Olympic gold medalist Dominique Moceanu was terrified when she first spoke out in 2008 about the verbal, emotional and physical abuse she experienced as a USA gymnast. She knew her life was about to change for the worse as she stepped forward to level accusations at noted coaches  and the toxic culture that perpetuated the mistreatment.

"I needed to heal and I needed to begin speaking about it," Moceanu told an audience Wednesday at the "Athletes & Abuse" symposium held at the University of Pennsylvania and sponsored by Child USA, an advocacy organization based at Penn.

Eight years after she first spoke out, gymnast Jamie Dantzscher sought out Moceanu during a team reunion and told her that USA Gymnastics team doctor Larry Nassar  molested athletes under the guise of medical treatment. Moceanu convinced her to report the abuse to a third party agency.

"Literally, there was no oversight," said Moceanu.

On Wednesday, Child USA announced it has established a commission to examine how the institutions involved in the Nassar scandal – including Michigan State University, the U.S. Olympic Committee, USA Gymnastics, the training facility Karolyi Ranch, and parents – responded to the athletes' claims of abuse. The information, including depositions and hearing transcripts, will be made available to the public through a searchable database.

"There will be a mass of evidence to study," said Marci Hamilton, CEO and academic director of Child USA. "How have that many institutions and people let that many children down?"

With an estimated 45 million U.S. children a year participating in sports, Hamilton expects that more abuse cases will continue to emerge.

For athletes at all ages and skill levels, success is often defined by pleasing a limited number of people, and that can put them in a vulnerable position when it comes to abuse. It can take time before they come forward, said Josh Shapiro, attorney general of Pennsylvania.

"They have to know we believe them," he said. "We have to make sure we create a safe and loving environment."

On average, kids tell the truth 98 percent of the time, said Steven J. Berkowitz, an attending psychiatrist in the department of child and adolescent psychiatry and behavioral sciences at Children's Hospital of Philadelphia.

The longer it takes for a child to disclose the abuse, the more likely the child is to develop psychiatric disorders, or turn to drugs and alcohol. For athletes, there is the added pressures that they may end up ruining a lifelong dream or goal by coming forward.

Youth sports can be a magnet for abuse, said Patty Dailey Lewis, executive director of the Beau Biden Foundation for the Protection of Children.  Youth organizations need to develop a code of conduct and background checks.

Teams also should address older children bullying younger children. "It is not just the adults," she said.

Steve Salem, CEO of the Cal Ripken Foundation, agreed that organizations should properly vet anyone who has access to children. "Pedophiles are looking for safe access to kids," he said.

Through its Resource Portal, the Ripken Foundation offers a low-cost way for organizations to conduct background checks on coaches, staff and volunteers. The perception that only strangers abuse kids is not accurate, he said.

"It is the people you know that you need to focus on," Salem said.

When Moceanu first came forward about her abuse, teammates, friends, other parents, and coaches publicly criticized her, and USA Gymnastics ostracized her.

"I always knew I was doing the right thing," she said.

In March 2017, the U.S. Olympic Committee apologized to the victims for the culture and lack of protection for the athletes that led to abuse scandals.  That same month, Moceanu and Dantzscher were among the gymnasts who testified before a Senate Judiciary Committee hearing on protecting young athletes from sexual abuse.

"Our voices were finally, finally being heard," Moceanu said.

In January, Nassar was sentenced to 175 years in prison for sexually abusing 150 women and girls who were gymnasts over two decades.