Child sexual abuse: prevention & education

There are a number of prevention activities specifically aimed at preventing the sexual abuse of children. Quadara and colleagues (2015) noted that these efforts predominantly involve:

• Protective behaviours education for children, which may also involve parents and broader school personnel or systems;
• Situational crime prevention – applied to risky settings, organisations and institutions, situational prevention is the recommended model for reducing the incidence of child sexual abuse within organisations (Smallbone, Marshall, & Wortley, 2008). Situational crime prevention essentially involves increasing protection within particular settings through, for example, whole-of-organisation policies that clearly outline acceptable and unacceptable behaviour towards children, the installation of closed-circuit televisions (CCTVs) and other such strategies;
• Therapeutic interventions for problem sexual behaviours and sexually abusive behaviours, targeting young people who are at risk of offending;
• Therapeutic prevention of re-offending, targeting:
  – young people who have become involved with the criminal justice system for sexually abusive behaviours, and
  – convicted adult sex offenders;
• Criminal justice and other statutory responses, to identify and monitor sex offenders and their involvement with children and young people; and
• Therapeutic work with children and adolescents who have experienced sexual abuse, to reduce their vulnerability to re-victimisation.

A systematic scoping review of sexual abuse prevention strategies (excluding protective behaviours education) found three common approaches are typically used: engaging and stopping those who are at risk of harmful or abusive sexual behaviours; situational prevention in child and youth serving organisations; and preventing the emergence of sexual abuse by promoting healthy families and communities (Vosz, McPherson, Tucci, et al., 2022).

A holistic approach to the prevention of child sexual abuse is recommended. A holistic approach includes prevention strategies at all levels, including primary, secondary and tertiary strategies (Holzer, Higgins, Bromfield, Richardson, & Higgins, 2006):

• Primary or universal interventions are strategies to reduce risk factors for abuse that are targeted at whole populations or communities;
• Secondary interventions target individuals who are at high risk for perpetration or victimisation; and
• Tertiary interventions seek to prevent recurrence of abuse that has occurred, and reduce the long-term consequences of abuse.

Primary prevention

Three types of primary prevention approaches have been developed: those that aim to raise awareness and change wider social attitudes and norms to child sexual abuse, those that aim to reduce the risks and vulnerabilities of children as potential victims, and those that address situational factors, for example, within organisational settings (Radford, Richardson Foster, Barter & Stanley, 2017).

Quadara and colleagues (2015) as part of their report on conceptualising the prevention of child sexual abuse, made several recommendations to strengthen current sexual abuse prevention efforts. One of these recommendations included the conduct of public education and social marketing campaigns. They suggested that public education and social marketing campaigns about the nature of child sexual abuse and who are likely perpetrators should be considered, in order to address:

• silence surrounding child sexual abuse;
• how children’s vulnerability relative to adults can conceal child sexual abuse;
• misinformation about perpetrators, which inhibits appropriate help seeking and acknowledging wrong-doing;
• community capacity and willingness to respond to disclosures appropriately; and
• the sexualisation of children and young people in popular culture, consumer and other media settings.

A meta-analytic review of child sexual abuse prevention programs published between 2014 and 2021 (including all programs that measured change in knowledge of child sexual abuse in one or more samples of participants) found an overall large effect size with significant improvements in participants’ knowledge following participation in prevention programs (Ferragut, Cerezo, Ortiz-Tallo, & Rodriguez-Fernandez, 2023).

The Stop it Now! Wales program is based on a range of educational programs for parents and professionals that challenge the stereotyped characteristics of perpetrators and provide skills and knowledge that enable the prevention of child sexual abuse. A recent evaluation of Stop it Now! Wales showed that both parents and professionals saw benefit in the program, with parents showing a 21% improvement in overall confidence to protect children compared to a 17% improvement among professionals (Hudson, 2018).

School-based sexual abuse prevention programs teach children skills such as how to identify dangerous situations, refuse an abuser’s approach, break off an interaction, and summon help. Many of these programs also aim to promote disclosure and reduce self-blame among young victims. Considerable evaluation research exists about these programs, suggesting that they achieve certain of their goals. Research shows, for example, that young people can and do acquire the concepts that are taught in these programs. The programs may also promote disclosure and help children not to blame themselves (Finkelhor, 2009).

Walsh and colleagues (2015) conducted a systematic review of the effectiveness of school-based education programs for the prevention of child sexual abuse. The studies included in this review show evidence of improvements in protective behaviours and knowledge among children exposed to school-based programs, regardless of the type of program. There is evidence that children’s knowledge does not deteriorate over time. The results also show that program participation may increase the odds of disclosure.

Minimal research has examined the impact of exposure to school-based education programs on disclosure of child sexual abuse. A recent study did however examine the impact of exposure to the U.S. Think First and Stay Safe abuse prevention program on abuse disclosure rates of 319 children who underwent a child forensic interview in a Midwestern child advocacy center. The research found that children exposed (vs. not exposed) to the Think First and Stay Safe program were significantly more likely to disclose abuse during the forensic interview, which in turn predicted significantly increased abuse substantiation likelihood (Elfreich, Stevenson, Sisson, Winstead, & Parmenter, 2020). The impact of education programs on informal disclosures (i.e. outside of forensic interviews) is not currently understood.

Research with Australian university students examined whether having received school-based child sexual abuse prevention programming was associated with experiencing sexual abuse. This research found that school-based child sexual abuse prevention attendance was reported by 29% of respondents, while 72% reported parent-led CSA education. Almost one quarter (24%) of participants reported CSA. Parent-led CSA education was found to be significantly associated with lower risk of CSA, but school-based child sexual abuse prevention attendance was not. The results of this research highlight the importance of protective parenting, and of building parenting capacity as part of CSA prevention efforts (Rudolph, Zimmer-Gembeck, & Walsh, 2022).

A qualitative study with trainers of a US school-based physical and sexual abuse prevention program, which explored program and school-related factors that they believed influence children’s disclosure, showed that key factors perceived to influence disclosure were appropriate time being allocated to the program, incorporation of key messages (including “it’s not your fault”, “telling a trusted adult”, and “it’s never too late to tell”), provision of specific examples, and repetition of key messages and the program itself (Blakey, Glaude & Jennings, 2019).

While the majority of primary prevention efforts targeting school-aged children have focused on protective behaviour to prevent victimisation, Letourneau and colleagues (2017) report on the development of a school-based universal prevention program focusing on the prevention of juvenile offending. The program, Responsible Behavior with Younger Children, aims to prevent the onset of inappropriate, harmful or illegal sexual behaviour by adolescents against younger children. A pilot conducted in four urban schools in the US found that program participation was associated with increased accuracy in knowledge about sexual abuse and related laws, and with increased behavioural intention to avoid or prevent sexual abuse with younger children and peer sexual harassment (Letourneau, Schaeffer, Bradshaw, Ruzicka, Assini-Meytin et al., 2022).

A 2017 Google survey of just over 200 teachers found that teachers thought that online safety (not limited to online sexual harm) should be taught from the age of seven and “82 per cent of the teachers did not think they had all of the resources they needed” to teach online safety to their students (cited by the Independent Inquiry into Child Sexual Abuse, 2020).

Secondary intervention

Assini-Meytin and colleagues (2020) discuss the need for a comprehensive approach to child sexual abuse prevention that includes approaches which specifically target potential perpetrators and the onset of offending behaviours. Such approaches include self-help interventions for people with sexual interest in children, universal school-based interventions targeting the onset of youth problem sexual behaviour, and changes to organisational contexts that reduce the likelihood of abuse (Assini-Meytin et al., 2020).

Quadara and colleagues (2015) discuss two examples of secondary intervention programs: Prevention Project Dunkelfield and the Stop it Now! UK and Ireland campaign:

•  Prevention Project Dunkelfeld (PPD), a German prevention strategy, targets paedophiles and hebephiles who have not been arrested or convicted of any sex crimes against children but who are interested in accessing help and treatment. This program aims to control participants’ thoughts and feelings towards children and incorporates cognitive behaviour therapy, group and individual therapy, sexological tools (e.g., finding ways to connect with adult sexual partners) and medical options (e.g., chemical castration).
• Stop it Now! UK and Ireland is based upon a telephone hotline service and was established about 10 years ago in the UK (based on the US program) to allow individuals who are worried about their thoughts and actions around children to anonymously speak about their concerns (Denis & Whitehead, 2012).

Tertiary intervention

Quadara and colleagues (2015) also discuss two examples of tertiary prevention programs, including Circles of Support and Accountability (COSA) and the Good Lives model.

•  COSA, which was established in Canada 15 years ago, aims to support released child sexual offenders through group and individual meetings, help them find employment and housing, and reintegrate them back into society after their period of incarceration. Results indicate that offenders who have been part of COSA have between a 70% and 83% lower chance of sexual reoffending than those who did not partake in the group (Finkelhor, 2009; Wilson, Cortoni, & McWhinnie, 2009). The program is now available in the UK and the USA, and a trial is being conducted in South Australia (Worthington, 2015).
•  The Good Lives framework, as proposed by Ward and Gannon (2006), aims to understand offending within a broader concept of unmet needs or frustrations with satisfying universal human needs. The treatment is focused on building the offender’s self-esteem, self-confidence and sense of hope so they can work towards a better life that is free from child sexual abuse.

References

Assini-Meytin, L.C., Fix, R.L., & Letourneau, E.J. (2020). Child sexual abuse: The need for a perpetration prevention focus. Journal of Child Sexual Abuse, doi: 10.1080/10538712.2019.1703232.

Blakey, J.M., Glaude, M., & Williams Jennings, S. (2019). School and program related factors influencing disclosure among children participating in a school-based childhood physical and sexual abuse prevention program. Child Abuse & Neglect, 96, 104092.

Denis, D., & Whitehead, H. (2012). Stop it Now! UK & Ireland: Helpline and campaign report 2002–2012. Birmingham: Stop it Now! UK & Ireland.

Elfreich, M.R., Stevenson, M.C., Sisson, C., Winstead, A.P., & Parmenter, K.M. (2020). Sexual abuse disclosure mediates the effect of an abuse prevention program on substantiation. Child Maltreatment, 25(2), 215-223.

Ferragut, M., Cerezo, M.V., Ortiz-Tallo, M., & Rodriguez-Fernandez, R. (2023). Effectiveness of child sexual abuse prevention programs on knowledge acquisition: A meta-analytical study. Child Abuse & Neglect, 146, doi: 10.1016/j.chiabu.2023.106489.

Finkelhor, D. (2009). The prevention of childhood sexual abuse. The Future of Children, 19(2), 169–194.

Holzer, P.J., Higgins, J., Bromfield, L.M., Richardson, N., & Higgins, D.J. (2006). The effectiveness of parent education and home visiting child maltreatment prevention programs. (Child Abuse Prevention Issues No. 24). Melbourne: National Child Protection Clearinghouse.

Hudson, K. (2018). Preventing child sexual abuse through education: The work of Stop it Now! Wales. Journal of Sexual Aggression, 24(1), 99-113.

Independent Inquiry into Child Sexual Abuse (2020). The internet: Investigation report. IICSA, UK.

Letourneau, E.J., Schaeffer, C.M., Bradshaw, C.P., & Feder, K.A. (2017). Preventing the onset of child sexual abuse by targeting young adolescents with universal prevention programming. Child Maltreatment, 22(2), 100-111.

Letourneau, E.G., Schaeffer, C.M., Bradshaw, C.P., Ruzicka, A.E., Assini-Meytin, L.C., Nair, R., & Thorne, E. (2022). Responsible Behavior with Younger Children: Results from a pilot randomized evaluation of a school-based child sexual abuse perpetration prevention program. Child Maltreatment, DOI: 10.1177/10775595221130737.

Quadara, A., Nagy, V., Higgins, D. & Siegel, N. (2015). Conceptualising the prevention of child sexual abuse: Final report. (Research Report No. 33). Melbourne: Australian Institute of Family Studies.

Radford, L., Richardson Foster, H., Barter, C., & Stanley, N. (2017). Rapid evidence assessment: What can be learnt from other jurisdictions about preventing and responding to child sexual abuse. Connect Centre for International Research on Interpersonal Violence School of Social Work, Care & Community, University of Central Lancashire.

Rudolph, J., Zimmer-Gembeck, M., & Walsh, K. (2022). Recall of sexual abuse prevention education at school and home: Associations with sexual abuse experience, disclosure, protective parenting, and knowledge. Child Abuse & Neglect, 129, DOI: 10.1016/j.chiabu.2022.105680

Smallbone, S., Marshall W., & Wortley, M. (2008). Preventing child sexual abuse: Evidence policy and practice. Cullompton, Devon: Willan Publishing.

Vosz, M., McPherson, L., Tucci, J., Mitchell, J., Fernandes, C., Macnamara, N. (2022). It is time to focus on prevention: A scoping review of practices associated with prevention of child sexual abuse and Australian policy implications. International Journal on Child Maltreatment, doi: 10.1007/s42448-022-00143-8.

Walsh, K., Zwi, K., Woolfenden, S., & Shlonsky, A. (2015). School-based education programmes for the prevention of child sexual abuse: A systematic review. Campbell Systematic Reviews, 10, DOI: 10.4073/csr.2015.10.

Ward, T., & Gannon, T. A. (2006). Rehabilitation, etiology, and self-regulation: The comprehensive good lives model of treatment for sexual offenders. Aggression and Violent Behavior, 11(1), 77–94. doi: 10.1016/j.avb.2005.06.001

Wilson, R.J., Cortoni, F., & McWhinnie, A.J. (2009). Circles of Support & Accountability: A Canadian national replication of outcome findings. Sexual Abuse, 21(4), 412–430.

Worthington, E. (2015). Controversial paedophile support program to launch in South Australia in a national first. ABC News. Retrieved from: https://www.abc.net.au/news/2015-03-18/controversial-paedophile-support-program-launches-in-australia/6330022