Parent-Focused Sexual Abuse Prevention: Results From a Cluster Randomized Trial

Child Behavior Problems and Maltreatment Exposure

OBJECTIVES

Establish the longitudinal cross-lagged associations between maltreatment exposure and child behavior problems to promote screening and the type and timing of interventions needed.

METHODS

The Longitudinal Studies of Child Abuse and Neglect, a multiwave prospective cohort study of maltreatment exposure, enrolled children and caregivers (N = 1354) at approximately age 4 and followed them throughout childhood and adolescence. Families completed 7 waves of data collection with each wave occurring 2 years apart. Maltreatment was confirmed using official case records obtained from Child Protective Services. Six-month frequencies of behavior problems were assessed via caregiver-report. Two random-intercept, cross-lagged panel models tested the directional relations between maltreatment exposure and externalizing and internalizing behaviors.

RESULTS

Maltreatment exposure predicted increases in externalizing behaviors at ages 8 (b = 1.06; 95% confidence interval [CI] 0.14-1.98), 12 (b = 1.09; 95% CI 0.08-2.09), and 16 (b = 1.67; 95% CI 0.30-3.05) as well as internalizing behaviors at ages 6 (b = 0.66; 95% CI 0.03-1.29), 12 (b = 1.25; 95% CI 0.33-2.17), and 14 (b = 1.92; 95% CI 0.76-2.91). Increases in externalizing behaviors predicted maltreatment exposure at age 12 (odds ratio 1.02; 95% CI 1.00-1.05).

CONCLUSIONS

Maltreatment exposure is robustly associated with subsequent child behavior problems, strengthening inferences about the directionality of these relations. Early screening of externalizing behaviors in pediatric settings can identify children likely to benefit from intervention to reduce such behaviors as well as prevent maltreatment exposure at entry to adolescence.

Adapting a selective parent-focused child sexual abuse prevention curriculum for a universal audience: A pilot study

Parents are an obvious, but underutilized player in the prevention of child sexual abuse (CSA). A handful of universal parent-focused prevention programs have emerged, however, the evidence for these programs is mixed and the programs suffer ubiquitously from barriers to implementation (e.g., poor engagement, low participation) thereby limiting public health impact. To combat these barriers and improve evidence, researchers previously developed and tested a selective parent-focused CSA prevention program. While promising, the selective approach still leaves a gap in the prevention landscape-parents from the universal audience. However, there appear to be no standardized methods to inform this type of adaptation-interventions designed as universal or selective have primarily been delivered as such. This study sought to adapt the selective curriculum for a universal audience and examined the acceptability and feasibility of the program for evaluation in a future trial. Using mixed methods, N = 31 parents (i.e., primary caregiver for a child under 13) completed pre- and post-workshop surveys followed by a brief individual interview conducted via Zoom. Interviews, coded using content analysis methods, focused on three themes: parents as agents of prevention (e.g., prior action, confidence), curriculum (e.g., content, design), and engagement (e.g., future marketing and promotion). Overall participants' mean score on CSA-related awareness and intention to use protective behavioral strategies increased. The participants found the curriculum highly acceptable noting strengths in the content and design. All told, the results of this pilot study suggest the acceptability and feasibility of examining the efficacy of the universal parent-focused curriculum in a larger trial. Procedural challenges, such as bots in recruitment, identify areas of caution in design of the larger trial and a roadmap for others seeking to adapt selective programs for universal audiences.

Engaging Parents in Child-Focused Child Sexual Abuse Prevention Education Strategies: A Systematic Review

Parents are their children's first teachers and there are long-standing calls for their involvement in child sexual abuse prevention. In this rapid systematic review, we asked the following questions: what rationales are used to justify parental involvement in child-focused child sexual abuse (CSA) prevention programs? what approaches are used for parental engagement in child-focused CSA prevention programs? and what are the facilitators and barriers to parental involvement in child-focused CSA prevention programs? We searched CINAHL, Cochrane, ERIC, Medline, PsycInfo, Scopus, and SocINDEX in May 2021. A total of 57 papers met our inclusion criteria, comprised of 50 empirical studies, and 7 program descriptions. Rationales for parental involvement included monitoring and shaping parental attitudes toward CSA program delivery in schools; reinforcing children's learning at home; promoting parent-child communication about CSA prevention; building parent capacity to respond to child disclosures; and supporting program delivery for preschoolers. Types of parental involvement included the following: communication, learning at home, volunteering, decision-making, and collaboration with the community. Barriers to parent involvement included ineffective program engagement modalities, and parental fears and misconceptions.

The relationship between parental awareness of sexual abuse and children's skills to say "no"

INTRODUCTION

Child sexual abuse is a global and multidimensional social problem and causes devastating and permanent psychological, emotional, cognitive, behavioural, physical, sexual and interpersonal sequelae. This study examines the relationship between the ability to say "no" and parental awareness of sexual abuse in 4th grade primary school students.

METHODS

The study was conducted between April 2022 and June 2022 in primary schools in the central district of a province in north-eastern Turkey. The sample consisted of 310 students enrolled in 4th grade and their parents. We collected the data through a personal information form, the Ability to Say "No" Scale for Children and the Sexual Abuse Awareness Scale for Parents.

RESULTS

There was a weak positive correlation between the mean maternal scores of sexual abuse awareness and the mean scores of refusal and resistance in children (P < .05), as well as a weak positive correlation between the mean paternal scores of sexual abuse awareness and the mean scores of refusal and resistance in children (P < .05).

CONCLUSION

As mothers' and fathers' awareness of sexual abuse myths and of teachings and actions to combat sexual abuse increased, the refusal of children also increased. Also, as fathers' awareness of the signs of sexual abuse increased, children's refusal increased.

Child Sexual Abuse in Pakistan: A Phenomenological Study on Parental Understanding and Prevention Strategies for Child Protection

Child Sexual Abuse (CSA) is widespread and pervasive in Pakistan, presenting a significant threat to a child's physical health, psychological well-being, and overall development. This study aimed to empirically substantiate the understanding of parents regarding CSA and their utilized preventive strategies. The study utilized Social Ecological Theory to gain a deeper comprehension of the phenomenon. Data was collected through in-depth semi-structured interviews with 18 parents from Islamabad capital city, using a qualitative phenomenological research approach along with thematic analysis. Results reveal that most of the parents were highly aware of the most common aspects of sexual assault and molestation, but they were unaware of the more manipulative subtle forms such as "grooming." Additionally, they had a limited understanding of the long-term consequences of sexual abuse. While many parents knew about the option of involving the police in cases of abuse, they were unaware of helpline services and the availability of psychological support. In terms of prevention, most parents employed an integrated approach involving various preventive measures, such as educating their children about appropriate and inappropriate touch. These findings underscore the importance of implementing public-focused initiatives and community-based programs to enhance parental awareness, knowledge, and capabilities in preventing CSA in Pakistan.

Parental Involvement in Programs to Prevent Child Sexual Abuse: A Systematic Review of Four Decades of Research

This systematic review is the first to synthesize knowledge of parental involvement in child sexual abuse (CSA) prevention programs. Guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria, 24 intervention evaluations met the inclusion criteria of aiming to change parental knowledge, attitudes, behaviors, behavioral intentions, self-efficacy, response-efficacy, or capabilities for prevention of CSA. Included papers were identified via a combination of electronic database searches (PsycINFO, Web of Science, Scopus, Google Scholar, Cochrane Library, World Health Organization's International Clinical Trials Registry Platform, google.com.au, open.grey.eu, Global ETD, Open Access Theses & Dissertations, EThOS, and Trove) and direct communication with researchers. Improvement post intervention was found most commonly for parental behavioral intentions and response-efficacy, closely followed by parental behaviors, then capabilities, self-efficacy, knowledge, and lastly, parental attitudes. Improvements in behaviors, intentions, and response-efficacy occurred in 88 to 100% of the studies in which they were addressed, improvements in self-efficacy and capabilities occurred in 67 to 75%, and improvements in knowledge and attitudes occurred in only 50 to 56%. Many of the included evaluation studies suffered from methodological and reporting flaws, such as high participant attrition, lack of control group, lack of statistical tests, missed testing time points, and a lack of (or short) follow-up. Future parent-focused CSA prevention evaluations must address these concerns by conducting rigorous empirical research with sound methodologies and comprehensive reporting. Furthermore, study designs should consider measuring the real-world impact of increases in assessed parent variables, including their ability to prevent sexual victimization of children.

Adapting prevention programs for virtual delivery: A case study in adapting a parent-focused child sexual abuse prevention module

Background

Evolving and emerging contexts require interventions to respond and adapt. The COVID-19 pandemic necessitated a quick adaptation from in-person to virtual delivery. Not only were there few programs able to transition to virtual delivery, there was a lack of parent-focused CSA-prevention programs. The current study describes the responsive adaptation of a parent-focused child sexual abuse (CSA) prevention module (Smart Parents-Safe and Healthy Kids; SPSHK) for virtual delivery.

Design and methods

This two-phase study used mixed-methods to inform and pilot test adaptations to the virtual module. In Phase 1, parenting providers with and without experience delivering SPSHK (N = 110) completed anonymous surveys and a subsample (n = 27) subsequently participated in brief interviews elaborate on challenges and needed adaptations for virtual platforms.

Results

Providers indicated the greatest technological difficulties with parents' access to technology noting the inability to use a screensharing function. Thus, providers recommended no adaptations for the virtual delivery of SPSHK. In Phase 2, the virtual SPSHK module was piloted with nine parents. Results demonstrated virtual SPSHK was acceptable and feasibly implemented. Pre-posttest assessments indicated increases in parents' CSA-related awareness and use of protective behaviors.

Conclusion

The current study suggests the promise of virtual SPSHK implementation and may act as a blueprint for other parent-focused CSA-prevention programs, but also more general parenting programs, considering virtual delivery.

Implementation of a Universal School-Based Child Sexual Abuse Prevention Program: A Longitudinal Cohort Study

Child sexual abuse (CSA) is a public health problem of considerable magnitude. The prevailing primary prevention strategies are universal, school-based CSA prevention programs, some of which have been designated as evidence-based, such as Safe Touches. However, to reach their public health impact potential, effective universal school-based CSA prevention programs require effective and efficient dissemination and implementation strategies. The purpose of this study was to demonstrate the reach and effectiveness of a school-based CSA prevention curriculum, Safe Touches, when implemented on a wide scale. Using a longitudinal cohort design, children in second grade classrooms in public elementary schools in five counties received the Safe Touches workshop and completed surveys designed to assess gains in knowledge at four timepoints (one week prior, immediately post-workshop, 6- and 12-months post-workshop). In total, the Safe Touches workshop was delivered in 718 classrooms in 92% of school districts, reaching ~14,235 second graders. Multilevel models (n = 3,673) revealed that Safe Touches significantly increased CSA-related knowledge, and that these gains were maintained 12-months post-workshop (ps < .001). There were some small but significant time-varying effects among participants in schools with a greater percentage of low income and minority students, but these effects largely disappeared 12-months post workshop. This study demonstrates that a single-session, universal school-based CSA prevention program can effectively increase children's knowledge when implemented and disseminated on a wide scale and knowledge gains can be retained 12-months post intervention.

Preventive Education Outreach on Social Media: The Quest to Enroll Community Members in a Child Sexual Prevention Workshop

Social media is a frequently used tool in health promotion efforts although less so for the prevention of child sexual abuse (CSA). This is due, in part, to the lack of standardized branding guides for community-based efforts in how to craft messages related to CSA prevention. This study examined the use of Twitter (now "X") as a means of promoting participation in the adult-focused Stewards of Children CSA prevention workshop, prior to and following the implementation of a standardized branding guide. The exposure, reach, and engagement of the top tweets and top media tweets were examined over 24-months pre- and post-implementation of a five-point branding guide. Engagement was descriptively compared to the number of adults who enrolled in the Stewards of Children workshop. As evidenced by the increase in tweet impressions and the number of adults trained, it is likely the implementation of the branding guide was beneficial in promoting participation in the Stewards of Children workshop. Though participation in a program does not inherently suggest behavior change, getting participants to enroll is a crucial first step. The findings emphasize the potential of using social media to ultimately promote behavior change in the field of CSA prevention and beyond.

Provider Attitudes and Self-Efficacy When Delivering a Child Sexual Abuse Prevention Module: An Exploratory Study

BACKGROUND

As constant figures in children's lives, parents are key in protecting children from sexual abuse. One barrier to reaching parents is that the topic can be difficult to broach and is sensitive in nature. Such barriers can interfere with implementation and fidelity of evidence-based prevention strategies that are focused on reducing rates of childhood sexual abuse (CSA).

AIMS

In this exploratory study, we examine provider attitudes about delivering CSA-specific content in an evidence-based prevention module and their self-efficacy.

METHOD

Thirty-three providers participated in three surveys: prior to a skills-oriented training on how to deliver the CSA prevention module (pretraining), immediately posttraining, and 6 months posttraining. Changes in self-reported willingness to deliver content, beliefs about parents' role in CSA prevention, and confidence about their ability to deliver content were assessed over time. Open-ended questions were coded thematically to reinforce quantitative findings.

RESULTS

Prior to training, providers were worried that parents would respond negatively to CSA content and were concerned about their comfort level discussing victimization and sexual development. Findings suggest that skill-oriented training and provision scripts effectively supported providers and improved confidence in delivering CSA prevention content.

DISCUSSION

Provider self-efficacy is an important element of implementation fidelity. This exploratory study demonstrated that, though providers may approach CSA content with wariness and trepidation, adequate skills-oriented training can reduce negative attitudes and increase perceived efficacy in the actual delivery of CSA content that persists through implementation.

CONCLUSION

Skills-based training can significantly enhance fidelity in the delivery of difficult content included in parent-focused preventative interventions.

Taking a School-Based Child Sexual Abuse Prevention Program to Scale: a Cost Analysis

Cost analyses are used to determine overall costs of implementing evidence-based programming and may help decision makers determine how best to allocate finite resources. Child sexual abuse (CSA), regularly viewed as a human rights violation, is also a public health concern estimated to impact 27% of females and 5% of males by age 18. Universal, school-based CSA programs are one prevailing prevention strategy. However, there are no known cost analyses of school-based CSA prevention programming, thereby limiting potential scalability. Using the ingredients method, this cost analysis presents the findings of implementing Safe Touches, an evidence-based universal prevention program, across four sites (i.e., counties) in one mid-Atlantic state. Reaching a total of 14,235 s grade students, results indicate an average cost of $43 per student, an average classroom cost of $859, an average district cost of $10,637, and an average site cost of $154,243. There was a noted decrease in costs when more students were reached, suggesting a need to focus efforts on bolstering the reach of implementation efforts. Sensitivity analyses explored variations in implementation constraints such as personnel and facilities suggesting a range of per-student costs (lower-bound per-student cost = $34; upper-bound per-student cost = $64). Findings presented herein may be used to inform future universal CSA prevention efforts by providing detailed information about the costs of large-scale implementation of an evidence-based program among elementary-aged children.

The multiphase optimization strategy (MOST) in child maltreatment prevention research

Each year hundreds of thousands of children and families receive behavioral interventions designed to prevent child maltreatment; yet rates of maltreatment have not declined in over a decade. To reduce the prevalence and prevent the life-long negative consequences of child maltreatment, behavioral interventions must not only be effective, but also affordable, scalable, and efficient to meet the demand for these services. An innovative approach to intervention science is needed. The purpose of this article is to introduce the multiphase optimization strategy (MOST) to the field of child maltreatment prevention. MOST is an engineering-inspired framework for developing, optimizing, and evaluating multicomponent behavioral interventions. MOST enables intervention scientists to empirically examine the performance of each intervention component, independently and in combination. Using a hypothetical example of a home visiting intervention and artificial data, this article demonstrates how MOST may be used to optimize the content of a parent-focused in-home intervention and the engagement strategies of an intervention to increase completion rate to identify an intervention that is effective, efficient, economical, and scalable. We suggest that MOST will ultimately improve prevention science and hasten the progress of translational science to prevent child maltreatment.

Child Sexual Abuse as a Unique Risk Factor for the Development of Psychopathology: The Compounded Convergence of Mechanisms

Meta-analytic, population cohort, prospective, and clinical studies provide systematic evidence that child sexual abuse accounts for unique variation in several deleterious outcomes. There is strong evidence for psychiatric disorders, including posttraumatic stress disorder and mood, anxiety, and substance use disorders, and mixed evidence for personality disorders. Evaluation of sex-specific outcomes shows strong evidence for teenage childbearing, sexual revictimization, and sexual dysfunction and mixed evidence for heightened sexual behaviors and sexual offending. This review further demonstrates not only that survivors suffer the noxious impact of traumatic sexualization but that additional transdiagnostic mechanisms, including the biological embedding of stress, emotion dysregulation, avoidance, and insecure attachment, converge to compound risk for deleterious outcomes. A road map to enhance the rigor of future research is outlined, and specific recommendations for evidence-based policy making to boost prevention efforts and increase access to treatment are discussed.