Child Sexual Abuse Prevention Bulletin Effective prevention requires understanding the complex interplay of factors that influence child sexual abuse. Several models of prevention can be useful to inform the development of child sexual abuse prevention programs. (Nation et al., 2003). Two major models of prevention are commonly used in strategic planning around prevention: the Public Health Model and the Ecological Model. These models define when prevention happens and to whom prevention efforts are directed, respectively (Townsend, 2008). This document examines the two models. The Public Health Model of Prevention The field of public health has been integral in changing the focus of anti-sexual violence prevention work from treating a person after they have been victimized to preventing violence from happening at all (McMahon & Puettl, 1999). Caplan (1964) proposed the model which is now widely used in developing prevention programs, which classifies prevention efforts as primary, secondary, or tertiary. This model of prevention specifies when prevention happens (Townsend, 2008). The Types of Prevention in the Public Health Model Primary prevention of child sexual abuse involves stopping sexual abuse before it starts (Becker & Reilly, 1999; Townsend, 2008). In universal primary prevention, efforts target a large group; while selective primary prevention efforts are directed towards those who are at risk for victimization or perpetra- tion (McMahon & Puettl, 1999).1 The primary prevention of child sexual abuse involves components such as: - Teaching people about healthy relationships , how to identify a situation that could become abusive, and protective policies and actions organizations that work with children can implement. - Teaching people what to do to if they suspect that someone is at risk of abusing or being abused. - Working to change social structures or norms that support the occurrence of child sexual abuse. Secondary prevention of child sexual abuse aims to reduce the potential short-term harm that can result from child sexual abuse, usually by improving how people and social services respond to survivors of abuse. This also includes ensuring that survivors have access to services such as advocacy, health care, and/or legal support. Secondary prevention efforts commonly involve educating the public and increasing awareness about the issue. The secondary prevention of child sexual abuse includes: - Teaching possible responders (e.g., doctors, advocates, parents, teachers) how to screen for child sexual abuse and what to do if they suspect that abuse has happened or if a child discloses. - Increasing awareness about social services available to survivors of abuse. - Reducing the stigma associated with talking about child sexual abuse. Tertiary prevention of child sexual abuse involves preventing further harm to a person already involved in an incident of sexual abuse. The two most common types of tertiary prevention in child sexual abuse are: - Working with perpetrators to prevent them from reoffending (Becker & Reilly, 1999). - Working with survivors to prevent longterm problems. The Social-Ecological Model of Prevention The social-ecological model of violence prevention examines the multiple systems that surround an act of violence. It emphasizes the idea that child sexual abuse prevention and other types of violence prevention require changing norms, climate, and culture. Therefore, it addresses how we can promote both community change and individual behavior change. There are many factors that increase or decrease the risk of individual violence. These factors occur at the level of the individual, relation- ships, community, and society (Townsend, 2008). Kelly’s Ecological Model The first model, developed by Kelly (1966, 1968, 1971), proposes that people and organizations in the community depend on and influence one another. As applied to child sexual abuse prevention, Kelly’s model is most useful in understanding how to prevent the harm caused by victimization. There are three main settings that influence the degree of harm resulting from child sexual abuse, according to Kelly’s model (Kelly, Ryan, Altman, & Stelzner, 2000): - Person constructs: Characteristics of individuals (e.g., age, gender) - Events: An occurrence that provokes an individual and community response - Environments: Characteristics of a community (e.g., social norms, community services) Bronfenbrenner’s Ecological Model The ecological model proposed by Bronfenbrenner (1979, 1986, 1995) is similar to Kelly’s model, but this model takes a closer look at the systems that influence human development, rather than a particular event or problem. This model is often used to inform the primary prevention of violence, as well as the prevention of the harm caused by violence. The systems proposed by Bronfenbrenner are as follows: - The microsystem includes interactions between people and their immediate environments. Aspects of the microsystem that could support the occurrence of child sexual abuse include family stress, secrecy, or a lack of social support. Alternatively, family, friends, and peers who demonstrate respectful and healthy communications as the norm can serve as an example of the microsystem contributing to the prevention of child sexual abuse. The interactions between a perpetrator and victim could be classified as part of the microsystem. - The mesosystem contains the links between a person’s immediate environments, including the way these environments work together to support a child. When a child’s school does not discuss problems the child is having with that child’s parents, this could be a way that the mesosystem influences child sexual abuse. Alternatively, if the school identifies and responds to risk factors and struggles in a child’s life, this is a way the mesosystem could contribute to the prevention of child sexual abuse. - The exosystem is the social context that an individual exists in, including the community and neighborhood, as well as the organizations and social services available to the individual. Whether or not the individual directly interacts with these organizations, they still have an effect on that individual. For example, if there are no rape crisis centers in a given community, a family may be less willing or able to seek help if their child is being abused. Alternatively, if a rape crisis center provides community-based presentations on bystander intervention, this is one way the exosystem can influence the prevention of child sexual abuse perpetration. - The macrosystem includes social norms, values, and conditions of the greater environment. If a society is oppressive, contains economic inequity, or values secrecy, child sexual abuse may be encouraged. For many people and communities, these factors tend to take away power and connectedness, which can help to protect a person from sexual abuse. Alternatively, when the macrosystem is based on equality, respect, and a reverence for all members of society, this is one way it can serve to prevent the exploitation and abuse of children. - The chronosystem addresses the element of time as it relates to an individual. For example, the timing of life changes and a child’s development both impact that child. The individual is the person who is shaped by Bronfenbrenner’s systems. Characteristics of the individual, such as genetics, race, gender, and mental health, also shape an individual and that individual’s interactions. The systems that change this individual are constantly interacting and changing. Using the Ecological Model to Prevent Child Sexual Abuse As a result of the multiple factors that influence child sexual abuse, there are many components to a successful prevention effort. Prevention educators and advocates can draw from these models of prevention when planning, drafting, implementing, and evaluating their child sexual abuse prevention programs. According to the ecological model of prevention, the burden of prevention should be distributed across community members, organizations, and social structures. For example: - Individuals can pass on information they learn about child sexual abuse to each other and challenge each others’ problematic viewpoints. They can report suspected child sexual abuse to authorities. - Individuals having sexual thoughts about children should seek treatment to prevent engaging in abusive behaviors - Perpetrators of child sexual abuse can enter treatment to end their abusive behaviors. - Advocates can work to educate society about child sexual abuse and ways that community members can become actively engaged in its prevention. They can work with at risk children to lower their risk of being abused and assist parents and caregivers in accessing resources that can help reduce stress and risks - Parents can work to establish healthy boundaries and monitor their child’s interactions with others, emphasizing respectful interactions and ways that their child can stand up against violence they see or experience. Parents can learn to identify and address warning signs in children who display risks for perpetration. - Families can create open and loving lines of communication that will allow their children to disclose abuse. - Community members can work to learn and identify early warning signs of child sexual abuse perpetration so that they can connect potential perpetrators (both children and adults) to appropriate services and interventions. - Researchers can conduct studies to learn more about abuse and evaluate prevention programs. - The health care system can teach professionals how to support new parents in caring for children, accessing resources and identifying children who have been abused and give them the skills they need to handle a disclosure or evidence of abuse. - The criminal justice system can demonstrate to potential offenders and the community at large that child sexual abuse is a serious crime that will be punished accordingly. - Local, state, and federal governments can fund programs and research and support laws that help to prevent child sexual abuse. 1 There is some discrepancy in the literature about whether efforts that target high-risk groups constitute selected primary prevention or secondary prevention. This may be due to the origins of the public health prevention model in disease rather than violent behavior, as well as differing conceptualizations of what is ultimately being prevented (i.e., the violent behavior itself or the harm caused by violent behavior). This bulletin was compiled by Emily Dworkin, with contributions from Hallie Martyniuk, and is part of a Child Sexual Abuse Prevention Information Packet. Visit the National Sexual Violence Resource Center at http://www.nsvrc.org. References Becker, J. V., & Reilly, D. W. (1999). Preventing sexual abuse and assault. Sexual Abuse: A Journal of Research and Treatment, 11, 267-278. doi:10.1177/107906329901100403 Bronfenbrenner, U. (1979). The Ecology of Human Development: Experiments by Nature and Design. Cambridge, MA: Harvard University Press. Bronfenbrenner, U. (1986). Ecology of the family as a context for human development: Research perspectives. 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Understanding and changing social systems: An ecological view. In J. Rappaport & E. Seidman (Eds.), Handbook of Community Psychology (pp. 133-160). New York: Plenum Press. McMahon, P. M., & Puettl, R. C. (1999). Child sexual abuse as a public health issue: Recommendations of an expert panel. Sexual Abuse: A Journal of Research and Treatment, 11, 257-266. doi:10.1177/107906329901100402 Nation, M., Crusto, C., Wandersman, A., Kumpfer, K. L., Seybolt, D., Morrissey- Kane, E., & Davino, K. (2003). What works in prevention: Principles of effective prevention programs. American Psychologist, 58, 449-456. doi:10.1037/0003-066X.58.6-7.449 Townsend, S. M. (2008). Primary prevention of sexual violence: A technical assistance guide for planning and evaluation. Enola, PA: Pennsylvania Coalition Against Rape. This project was supported by Cooperative Agreement #5VF1CE001751-02 from the Centers for Disease Control and Prevention. © National Sexual Violence Resource Center 2011. All rights reserved.