Effectiveness of a school-based intervention to prevent child sexual abuse—Evaluation of the German IGEL program

BackgroundChild sexual abuse (CSA) is a problem with severe consequences for victimized children. A variety of interventions have been developed and implemented over the last decades to prevent CSA. However, most of them have not been systematically evaluated to determine their effectiveness. The IGEL program is a school-based intervention to prevent CSA in third-grade primary school children in Germany.MethodsThis study was conducted using a quasi-experimental design, in which almost 300 children and their parents from eight intervention and four control schools were surveyed three times (pretest, posttest, 3 months later). In order to measure outcomes, a questionnaire was developed based on validated instruments to assess the knowledge, courses of action and self-protective skills of the children. Furthermore, increased anxiety and generalized touch aversion were examined as potentially harmful side effects of the program.ResultsThe results clearly demonstrate increased CSA-related knowledge and courses of action in children from the intervention group compared to the control children. These effects were medium-sized and sustained for at least three months after the last session. No meaningful negative side effects were detected in the evaluation for either the children or parents.ConclusionThe outcome evaluation indicates that the IGEL program is an effective intervention in terms of knowledge about CSA and known courses of action, and may therefore contribute to the prevention of CSA in primary schools. Despite this positive core finding of the intermediate outcomes, some adaptations of the program to children with different cultural backgrounds were made prior to further dissemination.     

Child sexual abuse prevention programs: do they decrease the occurrence of child sexual abuse?

OBJECTIVE: The primary goal of the current study was to determine whether rates of child sexual abuse differed among undergraduate women who either had or had not participated in a sexual abuse prevention program during childhood. A secondary goal was to determine whether differences emerged in sexual satisfaction or avoidance of sexual activity between those women who had or had not participated in such a program. METHOD: Eight hundred and twenty-five women undergraduates from a New England state university filled out a survey on "sexual experiences" for research credit. Respondents were asked detailed questions regarding past histories of child sexual abuse and participation in school-based prevention programs during childhood. Additionally, they responded to questions about their current sexual satisfaction and sexual behaviors. RESULTS: Sixty-two percent of the sample reported having participated in a "good touch-bad touch" sexual abuse prevention program in school. Eight percent of respondents who reported ever having had a prevention program also reported having been subsequently sexually abused, compared to 14% of respondents who did not ever have a prevention program. No differences were found in adult sexual satisfaction or on behavioral measures of sexual activity between those respondents who had and had not participated in a prevention program. CONCLUSIONS: This is the first study to find that school-based child sexual abuse prevention programs are associated with a reduced incidence of child sexual abuse. Additionally, contrary to concerns voiced in the literature, there was no evidence that prevention programs are associated with decreased sexual satisfaction or avoidance of sex in adulthood. Implications of the results for further study are discussed.     

Parents as protectors: A qualitative study of parents’ views on child sexual abuse prevention

Although parents are essential to child sexual abuse (CSA) prevention efforts, their views on prevention and protection are not always represented in the research literature. In this qualitative study of 24 Australian parents, beliefs about CSA, its risk factors, prevention methods, and parents’ role in CSA protection, and parents' approaches to protection of their own children, are examined. Findings were condensed into five themes: (a) parents' understanding of child sexual abuse, grooming and risk; (b) parent-led CSA education; (c) parents’ beliefs about CSA education; (d) children recognizing and resisting CSA; and (e) parent responsibility for protection. Findings suggest that parents have a good knowledge of CSA and its risks. However, they do not provide their children with the comprehensive prevention messages recommended by prevention campaigns and many concentrate on abduction dangers. This gap between knowledge and parental communication with children could be due to parents' beliefs that there may be harms associated with education of children about CSA (e.g., such as inciting new fears and worries or reducing trust in others) and that the method may not be effective in protecting children from CSA. This study adds to the existing literature by presenting information that could be useful in designing programs to include parents in CSA protection and by approaching CSA research with parents as the key agents in the protection of children.     

“Body self” in the shadow of childhood sexual abuse: The long-term implications of sexual abuse for male and female adult survivors

Childhood sexual abuse (CSA) may have long-term negative outcomes for victims’ body representations. In this study we examined a model in which the relation between CSA and an individual’s discomfort when in close proximity to others is mediated by disrupted body boundaries, and the relation between CSA and body shame is mediated by body self-objectification. Since most of these variables were conceptualized and assessed primarily among women, gender differences regarding the proposed model were examined. Study participants were 843 college/university students (536 women and 307 men). Results from structural equation modeling analyses indicated that in both genders, disrupted body boundaries mediated the relations between CSA and an individual’s discomfort when in close proximity to others, as well as between CSA and body shame. Body self-objectification was not associated with history of CSA. Finally, we discuss the role these findings may play in the detrimental long-term effects of CSA on both male and female survivors, and refer to their common underlying mechanism.     

“What Works”: systematic review of the “FRIENDS for Life” programme as a universal school-based intervention programme for the prevention of child and youth anxiety

Mental health disorders are currently the leading cause of disability among young people, internalising disorders such as anxiety and depression representing the most predominant mental health problems experienced. Given the high prevalence rates, low rates of treatment and associated adverse effects on social, emotional and academic functioning, the need to prevent the development of anxiety disorders in children and adolescents is paramount. The FRIENDS for Life intervention programme has been endorsed by the World Health Organisation as an evidence based programme effective for the prevention of child and youth anxiety. The purpose of this article is to systematically review the research base surrounding the FRIENDS for Life programme. All reviewed studies found that the programme had a positive impact on primary anxiety outcome measures compared to control groups, with small to medium effect sizes reported. However, a number of methodological and design concerns were identified across studies. Further quality school-based research is needed to ameliorate these challenges.     

“Talking about child sexual abuse would have helped me”: Young people who sexually abused reflect on preventing harmful sexual behavior

Harmful sexual behavior carried out by children and young people accounts for about half of all child sexual abuse perpetration. The aim of this study was to draw on the insights of young people who had been sexually abusive to enhance the current prevention agenda. The study involved semi-structured interviews with 14 young people and six treatment-providing workers. Sampling was purposive and the young people had previously completed a treatment program for harmful sexual behaviour in Victoria, Australia. The young people were approached as experts based on their previous experience of engaging in harmful sexual behavior. At the same time, their past abusive behavior was not condoned or minimised. Constructivist Grounded Theory was used to analyse the qualitative data. Opportunities for preventing harmful sexual behavior were the focus of the interviews with young people and workers. The research identified three opportunities for prevention, which involved acting on behalf of children and young people to: reform their sexuality education; redress their victimization experiences; and help their management of pornography. These opportunities could inform the design of initiatives to enhance the prevention agenda.     

Is child sexual abuse declining? Evidence from a population-based survey of men and women in Australia

OBJECTIVE: Substantiated cases of child sexual abuse (CSA) in the United States have declined significantly over the past decade. This may, or may not, reflect change in the underlying rate in the general population. This study examines age-cohort differences in the prevalence of self-reported CSA experiences of men and women aged 18-59 years in a community-based sample from a comparable western nation. METHOD: In April 2000, we completed a cross-sectional, telephone-based survey of a randomly selected national sample of men and women in Australia. Volunteers (876 males, 908 females) answered a range of questions about health status and sexuality, including unwanted sexual experiences before the age of 16 years. Of selected adults with publicly-listed telephone numbers, 61% agreed to participate. There were few differences between the volunteers and the Australian population on demographic variables and health indicators. RESULTS: Non-penetrative CSA was twice as common among women (33.6%) than men (15.9%). Approximately 12% of women and 4% of men reported unwanted penetrative experiences. CSA was reported significantly less often by younger males, with a linear decline from the oldest to youngest men. Among all females who had intercourse before age 16, older women were much more likely than younger women to say they were an unwilling partner on the first occasion. If first intercourse occurred at age 16 or later, there were no age-cohort differences in risk of first-time abuse. Self-reported "openness" and "comfort" during the telephone interviews was not systematically related to prevalence of CSA. CONCLUSION: These population-based findings provide evidence of a decline in the underlying rate of CSA in Australia. Although every measure of CSA inevitably is flawed to some extent, these trends in self-report complement official statistics that show substantial decline in recent years.     

Assessing child abuse: “We need to talk!”

BackgroundThis discussion paper adds to the recent critical debate concerning retrospective measurement of childhood abuse and adverse experiences. A series of recent articles found only modest overlap of prospective informant-based records with retrospective self-report questionnaires, with biases evident in the latter. However, this literature has omitted the use of investigator-based interviews as an alternative retrospective tool for triangulation of measurement. Validated interview approaches can ascertain accurate data using expert scoring that can be used to test both dose-effect and specificity analyses for further research and treatment purposes.ObjectiveArguments for the retention and further promotion of intensive interview measures for retrospective assessment of childhood neglect and abuse in relation to lifetime clinical outcomes are presented, with illustrative analyses.Method and resultsA network analytic approach is outlined, with six types of childhood abuse or neglect experiences scored via a well-validated interview (the Childhood Experiences of Care and Abuse). This indicates distinct pathways between types of neglect and abuse, but also from more common emotional abuse (antipathy, critical parenting) through to more pernicious psychological abuse (coercive, sadistic control) involving physical abuse or sexual abuse pathways. This is supplemented by a case vignette to illustrate the different pathways indicated.ConclusionsThe interview approach gives victims a voice with their narrative (chance to talk) needed for better understanding of the specific dynamics of child abuse and neglect and for an entry into psychotherapeutic work. We need to ensure that such methods are retained in the research and practitioner portfolio of measurement tools.     

‘I learned to accept every part of myself’: the transformative impact of a theatre-based sexual health and HIV prevention programme

The family—via communication (or lack thereof)—is a primary avenue for sexuality education. While most research on family sexuality communication has examined the content of parent–child communication (e.g. topics discussed), relatively few studies have assessed the process, the way in which communication occurs. This paper presents an analysis of communication process based on data collected during a qualitative, observational study of family sexuality communication with thirty low‐ and middle‐income African American mothers and their adolescent daughters living in an urban area in the southeastern USA. Two dimensions of communication process emerged: affective and stylistic. Elements of the affective dimension included connection, empathy, comfort, anger, and silence. Elements of the stylistic dimension included interactive versus didactic communication styles, use of a variety of persuasive techniques, body language, and setting. Results suggest that the process of sexuality communication is as, if not more, important than content and that affectively open and stylistically interactive sexuality communication is related to the context of close and connected mother–daughter relationships.     

“Every time someone comes forward,it makes it easier for the next survivor to be heard”: Sport as a triggering agent to break the silence of child sexual abuse

This research explored cultures of silence around child sexual abuse (CSA). On July 10, 2018, in response to multiple sexual abuse cases occurring in sport, sport news site Deadspin published a reader letter detailing CSA. This article prompted others to comment by sharing their accounts of CSA. Through qualitative analysis of 47 posts, we analyzed CSA victims’ lived experiences, with a focus on how cultural and social forces silenced them. Results indicated that silencing of CSA victims occurred through three overarching mechanisms: (a) patriarchal master narrative; (b) trauma-related shame; and (c) systemic power. The results illuminate the cultural and social factors that CSA victims experience and provide opportunities for parents, family members, and other stakeholders to better understand these constraints. In doing so, victims can be better supported, and needed discourse on CSA can occur more frequently to help identify solutions to this pervasive social problem.     

“They were the ones that saw me and listened.” From child sexual abuse to disclosure: Adults’ recalls of the process towards final disclosure

BackgroundWhen child sexual abuse (CSA) is not disclosed, children run the risk of being subjected to longer or repeated abuse, not receiving necessary treatment, and being re-victimized.ObjectiveThis study examines what adults exposed to child sexual abuse in hindsight evaluate as important for disclosure. The aim was to explore exposed own experiences of steps towards final disclosure.Participants and settingData were obtained from adult users of Norwegian Sexual Abuse Support Centers. Included were users exposed to CSA before the age of 18 (N=23).MethodsData were collected through anonymous questionnaires at each support center. The material was transcribed and analyzed in the tradition of Interpretative Phenomenological Analysis.ResultsThe study illustrates a process towards disclosure as a dialogically anchored process evolving over time and along life-course inside encounters with important others towards whom the exposed pays attention, attunement, and adjustment whether to tell, delay, re-try, turn towards others, or actually disclose. Their experiences elucidate processes towards exploring and telling through direct and indirect hints and signs, decisions to tell, re-decisions and delaying, or withholding until adulthood, and the dependency on trusted confidants who ask and listen for final disclosure to occur.ConclusionThus, the present study sends an important message to exposed, confidants, and professionals when questions of CSA appear. That is to know of, facilitate, trust, and tolerate the dialogical dependency on being asked and heard by trusted persons and the many steps a process towards disclosure of CSA may entail in order to succeed.     

To know,to decide,to act: the young child’s right to participate in action for the environment

This article draws on a research study that focused on young children’s involvement in an environmental curriculum that created for them opportunities to display their competence and confidence through knowing, deciding and acting for the environment within a supportive early childhood setting. When young children are involved in making decisions that affect their lives, including those decisions regarding sustainability and the natural environment, they are capable in contributing to the decision-making that leads them to purposeful action. The research revealed the importance of honouring the young child’s right to know about social and environmental issues; to be part of conversations and possible solutions; to have their ideas and contributions valued; to seek solutions with others in order to be able to take meaningful action. The article explores the notion that when the rights of young children are respected, they are confident advocates for the environment and for a more sustainable world.     

Legal decision–making in child sexual abuse investigations: A mixed–methods study of factors that influence prosecution

Prosecution of child sexual abuse cases is an important aspect of a community's response for holding perpetrators accountable and protecting children. Differences in charging rates across jurisdictions may reflect considerations made in prosecutors' decision–making process. This mixed–methods, multiphase study used data from a Children's Advocacy Center in a suburban county in the Southern United States to explore the factors associated with child sexual abuse cases that are accepted for prosecution and the process followed by prosecutors. Data were sequentially linked in three phases (qualitative-quantitative-qualitative), incorporating 1) prosecutor perceptions about what case characteristics affect charging potential, 2) 100 case records and forensic interviews, and 3) in–depth reviews of cases prosecuted. Content analysis was used to identify influential case elements, logistic regression modeling was used to determine factors associated with a decision to prosecute, and framework analysis was used to further confirm and expand upon case factors. Overall, findings indicate that prosecution is most strongly predicted by caregiver support and the availability of other evidence. The decision to prosecute was found to include a process of ongoing evaluation of the evidence and determination of a balanced approach to justice. The decision to prosecute a case can be influenced by strong and supportive investigative practices. An important implication is that interaction among multidisciplinary professionals promotes communication and efforts, further enhancing discretion about potential legal actions.     

“His body is human,but he has a tiracchāna heart”: An ethnographic study of the epigenesis of child abuse in Cambodia

In Cambodia, more than half of all children experience physical, emotional, or sexual abuse. This article examines how Cambodians view the causes and effects of child abuse and analyses its underlying cultural forces. Adopting a conceptual framework originally developed for the cultural context of violence against women, 110 cases of child abuse were ethnographically studied, comprising 61 cases of sexual abuse (50 girls and 11 boys), 26 cases of physical abuse (13 girls and 13 boys), and 23 cases of emotional abuse or neglect (13 girls and 10 boys). The perpetrators included fathers and other close relatives, lay Buddhist officiants and monks, and neighbors. Most informants viewed the sexual or physical abuse of children as stemming from “cultural attractors,” including blighted endowment caused by deeds in a previous life, a bad character starting early in life, astrological vulnerability to abuse, preordained entanglement between the child and the abuser (they are “fated” to meet), sexual craving, “entering the road to ruin,” and a moral blindness that portrays the abuser as blameless. Although these traits are similar to those identified in the explanations of violence against women, there were notable differences such as the role of the tiracchāna in explaining sexual abuse, including incest. Using these findings, this article identifies a cultural epigenesis of child sexual abuse, and provides a blueprint for developing a culturally responsive plan to prevent child abuse.     

Decisions and attitudes concerning child sexual abuse: does the gender of the perpetrator make a difference to child protection professionals?

Objective: An investigation was conducted into whether child protection investigators, specifically social workers and the police, are as likely to take seriously a case of child sexual abuse if it had been perpetrated by a female rather than a male. Also, to examine whether the decisions relating to female-perpetrated abuse were predicted by participants’ sex role perceptions of women and their attitudes concerning women’s sexualized behavior towards children.Method: Participants advocated decisions in response to four hypothetical case of child sexual abuse in which the perpetrator was either male or female. The female perpetrators were then rated on femininity and masculinity characteristics and attitudes concerning women’s sexualized behavior toward children were assessed.Results: Following male—rather than female—perpetrated sexual abuse, case registration and imprisonment of the perpetrator was considered more appropriate by all participant groups; male social workers also considered social services involvement and investigation as more appropriate. A substantial number of decisions concerning female perpetrated abuse were predicted by participants’ attitudes.Conclusion: While child protection professionals considered child sexual abuse perpetrated by females to be a serious issue warranting intervention, a number of advocated decisions suggested that they did not consider female-perpetrated abuse to be as serious as male-perpetrated abuse. The implication is that victims of sexual abuse perpetrated by a woman may be less likely to receive the protection afforded victims of male-perpetrated abuse. Furthermore, professionals’ practices may be inadvertently perpetuating the view that female child sexual abuse is rare or less harmful than abuse carried out by males.Spanish abstract was not available at time of publication.     

Design,implementation and evaluation of school-based sexual health education in sub-Saharan Africa: a qualitative study of researchers’ perspectives

This study investigated facilitators and challenges to designing, implementing and evaluating school-based sexual health education in sub-Saharan Africa, using interviews with intervention designers and researchers. At the pre-planning and planning stages, participants reported that facilitating factors included addressing the reproductive health needs of participants, contextual (culture, religion, economic and social) considerations and the adoption of holistic approach to sexuality education. Lack of open communication about sexual health matters between young people and adults; concerns that sexual health education could encourage sexual activity; and inadequate funding, were key barriers. Implementation was facilitated by the involvement of relevant stakeholders, the training of facilitators and adopting strategies to overcome resistance to sexual health education. The provision of structured, detailed lessons plans and monitoring with supportive supervision optimised fidelity of delivery. Barriers to implementation included facilitators’ resistance to teaching safe sex promotion and logistical challenges in school environments. Participants also reported that the validity of self-reported adolescent sexual behaviour (as part of evaluation) may be improved by complementing well-designed self-report surveys with computerised audio devices for data collection, qualitative interviews and participant observation. Study findings generate recommendations to improve future forms of school-based sexual health education in sub-Saharan Africa.