儿童性虐待的初级预防:以儿童为重点的干预措施

A. Pellai, Myriam Caranzano-Maitre
{"title":"儿童性虐待的初级预防:以儿童为重点的干预措施","authors":"A. Pellai, Myriam Caranzano-Maitre","doi":"10.21427/D7N427","DOIUrl":null,"url":null,"abstract":"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","PeriodicalId":30337,"journal":{"name":"Irish Journal of Applied Social Studies","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2015-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"10","resultStr":"{\"title\":\"Primary prevention of child sexual abuse: Child focused interventions\",\"authors\":\"A. Pellai, Myriam Caranzano-Maitre\",\"doi\":\"10.21427/D7N427\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"Sexual abuse is a problem affecting the psychosocial development of many children all over the world. 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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. 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引用次数: 10

摘要

性虐待是影响世界各地许多儿童心理社会发展的一个问题。流行病学研究表明,性虐待在所有人口、种族和家庭群体中蔓延,男性和女性都有,犯罪者既可以包括家庭圈子以外的人,也可以包括家庭圈子内的人。在过去的十年中,基于网络的对未成年人的性侵犯的全新现象给临床和预防领域的工作人员带来了新的挑战。在当今世界,大多数儿童性虐待的受害者仍然保持沉默,独自一人,得不到帮助。与此同时,大多数儿童和青少年没有接受基本的性教育、预防信息和生活技能,而这些是他们健康、安全和快乐成长所需要的。在针对儿童的规划得到推广之后,越来越多的证据表明,犯罪者也需要成为预防的目标。如果在他们虐待儿童的早期阶段就发现、认识和帮助他们,就可以有效地促进他们消除对儿童的性冲动,并产生积极的长期影响。本文描述了迄今为止在以学校为基础的初级预防领域所做的工作,以减少新一代的受害风险。它讨论了初级预防在过去是如何发展的,以及属于“数字原住民”一代的儿童和青少年的新的预防需求。尽管缺乏从有效性研究中得出的明确证据表明,在学校采取协调一致的行动是该领域初级预防的最佳资源,但迄今为止,现有的荟萃分析和指南证实,这是该领域最具有效性潜力的方法之一。鉴于这些评论,文章还讨论了神经科学的贡献如何使促进儿童和青少年预防活动的新程序成为可能,特别提到了世界卫生组织采用的以生活技能为基础的教育(LSBE)模式,作为实施针对儿童和青少年的预防项目的范例。性虐待是世界上最普遍但又被低估的社会病态之一。对儿童性虐待没有明确和普遍认可的定义,这在预防、临床和流行病学领域造成了不少问题。然而,这一领域的许多专家都同意美国医学协会提出的定义,即“儿童性虐待初级预防的参与:以儿童为中心的干预措施,使儿童参与尚未发育成熟且不能给予知情同意的性活动”(美国医学会,1992年,第10页)。在欧洲,欧洲委员会成员国在《欧洲委员会保护儿童免遭性剥削和性虐待公约》(最著名的是《兰萨罗特公约》)中有一个法律定义,其中规定:“每一缔约方应采取必要的立法或其他措施,确保将下列故意行为定为刑事犯罪:(一)与未达到法定进行性活动年龄的儿童进行性活动的;B.在下列情况下与儿童进行性活动:-使用胁迫、武力或威胁;或者——虐待是基于对儿童的公认的信任、权威或影响力,包括在家庭中;虐待是针对儿童特别脆弱的情况,特别是由于精神或身体残疾或依赖的情况”(欧洲委员会第201号条约系列)。这一定义使各缔约方有责任决定禁止与儿童进行性活动的年龄,而不是要规定和管理未成年人之间两厢情愿的性活动。正如美国医学协会和欧洲委员会的定义明确指出的那样,儿童性虐待的特点总是缺乏受害者的知情同意。但除此之外,我们知道,几乎所有的性侵案件都有一个问题,那就是受害者无法报案。更高的报告率将有助于防止进一步的再次受害,同时可能查明虐待的肇事者,使他接受临床治疗并面临法律诉讼。许多研究人员对这一现象的流行病学进行了分析和研究。所有最近的元分析,尽管数据存在差异,但都得出了同样的结论,儿童性虐待是一个严重的问题,因为7.9%的男性(7.4%,无异常值)和19.7%的女性(19.2%,无异常值)在18岁之前遭受过某种形式的性虐待(Pereda, Guilera, Forns, GómezBenito, 2009 a)。 性虐待是影响世界各地许多儿童心理社会发展的一个问题。流行病学研究表明,性虐待在所有人口、种族和家庭群体中蔓延,男性和女性都有,犯罪者既可以包括家庭圈子以外的人,也可以包括家庭圈子内的人。在过去的十年中,基于网络的对未成年人的性侵犯的全新现象给临床和预防领域的工作人员带来了新的挑战。在当今世界,大多数儿童性虐待的受害者仍然保持沉默,独自一人,得不到帮助。与此同时,大多数儿童和青少年没有接受基本的性教育、预防信息和生活技能,而这些是他们健康、安全和快乐成长所需要的。在针对儿童的规划得到推广之后,越来越多的证据表明,犯罪者也需要成为预防的目标。如果在他们虐待儿童的早期阶段就发现、认识和帮助他们,就可以有效地促进他们消除对儿童的性冲动,并产生积极的长期影响。本文描述了迄今为止在以学校为基础的初级预防领域所做的工作,以减少新一代的受害风险。它讨论了初级预防在过去是如何发展的,以及属于“数字原住民”一代的儿童和青少年的新的预防需求。尽管缺乏从有效性研究中得出的明确证据表明,在学校采取协调一致的行动是该领域初级预防的最佳资源,但迄今为止,现有的荟萃分析和指南证实,这是该领域最具有效性潜力的方法之一。鉴于这些评论,文章还讨论了神经科学的贡献如何使促进儿童和青少年预防活动的新程序成为可能,特别提到了世界卫生组织采用的以生活技能为基础的教育(LSBE)模式,作为实施针对儿童和青少年的预防项目的范例。性虐待是世界上最普遍但又被低估的社会病态之一。对儿童性虐待没有明确和普遍认可的定义,这在预防、临床和流行病学领域造成了不少问题。然而,这一领域的许多专家都同意美国医学协会提出的定义,即“儿童性虐待初级预防的参与:以儿童为中心的干预措施,使儿童参与尚未发育成熟且不能给予知情同意的性活动”(美国医学会,1992年,第10页)。在欧洲,欧洲委员会成员国在《欧洲委员会保护儿童免遭性剥削和性虐待公约》(最著名的是《兰萨罗特公约》)中有一个法律定义,其中规定:“每一缔约方应采取必要的立法或其他措施,确保将下列故意行为定为刑事犯罪:(一)与未达到法定进行性活动年龄的儿童进行性活动的;B.在下列情况下与儿童进行性活动:-使用胁迫、武力或威胁;或者——虐待是基于对儿童的公认的信任、权威或影响力,包括在家庭中;虐待是针对儿童特别脆弱的情况,特别是由于精神或身体残疾或依赖的情况”(欧洲委员会第201号条约系列)。这一定义使各缔约方有责任决定禁止与儿童进行性活动的年龄,而不是要规定和管理未成年人之间两厢情愿的性活动。正如美国医学协会和欧洲委员会的定义明确指出的那样,儿童性虐待的特点总是缺乏受害者的知情同意。但除此之外,我们知道,几乎所有的性侵案件都有一个问题,那就是受害者无法报案。更高的报告率将有助于防止进一步的再次受害,同时可能查明虐待的肇事者,使他接受临床治疗并面临法律诉讼。许多研究人员对这一现象的流行病学进行了分析和研究。所有最近的元分析,尽管数据存在差异,但都得出了同样的结论,儿童性虐待是一个严重的问题,因为7.9%的男性(7.4%,无异常值)和19.7%的女性(19.2%,无异常值)在18岁之前遭受过某种形式的性虐待(Pereda, Guilera, Forns, GómezBenito, 2009 a)。 作者将Finkelhor(1994)报告的儿童性虐待的国际流行率与最近的出版物进行了比较。他们的结论是,在15年期间,患病率基本保持不变,特别是对妇女的虐待案件(Pereda, Guilera, Forns, & Gómez-Benito, 2009b)。因此,鉴于这一问题在世界范围内的严重程度及其对全世界儿童的发展和福祉构成的风险,儿童性虐待在公共卫生领域是一个极其重要的问题,因此制定最有效的预防战略至关重要。这篇文章盘点了迄今为止关于儿童性虐待初级预防的了解,已经做了什么,需要做什么,特别是关于新的27爱尔兰应用社会研究杂志技术和所谓的基于网络的儿童性虐待案件的增加。本文特别侧重于初级预防,即针对健康人口的战略。在初级预防方面,我们指的是为防止某一特定人口群体产生健康问题而制定的所有战略。它以健康人口为目标,通常是普遍的(针对全体人口)或选择性的(针对高危人口)。预防策略包括提供信息(例如,定义CSA以及它在每个社会中是如何被低估的),培养技能(例如,如何预防它,儿童应该知道什么来阻止和离开危险情况,与谁交谈)和提供资源(例如热线,学校培训人员,使人们能够在任何形式的潜在虐待发生之前阻止它的资源)的组合。从历史上看,儿童性虐待的初级预防是通过两种定义明确的方法实现的,这些方法在文献中有所描述,并在世界许多地区大规模实施。第一种方法是建立在组织和管理针对学童(以及他们的老师和家长)的项目的基础上,旨在提高潜在性虐待受害者识别和避免危险情况的能力,并向依恋人物寻求帮助。第二种预防方法是基于这样一种想法,即成年人应该承担预防儿童性虐待的责任,公共卫生当局和预防专家应该求助于他们,而且只求助于他们,以减少案件的数量和频率。这就是Stop It Now的工作特色,该组织自1992年以来一直致力于帮助成年人、家庭和社区采取行动,保护儿童的安全,尤其是在他们受到伤害之前。成年人有责任为儿童创造安全的环境,并了解可能表明个人有可能对儿童进行性虐待的危险情况或行为的警告信号。这篇文章集中讨论直接针对儿童的预防战略。因此,我们将不讨论针对成年人的预防问题,包括滥用者或潜在滥用者。从这一点开始,我们将分析针对作为性虐待潜在受害者的未成年人的工作。以学校为基础的初级预防自20世纪70年代末以来,在学校,特别是在美国,推行了一项具体的预防行动程序。这是基于证据(Finkelhor & Browne, 1985),大多数性虐待受害者,在他们作为受害者的个人经历中,呈现出五个特征:儿童性虐待的初级预防:以儿童为中心的干预措施a)面对施虐者保持沉默,尽管存在明显的情绪不适迹象,这些迹象起到警告作用,帮助受害者意识到正在发生的事情必须被解释为危险和侵略;b)受害者对所发生的事情感到困惑,因为大多数受害者在受害之前从未收到过关于儿童性虐待的任何信息;c)对施虐者的情感矛盾,在许多情况下,施虐者是受害者非常熟悉并且经常爱的人d)对所发生的事情保密,这种情况自动允许施虐者进行进一步的虐待(也许也是对没有报告发生的同一受害者);e)没有专家的帮助请求和干预,以减少受害者的创伤程度或减少可能的短期、中期和长期临床后果的影响。未成年人一旦受到创伤,就会发现自己很孤独,常常感到无能为力和羞耻,无法向重要的依恋对象寻求帮助。 作者将Finkelhor(1994)报告的儿童性虐待的国际流行率与最近的出版物进行了比较。他们的结论是,在15年期间,患病率基本保持不变,特别是对妇女的虐待案件(Pereda, Guilera, Forns, & Gómez-Benito, 2009b)。因此,鉴于这一问题在世界范围内的严重程度及其对全世界儿童的发展和福祉构成的风险,儿童性虐待在公共卫生领域是一个极其重要的问题,因此制定最有效的预防战略至关重要。这篇文章盘点了迄今为止关于儿童性虐待初级预防的了解,已经做了什么,需要做什么,特别是关于新的27爱尔兰应用社会研究杂志技术和所谓的基于网络的儿童性虐待案件的增加。本文特别侧重于初级预防,即针对健康人口的战略。在初级预防方面,我们指的是为防止某一特定人口群体产生健康问题而制定的所有战略。它以健康人口为目标,通常是普遍的(针对全体人口)或选择性的(针对高危人口)。预防策略包括提供信息(例如,定义CSA以及它在每个社会中是如何被低估的),培养技能(例如,如何预防它,儿童应该知道什么来阻止和离开危险情况,与谁交谈)和提供资源(例如热线,学校培训人员,使人们能够在任何形式的潜在虐待发生之前阻止它的资源)的组合。从历史上看,儿童性虐待的初级预防是通过两种定义明确的方法实现的,这些方法在文献中有所描述,并在世界许多地区大规模实施。第一种方法是建立在组织和管理针对学童(以及他们的老师和家长)的项目的基础上,旨在提高潜在性虐待受害者识别和避免危险情况的能力,并向依恋人物寻求帮助。第二种预防方法是基于这样一种想法,即成年人应该承担预防儿童性虐待的责任,公共卫生当局和预防专家应该求助于他们,而且只求助于他们,以减少案件的数量和频率。这就是Stop It Now的工作特色,该组织自1992年以来一直致力于帮助成年人、家庭和社区采取行动,保护儿童的安全,尤其是在他们受到伤害之前。成年人有责任为儿童创造安全的环境,并了解可能表明个人有可能对儿童进行性虐待的危险情况或行为的警告信号。这篇文章集中讨论直接针对儿童的预防战略。因此,我们将不讨论针对成年人的预防问题,包括滥用者或潜在滥用者。从这一点开始,我们将分析针对作为性虐待潜在受害者的未成年人的工作。以学校为基础的初级预防自20世纪70年代末以来,在学校,特别是在美国,推行了一项具体的预防行动程序。这是基于证据(Finkelhor & Browne, 1985),大多数性虐待受害者,在他们作为受害者的个人经历中,呈现出五个特征:儿童性虐待的初级预防:以儿童为中心的干预措施a)面对施虐者保持沉默,尽管存在明显的情绪不适迹象,这些迹象起到警告作用,帮助受害者意识到正在发生的事情必须被解释为危险和侵略;b)受害者对所发生的事情感到困惑,因为大多数受害者在受害之前从未收到过关于儿童性虐待的任何信息;c)对施虐者的情感矛盾,在许多情况下,施虐者是受害者非常熟悉并且经常爱的人d)对所发生的事情保密,这种情况自动允许施虐者进行进一步的虐待(也许也是对没有报告发生的同一受害者);e)没有专家的帮助请求和干预,以减少受害者的创伤程度或减少可能的短期、中期和长期临床后果的影响。未成年人一旦受到创伤,就会发现自己很孤独,常常感到无能为力和羞耻,无法向重要的依恋对象寻求帮助。 正是由于这个原因,以在小学(首先)以及在中学的第一班提供的方案为基础的教育方法已经取得了进展 正是由于这个原因,以在小学(首先)以及在中学的第一班提供的方案为基础的教育方法已经取得了进展
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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
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