School and program related factors influencing disclosure among children participating in a school-based childhood physical and sexual abuse prevention program

BackgroundSchool-based child abuse prevention programs were created to provide knowledge so that children can recognize abuse, teach skills that decrease children’s risk for abuse, normalize the disclosure process, and provide a pathway for children who may be experiencing abuse to report the abuse.ObjectiveThe purpose of this study was to explore school and program factors that trainers in a school-based prevention program believed were associated with disclosure among youth from kindergarten through 12th grade.Participants and settingThis study is based on eighteen trainers and administrators who work with the Play it Safe!® school-based program in Dallas-Fort Worth area.MethodsUsing the qualitative case study method, in-depth interviews were conducted.ResultsData analysis revealed three factors that influenced disclosure: school, school personnel, and program features. The school-related factor was time allotted to the training. The school personnel-related factors were disengagement, ambiguity concerning abuse, prior history with children, and professionals’ personal history of abuse. Finally, the program-related factors were the core messages of the training, providing specific examples, and repetition of the program. To date, there is a dearth of studies that explore the role that schools and school personnel play in the disclosure process.ConclusionChild abuse has devastating effects on children’s physical, social, emotional, and psychological well-being. Understanding more about schools, personnel, and program-related factors that lead to disclosure, which are more amenable to change, is critical to ensuring the safety of children.     

Differential understanding of sexual abuse prevention concepts among preschoolers

Most evaluations of sexual abuse prevention programs employ composite knowledge scores that may mask whether individual skills are differentially understood. The few studies examining separate skills have provided no statistical justification for doing so. This study attempted to validate empirically distinct prevention skills and whether children comprehend these skills in the order taught by prevention programs: RECOGNITION (of good and bad touch), SAY-NO (refuse the perpetrator), GO (leave the situation), TELL-WHO (find an adult), and TELL- WHAT (accurately disclose the abuse). Subjects were 117 preschoolers who were individually administered the “What If Situations Test” (WIST). Analyses confirmed that the WIST was composed of six skills. The hypothesized sequence of skills produced a high coefficient of reproducibility, but an even higher coefficient was obtained when three common sequence reversals were added to the existing logical sequences. We discuss explanations for these cognitive sequence reversals and applications of this information for teaching preschoolers prevention concepts.     

Evaluation of a school-based sexual abuse prevention program: Cognitive and emotional effects

This study evaluated a school-based child sexual abuse prevention program which consisted of separate 2-hour workshops for children, parents, and teachers. Questionnaires concerning the children's knowledge about sexual abuse prevention and level of emotional distress were developed and administered to 88 children, ages 5-12, and 60 parents before and after the program. In addition, 12 teachers completed questionnaires about the children's level of emotional distress within 2 weeks after the program. Comparison of the children's knowledge before and after the program showed significant increases in knowledge about strategies for coping with potential abuse situations. Also individual children's responses were compared with their parents' responses. After the program the parents had a more accurate appraisal of their children's knowledge, and in addition, there was a significant increase in how much parents reported that they had talked with their children about sexual abuse. In terms of possible adverse emotional effects of the program, neither teachers nor parents noticed signs of increased emotional distress. In addition, the children reported that the program made them feel safer and better able to protect themselves. The findings support the value of providing sexual abuse prevention programs to children.     

Neuroticism as a risk factor for child abuse in victims of childhood sexual abuse

Findings on the relationship of experienced sexual abuse and abuse behavior in adulthood are ambiguous. However, associations between experienced abuse and neuroticism as well as between neuroticism and active child abuse have been reported repeatedly. In our study, we compared pedosexual child abusers with consumers of internet child pornography and control subjects with adult-sexual preference with regard to traumatic childhood experience (Childhood Trauma Questionnaire, CTQ), personality traits (NEO – Personality Inventory – Revised, NEO-PI-R), and sexual abnormalities (Multiphasic Sex Inventory, MSI). In an initial analysis, sexual abuse experienced in childhood was not directly linked to sexual abuse behavior in adulthood. However, this relationship was mediated by neuroticism. In a second step, the CTQ scales were conflated and, using a structural equation model, direct links between the overall level of abuse experienced in childhood (generally high CTQ levels) and sexual abuse behavior in adulthood revealed again the mediation by neurotic personality. We conclude that the overall level of abuse experienced in childhood in general, and less sexual abuse experience in particular, modulates the tendency for child sexual abuse behavior in adulthood. Data suggest that, depending on the resilience of an individual, abuse experience during childhood increases the likelihood of developing neurotic personality traits in later life, which are in turn considered to increase the risk of child sexual abuse in child sex offenders.     

Forensic medical results and law enforcement actions following sexual assault: A comparison of child,adolescent and adult cases

BackgroundIn sexual assault cases, little research has examined differences in forensic medical findings and law enforcement response by victim age across the entire age range.ObjectiveThis study addressed this gap by comparing four victim age groups: adults, adolescents over the age of consent, adolescents under the age of consent, and children under 12.Participants and settingCases were randomly sampled from a statewide database of medical reports on sexual assault examinations conducted in hospital emergency departments, including only cases reported to law enforcement (N = 563).MethodsData were combined from a medical report database, from coding of medical documentation and crime laboratory reports, and from case data provided by law enforcement.ResultsRates for both younger and older adolescent victims and adult victims were comparable, with no statistically significant differences on most variables: penetration, perpetrator use of force, non-genital and genital injuries, presence of biological evidence, generating assailant DNA profiles, DNA match to suspect, hits in the FBI’s DNA database, and law enforcement unfounding (i.e., determining allegations to be false or baseless). Child victims were significantly less likely to have a non-genital injury, and their cases were significantly more likely to be founded by law enforcement. Arrests were significantly more likely when victims were under the age of consent.ConclusionsDespite significant differences by victim age, similarity between adolescent and adult cases was substantial. Both younger and older adolescents may be at higher risk of physical violence during sexual assault than previously recognized, and need greater attention in response systems.     

Influence of implementation fidelity on the effectiveness of a T-CBT program targeting emotional problems in childhood

Super Skills for Life (SSL) is a transdiagnostic program targeting children with internalizing problems. This study aimed to evaluate: 1) The Spanish SSL program's fidelity level; 2) the relationship between the implementation fidelity dimensions; 3) outcomes at posttest and 12-month follow-up depending on implementation fidelity; 4) mediation effects of self-concept dimensions to reduce internalizing and externalizing problems at follow-up. Participants were 119 schoolchildren aged 8–12. Two groups were established: high (HFG) and low fidelity (LFG). At posttest, HFG presented lower depression, anxiety, total difficulties, and externalizing symptoms, and higher academic and family self-concept than LFG. At follow-up, LFG presented higher depression, total difficulties, and internalizing symptoms, and lower academic, social, and family self-concept. All posttest self-concept dimensions had a significant impact at follow-up on internalizing symptoms. Academic, social and physical self-concept dimensions impacted externalizing symptoms. Thus, although SSL program is effective for treating emotional symptoms even with low implementation fidelity, it is more effective with high implementation loyalty.     

Examining the utility of a train-the-trainer model for dissemination of sexual violence prevention in schools

Rates of childhood sexual abuse are unacceptably high, with potentially long-lasting consequences for those who have been victimized. Currently, there are a number of sexual violence prevention programs that have been developed to lower rates of victimization, increase awareness, and connect victims with resources. Within this area of research, there has been less focus on effective methods of program dissemination. For example, school-based sexual violence prevention programs have had positive outcomes; however, little is known about how these programs are disseminated. The train-the-trainer model of dissemination utilizes master trainers to equip others to implement programs, thereby allowing more adults to teach and subsequently more children to receive the program. This study used survey data from teachers and other school personnel (n = 127) to analyze the utility of a train-the-trainer model of dissemination for a sexual violence prevention program in the state of Hawai’i. Through responses of people who were trained to implement the program (59.8% of whom did implement), aspects of the training, the program itself, and factors affecting whether a person implemented the program were explored. Results suggest that time spent in training, job position, and time in that position predicted whether a person trained to implement the sexual violence prevention program followed through with teaching the program to students. Additionally, 54.7% of people who did implement the program had at least one student disclose sexual violence to them, indicating the importance of sexual violence prevention programming and dissemination of these programs.     

Impact of a universal school-based violence prevention program on violent delinquency: distinctive benefits for youth with maltreatment histories

Objective

Child maltreatment constitutes a strong risk factor for violent delinquency in adolescence, with cumulative experiences of maltreatment creating increasingly greater risk. Our previous work demonstrated that a universal school-based violence prevention program could provide a protective impact for youth at risk for violent delinquency due to child maltreatment history. In this study we conducted a follow-up to determine if participation in a school-based violence prevention program in grade 9 continued to provide a buffering effect on engaging in acts of violent delinquency for maltreated youth, 2 years post-intervention.

Methods

Secondary analyses were conducted using data from a cluster randomized controlled trial of a comprehensive school-based violence prevention program. Students (N = 1,722; 52.8% female) from 20 schools participated in 21 75-min lessons in grade 9 health classes. Individual data (i.e., gender, child maltreatment experiences, and violent delinquency in grade 9) and school-level data (i.e., student perception of safety averaged across students in each school) were entered in a multilevel model to predict violent delinquency at the end of grade 11.

Results

Individual- and school-level factors predicting violent delinquency in grade 11 replicated previous findings from grade 9: being male, experiencing child maltreatment, being violent in grade 9, and attending a school with a lower perceived sense of safety among the entire student body increased violent delinquency. The cross-level interaction of individual maltreatment history and school-level intervention was also replicated: in non-intervention schools, youth with more maltreatment in their background were increasingly likely to engage in violent delinquency. The strength of this relationship was significantly attenuated in intervention schools.

Conclusions

Follow-up findings are consistent with the buffering effect of the prevention program previously found post-intervention for the subsample of youth with maltreatment histories.

Practice implications

A relative inexpensive school-based violence prevention program that has been shown to reduce dating violence among the whole student body also creates a protective effect for maltreated youth with respect to lowering their likelihood of engaging in violent delinquency.     

Using state data sets and meta-analysis of low-powered studies to evaluate a school-based dropout prevention program for students with disabilities

This study explores the use of state data sets and meta-analysis of low-powered studies to evaluate a school-based dropout prevention program for students with disabilities. The program was implemented in several states. A randomized controlled trial was infeasible because schools were not chosen at random; furthermore, pretest data were minimal. The use of extant state data allowed these obstacles to be overcome by providing valid pre- and post-intervention outcomes as well as a large selection of schools and variables to create reasonable matches for the treatment schools. Results from four states were synthesized meta-analytically to evaluate whether the program had a significant impact on any of seven proximal and distal outcome variables. No such impacts were demonstrated. More importantly, this paper demonstrates and explains the methodological steps and choices involved in a quasi-experimental evaluation approach that may be applied to cases for which large amounts of extant data are available.     

Families at risk of poor parenting: A descriptive study of sixty at risk families in a model prevention program

Sixty families assessed to be at risk of poor parenting were the subject of this study. These families were participants in a model multidisciplinary program designed for the secondary prevention of poor parenting and the extremes of child abuse and neglect. The model program consists of special medical, psychological, social and developmental services to families on an inpatient, outpatient, and in-home basis. Demographic information on these 60 families was tabulated. Each family was given a monthly rating on a simple measure of family function. Ratings over lime were observed, and families were characterized in terms of a family rating vector (up. up-plateau, plateau, fluctuating, and down). Families were also described in terms of the constellation of problems brought to the therapy situation. Problem lists for each family were subjected to factor analysis. Five factor constructs which made clinical sense emerged from the analysis. Each factor could be labeled as a “family type.” These types were: (I) Abusive Family. (II) Neglectful or Antisocial Family. (III) Family with an Emotionally Unstable Parent, (IV) Family with Cultural or intellectual Limitation, and (V) Family with Child-Rearing Difficulties. Approximately 20% of these families did not fit the typology. Families were then divided into two groups—those who were relatively long-term, ongoing recipients of services, and those who left the program in the observation interval. Families were categorized according to family function rating vector and “family type.” It was noted among long-term families, measured improvement in family function was most evident in families with transient situational crisis (who did not fit the typology) and those with intellectual and cultural deficits (Type IV). Among the families who dropped from the program. 15% were no longer at risk. Sixty-three percent of the remaining families were not improving. These techniques may be useful in determining which at risk families are more successful candidates for prevention efforts.     

Cumulative childhood maltreatment and its dose-response relation with adult symptomatology: Findings in a sample of adult survivors of sexual abuse

In the present study, we examined the role of cumulative childhood maltreatment experiences for several health related outcomes in adulthood, including symptoms of psychological distress as well as perceived social support and hardiness. The sample comprised adult survivors of sexual abuse (N = 278, 95.3% women, mean age at first abusive incident = 6.4 years). One-way ANOVAs revealed a statistically significant dose-response relation between cumulative childhood maltreatment scores and self-reported symptoms of posttraumatic stress (PTSS), anxiety, depression, eating disorders, dissociation, insomnia, nightmare related distress, physical pain, emotional pain, relational problems, self-harm behaviors as well as on a measure of symptom complexity. Cumulative childhood maltreatment was also associated with lower levels of work functioning. An inverse dose-response relation was found for perceived social support and hardiness. Using a Bonferroni corrected alpha level, cumulative childhood maltreatment remained significantly associated with all outcome measures with the exception of eating disorder symptoms after controlling for abuse-related independent variables in hierarchical regression analyses. Results add to previous literature by showing that dose-response relation between cumulative childhood adversities and adult symptom outcomes could also be identified in a sample characterized by high exposure to adversities, and lends support to the notion put forth by previous authors that cumulative childhood adversities seem to be related to the severity of adult health outcomes in a rule-governed way.     

Listening to victims: Use of a Critical Incident Reporting System to enable adult victims of childhood sexual abuse to participate in a political reappraisal process in Germany

Recent revelations about the scope and severity of past child sexual abuse in German institutions set off a broad public debate on this issue, and led to the establishment of a politically appointed Round Table committee and an Independent Commissioner whose mandates were to reappraise the issue and develop recommendations for future policies. A media campaign was launched to publicize the establishment of a Critical Incident Reporting System (CIRS) whereby now-adult victims of past abuse could anonymously provide testimonials and let policy makers know what issues were important to them. Respondents could either call a hotline number or communicate by mail or email. The information collected was documented and analyzed by a research team, and the results of interim reports were included in the recommendations of the Independent Commissioner and the Round Table committee. Most of the respondents described severe and repeated occurrences of childhood sexual abuse. For many, priorities were improvements in therapy and counseling services, the abolishment of the statute of limitations on prosecuting offenders, and financial compensation. Based on the recommendations of the Round Table and the Independent Commissioner, two new laws were adopted as well as an action plan and some guidelines. In addition to rules for recompensation of victims in an institutional context a fund for victims of sexual abuse in intrafamilial context was established by the Federal Government. Another effect of this process was raising societal sensitivity to the problem of child sexual abuse. The use of a CIRS enabled those directly affected by childhood sexual abuse to have some input into a political process designed to address this issue. Such an approach could have applicability in other countries or in other domains of public health and other forms of societal conflict as well.     

The development and evaluation of a training program for school-based professionals dealing with child abuse: The University of Toronto interfaculty child abuse prevention project 1978–1979

This paper reports on a child protection training program for teachers, social workers, and nurses. The training format consisted of two 5-day workshops, one for preprofessional students and the other for practicing professionals, and two one-day workshops for students. The evaluation employed a pre-test/post-test design. Data were obtained from a total of 254 workshop participants who were randomly selected from a group of 400 volunteers. The training program was designed to provide information and experience in the areas of identification, family dynamics, legislation, intervention, and team responses. Curriculum effects were the dependent variables; group characteristics were the independent variables. The general finding was that the program was an effective means of accomplishing its objectives. Some of the specific findings were that professionals wanted more content in contrast to students who were satisfied with experiences which simulated practice. Both social work professionals and students were more confident in their ability to deal with the problem of child abuse before and after the program than teachers and nurses. In contrast, teachers began and ended the program with relatively low confidence and information levels. Overall, nurses had the highest level of entry and exit knowledge at the beginning and the end of the program. While the results indicate that the three groups profited from shared training experiences they also suggest that certain areas of training may best be realized by specialized workshops.