Primary prevention of child sexual abuse: Child focused interventions

Sexual abuse is a problem affecting the psychosocial development of many children all over the world. Epidemiological studies have demonstrated that sexual abuse is spread across all demographic, ethnic and family groups, in both males and females, and perpetrators can include those outside the family circle as well as within it. In the last decade the whole new phenomenon of Internet-based sexual offending against minors has brought new challenges for those working in both the clinical and prevention fields. In the world today, most victims of child sexual abuse still remain silent, alone and without help. At the same time, most children and teens do not receive basic sex education, preventive information and life skills that they need to grow up healthy, safe and happy. And after the promotion of programmes targeting children, there is growing evidence that perpetrators also need to become a target for prevention. If they are detected, recognized and helped at an early stage of their abusing career, extinction of their sexual drive towards children can be promoted effectively and with positive longterm effects. This paper describes what has been done to date in the field of schoolbased primary prevention to decrease victimisation risks among the new generations. It discusses how primary prevention has been developed in the past and the new prevention needs of children and teens belonging to the “digital natives” generation. Despite the lack of clear evidence derived from studies of effectiveness to show that concerted action in schools is the best resource for primary prevention in this field, to date the available meta-analyses and guidelines confirm that this is one of the methods with the best potential for effectiveness in this field. In the light of these remarks, the article also discusses how the contribution of the neurosciences has made possible the promotion of new procedures for preventive activities with children and adolescents, with particular reference to the Life Skills Based Education (LSBE) model adopted by the World Health Organisation as the paradigm for the implementation of prevention projects aimed at children and adolescents. Introduction Sexual abuse is one of the most widespread yet underestimated social pathologies in the world. There is no unequivocal and universally recognised definition of child sexual abuse and this has created not a few problems in the prevention, clinical and epidemiological fields. Nevertheless, many specialists working in this area agree on the definition put forward by the American Medical Association, “the engagement of a Primary prevention of child sexual abuse: Child focused interventions 26 child in sexual activities for which the child is developmentally unprepared and cannot give informed consent” (AMA, 1992, p. 10). In Europe, there is a legal definition Council of Europe member States in the Council of Europe Convention for the Protection of Children against Sexual Exploitation and Sexual Abuse (best known as the Lanzarote Convention) which states that “Each Party shall take the necessary legislative or other measures to ensure that the following intentional conduct is criminalised: a. engaging in sexual activities with a child who, according to the relevant provisions of national law, has not reached the legal age for sexual activities; b. engaging in sexual activities with a child where: – use is made of coercion, force or threats; or – abuse is made of a recognised position of trust, authority or influence over the child, including within the family; or – abuse is made of a particularly vulnerable situation of the child, notably because of a mental or physical disability or a situation of dependence” (Council of Europe Treaty Series No. 201). This definition gives each Party the responsibility to decide the age below which it is prohibited to engage in sexual activities with a child and is not intended to rule and govern consensual sexual activities between minors. As both the AMA and the Council of Europe definitions clearly state, child sexual abuse is always characterized by the lack of informed consent on the part of the victim. But besides this, we know that the problem connected with nearly all cases of sexual abuse is also the inability of the victim to report the abuse. Higher reporting rates would help prevent further re-victimisation and at the same time potentially identify the perpetrator of the abuse and make him undergo clinical therapy as well as face legal proceedings. The epidemiology of the phenomenon has been analysed and studied by numerous researchers. All the most recent meta-analyses, despite disparity of data, come to the same conclusion that child sexual abuse is a serious problem, as 7.9% of men (7.4% without outliers) and 19.7% of women (19.2% without outliers) have suffered some form of sexual abuse prior to the age of eighteen (Pereda, Guilera, Forns, GómezBenito, 2009 a). The authors compared the international prevalence rates of child sexual abuse reported by Finkelhor (1994) with more recent publications. They concluded that in a 15-year period the prevalence rate had remained more or less constant, especially regarding cases of abuse towards women (Pereda, Guilera, Forns, & Gómez-Benito, 2009b). So, in view of the extent of the problem worldwide and the risk that it poses to the development and wellbeing of children all over the world, child sexual abuse represents a subject of enormous importance in the field of public health and it is therefore essential to develop the most effective prevention strategies. This article takes stock of what has so far been learnt about primary prevention of child sexual abuse, what has been done and what needs to be done, particularly regarding new 27 Irish Journal of Applied Social Studies technologies and the increase in so-called web-based child sexual abuse cases. This article focuses in particular on primary prevention, that is, those strategies aimed at the healthy population. The context of prevention By primary prevention we intend all those strategies developed in order to prevent a health problem arising within a specific population group. It is aimed at the healthy population and is usually universal (aimed at the entire population) or selective (aimed at the at-risk population). Prevention strategies include a combination of providing information (for example, defining CSA and how it is underestimated in every society), building skills (for example, what to do to prevent it, what children should know to stop and leave at-risk situations, whom to talk to) and providing resources (for example hotlines, trained personnel in schools, resources enabling people to stop any form of potential abuse before it happens). Historically, primary prevention of child sexual abuse has been realised through two well-defined approaches, described in the literature and implemented on a large scale in many areas of the world. The first approach is based on the organisation and management of programmes directed at schoolchildren (and at their teachers and parents) and aimed at increasing the ability of potential victims of sexual abuse to recognise and avoid at-risk situations and seeking help from attachment figures. The second preventive approach is based on the idea that it is adults who should bear responsibility for the prevention of child sexual abuse, and that it is to them and only to them that public health authorities and specialists in prevention should turn to reduce the number and frequency of cases. This approach has characterised the work of Stop It Now, an organisation that since 1992 has aimed to help adults, families and communities by taking actions that keep children safe – especially before they are ever harmed. It is the responsibility of adults to create safe environments for children and to understand the warning signs of risky situations or behaviour that might indicate an individual is at risk of sexually abusing a child. This article concentrates on preventive strategies aimed directly at children. Consequently, we will not pursue the topic of prevention directed at adults, including abusers or potential abusers. From this point on we shall analyse the work directed at minors as potential victims of sexual abuse. School-based primary prevention Since the end of the 1970s, a specific procedure for preventive action has been promoted in schools, especially in the United States. This was based on evidence (Finkelhor & Browne, 1985) that most victims of sexual abuse, in their individual experience as victims, presented five characteristic features: Primary prevention of child sexual abuse: Child focused interventions 28 a) Silence in the face of the abuser, despite the presence of clear signs of emotional discomfort, signs that function as warnings to help the victim realize that what is happening has to be interpreted as both danger and aggression; b) The victim’s confusion as to what was taking place, considering that most victims never received any information about child sexual abuse before their victimization; c) Emotional ambivalence towards the abuser, who in many cases is someone the victim knows well and often loves d) Keeping secret what has happened, a condition that automatically permits the abuser to carry out further abuse (perhaps also on the same victim who did not report the occurrence); e) No request for help and no intervention on the part of a specialist able to reduce the level of the victim’s traumatization or to reduce the impact of possible shortmediumand long-term clinical consequences. The minor, once traumatized, finds him/herself alone, often burdened by a feeling of impotence and shame, and feels unable to ask an important attachment figure for help. It is precisely for this reason that the educational approach, based on programmes to be offered in primary school (in the first place) but also in the first classes of secondary school, has