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The Prevention of Childhood Sexual Abuse
Preventing Child Maltreatment Volume 19 Number 2 Fall 2009
David Finkelhor examines initiatives to prevent child sexual abuse, which have focused on two primary strategies:
Recent major offender management initiatives have included
Although these initiatives win approval from both the public and policy makers, little evidence exists that they are effective in preventing sexual abuse.
Moreover, these initiatives, cautions Finkelhor, are based on an overly stereotyped characterization of sexual abusers as pedophiles, guileful strangers who prey on children in public and other easy-access environments and who are at high risk to re-offend once caught.
In reality the population is much more diverse. Most sexual abusers are not strangers or pedophiles; many (about a third) are themselves juveniles. Many have relatively low risks for re-offending once caught. Perhaps the most serious shortcoming to offender management as a prevention strategy, Finkelhor argues, is that only a small percentage of new offenders have a prior sex offense record that would have involved them in the management system. He recommends
Finkelhor explains that school-based educational programs teach children such skills as
The programs also aim to
Considerable evaluation research exists about these programs, suggesting that they achieve certain of their goals. Research shows, for example, that young people can and do acquire the concepts. The programs may promote disclosure and help children not to blame themselves. But studies are inconclusive about whether education programs reduce victimization. Finkelhor urges further research and development of this approach, in particular efforts to integrate it into comprehensive health and safety promotion curricula.
Finkelhor also points to evidence that supports counseling strategies
High-profile, recent public policy initiatives aimed at protecting children from sex crimes have all focused on how to manage known sex offenders. The initiatives include efforts to control
Bluntly put, this policy area has been discouraging for practitioners and social scientists favoring evidence-based prevention. None of these high-profile strategies has been built on empirical evaluation, and virtually all have gone to national scale without research or even much pilot testing. [*2]
Several have been legislated and implemented over the objections of sex-offender management authorities. They may yet be shown to have some positive effects, but they also appear to be creating many serious fiscal, bureaucratic, and legal problems, as well as having other unintended negative consequences. [*3] It will be years before this is all sorted out.
Meanwhile, another less visible stream of prevention strategies that derive from the 1980s focuses on education and consists mostly of programs that teach children, families, and youth-serving organizations how to prevent and respond to sex offenses and risky situations. [*4]
These initiatives have been subjected to more evaluation research, though results are as yet inconclusive. The findings are generally positive, suggesting that educational programs achieve certain of their goals, but the research has not demonstrated unambiguously that the programs reduce victimization. [*5]
These programs have considerable, though not universal, support among practitioners, but their implementation has languished in recent years.
As a whole, it would have to be said that, as yet, no true evidence-based programs or policies exist in the area of preventing child sexual abuse.
Yet in spite of the evidentiary chaos, philosophical disagreement, and meager evidence base in this policy area, sex crimes against children have declined dramatically since the early 1990s, in concert with overall crime declines and other child welfare improvements. This is undeniably good news, suggesting that something is helping. But it is hard to ascertain whether any of the organized prevention initiatives have contributed to this decline.
The Prevention of Child Sexual Abuse
In this article I will briefly review organized prevention efforts,
noting in particular the evaluation evidence relevant to each.
I will also discuss some developing areas for prevention, try to draw implications from the sex crime decline, and conclude with some recommendations.
For purposes of this review, I define child sexual abuse
The definition includes offenders who are related to the child victims as well as those who are strangers. It includes offenders who are adults as well as those who are themselves children and youth. It includes certain kinds of non-contact offenses, such as exhibitionism and using children in the production of pornography, as well as statutory sex crime offenses, in addition to the sexual fondling and penetrative acts that make up a majority of the cases. I will refer to the offenders variously as child molesters, sexual abusers, and child sex offenders.
According to widely cited meta-analyses based on surveys of adults, sizable proportions of U.S. adults report a history of sexual abuse
In light of evidence that sexual abuse rates have declined in the past fifteen years, however, these estimates should probably not be applied to current cohorts of children.
Crime and abuse data are most frequently and accurately presented in terms of annual rates. One recent national victim survey estimated that 3.2 percent of children aged two to seventeen were sexually victimized in a single year (2002). [*8]
In terms of cases known to authorities, aggregated data show that child protection authorities substantiated 78,000 cases of sexual abuse nationally in 2006. [*9]
No data source aggregates the number of cases known to child protection authorities and those known to law enforcement.
Studies of risk factors for sexual abuse show girl victims outnumbering boys.
Other risk markers for child victimization include
Histories of sexual abuse are strongly associated with adverse social, psychological, and health outcomes in both retrospective and prospective studies. [*11]
Offenders are overwhelmingly male, ranging from adolescents to the elderly. There are two life-stage peaks in onset for offending,
Justice System Strategies
Orthodox “preventionists” do not typically favor criminal justice system approaches because they are “tertiary” strategies, applied after the harm has already occurred, and are often expensive. But justice system approaches to sexual abuse have captivated public and policy attention and, for that reason alone, cannot be ignored. Moreover, practitioners committed to their application believe that they have “primary prevention” effects, because in theory the fear of swift, certain, and serious punishment by the justice system will deter the abuse before it happens.
One fundamental problem regarding prevention policy in the justice system is that it is based on an overly stereotyped and generally mistaken characterization of the offender population. [*13]
The stereotype typifies child sexual abusers as exclusively adult men who are sexually oriented to pre-pubescent children (that is, pedophiles) and who thus are strongly motivated to offend. These men are seen as being guileful and skilled in relating to children, likely to prey on children they encounter in public environments, generally resistant to treatment, deterrence, or rehabilitation, and thus highly likely to offend again.
The well-publicized behavior of a worrisome core of offenders has helped reinforce this stereotype. Overall, the sex abuser population is much more diverse and less uniformly insidious and intractable than the stereotype might suggest.
First, most abusers are probably never caught, arrested, and convicted, [*14] which limits generalizations about this population. But among those who are, most are not pedophiles. In fact, about half of all victims are post-pubescent, ranging in age from twelve to seventeen, [*15] so that most of their offenders would not qualify as pedophiles.
Moreover, about a third of offenders against juveniles are themselves juveniles (an even larger share of the offenders against young juveniles are juveniles). [*16] These young offenders are also not pedophiles, but include a mixed group of generally delinquent youth and youth who engage in somewhat impulsive, developmentally transitory behavior. [*17]
Even among adults who victimize children under thirteen, at least a third or more do not qualify as pedophiles. [*18] The equation of sexual abuse with pedophilia is thus misleading.
[Third,] The notion that molesters use public venues or approach unknown children is also misleading. Among victims of sexual abuse coming to law enforcement attention,
Also in defiance of the child sexual abuse stereotype, as many as one-third of all adult offenses against juveniles are estimated to involve what have been called “compliant victims” or “statutory sex offenses.” Such offenses involve teens who have quasi-voluntary sexual relationships with much older adults, the dynamics of which can range from manipulation and seduction by the adult to aggressive initiation by the teen. [*20]
These are crimes with negative effects on youth and society as whole, but their dynamics differ from the stereotype of child molesting. [*21]
In Washington state, for example,
Meta-analyses that aggregate the findings of many studies estimate that
Sexual recidivism rates for juvenile offenders and family offenders are considerably lower than the overall rate, while rates for offenders against boys tend to be higher.
Child molesters are more likely to be educated and employed than other criminals, which researchers believe may help explain their relatively lower recidivism.
In sum, the child sex offender population is diverse. It ranges
Practitioners have available a variety of tools to assess the risk for re-offending. Although these tools are far from foolproof, they perform about as well as any social-scientific prediction instruments and have been improved in recent years. [*24]
The major criminal justice policy initiatives of recent years
Less prominent efforts
Despite wide implementation of these strategies, however, researchers have formally evaluated few of them. Still, some evidence about their success exists, and certain extrapolations can be made from similar policies in other crime domains.
In the next section I discuss some of these strategies and the evidence concerning them.
[a] Offender Registration
All states now have electronic sex offender registries. One goal of these registries is to allow more rapid apprehension of re-offenders; another is to prevent crime by deterring existing and future offenders.
Some observers, though, argue that registration, like a lot of offender management practices, makes it harder for offenders to reintegrate into society and violates the rights of those who have already paid their debt to society, particularly those forced to register retroactively.
Registries were implemented during the late 1990s, after crime had already begun declining, making it unlikely that registries are the primary factor in that decline, although they may have contributed.
Cohort and case control studies show mixed results, but some have positive, if very conditional, findings.
One time-series analysis, for example, found that registration laws had deterrence effects, specifically among offenders who knew their victims or lived near them. But though the study linked registration with reduced offending among first-time offenders, it found increased offending among those who were already registered, suggesting a possible boomerang effect from the stigma (increased difficulty finding jobs and housing, for example). [*25]
Another study looked at offending rates in ten states before and after registration laws had been implemented.
An evaluation in Washington state found lower recidivism rates among offenders who were in compliance with the registration laws than among non-compliant offenders, but the finding may have nothing to do with the effect of registration itself. [*27]
Another study also found a non-significantly lower recidivism rate for registrees, with a greater effect for felons than for misdemeanants. [*28]
Registration has not been adequately analyzed even by relatively low-quality studies. One can point to a few findings suggesting that registration helps, but also null findings and at least some suggesting negative effects. Analysts have found high rates of non-compliance with registries, and legislatures have recently tried to increase penalties for non-compliance and to bolster enforcement.
Before imposing such increased costs in the form of policing and incarceration, however, it would be wise to be more confident about the utility of registration. The issue is complicated by the arguments of some analysts that the public wants to know where sex offenders are, whether or not registration reduces sex crime. These arguments suggest that researchers should also investigate the effects of registration on public confidence in authorities and on the public’s sense of safety.
[b] Community Notification
Although community notification and registration are often implemented and studied together, community notification is in reality a separate policy. Many registries were developed originally as resources for police. Only later were policies developed (promoted by Megan’s Law in 1996) to inform the community in general and neighbors in particular of the whereabouts of offenders.
In some states law enforcement goes door to door, makes calls, and posts handbills. In theory such notification allows community members to take steps to protect themselves against specific offenders in their midst. It may also help law enforcement to educate the public about how to protect children in general.
Once again, critics say that it may inhibit the reintegration of offenders into society and result in more transience, maladjustment, and deviant behavior.
No high-quality studies exist, and the correlational studies have mixed results.
Researchers have, though, shown that notification makes families more likely to take steps to protect themselves. And public opinion surveys have generally found the public to favor notification laws. [*33]
Law enforcement personnel appear less favorable, because of the work involved and because of the belief of probation and parole officials that notification complicates their efforts to find jobs and housing for offenders *34]
Studies have documented the difficulties offenders have in finding jobs and places to live, and in avoiding harassment, [*35] when their status is made known. It is unclear how much community notification aggravates these problems.
Community notification has not been well studied. Correlational studies have found some links between notification and reduced offending, [*36] but because crime rates have been declining generally, it is impossible to be certain what role notification has played.
Nonetheless, notification policies appear to be popular with the public, who want to know where sex offenders are. Although informed citizens do appear to take some protective steps, it may be that their anxiety is unnecessary in most cases. Nor is it clear that the steps that families take are effective or based on a true understanding of the dynamics of sex offending.
Community notification seems to be based primarily on the belief that the danger is posed by strangers, who are in fact a minority of offenders. If community notification takes time away from other more effective things that law enforcement would otherwise be doing, it could be counterproductive.
[c] Mandatory Background Checks
Public offender registries have made it possible to identify potential offenders who may be applying to work or volunteer in various businesses and organizations. Searches are increasingly expected or required as part of standard employment practices. In theory these searches bar dangerous people from youth-serving environments and discourage others with records from applying. They impose costs, however, particularly on volunteer nonprofits, and questions have been raised about whether they in fact create safer environments. They may also disqualify otherwise useful volunteers or employees with minor offense records who pose little risk.
The true benefits and costs of background checks have not been systematically researched.
The private company with the largest franchise for background checks has reported, after five years of screening 3.7 million names,
It is not clear that those detected with criminal or sex offenses were being screened for work in child-serving organizations, because many other employers use these checks.
Conducting background checks has become such standard practice that it is not clear that evidence about their efficacy would have much effect on policy. However, research is still badly needed to help organizations and employers develop and use the results from these checks, because it is not at all clear what kinds of histories among which kinds of individuals indicate an unacceptable level of risk.
[d] Residency Restrictions
Since 2000, many states and localities have rushed to enact statutes and ordinances (often called Jessica’s Laws) restricting where sex offenders can live and visit. Thirty states as well as many localities have such statutes, which are purported to protect children in schools, day care centers, and churches from predatory activity by sex offenders. [*38]
The policies have been widely criticized by sex offender management authorities, who note that in some places it is almost impossible for offenders to find housing. Their increased instability and transiency makes it harder to keep track of offenders and raises the likelihood of re-offending. The restrictions can also have cascading effects, as no community wants to be left standing as a sex offender “haven.”
These policies have been adopted without any evidence about their efficacy. Critics have pointed to research showing how few offenses originate in contacts of the sort that would potentially be inhibited by such statutes. [*39]
Other research has pointed to the draconian restrictions such statutes impose on where offenders can live and has documented some increased transiency in the wake of their implementation. [*40]
The logic model behind these restrictions appears fundamentally flawed, given that most sexual abuse occurs within established family and social networks and also that motivated offenders, wherever they happen to live, can go where they wish in search of victims.
But because the restrictions have been widely implemented, these laws should be evaluated. Their appeal highlights two unfortunate realities.
[e] Sentence Lengthening and Civil Commitment
The period of incarceration for sex offenders has increased substantially over the past twenty years through
More recently, states have also developed policies under so-called “civil commitment” procedures to continue to hold some persons deemed to be sexually dangerous even after they have served their criminal sentences. [*]
No studies have tested whether sentencing practices have an effect on sex crime. Some studies of crime in general have linked higher incarceration rates with decreasing crime in general. [*41]
The effect is thought to result more from incapacitation than from deterrence. It is not clear how much of the improvement is achieved through longer sentences and how much through increased apprehension and incarceration of criminals.
Meta-analyses on the issue of sentence length suggest that length by itself bears no relationship to the likelihood to reoffend. [*42]
The high cost of increased incarceration, however, has been well established, as has the declining marginal advantage of incarceration as more people are incarcerated—because each new expansion of the prison population tends to involve more of the less recidivistic offenders.
It is unclear from current evidence the extent to which longer sentences and civil commitment do or can reduce overall risks of child molestation.
[f] Enhanced Detection and Arrest
The most elemental thing the criminal justice system can do about a crime is to increase its detection and disclosure and the likelihood that the offender will be arrested and prosecuted. Disclosure can terminate abusive relationships, which are frequently ongoing in child sexual abuse, and prevent future ones.
The offenders who are caught, even if they are not incapacitated, are deterred through embarrassment, humiliation, and increased vigilance by members of their social network. Other potential offenders are deterred by the circulation of news that offenders get caught.
Law enforcement has indeed increased its staffing and efforts in recent decades to promote disclosure and increase its capacity to investigate (including the use of undercover efforts), arrest, and prosecute.
The main criticism of these policies has concerned whether law enforcement has targeted too many minor offenders, such as juveniles or statutory sex crime offenders.
No studies have tested whether increased law enforcement efforts to disclose, investigate, and arrest have a deterrent effect on sex crime offending against children.
Some general research on criminology seems to support increased detection and arrest. Regarding drunken driving, robberies, and domestic violence, for example, increased enforcement has had demonstrable deterrent effects. [*43]
Interestingly, in the domestic violence area the deterrence effects have been limited to employed offenders. This finding is particularly relevant to child sexual abuse, much of which occurs in family and network contexts and involves offenders much more likely to be employed than other felons.
In the case of adolescent offenders, however, some research suggests that arrest is linked with increased subsequent offending. [*44]
The potential efficacy of detection and arrest is confirmed by evidence that many child sex abusers offend repeatedly before getting caught, but thereafter have relatively low recidivism rates compared with other offenders. Getting caught may thus play a crucial role in desistance. [*45]
General criminology research tends to confirm that offenders are deterred more by an increase in the risk of getting caught than by an increase in the severity of the likely punishment. [*46]
Thanks to the increased disclosure of child sex abuse to authorities, a crime that once rarely made an appearance in court now dominates court dockets.
No research, however, exists about the utility of enhanced detection and arrest. Logic and some research from related fields suggest that it could be helpful in preventing and deterring abuse, but such effects cannot be posited based on current evidence.
[g] Mental Health Treatment
Many practitioners and researchers have advocated in favor of counseling for sex offenders both to increase skills for behavioral self-regulation and to help resolve problems that may underlie the offending. The availability of treatment options has grown, but many offenders still do not receive high-quality treatments. Barriers to such treatment include
Of all justice system policies, therapy for sex offenders has received by far the most extensive evaluation.
In regard to adult offenders, the only evaluation that used the gold-standard experimental design (that is, it divided participants randomly into treatment and no-treatment groups) concerned a relapse-prevention treatment program that in the end proved to have no effect on recidivism. [*47]
But meta-analyses have identified as many as sixty-nine formal evaluations of treatment and have concluded that treatment reduces sexual re-offending as much as 37 percent. [*48]
Because these studies were not experimental, however, many observers have reserved judgment. [*49]
The treatment judged most effective by the meta-analytic studies was cognitive-behavioral therapy, which identifies the habits, values, and social influences that contribute to offending and teaches offenders self-management skills to reduce their risk.
Regarding juvenile sexual offenders, the research evidence is more convincing.
Three evaluations using experimental designs have supported the use of Multi-systemic Therapy, an intensive family intervention that targets parenting skills, affiliations with delinquent peers, and school problems. [*50]
Two other experimental studies have shown that cognitive-behavioral therapy can prevent additional reports of abusive or inappropriate behavior by preadolescents who are exhibiting such behavior. [*51]
Treatment does not guarantee public safety, but evidence-supported interventions should clearly be offered to juvenile offenders and youth with sexual behavior problems as a prevention strategy. Therapy for adult offenders may eventually prove effective in preventing additional crimes as well, but additional research is needed.
[h] Community Reintegration and Supervision
Some practitioners have argued for improved ways of integrating and supervising sex offenders when they return to the community to prevent re-offending. An innovative program originating in Canada called the Circles of Accountability and Support recruits and trains five community volunteers for each offender; one meets with the offender daily.
An evaluation over four and a half years found that offenders paired with Circles volunteers had a 70 percent lower rate of offending than those not so paired. [*52]
This is a promising idea that could use some additional evaluation.
Criminal Justice Policies: Conclusion
Enormous energy has gone into trying to manage sexual offenders to improve safety for children.
The fundamental weakness in management as a prevention strategy is that so few new molestations occur at the hands of persons with a known record of sex offending. Only around 10 percent of new arrests for sex crimes against children involve individuals with prior sex offense records. [*53]
Because it is likely that known offenders are more readily detected, the share of known offenders responsible for all child molestation overall (detected and undetected) is probably even smaller. Thus even strategies that are 100 percent effective in eliminating recidivism among known offenders would reduce new victimizations only a little.
Nonetheless, criminal justice strategies are highly popular and will continue be implemented. Their strongest justification is that they are widely seen by the public as part of a system that holds people accountable for serious crimes and provides a measure of justice for victims and their families.
Such justifications may even trump evidence eventually showing that the strategies fail to reduce risk. But to the extent that prevention and increased safety are key objectives of these strategies, researchers should establish a broader foundation and tradition of program evaluation to help guide the strategies in the most favorable direction.
It might be useful to establish an institution (perhaps associated with some prestigious entity like the National Science Foundation) to conduct evaluations and provide scientifically informed recommendations on sex offender management policy, just as the Centers for Disease Control and Prevention, for example, helps to promote informed epidemic management policy.
Today the empirical research offers relatively little basis for favoring one criminal justice strategy over another. Nonetheless, policy making must continue.
My own sense is that four areas deserve priority attention
The second major strain of child sexual abuse prevention efforts has focused on education. Primarily targeted at children themselves, these efforts have also been aimed at families, teachers, youth service workers, and others who may be in a position to intervene.[*54]
One central goal has been to
But the programs have also had clear secondary goals.
The educational programs have been most successfully delivered through schools, but have recently also been adopted by religious education programs and youth-serving organizations. Different programs have targeted children of different ages, ranging from preschoolers to elementary and middle school children. Increasingly the programs have been bundled into larger safety and health education curricula. Widely disseminated models include multi-session curricula for school-age children such as the Talking about Touching program[*55] and the Child Assault Prevention Program.[*56]
Although in wide use at one time during the late 1980s, the programs have drawn a variety of criticisms, among them
Research on Educational Programs
Many researchers have conducted studies of these educational programs, but few have addressed the question of whether they prevent abuse. Analysts have, however, examined various aspects of program performance, and overall they have bolstered the credibility of the programs by producing more reassuring than discomfiting findings.
Do children learn the concepts?
Many studies summarized in a variety of reviews find that children of all ages acquire the key concepts being taught.[*57] In fact, younger children show more learning than older children.[*58]
An international meta-analysis found that children of all ages who had participated in an education program were six to seven times more likely to demonstrate protective behavior in simulated situations than children who had not.[*59]
Such a finding is far from establishing that children can necessarily avoid abuse, but it lessens the concern that the concepts are categorically too complicated to be learned.
Are there unintended consequences?
Can offenders be foiled?
Some observers have argued that the victim empowerment messages of education programs (getting children to say no or retreat from molesters) are doomed to failure because of the inherent authority, motivation, and guile of molesters.[*66]
The argument is based in part on studies of convicted and incarcerated offenders who reported being highly motivated to abuse, unlikely to be deterred, and willing to use forceful or sophisticated strategies to engage their victims.[*67]
Such a characterization of abusers and abuse dynamics, however, is greatly oversimplified. As noted, it fails to take into account the wide variety of offenders and offense situations, many of which would be suited for child refusal tactics.[*68]
Such situations would include encounters with youthful offenders, such as babysitters or peers, and with adult offenders who may be tentative or anxious in their approach, as well as public encounters, such as on buses, where the child may be able to elicit assistance.
In addition, the targets of such education extend beyond young children to include adolescents who have considerably more skill and authority in their own right.
In addition, the goal of education is
Meeting such goals could justify the programs even if resistance and avoidance were in themselves difficult to achieve.
Does education prevent victimization?
No studies based on strong research designs have looked at the question of preventing abuse. Two observational studies that tried to assess the issue yielded somewhat mixed findings.
Additional inferential support for educational programs to prevent sexual abuse comes from broader research on other forms of school-based prevention. A variety of programs with similar theoretical underpinnings have proven effective in high-quality randomized controlled evaluations.[*72]
One such program attempts to reduce bullying.[*73] Other successful school-based prevention programs are aimed at drug use, pregnancy prevention, and interpersonal skills development. Like sexual abuse prevention programs, many of these programs are cognitively complicated, involve judgments about the intentions of other people, and attempt to train children to resist pressures from other, in many cases, more authoritative people. The scientific literature is conclusive that this type of approach works as a general prevention strategy.[*74]
Does education accomplish other goals?
Exposure to a sexual abuse prevention program also appears to have other benefits. A meta-analysis reports evidence that the programs result in increased disclosure.[*75] One study also found that program-exposed youth were less likely to blame themselves in the wake of victimization.[*76] Reductions in self-blame are believed to be associated with better mental health outcomes among those who experience sexual abuse.[*77]
Although researchers have conducted no experimental evaluations of whether educational programs prevent sexual abuse, they have provided a variety of supportive empirical findings so far. They show, for example, that young people do acquire the concepts.
All this evidence suggests that the approach offers promise and should be further developed and evaluated.
Intimations of potential success also undermine the argument among critics that it is not “moral” or fair to place the burden of prevention on children. Although researchers and practitioners agree that children should not be given sole responsibility for prevention, nonetheless, it might also be considered morally reprehensible not to equip children to take potentially effective actions to prevent sexual abuse.
It might, for example, be said that adult motorists should be responsible for protecting children on bicycles from collisions with automobiles, but few would argue that children should not wear helmets when biking. Likewise, it might be said that the responsibility to protect children from kidnappers should be with adults and law enforcement, but few would argue against teaching children not to get into cars with strangers. The “burden of responsibility” argument may mean that adults should do everything they can. But it is not an argument against providing children with potentially useful prevention skills.
Educational Programs: Conclusion
Given some encouraging findings and a prevention model that has proven successful in other youth safety areas, it would seem prudent to continue to pursue educational strategies to prevent sexual abuse.
The main challenge would appear to be access. Schools that are under pressure to enhance their academic programs are also receiving appeals to add sexuality education, dating and domestic violence, bullying, suicide prevention, and Internet safety content to their already-full curriculum.
The key question for sexual abuse prevention is whether it can be successful if it is part of a more comprehensive prevention curriculum. Certainly there is overlap in many of the skills that these programs teach — refusal, help-seeking, emotion management, and decision making. It would be useful to develop and implement more comprehensive programs and then to evaluate them to assess whether their content allows prevention in each domain to be successful.
In addition, educational approaches should expand to encompass all types of sexual abuse and sex crimes against children, including peer sexual assault in dating relationships, statutory sex crimes between teens and considerably older adults,[*78] and both new and conventional kinds of sex offenses that are being facilitated by the Internet. [*79]
Community Prevention of Offending
In addition to justice system efforts to control known offenders and educational efforts directed at children, a number of other strategies to prevent sexual abuse have been proposed or implemented on a smaller scale.
Drawing on other community-oriented (as opposed to clinic- or school-based) primary prevention strategies in public health, one recent concept has proposed trying to target potential abusers (usually through public advertisements) with messages that reinforce the awareness that their behavior is wrong and harmful, and urging them to seek help, often through a confidential telephone hot line.
A related approach has tried to mobilize third parties or what have also been called “bystanders” — for example, family members and friends and colleagues of either victims or offenders — to detect situations where abuse is actually or potentially occurring and to intervene to protect the child or report the situation.
Some surveys have shown that overall community knowledge and attitudes about sexual abuse can shift in the wake of ad campaigns.[*80] Follow-up studies have also shown that some offenders do contact the hot lines, meaning that some potential offenders at least attend to the publicity.[*81] It is not clear, however, whether the hot line calls have prevented any abuse. The calls, for example, may be simply from individuals already well-inhibited by conscience about their desires.
The bystander research literature is better developed. Some high-quality studies about bystander education in high schools and college campuses show that programs about rape and interpersonal violence are capable of changing attitudes and encouraging actual interventions among bystanders.[*82] No studies have shown yet that they reduce the likelihood of sexual assault. But some studies suggest that changing bystander attitudes can decrease bullying among children.[*83] This line of research is particularly encouraging about the possibility of bystander education to prevent peer sexual abuse.
Appeals to potential offenders seem to work best when they involve behavior that is normatively ambiguous or has some subcultural support — for example, driving faster than the speed limit or furnishing liquor to minors. But most sexual acts between adults and children are not in this category. Nor are they similar to the other public health behaviors that have been successfully targeted by advertising, such as smoking or even hitting children, both of which have had considerable normative support, as indicated by public opinion surveys.
Some forms of sexual abuse do involve normative ambiguities — for example, adults seducing apparently willing teens — and public awareness campaigns directed at potential offenders in these cases may have the greatest chance of success.
A fundamental problem with the hot line and self-referral strategy for potential offenders is that in the current statutory and retributive environment, it is hard to promise or persuade an offender that he will get confidential help. Nor is it clear that promises of confidentiality are ethical. So this seems a strategy fraught with difficulties and without good models of success from other domains.
By contrast, bystander mobilization does seem promising. Models in related areas show its potential for success. The strategy should be more formally developed and evaluated, but as it could easily be incorporated into the school-based educational strategy, it is probably best not thought of as a stand-alone strategy.
Harm Mitigation as Prevention
Prevention strategies in child sexual abuse should encompass efforts to minimize harm as well as to reduce occurrences, to reduce some of the personal and social costs of sexual abuse associated with its legacy of mental health, physical health, and interpersonal problems.
The best-supported, evidence-based practices in the sexual abuse field are the therapeutic interventions that have been developed to mitigate harms among victims.
Five clinical trials have established that cognitive-behavioral therapy with child sexual abuse victims and their families is effective at reducing symptoms of post-traumatic stress.[*85] Trauma-focused cognitive-behavioral therapy involves a package of counseling interventions that
Some evidence also shows that Children’s Advocacy Centers improve outcomes for victims by providing child-sensitive interviewers, arranging for medical evaluations, and connecting victims to mental health services.[*86]
Not all children have symptoms or difficulties in the wake of sexual abuse,[*87] so a key research challenge is to ascertain what level of intervention is needed for which children. But clearly a great deal can be done to minimize harm even after an experience of abuse.
A variety of other possible avenues for prevention have also been suggested. F
or example, Stephen Smallbone, William Marshall, and Richard Wortley[*88] describe a strategy of “developmental prevention” to forestall some of the developmental deficits that may lead a person to become a sexual abuser —
The authors also point to a set of “situational prevention” strategies that try to alter environments or inter-actional contexts (particularly in child-serving organizations) to make abuse less likely — for example, the Boy Scout requirement of “two-deep leadership” prohibiting private activities between one adult volunteer and one child.
Although the Centers for Disease Control and Prevention has developed guidelines for preventing abuse in youth-serving organizations,[*89] few other coherent programs and no evaluations have yet been undertaken around such ideas.
Another speculative prevention strategy has involved attempts to develop a psychological screening tool to identify possible abusers, even those without criminal histories.[*90] A key problem with this strategy is that the many false positives from such a screen could risk branding innocent people as child molesters (or even as potential child molesters).
Decline in Incidence: Implications for Prevention
Although the field of child sexual abuse cannot yet point to many proven prevention strategies, it can take considerable encouragement and learn lessons from recent trends.
Sex crimes against children appear to have declined dramatically in recent years.
The fact that the evidence for declines comes from victim self-report studies as well as official data tends to confirm that these trends are real and not due simply to reporting or other artifacts.[*92] Other analyses of the data also discount the argument that trends are artifacts.[*93]
Several salient features of the declines are worth highlighting to identify possible lessons for prevention. The declines occurred, not alone, but in the context of large reductions in crime in general and in physical abuse as well, and at a time when many other child welfare indicators, including teen pregnancy, teen suicide, running away, and drug abuse, were improving. The sex abuse declines, like some of the other positive trends, began between 1992 and 1995 after a worsening trend during the late 1980s. The declines did not appear to be specific to type of victim, or offender (family, acquaintance, stranger, juvenile, or adult), or confined to certain regions.
A recent review noted four explanations consistent with the timing and breadth of the trends.[*94]
No evidence as yet causally connects any of these developments with the declines in sexual abuse, but the declines themselves have possible implications for prevention policy.
No strong scientific evidence points as yet in the direction of one strategy or program to prevent sexual abuse. Clearly more research is needed to help develop and identify such strategies.
In setting priorities for further development, educational programs using school settings have some claim, based on five convergent lines of evidence and argument.
The arguments against these child-focused educational programs — that they cannot foil abuse by adults and that they put all the burden on children — have, as noted, major flaws. Some offenders, especially other youth and ambivalent adults, can almost surely be dissuaded, even by children. Moreover, other child-focused prevention techniques — such as wearing bicycle helmets — have been embraced after they have been proven to work.
Research on such educational programs, however, cannot be the sole focus of prevention, because the research evidence is still somewhat equivocal and because in reality advocates have investments in other strategies as well. In particular, the management of known offenders will continue to be a strong preoccupation of the public and policy makers.
Sex offender management strategies pose many problems. The strategies are limited in what they can accomplish, because they focus only on the small group of offenders who have already been identified and ignore all the rest. Many of the strategies are based on flawed logic models and misconceptions about the predominant dynamics of sexual abuse.
Moreover, the research evidence in support of these strategies is equivocal. Yet still, they have tremendous support among influential policy makers, many of whom may not be interested in or responsive to evaluation results. Indeed, policy makers’ pre-occupation with these offender management strategies likely diminishes the resources for and interest in other potential strategies.
There is a clear need to rejuvenate evidence-based practice in offender management policy, but doing so is a daunting challenge. Some jurisdictions, such as Washington state[*95] and Canada,[*96] are fostering closer collaborations between researchers and policy makers, and these may help. Researchers in the field also need to propose well-designed experiments. But politicians and corrections and law enforcement officials may also have to take courageous actions to make evaluation a larger component of policy making in this area.
Outside of the justice arena, treatment services should be made available to children who have been victimized and who have symptoms or other disturbances and concerns in the wake of abuse. Solid evidence shows that certain forms of cognitive-behavioral therapy reduce such problems. National initiatives are already under way to make such treatment standard and widely available,[*97] and its successes should be highlighted and imitated by those who want to see a planned, empirically based approach applied to related sexual abuse prevention programming.
Other strategies for preventing sexual abuse and its consequences, such as community publicity efforts or outreach to potential offenders, are certainly worth exploring as well.
However, it would not be wise to see these strategies as a substitute for school-based prevention,[*98] especially given evidence that major improvements have occurred under current practices that do include such prevention approaches. New strategies should be viewed as additions rather than alternatives and should be required to show empirical promise before being widely embraced.
Sexual abuse is a special challenge, different in many of its dimensions from other types of child maltreatment, crime, and child welfare problems. But enormous strides have been made to understand the problem, educate the public, and mobilize resources to address it. With additional research and program development, there is every reason to believe much more can be accomplished.