School-based child sexual abuse prevention programmes: The evidence on effectiveness
| DOI | https://doi.org/10.1108/17466660200800017 |
| Pages | 31-53 |
| Published date | 04 May 2008 |
| Date | 04 May 2008 |
| Author | Ian Barron,Keith Topping |
| Subject Matter | Health & social care,Vulnerable groups,Children's services |
31
Journal of Children’s Services
Volume 3 Issue 3 November 2008
© Pavilion Journals (Brighton) Ltd
1 Chartered
Educational
Psychologist and
Associate Tutor/
Lecturer in the
School of Education,
Social Work
and Community
Education,
University of
Dundee, Scotland
2 Professor of
Educational and
Social Research
in the School
of Education,
Social Work
and Community
Education at the
University of
Dundee, Scotland
Introduction
Incidence and prevalen ce statistics over the l ast
two deca des indicate that child sexual abuse
was a s ignificant is sue for soci ety occurring
across a ll socio-econo mic levels a nd in all ethnic
groups ( Dhooper & Sc hneider, 1995) . Nelson
and coll eagues (2002) identified t he long-term
consequenc es of child sexual abuse on children ’s
psychosoci al developmen t, including depression,
suicide, interpersonal difficulties, substance
misuse, anxiety disord ers, delinque ncy and
revictimis ation. Simila r findings w ere reported by
Paolucci and colleg ues (2001) a nd Cicchetti and
Toth (19 95), the lat ter covering all forms o f child
maltreatme nt.
In an attempt to address these consequences,
Cowen (1983) outlined two levels of prevention.
Primary prevention was seen as cost-effective
because it aimed to teach children how to avoid or
escape abusive situations, compared with coping with
the consequences of abuse. In contrast, secondary
prevention sought the identification of ongoing or
past abuse where children disclosed abuse during
or after an abuse prevention programme. Within
this context, schools became a key location for the
delivery of primary and secondary prevention as they
were centres for education, included the whole child
population and were places where children were at
risk (Finkelhor, 1984).
Prevention programmes taught children to
verbally resist and tell publicly what had happened
Ian Barron1 and Keith Topping2
Abstract
This narrative review explored the efficacy of school-based child sexual abuse prevention programmes
between 1990 and 2002. There were 22 efficacy studies that met clear inclusion criteria. Results covered
both methodological design and the range of outcome measures. Methodology was analysed through
four dimensions (target population, prevention programme implementation, evaluation methodology
and cost-effectiveness). Outcomes for children covered nine categories (knowledge, skills, emotion,
perception of risk, touch discrimination, reported response to actual threat/abuse, disclosure, negative
effects and maintenance of gains). The studies had many methodological limitations. Prevention
programmes had a measure of effectiveness in increasing children’s awareness of child sexual abuse as
well as self-protective skills. Beyond minimal disclosure rates, there was no evidence to demonstrate
that programmes protected children from intra-familial sexual abuse. For a small number of children
prevention programmes produced minimal negative emotional effects. Recommendations for future
research, policy and practice, include realistic outcomes for child participants and locating programmes
within wider abuse prevention measures.
Key words
Child sexual abuse; abuse prevention; efficacy; personal safety skills; child protection; programme
evaluation; victimisation
School-based child sexual
abuse prevention programmes:
The evidence on effectiveness
32 Journal of Children’s Services
Volume 3 Issue 3 November 2008
© Pavilion Journals (Brighton) Ltd
Reviews of the literature
Despite the dive rsity and limited sc ope of pr evious
traditi onal narrat ive review s from 19 90 onwards
(Finkel hor & Str apko, 1992; Gough, 1 993; Mayes et
al, 19 92; Milten berger & O ’Neil, 199 2; MacMill an
et al, 1994; Be vill & Ga st, 1998; Miltenberge r
& Robe rts, 1999; Carroll et al, 20 00), eviden ce
support ed the co nclusion th at most c hildren co uld
benefit from pre vention pro grammes th rough
concept s learned, increased knowledge and
acquire d self-prot ection ski lls. MacIn tyre and Carr
(2000) concluded that multi -systemic programmes
that f ocused on key adults in a c hild’s life were
more e ffective, that learni ng was be st through
discuss ion, video- modelling and behavi oural
methods and that children achieved m ore with
longer programmes. However, no review s were
able t o conclude that ther e had bee n an actu al
reducti on in abu se.
Meta-a nalyses o f effica cy studie s of sc hool-
based sexual a buse pre vention p rogrammes
confir med the main fin dings of the nar rative
review s. The m ost rece nt meta-a nalysis (Davis &
Gidycz , 2000) reviewed 27 studi es and found a
large effect s ize2 of 1.07. Sig nificant effects were
found for age, number of sessi ons, par ticipant
involv ement, ty pe of o utcome me asure an d use
of be havioural skills training. The hig hest effe ct
sizes were for program mes of f our sess ions or
more that util ised beh avioural training. Rispens
and c olleagues ( 1997) ex amined po st-test and
follow -up effec t sizes for 16 evaluatio n studies .
Signif icant mea n post-i nterventio n (d =. 71) and
follow up (d =.62) ef fect size s were found, wh ich
indica ted that abuse p revention programm es
were effective in teac hing chil dren sex ual
abuse knowledge and se lf-protect ion skil ls. The
modera tor varia bles of duration and con tent of the
progra mme (inte rvention character istics) and age
and s ocio-econo mic stat us (child charact eristics)
impact ed on ef fect siz e. The a uthors c oncluded
that the amoun t of in struction time an d explici t
traini ng in se lf-protec tion skil ls had an impact on
effect iveness.
In con trast, Hei dotting an d colleag ues’ (1995)
meta-an alysis of 18 studies , spanning pre-schoo l
and sc hool-age, found that brief pre vention
program mes also made an im pact. A ‘ moderate’
mean e ffect size was found for post -test know ledge
(d =.5 7) and a ‘medium’ mean effect size was
found from two weeks to one-year fo llow-up
(d =.4 7). Again, active be havioural teaching
methods were dis covered to be more effective.
School-based child sexual abuse prevention programmes: The evidence on effectiveness
(Reppucci et al, 1998). Such strategies partly evolved
from sex offender studies, where offenders reported
that they targeted children who they perceived as
more compliant and less likely to disclose (Budin &
Johnson, 1989). Programmes were therefore designed
to enable children to be more assertive.
From the c ontent of school-b ased abuse
prevention p rogrammes, it appe ared that most
programmes a ssumed that perpet rators were
strangers, w hereas the weight of evidence
suggested th at most sexual a buse was committed
by a known abuser (Finkelhor , 1994). Evidence also
existed sugg esting long-term h ome intervention w as
a more effe ctive strategy for preventing intra-fa milial
sexual abuse than school-based abuse prevention
programmes ( Wolfe, 1993). At a socio-political
level, Trude ll and Whatley ( 1988) argued that
prevention p rogrammes ignored the complexities o f
exceedingly challenging social contexts where, a t
worst, the blame was inadver tently landed with the
child for not having avoided the abuse or protected
themselves. In other words, prevention programme s
failed to recognise that the power in adult- child
relationships was located with the stronger
and more k nowledgeable adult, and violence
frequently o ccurred towards ch ildren because of
their percei ved and created vulnerability; that is,
children wer e unable to resi st, tell about o r avoid
abuse. Furth ermore, the emphas is in programmes
needed to be placed on saf e adults moving to
action to protect children, rather than on a naive
view of ch ildren protecting themselves. The au thors
contested th at intervention sh ould have focused on
wider social networks and no t just on the children.
The difficul ty in conducting meaningful
programme ev aluation has been highlighted by a
number of authors. The secre cy of abuse (Kri vacska,
1990), the documenting of th e absence of abu sive
incidents (K o & Cosden, 2001 ) and the lack of
exploration of children’s reac tions to programme s
directly wit h the children t hemselves (Finkelhor &
Dziuba-Leather man, 1995) were all seen as barr iers
to effective research.
Although the re were many una nswered questions
about the efficacy of abuse prevention program mes,
a growing number were delive red in American and
British scho ols over the 198 0s and 1990s, bu t with
little evalu ation. Many of t he programmes focu sed
on the ele mentary school yea rs because of th e high
incidence of abuse for young children (Finkelh or
et al, 199 0). Conte and Be rliner (1981) foun d that
60% of vic tims were less t han 12 years old , and the
average age for intra-familial abuse was 10.8 years
(Brassard et al, 1983).
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