The paper focuses on the management of intrafamily child sexual abuse cases. The wide range of specialized programs which have been developed to address this problem is attributable to professional and societal ambivalence about whether child sexual abuse should be regarded as a crime, a form of mental illness, or as a major symptom of broader family dysfunction. Other factors which impact on appropriate program development include the low likelihood of successful prosecution of the offender, increased trauma from the helping system, limited jurisdiction and resources of child protection agencies, and the difficulty of keeping families in treatment. The most difficult aspect of any attempt to analyze or compare treatment systems is the development of a conceptual framework by which they can be examined in an organized manner. Factors which are considered in any analysis include predominant philosophical orientations, legal limitations on the program, and the availability of alternative resources or skilled personnel. The major types of programs are the victim advocacy model, characterized by the belief that child sexual abuse is a crime; the improvement model, which emphasizes sensitive intervention and successful prosecution; and the system modification model, which emphasizes the reduction of impact and trauma of the legal process on the child and family. Other major types of programs are the independent model, which operates independently of the community legal and political system, and the system alternative model, which views child sexual abuse as a symptom of illness or dysfunctional behavior patterns within the family. Fourteen notes and 16 references are included.