| Today's NAASCA news:
December 6, 2013
Child abuse reforms taking center stage
by John Finnerty -- CNHI State Reporter
HARRISBURG — Cumbersome legal definitions of child abuse can stymie doctors, nurses and caseworkers who might believe a child is in danger, according to advocates lobbying for changes to the state's child welfare system.
Key bills to toughen penalties for child abuse and failure to report it could be on the governor's desk before the end of the month. Those include a signature piece of legislation that advocates say will change the way child abuse is defined.
The key change involves essentially rewriting the law so almost anything that would be considered simple assault can now be described as child abuse. Under existing law, a doctor is often asked to determine if the child suffered “severe pain” as a result of the abuse, said Cathleen Palm, who leads the Protect Our Children Committee, an advocacy group that has been fighting for revamped child protection laws.
The state House has already approved the bill that would reform the definition of child abuse. A final Senate vote could take place next week.
The unwieldy definition can cripple abuse investigations before they begin as caseworkers and others in the child protection system are stymied, Palm said.
“(Child protection workers) are trained to screen based on what the law says,” Palm said.
The chilling effect is felt across the child protection system.
It matters to the nurse who calls to report that a child is covered in bruises only to see nothing happen, Palm said. It matters to the dispatcher who takes the call and determines that the injuries described by the nurse probably don't meet the state standard for abuse, so the case is put on a backburner, Palm said.
It matters to doctors who treat children with suspicious injuries only to struggle to guess if the child suffered the type of “severe pain” required to call the acts abuse, she said. And, most of all, it matters to the children who listen to a caseworker tell their abusers the victims' injuries don't count as child abuse, Palm said.
Fifteen of the 31 families in which children died as a result of abuse in Pennsylvania in 2012 had been visited by child protective services in the 16 months before the victims were killed, according to Department of Public Welfare data.
“This isn't about jacking our numbers up,” Palm said. “We are concerned because kids are not being provided pathways to services or investigations.”
Coming up with a workable new definition has not been easy. Early on, Bucks County District Attorney David Heckler, who chaired the state's task force on child protection, worried that lawmakers would hedge on toughening the abuse language out of concerns about interfering with the right of parents to discipline their children. Those concerns were resolved, but physicians say there are other problems in some of the legislation.
The state is not eliminating the right of parents to claim that abuse is the result of religious beliefs, said Dr. Pat Bruno, a Northumberland County physician who specializes in recognizing and treating child abuse.
Just as badly, shaking a toddler would remain legal, Bruno said.
“First of all, the statement about ‘forcefully shaking a child if the child is under one year of age' should be changed to ‘forcefully shaking an infant or a child.' ” Bruno said. “There is no reason to ever shake an infant or a child. Indeed, there have been many reported cases of shaking causing the same damage to a child greater than one year of age as it does to a child less than one year of age.”
The move to revamp the definition of child abuse is one of 10 bills moving in the Senate. Others stiffen penalties for abuse or failing to report abuse and aim to improve communications between law enforcement and child protective services.
Advocates fret that those efforts may translate into a flood of reports of child abuse that only strain already overworked and burned out caseworkers.
Greater public awareness about child abuse has already translated into a dramatic increase in reports of suspected abuse, according to Department of Public Welfare data. The state's ChildLine hotline received 26,664 reports of suspected abuse in 2012, a 9 percent increase over 2011.
Just 13 percent of reported child abuse cases in Pennsylvania, 3,565, were substantiated by caseworkers. It's difficult to compare one state to another because not all states use the same terms. But in Nevada, for comparison, 26 percent of child abuse reports were substantiated by authorities, according to the Annie E. Casey Foundation.
“I know the Children and Youth caseworkers we deal with are going 120 percent,” said Paula Eppley-Newman, executive director of Beginnings Inc., a nonprofit focused on early childhood development in Johnstown. Beginnings just received $120,000 from the state to offer in-home parenting classes to families in a bid to prevent child abuse. The organization also runs the court-appointed special advocate program in Cambria County, which provides independent representatives to look exclusively after the interests of children in custody or similar family law disputes.
Palm said caseworkers and advocates are concerned about the effects of a new definition of abuse, coupled with more aggressive penalties for those who neglect to report it.
“Getting the laws passed is going to be the easy part,” Palm said. “We are nervous. That's one of things we're going to have to be attentive about.”
The list: Priests accused of child sex abuse disclosed
by Emily Gurnon
(Ability to do a search on the names is on the site)
The Roman Catholic Archdiocese of St. Paul and Minneapolis on Thursday released its list of priests "credibly accused" of sexually abusing children.
The list of 34 priests dates to 1950. It includes at least one priest from 92 of the archdiocese's 188 parishes, the archdiocese reported.
Ramsey County District Judge John Van de North on Monday ordered the list be made public. He gave the Twin Cities archdiocese and the Diocese of Winona until Dec. 17 to do so.
Archbishop John Nienstedt said in a letter on the archdiocese website Thursday that it would disclose all "credible and ... substantiated" claims on the website from now on.
"This is a tragedy that has caused insufferable harm to victims, their families, parishioners and the church," Nienstedt wrote. "I must say once again to all victims of this abuse: I am so sorry for the pain you have endured."
Attorney Jeff Anderson, who specializes in representing clergy abuse victims, said at a news conference that Thursday's release of priest names was a step forward.
"We believe that survivors will be given permission in a way they haven't before to break the silence and share the secret," Anderson said.
The information also may aid law enforcement in investigating the crimes, he said.
But the abusive priests themselves should not be the sole focus, Anderson said.
"The real imperative is to expose the top officials, current and past, who made the conscious choice to allow these men to continue to abuse and reoffend repeatedly year after year, time and time again," he said.
"And until the top officials of the archdiocese who are complicit in the clerical crimes are held to account and fully exposed, the pattern seems to inevitably continue on its headlong course."
Anderson said he was certain the list did not include all offending priests.
At Anderson's office was Jim Keenan, who sued former priest Thomas Adamson for abuse he suffered in 1967. Keenan called the list's release the "right step ... but a tiny step.
"Try to put your hands around the idea that a religious organization has to be forced to protect children," he said. "That's crazy."
The list came out of a 2004 study commissioned by the U.S. Conference of Catholic Bishops and conducted by John Jay College of Criminal Justice in New York. The study counted victims of clergy sexual abuse over the previous 50 years, with perpetrators' names provided by the dioceses and archdioceses.
It originally included 33 names. The archdiocese added Curtis Wehmeyer, who was convicted of molesting two boys while he served at Blessed Sacrament in St. Paul.
The names are: Thomas Adamson, John T. Brown, Cosmas Dahlheimer, Gilbert DeSutter, Gilbert Gustafson, Louis (aka Joseph) Heitzer, Rudolph Henrich, Francis Hoefgen, Richard Jeub, Dennis Kampa, Robert Kapoun, Jerome Kern, Lee Krautkremer, Ronan Liles, Alfred Longley, Brennan Maiers, Timothy McCarthy, John McGrath, Paul Palmitessa, Joseph Pinkosh, Francis J. Reynolds, Richard Skluzacek, Michael J. Stevens, Thomas Stitts, Robert Thurner, Clarence Vavra, Joseph Wajda, Raymond Walter, Curtis Wehmeyer and Robert Zasacki.
Also on the list but considered by the archdiocese to be the subject of "unsubstantiated" allegations are Eugene Corica, Robert Loftus, Patrick Ryan and Roger Vaughn.
Severe chronic depression is more likely in child sex abuse victims
Stress linked to abuse makes the brain more vulnerable to depression
A new study reveals the highest risk variables of chronic depression in the population, such as having suffered previous episodes of depression, delayed treatment, whether it is related to other physical or mental health problems, or having suffered sexual abuse during childhood.
Chronic major depressive disorder, with episodes that last more than 24 months, affects almost half of patients seeking treatment for depression and carries with it significant problems in terms of disability, suffering and the cost of healthcare.
A piece of research carried out by Mauro García-Toro, a scientist from the University of the Balearic Islands (UIB), during a stay at Columbia University in New York, along with researchers from both institutions, reveals the main risk factors for this disease.
Published in the ‘Journal of Affective Disorders', the study analyses several variables related to the physical and mental health of over 35,000 residents of the USA who are representative of the country's population.
After three years, the researchers got back in contact with the same people to observe how these variables had evolved and they focused on identifying the characteristics that increased the risk of severe chronic depression persisting once it has started.
As García-Toro explains to SINC: “Identifying risk factors for the persistence and remission of severe depression is important in order to progress in our understanding of the causes and development of the most effective preventative treatments and therapies.”
The experts concluded that the highest risk variables for this illness were early onset of depression, delayed treatment, whether it is linked to other physical or mental health problems, and sexual abuse in childhood.
“The longer depression persists, the more likely the subjects interviewed are to recount having undergone sexual abuse, which no doubt means that they have been exposed to severe stress on many occasions in early life,” notes García-Toro.
In fact, the researcher affirms that, “In addition to the usual psychological trauma, it has been demonstrated that this stress modifies the neurochemistry and structure of the brain, making it more vulnerable to depression.”
Another consequence of abuse
The results reveal that 10% of all the people interviewed said that they had undergone sexual abuse as children, but of those who suffered severe depression for more than five years, this proportion approached 40%.
“These data are for men and women,” the researcher points out. Thus, “as we know that sexual abuse is much more common in girls, it is highly likely that in the adult female population more than half of those with severe depression for more than five years suffered sexual abuse as children.”
According to the authors, it is important to bring this situation to the fore in order to discover such examples – as not all patients recount these events spontaneously – and thus be able to intervene to improve treatment for those suffering from chronic depression.
Sex, Violation, Power: “Nothing will be done that the survivor does not agree to.”
by David Trower
When someone becomes the victim of a sexual assault, they are faced with some hard choices that are not easy to make. However, those decisions can have long-lasting impact. One of the major choices they have to make it whether to go to the hospital after the sexual assault.
When a victim of sexual assault goes to the hospital within 72-96 hours after the sexual assault has occurred, the collection of a rape kit by a Sexual Assault Nurse Examiner (SANE) can occur with the victims consent.
Anne Galloway, a SANE practicing in New York, took part in the recording of “A Body of Evidence: Using the NYS Sexual Offense Evidence Collection Kit” video produced by the New York State Division of Criminal Justice Services.
In the video, Galloway said collecting a rape kit is “a process that is inherently invasive and, unfortunately, often degrading for the patient, yet vitally important for the successful investigation and prosecution of sexual assault cases.”
According to the Rape, Abuse & Incest National Network, a rape kit, used to collect evidence during the forensic medical exam, “may also be referred to as a Sexual Assault Evidence Collection kit, a Sexual Assault Forensic Evidence (SAFE) kit, a Sexual Offense Evidence Collection (SOEC) kit, or a Physical Evidence Recovery Kit (PERK) kit.”
Also taking part in the recording of the video, “A Body of Evidence,” was actress Marisk Hargitay, who plays Detective Olivia Benson in the NBC drama “Law and Order: Special Victims Unit.” Hargitay works off screen with the Joyful Heart Foundation she created in 2004 whose “mission is to heal, educate and empower survivors of sexual assault, domestic violence and child abuse, and to shed light on the darkness that surrounds these issues,” Hargitay said in the video.
Hargitay, when preparing for the role of Detective Benson, trained as a rape crisis counselor. She has also testified before Congress to urge lawmakers to address the backlog of untested rape kits through the country, and she launched the web site www.endthebacklog.org to address the issue. In Texas alone, the existing backlog numbers at least 15,900 with estimates as high as 20,000 backlogged rape kits, as reported by The New York Times.
“The severity of the trauma and complexity of the healing process truly hit home when I started receiving emails and letters from survivors sharing their stories,” Hargitay said in the video. “That these individuals would reveal something so intensely personal – often for the very first time – to someone they knew only as a fictional character on television, demonstrated to me how desperate they were to be heard, how desperate they were to be believed, understood, comforted and healed.”
Hargitay goes on in the video to address medical first responders and their role in the healing process for victims of sexual assault.
“Your primary obligation is to you patient,” Hargitay said in the video. “But in a sexual assault case, that patient – as callous as this may seem – is also the crime scene: a living, breathing, feeling, traumatized body of evidence in desperate need of both your professional skills and your deepest human compassion – the compassion we know you already have in abundance.”
Amy Perkins serves as the executive director for the Advocacy Center for Crime Victims and Children in Waco. The Advocacy Center serves the entire Heart of Texas area, covering McLennan, Hill, Falls, Bosque, Limestone and Freestone counties.
“We serve male and female victims here at the Advocacy Center,” Perkins said. “About 10 percent of victims that come through our door are male. For example, over the past five years, we had 488 males that were assisted. The trend is actually growing as people recognize more and more that little boys, young men and adult men can be sexually assaulted.”
Education and prominent national stories are helping increase the visibility of the issue of male victims of sexual assault.
“We see our numbers increasing just as the stigma is not so much as it used to be,” Perkins said. “It used to be a very taboo subject. Sexual assault in general, much less sexual assault of a male victim. So we're seeing that through our education, through our prevention services that it is not quite as taboo as it used to be but we have a long way to go based on the statistics that we see.”
The Advocacy Center in Waco provides the SANE nurses that perform the forensic medical exams for victims.
“If it's within 96 hours and someone is sexually assaulted and they respond to or show up at the hospital or call law enforcement and law enforcement accompanies them to the hospital, we have our SANE nurses that go and collect the evidence,” Perkins said. “We have what we call hotline advocates who are specially trained volunteers who are trained to go into the room with them, hold their hand, explain to them what's happening and advocate on their behalf.”
The process of becoming a SANE is an extensive and time-consuming process.
“Our sexual assault nurse examiners receive hours and hours of training,” Perkins said. “They have to be RN's and have to have two years of experience and then go to two weeks of training to become a SANE nurse. And then they have to observe usually for about a year before they can begin to provide services as a SANE. Any victim of sexual assault, if it is acute, which is within about 96 hours, then they respond to either Providence or Hillcrest here in town.”
SANE nurses are qualified to work with both male and female victims.
When a SANE responds to a sexual assault case, “they will talk to the victim, get a history, find out what going on, make the patient feel a little more comfortable,” Perkins said. “They will do the evidence collection and just make sure that they are OK. If they need further treatment, they will refer them to hospital staff to help them out if they need to be admitted, if they need X-rays, things of that nature.”
According to the website www.surviverape.org by the Boston Area Rape Crisis Center, a rape kit “is a box that contains all the necessary materials to collect evidence” during the forensic medical exam.
The contents of the rape kit can vary from state to state, according to the website www.endthebacklog.org, most kits include the following items:
Detailed instructions for the examiner
Forms for documenting the procedure and evidence gathered
Tubes and containers for blood and urine samples
Paper bags for collecting clothing and other physical evidence
Swabs for biological evidence collection
A large sheet of paper on which the victim undresses to collect hairs and fibers
Dental floss and wooden sticks for fingernail scrapings
Sterile water and saline
Envelopes, boxes and labels for each of the various stages of the exam
During the sexual assault, the victim has no control. It is important that during the recovery and healing process, that the victim is empowered and in control of the entire process, according to the Indiana Coalition Against Sexual Assault.
The Boston Center stresses, “The survivor is in control of the entire exam. Before each step of the Kit, the medical provider should explain the step and ask the survivor if they want to continue. Nothing will be done that the survivor does not agree to.”
When a SANE begins the examination, they begin by collecting a thorough medical history.
Then they have the victim undress while stand on a large sheet of paper to collect the clothes plus any hair or fiber evidence that may fall from the clothes or body to be tested.
Then the head-to-toe physical exam begins. During this portion of the exam, any injuries from the attack are documented and evidence is collected.
The SANE will collect biological evidence, such as blood, saliva, urine, semen, skin cells and hair. This is done “by taking swabs of the victim's skin, genitalia, anus and mouth, scraping under the victim's fingernails and combing through the victim's hair,” according to www.endthebacklog.org web site.
The SANE will also take photographs to document any injuries or bruises that occurred during the attack.
The forensic medical exam is an intensive exam that can take from four to six hours, but a victim can decline any or all parts of the examination at any point during the examination process.
It is recommended that even if a victim is unsure if they want to go to the police and press charges that they go to the hospital and have a rape kit collected. That allows them time before needing to make a decision on whether to press charges. It also allows critical evidence to be collected before it is lost.
Under the Violence Against Women and Department of Justice Reauthorization Act of 2005, states are not allowed to “require a victim of sexual assault to participate in the criminal justice system or cooperate with law enforcement in order to be provided with a forensic medical exam, reimbursement for charges incurred on account of such an exam, or both.”
Not only does the Advocacy Center provide the SANE nurses to collect the forensic medical exam, but they are also involved in providing long-term support for victims of sexual assault.
The Advocacy Center works with victims of all crimes. However, a vast majority of those it serves are victims of sexual assault. It provides individual therapy for male and female victims of all ages of sexual assault whether the sexual assault was recent or if it happened when they were a child. They also provide sexual assault survivor support groups for women, men, boys, girls and teens, Perkins said.
Anyone interested in joining a support group or coming in for services can contact the Advocacy Center at 254-752-9330.
“If there is a specific need that a victim or survivors are having, we will be glad to connect them with other survivors or a support group,” Perkins said.
The Advocacy Center also engages in community education.
“We have an intervention/education program and it's their job to go out and talk to schools and community groups, civic organizations and things of that nature,” Perkins said. “They talk about bullying. About what's appropriate to change the cycle of violence so when little boys grow up they don't think that it's OK to victimize someone.”
For male survivors of sexual assault, MaleSurvivor is a national organization that provides resources to help with hope, healing and support for male survivors of sexual assault.
In addition to providing an online forum for male survivors of sexual assault, MaleSurvivor provides what they call Weekends of Recovery.
“The Weekends of Recovery are a wonderful program,” Christopher Anderson, executive director for MaleSurvivor, said. “There really is no other organization working with sexual abuse survivors of males, or females really, that does a program quite like this.”
The Weekends of Recovery provide an opportunity for male survivors to meet other survivors and experience a weekend of healing.
“The weekends are really transformative experiences,” Anderson said. “At the heart of the weekends, what really makes it so powerful is for many survivors it's an opportunity to come together to community with other male survivors. Often times it's the first time in their lives they've ever had the opportunity to speak about what happened about what was done to them at earlier points in their lives and be heard by other survivors.”
Anderson is a male survivor of sexual assault himself. He has attended three of these Weekends of Recovery.
“For me the moment that changed everything was when I walked into the room and I was surrounded by about 30 people,” Anderson said. “I hadn't met anybody. I hadn't introduced myself. I didn't know anyone's name but I made eye contact with one other person and I almost broke down crying because it was the first time in my life that I didn't feel alone.”
Male survivors experiencing a Weekend of Recovery for their first time experience a sense of community they never really had before, a community of survivors with similar experiences, Anderson said.
“Obviously I had been around people before, but I never before had seen in someone else's eyes what I saw in my own face when I looked in the mirror,” Anderson said. “There was a moment that just happened that gave immediate recognition that I just knew I wasn't alone and it began to change a lot of things for me.”
For Anderson and MaleSurvivor this kind of experience is really at the heart of the Weekends of Recovery.
Preventing abuse in the UK: a matter of education
by Holly Dustin
A new campaign by the UK Government's Home Office, This Is Abuse, is a critical step to preventing violence against women and girls, but the Department for Education's failure to support it is baffling, says Holly Dustin
Recent research from the Office of the Children's Commissioner in England has highlighted disturbing levels of abuse experienced by girls and young women, often at the hands of friends and boyfriends. It is a problem that the Home Office is tackling with its re-launched This Is Abuse campaign which, refreshingly, turns the traditional prevention campaign on its head by challenging abusive attitudes and behaviours in boys and young men, rather than focusing on the behaviour of the victim.
Attitudes and behaviours are formed early, so the Home Office's focus on young men is well targeted. There is a great deal of research to show that this group are most likely to hold violence-condoning attitudes and are influenced by harmful images in the media. For example, research this year also by the Children's Commissioner found that boys are more likely than girls to seek out pornography, and that it is linked to negative attitudes towards women, viewing women as sex objects and having earlier and riskier sexual activity.
There is growing evidence about the way in which our sexualised media, including pornography and music videos, provides a ‘conducive context' in which violence against women and girls flourishes. So it is a smart move by the Home Office to run the new This Is Abuse campaign ads on MTV and to use pop stars and DJs in a series of films ‘calling out' abusive behaviour. The new campaign also links in to a storyline on youth soap, Hollyoaks, about domestic violence and Hollyoaks stars have been doing the rounds on breakfast TV sofas with government Ministers and experts to promote the campaign.
NSPCC research in 2009 found that almost one in three teenage girls had experienced sexual violence from a partner, and that teenagers are the age-group most at risk from domestic violence. Research also by the NSPCC on ‘sexting' (sharing sexual messages or images via mobile phones or online) in 2012 found that it is linked to coercive behaviour, harassment and even violence and disproportionately affects girls . The problem was tragically highlighted by the case of 13 year-old Chevonea Kendall-Bryan who fell to her death from a block of flats in 2011 whilst begging a boy to delete an image of her being raped by another boy that had been passed around her school. Our own poll in 2010 found that one that in three 16-18 year old girls in the UK have been ‘groped' at school or experienced other unwanted sexual touching.
The Home Office leads a cross-government strategy on violence against women and girls, an approach for which our members had long-campaigned. This Is Abuse delivers on one of the priority objectives of the strategy:
“ To prevent violence against women and girls from happening in the first place, by challenging the attitudes and behaviours which foster it and intervening early to prevent it .”
Despite this commitment, prevention remains the weakest part of the government's strategy. There is an absence of any real vision of how to achieve a violence-free society and key departments, notably the Department for Education in Westminster, are failing to play their part in the task of prevention. The Department has said repeatedly that it will not be disseminating This Is Abuse to schools in England – meaning that the opportunity to use campaign materials may be missed, as well as any warning to school staff to prepare for disclosures from children who have seen the ads. This is baffling from the key department with responsibility for child protection and is one of the reasons why the Westminster government was scored just 24/100 earlier this year for its action on prevention.
Westminster policy and practice is still predicated on the assumption that violence is somehow inevitable and this is reflected at local levels. In February this year, the report of a joint inspection on young sex offenders found that, in many cases, there had been an earlier display of sexually harmful behaviour which had been over looked, minimised or dismissed by parents, teachers and social workers. The result was that an opportunity to intervene at an early stage was lost. More recently an Ofsted Inspection found that poor teaching of Public Social Health and Economic (PSHE) education is leaving children vulnerable to sexual exploitation. Our own surveys with local Secondary Schools as part of our Schools Safe 4 Girls campaign found a general failure to address violence against women and girls adequately, with few specific policies and little ongoing training for staff.
The researchers who carried out the NSPCC's qualitative research into sexting said this:
"As researchers going into the schools to meet with young people, we were distressed by the levels of sexist abuse and physical harassment–even violence–to which the girls were subject on a regular basis. More than this, we were struck by the way in which it is entirely taken for granted by both girls and boys–even when the same behaviours would be grounds for dismissal in other settings and among adults (e.g. in the workplace) or for arrest and prosecution if they happened in public space."
That we afford girls less protection from harassment and abuse than adult women is horrifying and deeply shameful. This is not to say that there aren't good initiatives in schools and local areas. There are. But there is no national plan or coordination of activity to prevent abuse.
The From Boys to Men project found that social marketing campaigns such as This Is Abuse need to be integrated with work with young people to be properly effective. So whilst the Home Office is to be applauded for continuing to run the campaign, it can only ever be one step in a comprehensive programme of work to prevent and eliminate violence against women and girls.
It is clear what action governments at all levels need to take. A large-scale UN study on men who perpetrate sexual and domestic violence found that tackling social norms and damaging notions of masculinity, and promoting gender equality is key to ending violence. The ground-breaking Model of Perpetration prepared for the EU sets out pathways to violence, and consequently what policy interventions are required to disrupt those pathways. Our own report, A Different World Is Possible, uses the Model to set out a blueprint strategy on prevention. Research on sexual consent from the Children's Commissioner stressed the importance of work with young people on how to gain enthusiastic consent, in line with the Sexual Offences Act, not just how to give it.
Key elements of a prevention strategy include: a legal obligation on schools and other educational institutions to do preventative work with young people and ongoing training for teachers on how to identify the signs of abuse and respond appropriately; a guarantee that both survivors of abuse and perpetrators have access to specialist support in the community; long term investment in public campaigns like This Is Abuse which are targeted at specific groups (similar to the long-running road safety campaign THINK!); further work to regulate and restrict harmful messages in the media that condone violence, building on recent action to address children's safety online; and community and bystander programmes. Critically, we need to see leadership from politicians at national and local levels in the same way that successive Directors of Public Prosecution have said this is a priority issue for them and have revolutionised their policy on child sexual abuse in the wake of the Savile case.
We cannot continue to wring our hands at the litany of abuse and, in extreme cases deaths, of women and girls in our homes, communities, schools and workplaces. The government must build on This Is Abuse by setting out the step by step pathway to achieving a world free from violence against women and girls.