Child sexual abuse prevention programs: a meta-analysis

Effectiveness of school-based interventions on child sexual abuse knowledge in children with disabilities: Systematic review and meta-analysis

BACKGROUND

Children with disabilities (CWDs) constitute a substantial segment of the population who encounter abuse, emphasizing the need to comprehend the influence of school-based interventions on this susceptible group.

AIM

This systematic review and meta-analysis aimed to identify and evaluate the effectiveness of school-based interventions in enhancing child sexual abuse (CSA) knowledge among CWDs.

PARTICIPANTS

This meta-analysis incorporated seven published studies, encompassing 387 CWDs.

METHODS

Our study synthesizes findings from seven experimental and quasi-experimental studies, adhering to the PRISMA guidelines. The study was registered in PROSPERO. The literature search, conducted between September 25, 2023, and October 2, 2023, employed various databases and keywords relevant to the study's scope. The research question and articles' eligibility were assessed using the Population, Intervention, Comparison, Outcomes, and Study type (PICOs). The meta-analysis was conducted using the Comprehensive Meta-Analysis (CMA) software.

RESULTS

The school-based intervention greatly impacted CWDs' CSA knowledge scores (Hedges's g = 1.026 [95% CI: 0.845; 1.208], z = 11.074, p = 0.000). The findings of this meta-analysis demonstrate that Questionnaire/scale-based knowledge measurement (Hedges's g = 2.586 [95% CI: 0.920; 4.252], z = 3.043, P = 0.002) and Vignette-based knowledge measurement (Hedges's g = 1.065 [95% CI: 0.655; 1.474], z = 5.100, p = 0.000) are effective in assessing CWDs' knowledge of CSA.

CONCLUSION

This systematic review and meta-analysis of seven randomized controlled studies and quasi-experimental studies provide robust evidence supporting the effectiveness of school-based interventions in significantly enhancing CSA knowledge among CWDs.

IMPLICATIONS TO PRACTICE

These findings are potentially significant evidence for education professionals, including educators and school health nurses.

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.

Exploring Screening Practices for Child Sexual Abuse in School Settings: An Integrative Review

Child sexual abuse (CSA) is a pervasive public health problem. If left undetected, CSA can result in immediate and long-term health problems, which can be mitigated through early identification. Schools are an ideal environment to implement screening measures, and school nurses (SN) are uniquely poised to intervene and respond early. The aim of this review was to systematically examine and synthesize the international evidence related to screening for early identification of CSA in schools. Themes emerging from the analysis were SN behaviors relative to screening, potential instruments or approaches for screening, and SN and school professionals' beliefs about CSA screening practices. This review found little evidence that CSA screening is occurring in schools. However, SNs are aware that screening falls within their scope of practice and many SNs feel they should be screening for it. A constant proactive approach by SNs is necessary to improve early identification and subsequent intervention.

Effectiveness of child sexual abuse prevention programs on knowledge acquisition: A meta-analytical study

BACKGROUND

Child sexual abuse (CSA) is a type of maltreatment considered a global health problem. CSA is a traumatic experience with important consequences for the victim's health. It is essential to report the effectiveness of CSA prevention programs to offer society useful tools to combat this abuse.

OBJECTIVE

We aimed to study the effectiveness of CSA prevention programs on the knowledge acquisition based on comparing pre- and post-treatment changes, and also if their effectiveness is related to program-related and methodological variables.

PARTICIPANTS AND SETTINGS

Standardised mean change (with studies that report pre-post program measures) of the effectiveness of CSA prevention programs published between 2014 and 2021 was carried out.

METHODS

The general effectiveness of these programs and whether the results were influenced by program-related variables (the duration, the target population, participants' age, or the type of intervention) or by methodology-related factors (the agent who taught them, the geographical area where they were carried out or the way the programs were evaluated) were analysed. A total of 43 samples analysing knowledge about CSA as a dependent variable were included.

RESULTS

The results reported a combined effect size considered large (dMR = -0.96, 95 % CI [-1.10, -0.82], p < .001). High inter-study heterogeneity was observed in the meta-analysis, although only the geographic area where the studies were conducted appears as a significant moderator.

CONCLUSIONS

In conclusion, the prevention programs included in this analysis significantly improved the participants' knowledge acquisition.

The Impact of a Public Health Campaign to Deter Viewing of Child Sexual Abuse Images Online: A Case Study of the UK Stop It Now! Campaign

Public campaigns offer an opportunity to prevent child sexual abuse by raising awareness and promoting help available to bystanders, victims, and those at risk of perpetrating the abuse. This paper explores the impact of The Lucy Faithfull Foundation's 'Stop It Now!' campaign in the UK (2015-2018) on help-seeking. Helpline calls (11,190 unique callers), website analytics (109,432 new website visitors) and three website-hosted surveys (N = 252) provided data on help-seeking, awareness, and self-reported behavior. Results indicated that there were more visitors to the help website during active campaigning periods, and helpline callers and website visitors were more likely to seek help after viewing campaign materials during active than non-active campaign periods. Help-seekers were predominantly men concerned about their own behavior. Survey 2 respondents concerned about their own behavior (n = 53) indicated that their awareness of the law (75.5%), and legal and personal consequences (67.9%) had changed after hearing about the campaign, and 66% reported a change in behavior. Public health campaigns may be an effective way to promote help-seeking and prevent abuse.

Unpacking School-Based Child Sexual Abuse Prevention Programs: A Realist Review

Background: Existing efforts to understand school-based child sexual abuse (CSA) prevention programs mainly focus on the effectiveness of these programs in increasing participants' CSA knowledge and self-protective skills. There are currently no reviews addressing the underpinning pathways leading to these outcomes. In order to increase our understanding about the underpinning causal and contextual factors and inform the further development of school-based CSA prevention programs, a realist review was conducted to synthesize existing evidence from a broad range of data. Methods: An iterative search of electronic databases and grey literature was conducted, supplemented with citation tracking to locate relevant literature. For quantitative evidence, we considered evaluation studies that focused on students aged 5-18 years, who were enrolled in primary or secondary schools; for other types/formats of studies/documents, no population restrictions were applied. We included school-based CSA prevention programs that focused on improving knowledge of CSA or self-protective skills. Outcomes of interest included knowledge of CSA or self-protective skills. We did not apply methodological filters in terms of the types of studies to be included. Thematic content analysis was conducted to synthesize data. Results: Sixty-two studies were included. Five themes and five overarching Context-Strategy-Mechanism-Outcome configurations (CSMOs) that contributed to the success of school-based CSA interventions were identified, including tailoring programs to participants' cognitive developmental levels, repeated exposure of key concepts and skills, utilization of interactive delivery methods and positive feedback, delivery of positive information and application of the 'train-the-trainer' model. Implications: Findings from this realist review provide insights into the underlying program theory of school-based CSA prevention programs, which can aid in the development and implementation of these programs in the future.

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.

Knowledge Gains from the Implementation of a Child Sexual Abuse Prevention Program and the Future of School-Based Prevention Education

School-based child sexual abuse (CSA) programs effectively increase students' CSA-related knowledge. This study focuses on an implementation trial of Safe Touches, an empirically supported, school-based CSA prevention program, that was disrupted by the COVID-19 pandemic. We sought to demonstrate gains in CSA-related knowledge following Safe Touches but were limited to a pre-post design. A total of 2,210 students across five counties in a Mid-Atlantic state received the Safe Touches workshop between September 2019 and March 2020. McNemar's chi-square test was used to assess changes in the proportion of correct responses pre-workshop (Time 1) and one-week post-workshop (Time 2). Students' CSA-related knowledge increased significantly based on changes in mean CSA knowledge scores and the number of correct item-level responses assessed at Time 1 and Time 2 (p < .000). Leveraging the experience of the facilitators' who delivered these workshops prior to the disruption of implementation, we gathered facilitators' perspectives to explore the viability of offering Safe Touches virtually. In July 2020, 16 facilitators completed an electronic survey designed to understand the viability of a virtual Safe Touches workshop. Three themes emerged from facilitator feedback on virtual programming: student engagement concerns, handling disclosures, and technology access to a virtual program. The findings of this study indicate that the Safe Touches workshop significantly increased CSA-related knowledge and, overall, facilitators supported further exploration and development of a virtual Safe Touches workshop. The transition of empirically supported school-based CSA prevention programs to a virtual delivery modality is necessary to maintain an effective means of primary prevention and opportunity for disclosure.

How Do Survivor and Mandatory Reporter Status Correlate with Program Outcomes for an Adult-Focused Child Sexual Abuse Prevention Program?

This exploratory study investigated group differences and pre-post changes in knowledge, beliefs, and behavior by mandatory reporters and Child Sexual Abuse (CSA) survivor status for a CSA prevention training designed for the general public. Of the 8,114 study participants, 32% identified as having experienced CSA, and 77% indicated they were mandatory reporters for child abuse and neglect. Mandatory reporters had higher baseline knowledge about CSA than those who were not mandatory reporters and reported more CSA preventative behaviors. Mandatory reporters continued to have higher levels of knowledge following the training. Survivors of CSA also had higher baseline knowledge about CSA and preventative behavior scores than individuals who are not survivors of CSA. Unlike mandatory reporters, they experienced fewer increases in knowledge. At posttest, there was no evidence of a difference in knowledge between CSA survivors and non-CSA survivors. For items related to beliefs, mandatory reporters had higher baseline scores than other participants. However, they had smaller gains, so mandatory reporters and non-mandatory reporters had more similar beliefs related to CSA after the training. There were few differences between CSA survivors and non-survivors on baseline beliefs related to CSA, though CSA survivors reported greater increases in beliefs that CSA prevention is their responsibility and in the idea that they know what to do to prevent CSA. These results have significant results for the development and evaluation of trauma-informed prevention programming.

Cultural Determinants and Parent-Child Communication as an Effective Tool to Prevent Child Sexual Abuse: A Quick Qualitative Study

The current study's sole specific goal was to use a qualitative approach, from the parents' emic perspective, to investigate the cultural determinants that influence using parent-child communication as an instrument to protect children from sexual abuse in the six electoral wards of Ife-East Local Government that covered the rural settlement of Ile-Ife. The study adopted a simple random sampling method to select a village from each ward and a convenient sampling method to select six parents from each village, making a total sample size of 36. The study utilized in-depth face-to-face interviews to garner the primary data and content analysis for data analysis. This study found and concluded that parents' economic activities, religious beliefs, fear of stigmatization or mockery, belief that giving a child sex education via parent-child communication promotes waywardness in the behavior of such a child, belief that sex education should be best confined to formal education, and overconfidence of the parents in their wards were among the cultural determinants influencing the efficacy of parent-child communication as a device to shield young ones from being victims of sexual abuse in the study location. The study recommended public enlightenment via various social institutions on dealing with these cultural determinants.

Examining the Awareness Levels of Parents on Child Sexual Abuse

Introduction:

Child sexual abuse (CSA) is defined as all kinds of actions that an adult uses a child for sexual purposes. The studies concluded that parents have incomplete or incorrect information and the protection of children against abuse is the fundamental duty of parents. This study analyses the CSA awareness levels of parents.

Methods:

Descriptive survey model is performed. The research sample covers 455 parents. The Child Sexual Abuse Awareness Scale for Parents and a demographical information form was used for research data collection and analyzed on SPSS 21.0 software.

Results:

A statistically significant difference was found between parents’ CSA awareness levels and age, gender, marital status, duration of marriage, education level, and number of children. The results showed that parents who were married for up to 10 years had a university degree, had only 1 child, and had higher awareness of sexual abuse myths. Contrary to expectations, no significant results were obtained regarding the signs of sexual abuse scores of groups with high awareness of myths of sexual abuse.

Implications for Research and Practice:

Contrary to the literature, the awareness levels of fathers about CSA are lower than the awareness levels of mothers, and the awareness levels of parents decrease as they get older. There is a need for further comprehensive and more scientific studies to identify the CSA problem in North Cyprus and propose solutions, and consequently prevention programs should be developed for professional groups that are related with child and parents.

State-level education policies: Opportunities for secondary prevention of child maltreatment

BACKGROUND

Exposure to child maltreatment creates risk for adverse social, health, and economic outcomes across generations. The socioecological model posits the well-being of individuals, including children and youth, is shaped by the larger systems they exist in. Employing state-level policies to position school settings to effectively identify and intervene in instances of child maltreatment is an important secondary prevention opportunity.

OBJECTIVE

This study examines the relationship between state-level policies that call for school based trainings to promote the recognition of and response to child maltreatment, and states' annual rates of substantiated child maltreatment reports.

METHODS

Relevant policies were identified and abstracted to generate measures of policy presence and comprehensiveness. The National Child Abuse and Neglect Data System was used to derive rates of substantiated child maltreatment reports by state and year. Child maltreatment rates were the dependent variable and policy measures were the primary explanatory variables in a difference-in-differences (DD) model series with state-level clustering and year-fixed effects.

RESULTS

The DD model series suggest significant, positive relationships between the presence of policies calling for school-based recognition and response training and child abuse (IRR 1.140, p = 0.04) as well as child physical abuse outcomes (IRR 1.150, p = 0.05). Sensitivity analyses suggest the relationships between policy presence and abuse outcomes were stronger for children than for adolescents.

CONCLUSION

These findings suggest that related policies may be effective secondary prevention tools for child maltreatment.

The Longitudinal Effects of Second Step Child Protection Unit on Children: Gender as a Moderator

We investigated the longitudinal effects of the Second Step Child Protection Unit (CPU; Committee for Children) on student outcomes through a randomized controlled trial. Eight schools with a total sample including 2,031 students were assigned randomly to the CPU intervention or the wait-list control condition. We employed a multi-process latent growth model using a structural equation modeling framework which simultaneously analyzed student outcome growth via the effects of the intervention. The moderating effect of gender was also included. Over four data collection waves (pretest, posttest, follow-up [6 months] and follow-up [12-months]), the intervention group students were better able to recognize appropriate requests in CSA scenarios than control group students over time. Teacher-student relations improved for the students in the intervention schools but worsened for the students in the control schools over time. Despite concerns that CSA prevention programs may result in the unintended consequence of making children more fearful, children in both conditions did not show increased fears over time. The longitudinal effect on CSA recognition was more pronounced among girls, who suffer from higher CSA prevalence, compared with boys. Implications for prevention, policy, and directions for future research are discussed.

Facilitators and Barriers to Child Sexual Abuse Interventions: A Qualitative Study of Interventions in Iran

Background: Child sexual abuse is a public health problem in most countries. Sensitization, research, and programs for identifying and preventing child sexual abuse have been carried out at the national level with increased political and social awareness and international commitments to decline its consequences. Objectives: This study investigated the facilitators and barriers to community-based interventions for child sexual abuse. Methods: Semi-structured interviews were conducted between September 2021 and March 2022 with 15 purposefully selected experts. The interviews were audio-recorded, transcribed, and analyzed using the content analysis method. Results: Several barriers and facilitators affected child sexual abuse interventions. The barriers included: (1) sociocultural challenges; (2) legal challenges and gaps; and (3) managerial-structural challenges, while the facilitators were: (1) the improvement of the quality of provided services; and (2) facilitative role of the law. Conclusions: Social interventions for child sexual abuse could consider some items to improve implementation, namely as follow: (1) the intersectional cooperation of organizations and beneficiaries to conduct child abuse interventions for children and their families at the local and national levels; (2) the implementation of empowerment activities for the return of children and parents to the community after child sexual abuse; and (3) the revision of the laws and establishment of more deterrent punishments.

JK, Vardhanan YS. Exploration of Adverse Childhood Experiences (ACEs) and Health Risk Behaviors (HRBs) in Male Recidivist Violent Offenders: Indian Scenario

Aggression and violent behavior are widespread in the world and cause serious threats to public safety. Violent criminal recidivism rates remain very high among certain groups of offenders. In India, the quantum of total violent crimes is continuously increasing from 2009 to 2019. Adverse childhood experiences can affect the development of a child in many ways, leading to highly maladaptive behaviors, such as serious, violent, and chronic (SVC) delinquency. This study was done as a case-control method among recidivist violent offenders and controls to examine the effects of adverse childhood experiences (ACEs) on violent criminality. The questionnaire included the World Health Organization Adverse Childhood Experiences International Questionnaire (ACE- IQ) and standardized measures of Health Risk Behaviors (HRBs). Thirteen categories of adverse childhood experiences of the recidivist violent offenders and controls were measured. Bivariate analysis showed that there was a significant relation (p < 0.001) between ACEs and violent criminality in cases (M = 72.14, SD = 6.80, N = 35) and controls (M = 44.91, SD = 5.39, N = 32). The largest correlation was found between collective violence and household violence (r = 0.813). Bivariate correlation analyses were highly significant between total ACE score and criminality (r (35) = 0.927, p < 0.001). The results reveal that household violence, community violence and collective violence experienced by recidivist violent offenders were nearly double the rate of the control group. Findings emphasize the need for evaluations of ACEs in recidivist offenders for better rehabilitation strategies and also the necessity for preventive efforts at all levels.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40653-021-00434-1.

Recall of sexual abuse prevention education at school and home: Associations with sexual abuse experience, disclosure, protective parenting, and knowledge

BACKGROUND

Child sexual abuse (CSA) prevention is dominated by a focus on child education. However, evidence that this education reduces CSA risk is limited and mixed.

OBJECTIVE

We investigated whether participants' history of receiving school-based child sexual abuse prevention (CSAPP) was associated with experiencing CSA. Uniquely, we also investigated whether parent-led CSA education (PLSAE) and received protective parenting were associated with CSA. CSA knowledge was also considered.

METHODS

Australian university students (N = 1265, M_age = 22.8, SD = 7.7, Mo_age = 18, Md_age = 20, 75% female) reported their history of CSAPP and PLSAE, experience of CSA, disclosure of CSA, parenting, and CSA knowledge.

RESULTS

CSAPP attendance was reported by 29% of respondents, 72% reported PLSAE, and 24% reported CSA. PLSAE was significantly associated with lower risk of CSA, but was CSAPP attendance was not. PLSAE was significantly associated with higher levels of parental involvement/care and monitoring/supervision. In a multivariate logistic regression model, involvement/care and monitoring/supervision were associated with lower risk of CSA, but PLSAE was not. Neither CSAPP attendance nor PLSAE was associated with CSA disclosure or CSA knowledge.

CONCLUSIONS

These findings add to the small body of literature using reports of real-life experiences. Results call into question the over-reliance of child-education in CSA prevention and highlight the role of protective parenting. Building parenting capacity to include parenting practices is most likely to be effective for CSA prevention, such as monitoring and involvement, and should be included in CSA prevention efforts.

Mothers Attitudes Toward Child Sexual Abuse Prevention in Schools: A Preliminary Examination

Providing school-based child sexual abuse (CSA) prevention programs ensures that the majority of children will participate in programming. Since many parents may feel ill equipped to have such discussions with their children, programs offered in education settings can bring awareness to this issue. A sample of mothers (N = 268) from across the United States completed an online survey related to their experiences with and attitudes toward school-based CSA prevention programs. Most mothers (70%) had no exposure to prevention programs during their childhood, but the majority (95%) had a positive attitude toward programming for their children. Most mothers believed that offering CSA prevention in schools was important and could provide a safety net. Mothers desired programming that was age appropriate, involved parents and was activity based. These results can help inform schools' prevention programming.

"I am Learning to Protect Myself with Mika:" A Teacher-based Child Sexual Abuse Prevention Program in Turkey

This study aimed to explore the effectiveness of a teacher-based child sexual abuse prevention program entitled "I am learning to protect myself with Mika." The sample consisted of 290 children, their parents, and their classroom teachers. The participants were randomly assigned to intervention (n = 137) or wait-list comparison groups (n = 153) by classroom. The age of the children ranged from 46 to 71 months (M = 58.99, SD = 6.64). The prevention program was a 5-week program that consisted of five modules, including emotional awareness, good touch-bad touch, and body safety rules. To investigate the effectiveness of the prevention program, a latent Markov analysis was conducted. A three-class solution was identified as the best model: Status-1 (self-protecting group), Status-2 (risky secret keepers), and Status-3 (risk group). Following the intervention, members of the two at-risk groups (Statuses 2 and 3) were more likely to move into the Status-1 group than were those participants who had not received the intervention (wait-list comparison). Self-protection skills were analyzed using a 2 × 2 ANOVA with repeated measures. The increase in self-protection skills was greater for participants in the intervention group than for those in the wait-list comparison group from pre-test to post-test. Two-month follow-up analysis showed that gain in knowledge and skills was maintained. This program should be considered as a potential approach to meeting the need for child sexual abuse preventive efforts in Turkish preschool curriculum.

International Experience in Developing Programs for Teaching Children’s Skills of Safe Communication with Strangers

<p>Child safety is a priority for Russian child welfare state policy. Cases of child abduction by strangers for sexual abuse and exploitation are not so frequent, however they have grave and tragic consequences. In the Russian education system, there is a shortfall of domestic practices that prevent such cases by teaching children to recognize dangerous situations, refuse to communicate or ask for help. The article presents a thematic review of international practices aimed at preventing crimes against children and child abuse, which have proven their effectiveness not only by many years of experience, but also by scientific research. These practices particularly concentrate on teaching children skills of safe communication with an adult stranger. The methodology and psychological and pedagogical techniques of the practices are considered in the light of the evidence-based approach.</p>

Evaluation of the Child Safety Matters Curriculum for Improving Knowledge about Victimization among Elementary School Children: A Randomized Trial

This project employed a randomized-control design to evaluate the effectiveness of the MBF Child Safety Matters® (CSM) curriculum. Six Georgia schools across 3 counties agreed to participate, and 136 K - 5th grade classrooms were randomized to either receive the CSM curriculum or be a wait-list control and to receive the curriculum after the evaluation. In total, 2,414 students participated at pretest (1195 CSM and 1219 control) and 2,260 participated at posttest (1159 CSM and 1101 control). Pre/posttests were collected from all students prior to the delivery of the CSM curriculum and again approximately a month later to measure knowledge gains related to child safety. Intervention students displayed a greater increase in knowledge for the information taught in the CSM program as compared to students who did not receive the intervention (d = .29).

What Works in School-Based Programs for Child Abuse Prevention? The Perspectives of Young Child Abuse Survivors

Previous research has shown that youth consider school-based child abuse prevention programs as one of the most important strategies for preventing child abuse and neglect. This study asked young child abuse survivors how school-based child abuse prevention programs should be shaped and what program components they perceive as essential. Semi-structured interviews were conducted with 13 Dutch young adults that were a victim of child abuse or neglect. A literature review that resulted in 12 potential program components was used to guide the interviews. All young adults agreed that school-based child abuse prevention programs are important and have positive effects on children’s awareness of child abuse. Teaching children that they are never to blame for child abuse occurrences was considered one of the most important components of school-based programs, next to teaching children how to escape from threatening situations and to find help, increasing children’s social–emotional skills, promoting child abuse related knowledge, recognizing risky situations, and increasing children’s self-esteem. Further, the participants found it important to provide children with aftercare when a school program has ended. Overall, young child abuse survivors have a strong view on what should be addressed in school-based child abuse prevention programs to effectively prevent child abuse.

Effective Components of School-Based Prevention Programs for Child Abuse: A Meta-Analytic Review

School-based programs seem promising for child abuse prevention. However, research mainly focused on sexual child abuse and knowledge is lacking on how individual program components contribute to the effectiveness of school-based prevention programs for any form of child abuse. This study aimed to examine the overall effect of these school-based programs on (a) children’s child abuse-related knowledge and (b) self-protection skills by conducting two three-level meta-analyses. Furthermore, moderator analyses were performed to identify how program components and delivery techniques were associated with effectiveness. A literature search yielded 34 studies (158 effect sizes; N = 11,798) examining knowledge of child abuse and 22 studies (99 effect sizes; N = 7804) examining self-protection skills. A significant overall effect was found of school-based programs on both knowledge (d = 0.572, 95% CI [0.408, 0.737], p < 0.001) and self-protection skills (d = 0.528, 95% CI [0.262, 0.794], p < 0.001). The results of the first meta-analysis on children’s child abuse knowledge suggest that program effects were larger in programs addressing social–emotional skills of children (d = 0.909 for programs with this component versus d = 0.489 for programs without this component) and self-blame (d = 0.776 versus d = 0.412), and when puppets (d = 1.096 versus d = 0.500) and games or quizzes (d = 0.966 versus d = 0.494) were used. The second meta-analysis on children’s self-protections skills revealed that no individual components or techniques were associated with increased effectiveness. Several other study and program characteristics did moderate the overall effects and are discussed. In general, school-based prevention programs show positive effects on both knowledge and self-protection skills, and the results imply that program effectiveness can be improved by implementing specific components and techniques.

The effect of preventive psychosocial interventions directed towards mothers and children on children's knowledge about protection from sexual abuse

PROBLEM

Sexual abuse is a multidimensional public health problem that concerns all communities. Primary-level preventive approaches in the fight against sexual abuse have an important place. However, research involving parents in sexual abuse prevention interventions with children is limited. The aim of this study is to determine the effect of preventive psychosocial interventions directed towards mothers and their children on children's knowledge about protection from sexual abuse.

METHODS

The study has a quasi-experimental, comparative design with a control group and a pretest/posttest. The participants were assigned into four groups; namely, control, mother psychoeducation, child psychoeducation and mother-child psychoeducation.

FINDINGS

Significant difference was determined within and between the groups in the mean scores of the Good Touch Bad Touch Curriculum test (p < 0.001).

CONCLUSION

The preventive psychosocial intervention simplemented to mothers and their children increase children's knowledge about protection from sexual abuse.

Responsible Behavior with Younger Children: Examining the Feasibility of a Classroom-Based Program to Prevent Child Sexual Abuse Perpetration by Adolescents

Child sexual abuse (CSA) is a preventable public health problem typically addressed with either after-the-fact interventions or prevention programs focused on teaching children to protect themselves and report abuse. Such responses do little to prevent CSA victimization, leading to calls for prevention efforts targeting individuals most at risk of perpetrating CSA. These individuals include young adolescents, who are prone to making mistakes and bad decisions when it comes to their sexual behaviors. To begin to address this call to action, we developed Responsible Behavior with Younger Children (RBYC), a universal school-based prevention program to provide sixth and seventh grade students (and their parents and educators) with the knowledge, skills, and tools to prevent engaging younger children in sexual behaviors. School-based CSA prevention interventions are often met with feasibility and acceptability concerns including that (a) people at risk of offending are impervious to prevention efforts, (b) schools do not have the resources to take on additional programs, and (c) the content is too sensitive for educators, parents, and students. The goal of this article is to describe how the RBYC program was developed to address these concerns. We also summarize data on the feasibility of the RBYC program obtained from focus groups with educators, parents, and students during the development of the program and interviews with educators after a pilot randomized controlled trial (RCT). Feedback received during program development and after the pilot RCT suggests that RBYC is relevant, salient, palatable, and feasible for implementation in middle schools.

Healthcare Professionals' Views for the Content of the Teddy Bear Hospital for a Child Sexual Abuse Prevention Module

Worldwide studies have reported a drastic increase in child sexual abuse (CSA) involving very young children. In Malaysia, several attempts have been made to combat this problem via educational programs. Teachers have reported a lack of confidence in teaching this topic; hence a less threatening approach is needed. The Teddy Bear Hospital (TBH) is an innovation whereby the children bring their teddies while visiting the volunteers assuming healthcare practitioners' role. This execution is effective in reducing the children's anxieties about hospitalization and increasing their health knowledge. Therefore, our objective is to explore healthcare practitioners' (HCP) views for the content of TBH and its approach as a personal safety module toward preventing CSA. Eighteen in-depth-interviews were conducted. Interviews were thematically analyzed. Participants suggest the TBH method as a good approach to teaching prevention of CSA among preschoolers. Four main themes emerged from this study: (1) educating children about personal safety, (2) moral values and faith as a medium to prevent child sexual abuse, (3) addressing social media use in children, and (4) general approach to content delivery. The involvement of parents is crucial. Addressing moral values and faith and usage of social media platforms are also essential factors to look into.

Child Sexual Abuse in Pakistan: Using Evidence Based Social Ecological Model for Explanation and Policy Formulation

Due to recent high profile media reported cases of child sexual abuse in Pakistan a serious public concern is observed with a strong punitive public demand rather than proactive and preventive approach as solution. Instead of reactive approach, it is needed to formulate a policy based on valid causal ground for solution of this problem. Purpose of this cross sectional study is to provide a causal ground based on evidence based social ecological model for holistic policy response for addressing issue of CSA. Using ICAST-R, equal number of male and female 274 university students were asked about experience of CSA, re-victimization, age at the time of CSA, perpetrators, disclosure patterns and social support after disclosure of CSA. On the basis of data, evidence based social ecological model was used for explanation of individual, family, societal and institutional factors related to CSA in Pakistan for formulation of effective prevention strategy. According to findings most frequent age at the time of CSA is between 6th to 18th year of age with 9th year as most frequently reported. Experience of CSA was reported more frequently by boys than girls. Peers were identified as highest reported perpetrators and majority of the perpetrators were known to the child. Instead of reactive and punitive approach towards issue of CSA it is needed to formulate a policy based on social ecological factors of society.

Teaching Youth to Resist Abuse: Evaluation of a Strengths-Based Child Maltreatment Curriculum for High School Students

Child maltreatment (CM) is a serious and prevalent public health problem in the United States (U.S.) yet programming to combat the issue often overlooks high school aged youth (those aged 14-17). In 2017, over 90,000 youth in the U.S. experienced CM during their high school years (U.S. Department of Health and Human Services 2019). This manuscript will highlight the importance of prevention programs for youth affected by child maltreatment and report the findings of a pilot study that examined the effectiveness of the Childhelp Speak Up Be Safe Prevention Education Curriculum among high school students. The purpose of the pilot study was to determine if the revised and expanded curriculum for grades 9-12 was feasible and to examine the validity of the new survey items, including the RESIST strategy questions. The pilot study utilized a two-phase non-probability convenience sample to evaluate high school student gains in knowledge of safety related resistance strategies. High school students (N = 269) attending one urban charter public high school (grades 9-12) in the Southwest who completed pre- and post-survey RESIST strategy items participated in the pilot. The results indicated that students receiving the Childhelp Speak Up Be Safe Prevention Education Curriculum increased their identification and knowledge of safety related resistance strategies.

Preventing Sexual Violence in Adolescence: Comparison of a Scientist-Practitioner Program and a Practitioner Program Using a Cluster-Randomized Design

Numerous school-based prevention programs have been developed by scientists and practitioners to address sexual violence in adolescence. However, such programs struggle with two major challenges. First, the effectiveness of many well-established practitioner programs has not been rigorously evaluated. Second, effective scientific programs may be hard to implement into everyday school practice. Combining the knowledge of scientists and practitioners in a scientist-practitioner program could be a helpful compromise. The aim of the present study is to evaluate the effects of a scientist-practitioner program and a practitioner program using a cluster-randomized experimental design. Twenty-seven school classes were randomly assigned to either one of two programs or a control group. Outcome variables (knowledge, attitudes, behavior, and iatrogenic effects) were assessed at pretest, posttest, and a 6-month follow-up for 453 adolescents (55% female, Mage = 14.18). Short-term effects were found in both programs regarding general knowledge, knowledge of professional help, and victim-blaming attitudes. Long-term effects were found in both programs regarding general knowledge and knowledge of professional help and, in the practitioner program, in a reduction of victimization. No other effects were found on attitudes and behavior. No iatrogenic effects in the form of increased anxiety were found. Both the scientist-practitioner and the practitioner program show promise for the prevention of sexual violence in adolescence; in particular, the practitioner program may be a more cost-effective method.

Three Decades of Research: The Case for Comprehensive Sex Education

PURPOSE

School-based sex education plays a vital role in the sexual health and well-being of young people. Little is known, however, about the effectiveness of efforts beyond pregnancy and sexually transmitted disease prevention. The authors conducted a systematic literature review of three decades of research on school-based programs to find evidence for the effectiveness of comprehensive sex education.

METHODS

Researchers searched the ERIC, PsycINFO, and MEDLINE. The research team identified papers meeting the systematic literature review criteria. Of 8,058 relevant articles, 218 met specific review criteria. More than 80% focused solely on pregnancy and disease prevention and were excluded, leaving 39. In the next phase, researchers expanded criteria to studies outside the U.S. to identify evidence reflecting the full range of topic areas. Eighty articles constituted the final review.

RESULTS

Outcomes include appreciation of sexual diversity, dating and intimate partner violence prevention, development of healthy relationships, prevention of child sex abuse, improved social/emotional learning, and increased media literacy. Substantial evidence supports sex education beginning in elementary school, that is scaffolded and of longer duration, as well as LGBTQ-inclusive education across the school curriculum and a social justice approach to healthy sexuality.

CONCLUSIONS

Review of the literature of the past three decades provides strong support for comprehensive sex education across a range of topics and grade levels. Results provide evidence for the effectiveness of approaches that address a broad definition of sexual health and take positive, affirming, inclusive approaches to human sexuality. Findings strengthen justification for the widespread adoption of the National Sex Education Standards.

A serious-game for child sexual abuse prevention: An evaluation of orbit

BACKGROUND

Greater public and professional awareness of the extent and impact of child sexual abuse (CSA) has prompted the inclusions of prevention initiatives within school curricula. However CSA education is not always soundly grounded in empirical evidence, and evaluations of the impact of programs often inadequate.

OBJECTIVE

This paper reports on a randomized-control trial of an empirically informed serious-game for CSA prevention, for children aged 8-10 years. The study also evaluates the impact on learning of complementary classroom lessons and part completion of the Orbit game.

PARTICIPANTS AND SETTING

The evaluation involved 139 students (female = 78; male = 61) aged 8-10 years (Mage = 9.64, SD = 0.33), from an elementary school in Queensland, Australia.

METHOD

All children were pre-tested and post-tested (at 3 months) for knowledge of abuse prevention using the Children's Knowledge of Abuse Questionnaire-Revised (CKAQ-R-III), and a short form (SF) mapped to the learning objectives of Orbit . Children were assigned to one of three groups; i) play Orbit (n = 50); ii) play Orbit and CSA lessons (n = 55); and iii) control (n = 34).

RESULTS

Children in the Orbit play, and Orbit play and lesson groups, significantly (p < .001) increased their CKAQ SF scores, whereas those in the control group did not. Furthermore, those children who completed all of Orbit significantly (p < .001) increased their post-test CKAQ scores, whereas those who didn't complete the game did not.

CONCLUSIONS

This study shows the strength of a serious-games approach for school CSA prevention whilst reporting how child completion can impact learnings.

Student Knowledge Gain Following the Second Step Child Protection Unit: the Influence of Treatment Integrity

Treatment integrity is an important yet understudied component of school-based prevention programming, particularly for sensitive topics such as child sexual abuse prevention (CSA). This study examined student- and teacher-level characteristics, including components of treatment integrity, that contributed to greater knowledge gain among students participating in the Second Step Child Protection Unit (CPU). The study was conducted with 1132 students and 57 teachers from four elementary schools enrolled in a randomized controlled trial of the CPU. Students were administered assessments at pre-test, post-test, 6-month follow-up, and 12-month follow-up. Teachers were observed and rated on Content Integrity (CI; adherence to content), Process Integrity (PI; teacher enthusiasm, encouragement, behavior management), and Dose Received (DR; student behavior and interest) when delivering the lessons. Hierarchical linear growth modeling indicated that students who received the CPU made gains in the knowledge of CSA concepts and skills over a 12-month follow-up period. Girls had significantly greater CSA knowledge than boys immediately after the intervention, with gender remaining significant even when accounting for level-3 variables. Older children had better knowledge scores at post-test, but growth over time results revealed that younger students made greater gains. For students in 2nd through 4th grade, CI was more important for post-test outcomes, while for all students, CI and grade taught were important to post-test scores. Teachers of lower grades had students with a faster growth rate on correct responses to vignettes. Implications for CSA prevention programming and future research are discussed.

Making the Most of Clinical Encounters: Prevention of Child Abuse and Maltreatment

Child abuse is a public health concern with great costs to children, families, and society. Prevention of child abuse and maltreatment is an important clinical skill. Providers can take advantage of the opportunity to offer prevention interventions in the health care setting. Identification of risk factors and signs and symptoms of abuse, referral to local resources, parenting education, and application of the public health prevention framework should be integrated into clinical encounters. Identification of sentinel injuries enables tertiary interventions to save lives. Primary interventions during early childhood using effective parenting programs has been shown to reduce child maltreatment.

College students' recollections of childhood sexual abuse prevention programs and their potential impact on reduction of sexual victimization

BACKGROUND

Child sexual abuse prevention programs are offered in many schools globally, but research is scant on whether or not these programs actually decrease the rates of CSA among youth who participate in them.

OBJECTIVE

This study sought to determine if participation in a CSA prevention program (based on participant recall), in the US or another country, led to lower rates of self-reported past victimization among youth, affected disclosure and effects on sexual satisfaction.

PARTICIPANTS AND SETTING

One thousand five hundred and two students from an ethnically and racially diverse university in the southeast served as participants.

METHODS

Participants completed measures on line (Qualtrics). This included demographic information and participation in CSA prevention programs in schools, concepts that were covered, and recollections of sexual victimization. The second measure was a revised version of the sexual satisfaction scale (Derogatis Sexual Functioning Inventory).

RESULTS

Students who had not participated in a CSA prevention program were significantly more likely to be abused than those who did participate, regardless of the program or location (χ2 (1,1498) = 19.01, p < .001). Those participating in programs in the US were more likely to disclose abuse than those participating in the programs in other countries (χ2 (1,212) = 5.49, p = .019). No significant difference was found between those who participated in prevention programming and those who did not on sexual satisfaction (χ2 (1,1469) = 1.76, p = .184).

CONCLUSION

These results highlight the importance of universal CSA prevention programs in schools worldwide as one part of comprehensive prevention.

Sexual Abuse Disclosure Mediates the Effect of an Abuse Prevention Program on Substantiation

Although abuse prevention programs have proliferated, little research has explored the direct effects of such programs on actual child sexual abuse disclosure rates, and no research has explored the effects of such programs on child sexual abuse substantiation. Employing a quasi-experimental design, the present research reflects an exploration of the effects of exposure to the Think First and Stay Safe™ abuse prevention program on abuse disclosure rates of 319 children who underwent a child forensic interview within 2015-2018 in a Midwestern child advocacy center. Supporting our mediational hypotheses, children exposed (vs. not exposed) to the Think First and Stay Safe™ program were significantly more likely to disclose abuse during the forensic interview, which in turn predicted significantly increased abuse substantiation likelihood.

Prevention and early intervention in youth mental health: is it time for a multidisciplinary and trans-diagnostic model for care?

BACKGROUND

Similar to other health care sectors, mental health has moved towards the secondary prevention, with the effort to detect and treat mental disorders as early as possible. However, converging evidence sheds new light on the potential of primary preventive and promotion strategies for mental health of young people. We aimed to reappraise such evidence.

METHODS

We reviewed the current state of knowledge on delivering promotion and preventive interventions addressing youth mental health.

RESULTS

Half of all mental disorders start by 14 years and are usually preceded by non-specific psychosocial disturbances potentially evolving in any major mental disorder and accounting for 45% of the global burden of disease across the 0-25 age span. While some action has been taken to promote the implementation of services dedicated to young people, mental health needs during this critical period are still largely unmet. This urges redesigning preventive strategies in a youth-focused multidisciplinary and trans-diagnostic framework which might early modify possible psychopathological trajectories.

CONCLUSIONS

Evidence suggests that it would be unrealistic to consider promotion and prevention in mental health responsibility of mental health professionals alone. Integrated and multidisciplinary services are needed to increase the range of possible interventions and limit the risk of poor long-term outcome, with also potential benefits in terms of healthcare system costs. However, mental health professionals have the scientific, ethical, and moral responsibility to indicate the direction to all social, political, and other health care bodies involved in the process of meeting mental health needs during youth years.

Effectiveness of Programs for the Prevention of Child Sexual Abuse

Abstract. During the last decades, several studies have been conducted on the effectiveness of sexual abuse prevention programs implemented in different countries. In this article, we present a review of 70 studies (1981–2017) evaluating prevention programs, conducted mostly in the United States and Canada, although with a considerable presence also in other countries, such as New Zealand and the United Kingdom. The results of these studies, in general, are very promising and encourage us to continue this type of intervention, almost unanimously confirming its effectiveness. Prevention programs encourage children and adolescents to report the abuse experienced and they may help to reduce the trauma of sexual abuse if there are victims among the participants. We also found that some evaluations have not considered the possible negative effects of this type of programs in the event that they are applied inappropriately. Finally, we present some methodological considerations as critical analysis to this type of evaluations.

[ReSi: Evaluation of a Program for Competency Training and Prevention of Sexual Abuse in Kindergarten]

ReSi: Evaluation of a Program for Competency Training and Prevention of Sexual Abuse in Kindergarten This paper describes the "ReSi-Kompetenzförderprogramm" and its evaluation. Based on the resilience approach, this programme aims to foster the social-emotional, body-related and linguistic competencies of kindergarteners and teach them age-appropriate preventive knowledge concerning sexual abuse. A randomized-controlled trial was conducted (n = 412). At three different points in time the Kindergarten teachers and the parents filled in questionnaires about the children's competency development. To assess the knowledge and action strategies of the children, standardisized children interviews were conducted. Effects of the programme were found for self-assertion, stress management, communicative and interactional competencies, body-related competencies, conflict resolution competence and the communicative behaviour. Besides, children in the intervention group show greater knowledge about body parts, emotions and action strategies in security-relevant situations.

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

BACKGROUND

School-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.

OBJECTIVE

The 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 SETTING

This study is based on eighteen trainers and administrators who work with the Play it Safe!® school-based program in Dallas-Fort Worth area.

METHODS

Using the qualitative case study method, in-depth interviews were conducted.

RESULTS

Data 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.

CONCLUSION

Child 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.

Randomized controlled trial of the Child Protection Unit: Grade and gender as moderators of CSA prevention concepts in elementary students

BACKGROUND

Despite the importance of child sexual abuse (CSA) prevention, there are few recent randomized controlled trials of school-based CSA prevention programs.

OBJECTIVES

(1) To evaluate the effects of the Second Step Child Protection Unit (CPU) on students' CSA prevention concept knowledge, ability to recognize, report, and refuse unsafe touches, and perceptions of teacher-student relations and (2) investigate the moderating role of age and gender on program effectiveness.

PARTICIPANTS AND SETTING

Eight elementary schools in a large suburban school district in the northeast United States were randomly assigned to the intervention or control condition, with analyses conducted on a total of 2172 students.

METHODS

Students in intervention schools received the 6-week CPU and those in the control schools were exposed to business as usual. Students were administered assessments at baseline and then at post-test.

RESULTS

Univariate Analyses of Covariance revealed that students in the intervention schools had significantly higher scores on all outcomes than students in the control schools at post-test, even after controlling for baseline scores. Children in younger grades made greater gains from the program, and girls scored higher than boys in CSA knowledge and ability to recognize, refuse, and report unsafe touches, but both boys and girls made significant gains.

CONCLUSIONS

Results support the importance of beginning early with school-based CSA prevention efforts. Although boys are still at a relative disadvantage in terms of their knowledge and ability in this area, they are able to make gains at the same rate as girls.

Child Sexual Abuse Victimization Prevention Programs in Preschool and Kindergarten: Implications for Practice

With the alarming rates of child sexual abuse in the United States, there have been several attempts to develop and implement child abuse victimization programs in elementary schools across the country. Many programs have targeted older school-age children, but research shows that these programs can be effective for children of preschool and kindergarten age. This paper will review the literature that provides the rationale behind offering these types programs to the youngest of school-children, what these programs can offer, and describe specific programs that have been validated for preschool and kindergarten-aged children, using the best practice guidelines in the field of early childhood education. Recommendations for future programs and research needs are also offered.

Teacher Outcomes from the Second Step Child Protection Unit: Moderating Roles of Prior Preparedness, and Treatment Acceptability

Teachers play a critical role in child sexual abuse (CSA) prevention and intervention efforts. We examined the impact of the Second Step Child Protection Unit (CPU) on improving teacher awareness, attitudes, and teacher-student relations for 161 teachers. Teacher baseline scores and treatment acceptability were examined as moderators. Structural equation modeling (SEM) revealed a significant effect of the CPU on teachers' awareness, attitudes, and teacher-student relations, particularly for teachers with lower prior knowledge, attitudes, and student relationships. Teachers' acceptability of the CPU also moderated outcomes, where a higher level of acceptability of CSA interventions was associated with an increase in outcomes.

Enhancing Behavior Change Technique Coding Methods: Identifying Behavioral Targets and Delivery Styles in Smoking Cessation Trials

BACKGROUND

The behavior change technique (BCT) taxonomy v1 is often used in systematic reviews for identifying active components of interventions. Its utility could be enhanced by linking BCTs to specific target behaviors and qualifying BCT delivery style.

PURPOSE

To determine whether behavioral targets and delivery styles of BCTs can be coded reliably and to determine the utility of coding these characteristics.

METHODS

As part of a large systematic review of 142 smoking cessation trials, two researchers independently coded publicly and privately held intervention and comparator group materials, specifying the behavioral target (quitting, abstinence, medication adherence, or treatment engagement) and delivery style (tailored vs. not tailored; active participation vs. passive receipt) of each BCT.

RESULTS

Researchers coded 3,843 BCTs, which were reliably attributed to behavioral targets (AC1 = 0.92, PABAK = 0.91). Tailoring (AC1 = 0.80, PABAK = 0.74) and participation (AC1 = 0.71, PABAK = 0.64) were also coded reliably. There was considerable variability between groups in quitting and abstinence BCTs (ranges: 0-41; 0-18) and in tailoring and participation (ranges: 0-20; 0-32), but less variability for medication adherence and treatment engagement (ranges: 0-6; 0-7).

CONCLUSIONS

Behavioral targets and delivery styles of BCTs can be reliably identified and occur with sufficient frequency in smoking cessation trials for inclusion in quantitative syntheses (e.g., meta-regression analyses). Systematic reviewers could consider adopting these methods to evaluate the impact of intervention components targeting different behaviors, as well as the benefits of different BCT delivery styles.

Adaptation and Psychometric Evaluation of the Children's Knowledge of Abuse Questionnaire (CKAQ-RIII) in Greek Elementary School Children

The purpose of the present study was to culturally adapt and validate the Children's Knowledge of Abuse Questionnaire-RIII (CKAQ-RIII), a tool that examines children's understanding of sexual abuse concepts, for use in Greek elementary schools. A sample of 467 Greek school children between the ages of 6-9 was recruited from a private school. The CKAQ-RIII was administrated three times, before and immediately after a Child Sexual Abuse (CSA) prevention intervention program, as well as during a one-year follow-up evaluation. A subsample of the original population (N = 113) completed the one year follow up administration of CKAQ-RIII, along with the Body Awareness (BA) and the Emotional Differentiation (ED) subscales of the Emotion Awareness Questionnaire (EAQ). Internal consistency was high for the inappropriate touch scale (ITS) of the CKAQ-RIII and moderate for the appropriate touch subscale (ATS). Inter-item analysis showed that the majority of items were in an acceptable range. Pearson correlation coefficients analyses revealed strong associations between the two subscales of ITS and ATS, and the overall scores of the questionnaire. A mixed-subjects analysis of variance on the ITS showed an increase in knowledge post intervention, with third graders (8-9 year olds) generally scoring higher at baseline and demonstrating greater knowledge gains post intervention. A mixed-subjects analysis of variance was also conducted for the ATS where no significant increase in knowledge was found. Furthermore, analysis revealed a good concurrent criterion validity with good levels of agreement between CKAQ-RIII and ED, whereas no relationship was established between CKAQ-RIII and BA.

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

BACKGROUND

Child 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.

METHODS

This 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.

RESULTS

The 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.

CONCLUSION

The 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.

Reviewing the Focus: A Summary and Critique of Child-Focused Sexual Abuse Prevention

Due to the high incidence, and widespread detrimental health consequences, of child sexual abuse (CSA), effective prevention remains at the forefront of public and mental health research, prevention and intervention agendas. To date much of the focus of prevention has been on school-based education programs designed to teach children skills to evade adult sexual advances, and disclose past or ongoing abuse. Evaluation of sexual abuse prevention programs demonstrate their effectiveness in increasing children's knowledge of CSA concepts and protection skills, but little is known about their effects on children's capacity to prevent abuse. Moreover, concerns persist about the unintended side-effects for young children such as anxiety, worry and wariness of touch. This paper summarizes the recent history of CSA prevention and the critique of child-focused protection programs in order to demonstrate the need to compliment or replace these programs by focusing more on protectors in the children's ecology, specifically parents, in order to create safer environments in which abuse is less likely to occur.

Promoting young children's interpersonal safety knowledge, intentions, confidence, and protective behavior skills: Outcomes of a randomized controlled trial

Promoting young children's interpersonal safety knowledge, intentions confidence and skills is the goal of many child maltreatment prevention programs; however, evaluation of their effectiveness has been limited. In this study, a randomized controlled trial was conducted examining the effectiveness of the Australian protective behaviors program, Learn to be safe with Emmy and friends™ compared to a waitlist condition. In total, 611 Australian children in Grade 1 (5-7 years; 50% male) participated, with assessments at Pre-intervention, Post-intervention and a 6-month follow-up. This study also included a novel assessment of interpersonal safety skills through the Observed Protective Behaviors Test (OPBT). Analyses showed participating in Learn to be safe with Emmy and friends™ was effective post-program in improving interpersonal safety knowledge (child and parent-rated) and parent-rated interpersonal safety skills. These benefits were retained at the 6-month follow-up, with participating children also reporting increased disclosure confidence. However, Learn to be safe with Emmy and friends™ participation did not significantly impact children's disclosure intentions, safety identification skills, or interpersonal safety skills as measured by the OPBT. Future research may seek to evaluate the effect of further parent and teacher integration into training methods and increased use of behavioral rehearsal and modelling to more effectively target specific disclosure intentions and skills.