Sex Abuse
0. Supportive of victim
1. Equivocal or inconsistent reaction
2. Supportive of suspect
Comments: |
| B. |
Relationship to Victim
0. Close, nurturing relationship
1. Somewhat problematic relationship
2. Seriously problematic relationship
Comments: |
| C. |
Level of Dependency (on suspect)
0. Very independent of suspect
1. Somewhat dependent on suspect
2. Very dependent on suspect
Comments: |
| VIII. |
RESPONSE OF SUSPECT
1. Admits and takes responsibility
2. Admits but does not accept responsibility
3. Denies
4. Denies and blames victim
Comments: |
| IX. |
OTHER INDIVIDUAL AND FAMILY PROBLEMS |
| A. |
Substance Abuse
0. No substance abuse
1. Substance use in the environment
2. Substance use by nonoffending parent
3. Substance use by suspect
4. Severe addiction of the suspect
5. Victim given chemicals during abuse
Comments: |
| B. |
Violence
0. No violence in household
1. Suspect violent outside home
2. Suspect violent to nonoffending parent
3. Violence against child by nonoffending parent
4. Suspect violent to victim
Comments: |
| C. |
Mental Retardation
0. No mental retardation in family
1. Nonoffending parent mentally retarded
2. Victim mentally retarded
3. Suspect mentally retarded
Comments: |
| D. |
Mental Illness
0. No mental illness
1. Victim emotionally disturbed
2. Nonoffending parent mentally ill
3. Suspect mentally ill
Comments: |
| E. |
Physical Handicaps (completely or partially blind, deaf, amputee, spinal bifida, wheelchair bound)
0. None in household
1. Victim physically handicapped
2. Nonoffending parent physically handicapped
Comments: |
