CHILD SEXUAL ABUSE PREVENTION PROGRAMS FOR ADULTS This document was supported by Cooperative Agreement # 5VF1CE001751-02 from the Centers for Disease Control and Prevention. The content of this publication may be reprinted with the following acknowledgement: This material was reprinted, with permission, from the National Sexual Violence Resource Center’s publication entitled Child Sexual Abuse Prevention: Programs for Adults. This guide is available by visiting www.nsvrc.org © National Sexual Violence Resource Center 2011. All rights reserved. CHILD SEXUAL ABUSE PREVENTION PROGRAMS FOR ADULTS Child sexual abuse prevention programs have developed over time to engage adults in child sexual abuse prevention efforts. These programs acknowledge that educating children or potential victims alone cannot prevent the perpetration of child sexual abuse. True primary prevention of child sexual abuse calls for the prevention of perpetration and a societal investment. Adults can have several roles in the prevention of child sexual abuse. Adults fit into more than one of these roles, including: - Parent, guardian, or other family member. - Person who works with children (e.g., teacher, day care provider, health care provider, coach, advocate). - Member of the general public, especially potential bystander (e.g., community member, neighbor, and others). - Member of a group that can influence community/societal policies, actions and behaviors to prevent child sexual abuse (e.g., policymaker, media, corporate leader, etc.) Although public awareness about child sexualabuse has increased significantly in the past few decades, most adults do not have the information or resources needed to prevent abuse (Chasan-Taber & Tabachnick, 1999). As a result, it is difficult for adults to help educate children or other adults about child sexual abuse or to protect children from abuse. This guide is intended to provide sexual violence advocates with information about child sexual abuse prevention programs that target adults. It will provide information about the basics of such programs and an overview of evaluation research for these programs. This guide is intended to assist advocates and prevention educators in selecting or designing prevention programs,and to provide evidence to support them in advocating for these programs to funders and the community at large. Section One Moving Toward an Evidence-Informed Approach Program goals The general goals of prevention programs targeting adults include (Elrod & Rubin, 1993; Kolko, 1988; Wurtele, Kast, & Melzer, 1992): - Educate adults about what child sexual abuse is and how it can be prevented. - Decrease secrecy and increase conversation about sex and sexual abuse, both from adult to adult and from adult to child. - Teach adults about healthy sexual development and how to have open conversations with children about their body parts. - Help adults learn to recognize warning signs of abuse and act appropriately on this knowledge. - Teach adults to recognize problematic behavior in others and hold them accountable for changing their behavior to be more appropriate. - Improve adults’ reactions to children’s disclosures of abuse. - Teach adults to support children’s healthy development, both emotional and sexual. - Increase adults’ sensitivity to children. - Help adults talk to children and other adults about prevention topics. - Help adults identify children and youth with sexual behavior problems and seek appropriate help. The contents of these programs are very similar to the contents of programs designed to teach children the basic facts about child abuse and its prevention (Elrod & Rubin, 1993). Indeed, programs targeting adults are often conducted in conjunction with programs for children (Daro, 1994). Types of programs A brief discussion of several types of prevention programs that are typically used to educate and engage adults in preventing child sexual abuse follows: - Components of school-based programs for children, are typically training sessions for teachers who will be instructing the children and/or education/orientation sessions for parents and guardians. - Stand-alone parent education programs, generally involve either community-based prevention education sessions, prevention education as part of a broader parenting education program, or home-visitation programs for families who are considered to be at high risk of abuse. - Professionals who work with children who are mandated by law to report suspected child abuse, such as teachers and other school personnel, health care professionals, law enforcement representatives, employees of certain state agencies, and other individuals. - Public education campaigns can reach a broader audience than training-based prevention programs, but tend to be more narrowly focused on basic prevention topics. They attempt to raise awareness about the problem and help members of the public to identify signs of child sexual abuse, change their attitudes about child sexual abuse, and understand their role in prevention. - Media campaigns are public education campaigns that involve the development and distribution of media, such as brochures and pamphlets. Mass media campaigns are a subset of media campaigns that use print, television, and radio public service announcements, op-ed pieces in newspapers, billboards, and posters to reach audiences. - Social marketing campaigns draw upon research and behavior change theory to develop strategies. Key components include orienting the campaign to the target audience; conducting formative research and pre-testing of messages; developing strategies to address barriers and competition to adapting new behaviors; and, using standard marketing (Lefebvre & Flora, 1988). The specific prevention program curricula discussed in this guide focus primarily on preventing child sexual abuse and have been evaluated in peer-reviewed research articles since 1990. This guide is not intended as a comprehensive list of evaluated or commonly used child sexual abuse prevention program curricula.1 In particular, it is important to balance the push for evidence-based curricula with the encouragement of innovations in prevention programs that are evaluated. The National Sexual Violence Resource Center does not endorse specific prevention programs, including those discussed in this guide. A National Resource Directory & Handbook Preventing Child Sexual Abuse is available online at http://www.nsvrc.org Challenges in designing and implementing effective programs A common challenge in instituting child sexual abuse prevention programs is the social discomfort about topics related to sexuality (Daro, 1994). Many adults believe that topics such as these are highly personal and should be discussed within the family, as opposed to in public, if at all. As a result, adults may be reluctant to attend prevention education classes, read about prevention, or work to implement or support such programs. Funders may be unwilling to support programs that address sensitive sexual topics. Framing the issue around the protection of children and child health may encourage some people to support such prevention programs. For example, the Adverse Childhood Experiences (ACE) Study is a decade-long and ongoing study created to explore the childhood origins of our society’s health and social problems. The study finds that stressful or traumatic childhood experiences such as abuse, neglect, witnessing domestic violence, or growing up with alcohol or other substance abuse, mental illness, parental discord, or crime in the home can be pathways to negative social, emotional, and cognitive consequences. These experiences can lead to an increased risk of developing unhealthy coping mechanisms, risk of violence or victimization, disease, disability and premature mortality (Edwards et. al., 2003). The ACE Study calls for a multidisciplinary and integrated approach to prevention and intervention of childhood abuse and neglect. Section Two Prevention Programs Designed for Parents and Guardians Parents are, in many ways, ideal messengers for prevention efforts. They can have a direct effect on their children, other parents, and many professionals who work with children that they encounter in their daily lives. Parents may have preexisting skills, such as their instincts to protect their child and their intimate knowledge of child development, which can be built on through prevention programs (Daro, 1994). Child sexual abuse is a complex issue. Many individuals, including parents, need additional information about child sexual abuse and strategies to prevent this crime (Elrod & Rubin, 1993; Tutty, 1993). Adding to the problem, parents tend to overestimate their children’s knowledge about abuse, which may discourage them from passing on basic concepts (Tutty, 1993). Program goals The goals of prevention programs for parents and guardians commonly focus on teaching parents how to protect their own children from sexual abuse. There are four goals: Goal 1 Teach parents how to educate their children about child sexual abuse prevention. - Discuss topics without scaring child (Elrod & Rubin, 1993). - Teach child how to protect him/herself (Elrod & Rubin, 1993). - Teach child how to tell what is and isn’t abuse (Elrod & Rubin, 1993). - Tailor concepts to their children’s skills and developmental levels (Elrod & Rubin, 1993). Goal 2 Teach parents how to protect their children from child sexual abuse. - Understand that most people who sexually abuse children are known to the victim and the victim’s family. - Know the characteristics of people who sexually abuse children and the ways they manipulate parents and children. Goal 3 Teach parents to recognize signs that abuse is occurring and take steps to stop it. - Identify signs of abuse. - Respond appropriately to disclosures. - Monitor sexual development (Daro, 1994). - Learn about local child abuse reporting systems and services for victims and families (Daro, 1994). Goal 4 Teach parents how to strengthen healthy family dynamics. - Strengthen parent-child relationships. - Encourage supportive and open communication. - Discourage secrecy. Goal 5 Support prevention efforts directed at children and other adults. - Reinforce prevention messages in multiple contexts (Cox, 1998; Renk, Liljequist, Steinberg, Bosco, & Phares, 2002). - Discuss prevention concepts in natural settings (Cox, 1998, Renk et al., 2002). If the parent program is part of a school-based program to educate children, it will typically also aim to familiarize the parents with the information covered in the program for their children (Daro, 1994). Types of Programs Several types of programs are commonly used to reach and engage parents and guardians: - Education/orientation sessions done in conjunction with prevention programs directed at children (Cox, 1998). - Community-based prevention education sessions for parents. - Parenting education classes that contain information about child sexual abuse prevention (Daro, 1994). - Home-visitation programs for families who are considered to be at high risk of abuse, typically led by a nurse or prevention educator (Olds, Eckenrode, et al., 1998; Olds, Henderson, et al., 1998). - Public education and/or social marketing campaigns. Challenges in Designing and Implementing Effective Programs One of the main challenges facing parent/ guardian prevention programs is that these programs tend to be poorly attended (Daro, 1994). Those who do attend usually are already interested in or familiar with child sexual abuse prevention programs. A number of explanations have been suggested for this (Elrod & Rubin, 1993; Hebert, Lavoie, & Parent, 2002); specifically, that some parents may believe that: - They know all that they need to know about child sexual abuse. - They do not stand to benefit from the program. - Their children are not at risk of child sexual abuse. - Others will judge them or make assumptions about their family if they participate. - They feel there is nothing they can do to prevent child sexual abuse. When parents are questioned about their reasons for not attending prevention programs, the most commonly cited reason is time constraints (Hebert, Piche, Fecteau, & Poitras, 2001; Reppucci, Jones, & Cook, 1994, as cited in Hebert, Lavoie, & Parent, 2002). Factors important to parents and guardians when they are deciding whether to attend a child sexual abuse prevention program include (Elrod & Rubin, 1993): - Interest in the topic. - Qualifications of the prevention educator. - Usefulness of the information presented. - Source of the referral to attend the program. Parents are most likely to respond to referrals from doctors and schools, least likely to respond to referrals from television or newspaper advertisements or their workplace. - Time that they will be required to attend. This information can be used to tailor programs, particularly program recruitment tactics, so that parents and guardians are more likely to attend. General Evaluation of Programs Programs for parents alone show some promise, although additional research is needed. Parents who attended a presentation led by a prevention educator and participated in a group discussion were more likely to support a victim of sexual abuse than those who did not participate in the presentation and discussion (McGee & Painter, 1991). In this study, parents who watched a video containing role-play scenarios and/or participated in a group discussion were more able to identify appropriate responses to hypothetical abuse scenarios. Programs that include sessions for both parents and their children have consistently been found to be effective in their educational goals (MacIntyre & Carr, 2000). Programs for children that also contain components for their parents have been found to have increased knowledge, likelihood of disclosure, and use of self-protective techniques (Cox, 1998). The gains among children in these programs tend to last longer because they are reinforced in multiple settings. Parental gains include increased comfort in and knowledge about talking to their children about sexual abuse (Binder & McNeil, 1987). Home-visitation programs have also been found to effectively reduce the risk of abuse (Olds, Eckenrode, et al., 1998; Olds, Henderson, et al., 1998). Example of Evaluation Findings from a Parent Education Program ESPACE/Child Assault Prevention Project (CAP) Type of program: Parent workshop as part of school-based program for children. Techniques used: Lecture, linking to resources in the community, providing exercises for parents to do with children. Main topics: Child sexual abuse myths, signs of abuse, how to react appropriately to abuse. Duration: 2 hours Evaluation findings: For parents (Hebert, Lavoie, & Parent, 2002) - Increase in prevention knowledge. - More able to suggest appropriate interventions. - More likely to encourage children to use prevention strategies. - More likely to seek out agencies for help. - Increased knowledge about how to emotionally support children. For children with involved parents (Hebert, Lavoie, Piche, & Poitras, 2001) - Increase in prevention skills. Section Three Prevention Programs for People Working with Children Many types of people work with children and can be engaged in prevention efforts. These people can include teachers and other school professionals, health care professionals, counselors, day care providers, advocates, sports coaches, employees of community agencies who work with children, and others. They may have varying levels of familiarity with child sexual abuse, child development, and other topics important to abuse prevention. Because of their interactions with children and parents, they are often able to provide prevention education, notice warning signs of abuse, and intervene if abuse is suspected (Renk et al., 2002). All 50 states have mandated reporting laws for individuals who work with children.2 However, many mandated reporters are untrained in the nature of abuse and the nuances of reporting (Kenny, 2001). Mandated reporters who have not been trained may be unclear about the signs of child sexual abuse, fear negative consequences as a result of reporting, and misunderstand reporting laws, which may affect their reporting decision (Alvarez, Kenny, Donohue, & Carpin, 2004; Hawkins & McCallum, 2001). Most prevention efforts for people who work with children focus on teachers and other school professionals, who are mandated reporters in every state (Kleemeier, Webb, Hazzard, & Pohl, 1988). These people are the source of most child abuse reports in the United States (U.S. Department of Health and Human Services, Administration on Children, Youth, and Families, 2009). However, most schools do not train teachers about child sexual abuse, and teachers tend to find the programs that are offered to be lacking in quality and duration (Abrahams, Casey, & Daro, 1992). Program Goals The goals of prevention programs to educate and engage people who work with children tend to focus on teaching adults how to educate children and prevent ongoing abuse: Goal 1 Teach people who work with children how to educate children about child sexual abuse prevention. - Review the topics to be presented to children (Daro, 1994). - Teach presentation skills. Goal 2 Teach people who work with children how to identify and report child sexual abuse. - Discuss physical and behavioral signs of abuse (Hawkins & McCallum, 2001). - Review the local reporting system (Daro, 1994). - Discuss what to do with suspicions of abuse (Daro, 1994). - Review services for victims and families (Daro, 1994). - Role-play interventions and reactions to disclosures. Types of Programs Three types of programs are commonly used to reach people who work with children: - Training sessions for teachers who will be instructing children in a school-based prevention program. - Public education and/or social marketing campaigns. - Mandated reporter trainings. General Evaluation of Child Sexual Abuse Prevention Programs Unfortunately, few evaluations have been done to date to evaluate prevention programs for people who work with children. The findings of the limited number of evaluations that have been done include: - Programs to educate teachers have a positive impact on teacher knowledge (MacIntyre & Carr, 2000). - Trained mandated reporters tend to feel that they are able to make a reporting decision without relying only on physical evidence of abuse (Hawkins & McCallum, 2001). - Mandated reporters feel that their level of training is an important factor in their decision to report (Hawkins & McCallum, 2001). Evaluation of Prevention Program Curricula Teacher Training Workshop Curriculum Techniques used: Presentations, videos, role- playing, activities, discussion (Randolph & Gold, 1994). Main topics: Recognizing signs of abuse, responding to disclosures, reporting sexual abuse (Randolph & Gold, 1994). Duration: Three two-hour sessions Teachers who participated in this program (Randolph & Gold, 1994): - Were more likely to talk to children, friends, and colleagues about abuse. - Were more likely to report suspicions of abuse. - Possessed increased knowledge about sexual abuse. - Possessed improved attitudes about prevention. - Found the workshop to be “very much worth attending.” Section Four Prevention Programs Designed for the General Public Relatively recently, efforts to prevent child sexual abuse have begun to focus on members of the general public; in particular, on bystanders. In terms of child sexual abuse prevention, a bystander is a person who has an opportunity to act in a way to prevent or respond to child sexual abuse.3 A bystander may be in the environment of a child at risk for abuse, in the environment of a person who is at risk for committing child sexual abuse, present during an abusive situation, or present after a child has been abused (e.g., a mother who notices inappropriate sexual behavior in a friend of her child). The role of bystanders is to prevent both ongoing abuse and advocate for children’s needs. Bystanders may or may not have a child of their own or work with children regularly, but they have an important role to play in keeping children safe and can be engaged through broader prevention efforts. These prevention efforts aim to influence people who are able to do something to prevent child sexual abuse from occurring. Bystanders can also play important roles in responding to the needs of victims, survivors and people who sexually abuse children by helping them to access intervention services and by advocating for the services necessary to prevent and respond to abuse. Program Goals To effectively engage the general public, they must feel that can play an important role in preventing child sexual abuse. This first means connecting with them around prevention actions that seem “possible” and achievable to them. Prevention programs for the general public have several main goals: Goal 1 Educate the public about child sexual abuse. - Increase community knowledge about sexual abuse. - Change attitudes. - Make sexual abuse prevention a priority. - Support local prevention efforts. Goal 2 Change behaviors of community members. - Change behaviors that encourage sexual abuse. - Encourage bystanders to detect and intervene in sexual abuse. Types of Programs Public education and/or social marketing campaigns are used almost exclusively to reach the general public as the goal with this group is behavior change. Challenges in Designing and Implementing Effective Programs Campaigns that use media-based tactics tend to be expensive, so their success may be heavily dependent on the availability of funding. Obtaining funding can be difficult when advertisers and sponsors are uncomfortable with media that addresses sexual abuse. In addition, social marketing campaigns must be based on solid audience research to ensure that messages resonate with the target audience and that the campaign results in behavior change. Careful planning, implementation, and evaluation of campaigns are also required to ensure that they are effective. To implement campaigns such as these, a background in audience research and program implementation and evaluation is helpful. Partnerships with groups with this expertise can help inform successful campaigns. General Evaluation of Prevention Campaigns Few campaigns designed to reach the general public to prevent child sexual abuse have been evaluated, as they are a relatively new strategy in the effort to prevent sexual abuse. Although campaigns addressing topics other than child sexual abuse (e.g., anti-smoking efforts, campaigns to prevent drinking and driving) have been evaluated and found to be effective, some speculate that general conclusions about their ability to increase knowledge and change behavior cannot be drawn because the topics they address and methods they use are so varied (Hoefnagels & Baartman, 1997). However, this knowledge does provide hope that programs aiming to prevent child sexual abuse by engaging the general public in prevention can be effective. To date, the following is known about campaigns for the general public: - People who feel responsible to act and feel comfortable in their intervention skills are more likely to do so (Christy & Voigt, 1994). - Mass media campaigns may increase disclosures of sexual abuse (Hoefnagels & Baartman, 1997). - Media campaigns may be most effective when they are accompanied by more targeted efforts in order to take advantage of the heightened level of awareness. Evaluation of Specific Pprevention Campaigns4 Stewards of Children Program http://www.d2l.org/site/c.4dICIJOkGcISE/ b.6243681/k.6DB6/Stewards_of_Children.htm Primary audience: Bystanders Techniques used: Public service announcements on television and radio, educational pamphlet, educational website, online training program, interactive workbook, educational video and discussion opportunities Main topics: How to recognize signs of abuse, prevent abuse, and react appropriately to abuse Evaluation findings (Krugman, Lane, & Walsh, 2007; Rheingold et al., 2007): - Conflicting findings about whether program increases knowledge about child sexual abuse. - Improvement in attitudes about child sexual abuse. - Increase in primary prevention behaviors. - Improvements were sustained two months following program completion. - Not known whether this program decreases rates of child sexual abuse. STOP IT NOW! (www.stopitnow.com) Primary audience: The general public Techniques used: Media campaign, outreach campaign to high-risk families with an associated helpline, collaborations with influential people in the community, panels of those affected by sexual abuse, education of media outlets, trainings of professionals who work with families and children, encouraging people who sexually abuse children to get treatment. Main topics: Holding abuser accountable for actions, social responsibility for the prevention of sexual abuse, increasing awareness in those at risk for abuse, how to confront people who sexually abuse children and reducing tolerance of sexual abuse Evaluation findings (Chasan-Taber & Tabachnick, 1999; Tabachnick & Dawson, 2001): - Increase in public awareness and knowledge. - Adults significantly more likely to say they would report or take direct action when presented with scenarios of sexual abuse. - Increase in calls to helpline (Schober, Fawcett, Schultz, Cournoyer, & Wright, 2008). - Reduced incidence of reported child sexual abuse (Schober, Fawcett, Schultz, Cournoyer, & Wright, 2008). Section Five Conclusion Efforts to prevent the sexual abuse of children have flourished in the past couple decades. With this growth has come a shift away from expecting children to prevent their own victimizations (a risk- reduction approach) toward a more primary prevention approach that gets at the root causes of the perpetration of child sexual abuse and engages adults in the community to act, intervene, and respond. To date, many of these programs have yet to be evaluated in a rigorous empirical way. Although there have been a number of large, well-funded efforts to target adults in the prevention of child sexual abuse that have been evaluated, there are also many grassroots efforts created by advocates and implemented in local communities that are sowing the seeds needed to prevent sexual abuse. These local efforts are in a position to work toward a culturally competent approach, considering issues relevant to diverse populations that may be overlooked in larger campaigns. Increased inter-agency collaboration can encourage the sharing of such ideas and resources, particularly evaluation skills that will allow advocates and others implementing prevention programs to identify what works and what does not work. With collaboration, evaluation, and the hard work of many, prevention programs to educate and engage adults in preventing child sexual abuse will continue to expand over the decades to come. 1 For a more comprehensive list of prevention programs and the research (published before 2002) that has evaluated them, visit the University of Calgary’s online resource manual on child sexual abuse prevention programs at http://www.ucalgary.ca/resolve/violenceprevention. 2 For more information on state laws regarding mandated reporting, see Mandatory Reporters of Child Abuse and Neglect: Summary of State Laws, online at http://www.childwelfare.gov/systemwide/laws_policies/ statutes/mandaall.pdf 3 For more information on bystander intervention, refer to the NSVRC’s publication entitled Engaging Bystanders in Sexual Violence Prevention, available online http://www.nsvrc.org/_cms/fileUpload/Projects/Engaging_Bystanders.pdf. 4 Additional information may be found in “Incorporating Evaluation into Media Campaign Design” at http://new.vawnet.org/category/Documents. php?docid=1317. Section Six Publication Information About the Authors — Hallie Martyniuk and Emily Dworkin Hallie Martyniuk is an instructional designer specializing in the development of curricula and resource materials for state and national criminal justice and victim service programs. Her work includes Strengthening Military-Civilian Community Partnerships to Respond to Sexual Assault, the Pennsylvania Prison Rape Elimination Act (PREA) Toolkit, Advocate’s Manual for Working with Incarcerated Victims of Sexual Assault, and Masculinity and Violence. Emily Dworkin is a doctoral student in Clinical-Community Psychology at the University of Illinois at Urbana-Champaign. Broadly, her research examines narratives of survivors in relation to identity formation, as well as individual- and ecological-level predictors of mental health consequences of sexual assault. Formerly, she worked as the Resource Development Specialist at the National Sexual Violence Resource Center. 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