Key Findings Child Sexual Abuse: The Need for a Perpetration Prevention Focus © 2022 National Sexual Violence Resource Center. All rights reserved. This publication was supported by the Grant or Cooperative Agreement Number 6 NUF2CE002510-02-04, funded by the Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention or the Department of Health and Human Services. Research continues to advance and inform best practices for preventing sexual assault, abuse, and harassment. There is no form of sexual violence that draws more public attention than child sexual abuse (CSA). Media accounts of alarming stories have played a role in expanding intervention efforts for survivors and public outrage often drives criminal justice responses. Child Sexual Abuse: The Need for a Perpetration Prevention (Assini-Meytin et al., 2020) suggests using the public health framework to develop and guide primary prevention efforts designed to prevent the perpetration of CSA. This review calls for a broader effort to protect children by preventing harm before it happens through highlighting several programs that include a focus on preventing the onset of abusive behaviors as a necessary component to an overall prevention plan. Intervention efforts centered around children are typically victimization prevention programs focused on educating children to protect themselves from victimization by teaching them to recognize, resist and report abusive behavior. These programs are not sufficient prevention efforts according to the study. Education and awareness programs designed for children frequently focus on children themselves, teaching personal safely skills, alerting them to possible dangerous situations and the importance of telling someone. Most advocates are likely familiar with such programs as “No, Go, Tell” and “Good Touch, Bad Touch.” While there are positive outcomes to educating children and encouraging disclosure, there is limited evidence that such programs are effective in reducing rates of child sexual abuse (Assini-Meytin et al., 2020, p. 23). This approach has drawn criticism from advocates and researchers alike who argue that in addition to their lack of demonstrated effectiveness in preventing child sexual abuse (Finkelhor, 2009; Wurtele 2009; Zwi, 2007), these efforts alone appear to make children responsible for preventing their own victimization. Secondly, the authors argue that even the most effective criminal justice interventions would prevent only a small percentage of sexual offenses, since 95% of such crimes are committed by individuals with no prior sex crime convictions (Sandler et al., 2008). The researchers suggest that prevention efforts should take on a much broader focus including: identifying multiple types of people who offend, including those who have not come to the attention of law enforcement identifying differences that existbetween those known and unknown to law enforcement understanding risk and protective factors for CSA perpetration understanding the context of how and where they might offend (e.g., within organizations that serve youth) With this information, effective prevention programs to prevent perpetration can be developed and implemented. The study highlights three types of prevention programs currently being used to target potential perpetrators and offending behaviors. 1. Interventions that target individuals with sexual interest in children Prevention Project Dunkelfeld – Project Dunkelfeld began in 2004 in Germany to offer help to adults with an attraction to children, whether they have never acted on their attraction or have acted on their attraction but never been caught by authorities. (Unlike the United States, Germany does not have mandatory reporting laws that require professionals to report offenders to authorities). They enlisted participants through multiple media venues to advertise the availability of help using messaging that were non-punitive and included information about confidentiality and anonymity. The program includes weekly group and individual in-person therapy sessions designed to enhance behavioral control and reduce dynamic risk factors (Beier et al., 2014). A 2009 study found that about 75% of those enrolled in the program reported committing CSA at some point in their lifetime, and 41% of these reported that their crimes were not known to law enforcement (Beier et al., 2009). Several program evaluations suggest improvements on/reduction in some of the risk factors for CSA offending. However, the authors note “its effectiveness in helping individuals who have never offended to remain offense free is yet to be determined” (Assini-Meytin et al., 2020, p. 26) and cite the need for additional research to help determine what factors keep this group offense free. The authors note that U.S. mandatory reporting laws likely discourage in-person treatment for offenders both unknown to authorities as well as those who may acknowledge a sexual interest in children but have not committed an offense. To address this barrier, an online-based prevention effort was developed to offer anonymous treatment to adolescents. Help Wanted Prevention Intervention (Help Wanted) This online intervention is targeted to adolescents and young adults with sexual interest in prepubescent children and is currently being tested in the U.S. Help Wanted curricula includes/addresses: (1) defining CSA, (2) disclosing one’s sexual attraction to children, (3) coping with sexual attraction to children, (4) building a positive self-image, and (5) building a healthy sexuality while abstaining from harming children. An evaluation is underway to test the effectiveness of the curriculum in helping adolescents and young adults navigate their sexual attraction to children and remain offense-free (Assini-Meytin et al., 2020, p. 27). 2. Interventions that prevent the onset of perpetration among adolescents.Research shows according to crime reports a significant number of instances of child sexual abuse — one-third to one-half — are committed by adolescents and those under the age of 18 (Finkelhor et al., 2009, Finkelhor et al., 2014). Self-report victimization surveys indicate it could be over 75% of child sexual abuse being committed by those under 18 (Gerwitz-Meydan & Finkelhor, 2020). According to research only 19% of child sexual abuse cases that are committed by those under 18 resulted in police reports (Gerwitz-Meydan & Finkelhor, 2020), which may explain the large discrepancy between crime reports and self-reported victimization. Further, the peak age for sexual offending against children is 14 (Letourneau et al, 2017; Snyder, 2000). While adolescent offenders in the criminal justice system may have access to programs that focus on lowering recidivism, the authors suggest there is a need for prevention programs that focus on preventing the onset of harmful sexual behavior in adolescents who have not offended. Responsible Behavior with Younger Children (RBYC) is a school-based universal prevention curriculum for 6th and 7th grade youth (both boys and girls between the ages of 11-13) and their parents. Ten sessions focus on risk and protective factors such as low empathy and inappropriate perceptions of sexual behaviors and others. The curriculum also includes a psycho-education component that addresses developmental differences between older and younger children; an understanding of what CSA is, why it occurs; avoidance/prevention/ intervention strategies; and peer sexual harassment. The curriculum can be incorporated into already existing school prevention programs or be offered as a standalone program. Parents are given information to promote parental awareness of situational factors that increase the risk for CSA such as low parental supervision, encouraging parent-child communications about CSA, and establishing clear rules against sexual activity with younger children. Preliminary non-published findings are promising (Letourneau et al., 2017) and large-scale replication is needed to validate program effectiveness (Assini-Meytin et al., 2020, p. 28). If shown effective, the authors suggest a future possibility of combining elements of RBYC programs with school-based programs on healthy sexuality education. Both program types share common features that include social norms programming against sexual violence and strategies to support healthy decision-making. A program combining these elements could form a more comprehensive educational curriculum preventing sexual violence against both peers and younger children (Assini-Meytin et al., 2020, p. 28–29). 3. Interventions aimed at preventing and addressing sexual abuse within youth-serving organizations. Many organizations that serve large numbers of children and youth (e.g. educational, recreational and religious institutions) have developed a wide array of strategies over the past decade designed to reduce the likelihood of child sexual abuse. These strategies include staff training, stricter screening and hiring procedures, mandatory reporting of CSA, guidelines for adult-child interactions, and other protocols and safety mechanisms rooted in the “situational crime prevention framework” (Assini-Meytin et al., 2020, p. 30). The study notes that no evaluations have been completed on the effectiveness of these measures in preventing CSA within the organizations. Challenges The study identifies several critical challenges associated with taking a perpetration prevention approach, including: The need to better understand both adult and adolescent sexual interest and behaviors with children: The authors emphasize that relying on surveillance data from child protective services and law enforcement alone could be mischaracterizing and/or omitting data from a broader universe of sexual offenses. Interfamilial perpetration or incest: Noting research that indicates a sizable number of CSA offenses are perpetrated by family members (Assini-Meytin et al., 2020, p. 34), there is a need to understand effective strategies when the perpetrator is a family member. The projects referenced above (Help Wanted and RYBC) may help but are not targeted specifically to prevent incest (Assini-Meytin et al., 2020, p. 34). The authors suggest public attitudes reflect perceptions of CSA not borne out by evidence. These can include beliefs that people who commit CSA are monsters, that people who commit offenses are destined to re-offend, and that perpetration prevention may not be worthwhile (Assini-Meytin et al., 2020, p. 34). Using the Public Health Framework The study endorses using the public health framework (Dills et al., 2019) as a way to address many of the current gaps and inconsistencies in research on people who perpetrate sexual violence. The framework can systematically guide the development of prevention programs that will be effective at preventing perpetration. Defining the Problem: This first step of the public health framework to developing effective prevention programs involves identifying the: who, what, where, when, and why. Information on CSA victimization is largely based on three data sources: offenses reported to child service agencies, offenses reported to the police, and victim surveys (Assini-Meytin et al., 2020, p. 31). Additionally, reports known to authorities (child protective services and offenses reported to police) reflect only a small fraction of all CSA cases (Assini-Meytin et al., 2020, p. 31). As noted above, this has led to a research base that is inadequate and does not reflect the true realities of offenders, particularly those who have not yet offended and those who have, but remain outside the criminal justice system. Identify Risk and Protective Factors: Building on the surveillance step above, there may be different sets of risk and protective factors relevant to particular groups of people who commit sexual offenses that become critical to developing effective interventions. For example, the authors cite preliminary research that suggests those who have not acted on their attraction to children are significantly younger, less antisocial, and have more attraction to boys compared with those that have acted on their sexual attraction to children (Cohen et al., 2018). There is not enough information on adults and adolescents who acknowledge sexual interest in children to allow the development of a rigorous intervention — particularly the study notes, for those who have never offended or are not known to authorities.To learn more about risk and protective factors see the National Sexual Violence Resource Center’s (NSVRC) Risk and Protective Factors Infographic (2019). https://www.nsvrc.org/risk-and-protective-factors Program Development and Evaluation: This step is informed by the previous two components. The authors suggest prevention programs aimed at stopping perpetration are only just beginning to emerge. Assure widespread adoption: Widespread adoption of evidence-based programs includes training, networking, technical assistance, and ongoing evaluation. This can only occur after a program has been shown to be feasible and effective through research and evaluation. For more information on the public health framework see Dill et al., 2019, Continuing the Dialogue: Learning from the Past and Looking to the Future of Intimate Partner Violence and Sexual Violence Prevention. https://nsvrc.co/ContinuingTheDialogue Going Forward This review highlights the limited, but important, prevention efforts currently underway to prevent perpetration of CSA. This is a primary prevention strategy that requires a more systematic focus and robust effort toward understanding the context of who offends and why. Advocates know there is no single profile of a person who commits sexual violence, whether toward adults or children, and research is critical to prevention efforts. Prevention Messaging Advocates can continue to reiterate a core prevention message that sexual harassment, abuse, and assault is preventable. The continued elevation of messaging that child sexual abuse can be prevented and that child sexual abuse can be complex is vital. Past media messaging has served to outrage the public and perpetuate information that is often not true (e.g., be careful of strangers). As noted by the authors and others, this drives reactive responses and makes it impossible to prevent harm before it occurs. Additional Resources Reframing Childhood Adversity: Promoting Upstream Approaches (2021): This brief by FrameWorks Institute works through framing challenges of childhood adversity, offers guidance on how to communicate about child wellbeing and adversity. https://nsvrc.co/ReframingChildhoodAdversity Why Aren’t Kids a Policy Priority? The Cultural Mindsets and Attitudes that Keep Kids off the Public Agenda (2021): This report by FrameWorks Institute focuses on American mindsets about kids and how these mindsets limit the effectiveness of advocacy messaging. https://nsvrc.co/WhyArentKids Moving Toward Prevention: A Guide for Reframing Sexual Violence (2018): This guide by NSVRC and Berkeley Media Studies Group provides recommendations on how to frame sexual violence, develop effective prevention messages, and working with the media to inform and educate the public.https://nsvrc.co/3MovingTowardPrevention Getting Attention for Prevention: Guidelines for Effective Communication about Preventing Sexual Violence (2018): This brief by NSVRC and Berkley Media Studies Group covers how to communicate clearly about sexual violence and how to frame prevention. http://nsvrc.co/GettingAttention Adolescent Prevention Programs Programs aimed at stopping first-time perpetration with adolescents, who are responsible for a sizable number of CSA offenses, are critically important. In addition to the programs discussed above, advocates can also emphasize the importance of implementing comprehensive sexuality programs. While these programs have more than one focus or goal, preventing first-time perpetration through a variety of program objectives and elements is one. Additional Resources Key Findings: Comprehensive Sexuality Education as a Primary Prevention Strategy for Sexual Violence Perpetration (2021): This research translation explains the link between school-based sex education programs and sexual violence prevention, and how sex education can become an important strategy in preventing harm. https://nsvrc.co/KeyFindingsComprehesiveSexEd Adult Prevention Programs Adults are responsible for protecting children. Advocates can encourage schools and their community to consider many of the older school-based programs mentioned above as only one piece of larger prevention efforts. Teaching children the proper names of body parts and encouraging disclosure in situations where they don’t feel safe enhances a child’s ability to respond to victimization. School-based programs however cannot impact events and interactions that happen outside of school where children are least able to control their environments. Prevention programs that focus on the adults and adolescents around them are a necessary step. Additional Resources Stop It Now! Provides an online and anonymous helpline available to those concerned with child victimization as well as adults who feel at-risk to harm a child or may be concerned by their own thoughts and feelings. www.stopitnow.org Safe Secure Kids from the Pennsylvania Coalition Against Rape provides free resources to help caregivers prevent sexual abuse and harassment by communicating with children about respect and consent. This information is for parents, caregivers, and teachers of elementary-aged children. https://www.safesecurekids.org/ Addressing Sexual Abuse within the Family Addressing sexual abuse within the family requires stronger family and community supports, including parent and family support programs. A report from Harvard University Center on the Developing Child — suggests that children develop in “an environment of relationships” with parents and adults in and outside of the home. The capacity of those adults can vary. Strengthening the capacities of caregivers and the support for communities where they live is critical. The report suggests several policy areas that call for reexamination (Center on the Developing Child, 2010): Parenting education and home visiting programs Parental leave policies Income supports and “make work pay” programs Expanded professional development for early care and education providers It should be noted that none of these directly address abuse within the family. What they can do however is build protective factors that help prevent violence as well as more quickly expose problematic family situations and/or disclosures making the need for assistance more visible. Additional Resources Askable Adult prevention project from the Vermont Network Against Domestic and Sexual Violence is designed to increase supportive adults who can act as resources for children and teens by creating effective affirming relationships. https://www.vtnetwork.org/askableadult/ What is an Askable Adult?: The National Sexual Violence Resource Center’s podcast episode with the Askable Adult program creators (NSVRC, 2021). https://nsvrc.co/AskableAdultPodcast Evaluation Expand evaluation efforts for programs designed to prevent first-time perpetration. The field of sexual violence prevention has been looking at preventing first-time perpetration for quite some time. We are still lacking a solid evidence base to work from. It might be worthwhile to consider additional evaluation processes. The Evidence Project (CDC, 2013), provides information on other forms of accepted evidence in addition to the more rigorous research-based approach. One of those — experiential evidence — “is the collective experience and expertise of those who have practiced or lived in a particular setting” (CDC, 2013, p. 1). Experiential evidence includes the “insights, understandings, skills, and expertise accumulated over time and are often referred to as intuitive or tacit knowledge” (CDC, 2013, p. 1). Additional Resources Report Describing Projects Designed to Prevent First-Time Male Perpetration of Sexual Violence (Updated) (2008) — this summary report identified and compiled multiple programs designed to prevent first-time perpetration. https://nsvrc.co/FirstTimeMalePerpetration 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, 29(1), 22–40. https://doi.org/10.1080/10538712.2019.1703232 Beier, K. M., Grundmann, D., Kuhle, L. F., Scherner, G., Konrad, A., & Amelung, T. (2015). 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