A Qualitative Study of Psychosocial and Medical Care in German Childhood-Haus Facilities After Online Child Sexual Abuse

As part of the EU-funded PROMISE Elpis project, this qualitative study examines psychosocial and medical care standards for children and adolescents affected by online child sexual abuse (OCSA) within German Childhood-Haus (CHH) facilities. OCSA, encompassing acts such as grooming, sextortion, and the distribution of explicit materials, poses unique challenges due to its merge with other forms of abuse and the blurred boundaries between digital and physical abuse. The study seeks to identify existing practices, gaps, and areas for improvement in addressing OCSA. The method is based on semi-structured interviews with experts from psychosocial as well as medical care. These interviews were analyzed using structured content analysis. Results show that OCSA is often perceived as a comorbid condition accompanying physical abuse or legal cases, limiting systematic screening and intervention. Additional findings are the need for specialized training, standardized definitions and procedures regarding OCSA, and underscoring the importance of age- and developmentally appropriate, trauma-sensitive care for affected children and adolescents. Medical professionals report difficulty addressing OCSA cases because injuries may be invisible, while psychosocial teams cite insufficient training and the absence of standard protocols. The "metaphorical fog" surrounding OCSA - characterized by confusion about its scope and impact - exacerbates these challenges, complicating both diagnosis and treatment. Closing these gaps could improve the quality and consistency of care, enhancing recovery outcomes for affected children and reducing the long-term impacts of OCSA.