The Effectiveness of School-based Child Sexual Abuse Prevention Programmes:
A Systematic Review
Ian Barron
Doctorate in Educational Psychology
May 2008
CONTENTS
ACKNOWLEDGEMENTS
DECLARATION
ABOUT THE AUTHOR
ABSTRACT
INTRODUCTION
Literature Review
Background
Aims of the Review
Definitions
Child Sexual Abuse
Efficacy
Process evaluation
Outcome evaluation
Terminology
Why is this research important?
Traditional narrative reviews of the literature
Meta-analyses of the efficacy of child sexual abuse programmes
Political agendas
Local Authority and voluntary agency partnership imperatives
METHODS
Methodology for literature review
Exclusion and inclusion criteria
Criteria for inclusion
Definitions
Child sexual abuse
Prevalence
Incidence
Who is causing the problem?
Perpetrators
Summary of prevalence and incidence statistics
Efficacy
Prevention
RESULTS
Author, Date and Country
Total number of studies that met the criteria (1990-2002)
Researchers who conducted most efficacy studies
Geographical location of studies
Journal publication and date
Target population
Sample size
Gender
Age and grade
Socio-economic status
Urban/rural/suburban location
Ethnicity
Prevention programme implementation
Named programmes
Type of programme intervention
Number and length of sessions
Programme presenters
Type of evaluation study
Pre and post-test design, control groups and random allocation
Evaluation tools
Programme integrity check
Attrition rates
Measures of cost effectiveness
Outcomes for children
Knowledge of abuse prevention concepts
Comparison of programmes design
Evaluation of knowledge
Post-test and comparison/control group
Pre and post-test (no control group)
Pre and post-test with control group
Pre and post-test with control group (random allocation)
Abuse prevention skills
Emotional gains
Perception of risk
Disclosure
Maintenance of effects
Six weeks
Two to five months follow-up
One year follow-up
High School follow-up
Multiple exposure and follow-up
Negative effects
Evidence of some form of negative effect
Evidence of no negative effect
Teacher outcomes
Parental outcomes
DISCUSSION
Target population
Sample size
Demographic analysis
Studies omitted from the review
Prevention programme implementation
Outcomes for children
Knowledge
Prior knowledge
Child development and conceptual learning
Difficult concepts
Self-protection skills
Subjective experience and emotional gains
Perception of risk
Disclosure rates
Maintenance
Negative effects
Child characteristics
Teacher outcomes
Parental outcomes
Conclusions
Recommendations for programme developers
Recommendations for future research
LIST OF TABLES
REFERENCES
APPENDICES
ACKNOWLEDGEMENTS
I am grateful to the following that have played a key role in enabling this Doctorate to happen:
Professor Keith Topping (School of Education, Social work and Community Education, University of Dundee) for his support and invaluable advice as my doctorate supervisor.
Les Meade, Principle Psychologist, Dundee City Council, for his support in enabling the Doctorate to be a part of my continuing professional development within a local authority context
Jim Collins (Service Manager, Education Department, Dundee City Council) for providing part funding.
Laurie Mathews (Eighteen and Under) for commissioning the research and for Eighteen and Under for providing part funding.
The staff, children and families at Eighteen and Under who were involved in the research
The children and staff involved in the evaluation schools
Jane my wife for her generosity in giving her support and time.
Rodger Flavahan, Principle Psychologist, Angus Council, for persisting in keeping the doctorate door open for me, at its inception, as a route of development.
Pamela Black who reformatted tables one and two.
DECLARATION
I am the sole author of this paper. Unless otherwise stated, all references cited have been consulted by the undersigned. Neither this paper nor any part thereof has previously been accepted for a higher degree.
Ian Barron (May 2008)
ABOUT THE AUTHOR
This review originated as an example of what Lofland and Lofland (1995) called ‘starting where you are’. I was an educational psychologist (in local authority employment) of 14 years experience at the time of beginning the doctorate. I had provided training on a broad range of topics in child protection for teachers, educational psychologists and other education department staff as well as on a multi-agency basis for ten of those years. I had sat on the multi-agency child protection committee and policy development sub-committee in Angus Council for four years. At the time of beginning the doctorate I was the child protection designated officer for Dundee Educational Psychology Service. I had participated in local authority education department policy working groups for the development of child protection and personal safety within the curriculum and for anti-bullying. I had worked collaboratively with schools to enable them to develop personal safety curriculum for children with special needs. I collaboratively set up with both other professionals and survivors a help-line for male survivors of child sexual abuse (M-Line). This service expanded to the extent that it became entirely run by survivors for survivors of abuse. A further step was the partnership of M-Line with a service for female survivors of child sexual abuse. Finally at the time of beginning the doctorate I was part of a parliamentary cross-party working group on survivors of child sexual abuse.
Other great influences in my service delivery to the local authority included video interaction guidance (formerly known as SPIN), solution focused working, person centred planning and skilled helping. Principled and evidence based practice was at the core of my service delivery.
At the time of beginning to write the doctorate I was a 40 year-old middle class married heterosexual male with no dependents. In my youth I had experienced a Scottish comprehensive secondary school education in the north east of the country.
ABSTRACT
Literature Review
This review explored the research on the efficacy of school-based child sexual abuse prevention programmes. The aim of the review was to describe the breadth and depth of research related to efficacy studies in child sexual abuse primary prevention programmes. The review was a traditional narrative review tackled in a systematic and thorough way. There were 22 efficacy studies which met clear criteria. Results covered both methodological design issues 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 different categories of measures (knowledge, skills, emotion, perception of risk, touch discrimination, reported response to actual threat/abuse, disclosure, negative effects and maintenance of gains). Knowledge and attitude outcomes for parents and teachers were also examined. Due to the studies methodological limitations (e.g. few studies with control groups, the lack of random allocation of participants, the variety of outcome measures and the lack of standardized psychometric measures) it was difficult to come to any clear conclusions. Despite the methodological limitations most researchers indicated that their results showed that school-based sexual abuse prevention programmes had a measure of primary prevention effectiveness in increasing children’s awareness of child sexual abuse as well as self-protective skills. However there was no evidence to demonstrate that these programmes protected children from intra-familial sexual abuse, other than at a secondary prevention level of disclosure. For a small number of children abuse prevention programmes produced negative emotional and behavioural effects. These were not to a level of statistical significance but did have practice implications for teachers and other programme presenters. Recommendations for future research and for programme developers were provided.
The Effectiveness of School-based Child Sexual Abuse Prevention Programmes:
A Systematic Review
INTRODUCTION
Literature Review
This review explored the research on the efficacy of child sexual abuse prevention programmes and was a free standing paper as well as an introductory chapter to the empirical study. The review aimed to set the context and prepare the ground for later research both within the empirical study as well as for other researchers in the field. This review was a traditional narrative review tackled in a systematic and thorough way. The aim of the traditional narrative review was to gain and include the breadth and depth of research related to efficacy studies in child sexual abuse prevention programmes.
Despite the rapid growth internationally, in the implementation of child sexual abuse prevention programmes in schools, there was a lack of systematic evaluation of the effectiveness of such programmes. Child sexual abuse prevention programmes had therefore mostly been implemented on trust, rather than on any evidence of effectiveness (Finkelhor and Dzuiba-Leatherman, 1995). In addition, Jordan (1993) noted that such abuse prevention programmes were often built on false assumptions. Jordan emphasised the need to examine the assumptions underlying abuse prevention programmes particularly the distinction between detection and prevention.
At a national level, at the time of the review, the political agenda in Scotland highlighted the need for prevention and identification of child sexual abuse in schools, and recommended the expansion of abuse prevention programmes. Locally in Dundee, the city council proposed to implement the abuse prevention VIP materials (‘Very Important Person’ for children and ‘Violence Is Preventable’ for adolescents) into all Dundee schools through Scottish Executive funding. This review provided a research context as the first step in embedding a measure of evaluation into the child sexual abuse prevention programme, VIP (1998). It was anticipated that this review along with a future efficacy study of the implementation of the VIP programmes would contribute to the education departments reflections on the appropriateness or otherwise of city wide developments.
Background
Essentially, the child sexual abuse prevention programmes under review aimed to teach children knowledge and skills to help them avoid becoming victims of child sexual abuse. Krivacska (1989) argued that such prevention programmes needed to be set within a theory of both causative and maintaining factors for abuse. Of relevance, was Finkelhor’s seminal paper (Finkelhor, 1984), where he postulated that there were four preconditions necessary for sexual abuse to occur:
· The perpetrator must be motivated to abuse, leading to, for example - intervention for people who displayed behavioural and cognitive characteristics of perpetrators but who had not actually abused or programmes which focused on sex offenders’ motivations in an attempt to avoid re-offending.
· The perpetrator must overcome internal inhibitions, leading to, for example - sex offenders cognitive distortions being challenged within a backdrop of clear societal messages about what abuse is and its impact on children
· The perpetrator must overcome external inhibitions, leading to, for example - custodial sentences for offenders; vetting of job applicants for those in contact with children; safe environments created through clear behavioural protocols of what is safe and unsafe behaviour and safe adults’ increased awareness of how perpetrators operate as well as the impact of abuse on victims (Wyre, 1993).
· The perpetrator must overcome the child’s resistance, leading to, for example - increased child awareness of the knowledge and skills to resist child sexual abuse through abuse prevention programmes.
The focus of child sexual abuse prevention programmes in schools tended to fit within at least one, and possibly two of the four preconditions (Tutty, 1991). This review identified studies that focused on the third and fourth preconditions, i.e. children were taught knowledge and skills while, adult awareness of child sexual abuse was increased through teaching children abuse prevention.
Such abuse prevention programmes had been criticised for putting too much responsibility on children for keeping themselves safe through failing to understand the relational nature of power between adults and children (Wyre, 1993). Cohn (1986) went further to question whether children were the ‘appropriate prevention audience’. Cohn argued that children, who had a need to trust their adult caretakers for their psychosocial development, were placed through abuse prevention programmes into the untenable position where they had to shoulder the responsibility of protecting themselves from their so called caretakers. From a different perspective on the power dynamic, Briggs and Hawkins (1994) argued that children were only empowered when adults enabled this to happen and that attempts to empower children without parental education could place children at risk of physical punishment for challenging existing parenting norms.
Despite these concerns, the Report on the Expert Panel on Sex Offending (2001) argued for the need to teach children about the dangers of child sexual abuse along with the skills of how to avoid or stop abuse. The Report gave three mains reasons in support of their recommendation:
i) The high numbers of perpetrators indicated by incidence and especially prevalence statistics (Finkelhor, 1993),
ii) The limited number of treatment programmes provided for offenders (Social Work Services Inspectorate for Scotland, 1997),
iii) The small number of actual convictions (SWSIS, 1997).
Given the contradictory and conflicting views on child sexual abuse prevention programmes there was a need to systematically explore the research evidence.
Aims of the review
The review was established as a first step in evaluating the delivery of the child sexual abuse prevention programme ‘VIP’ into Dundee city council schools. The materials had been developed by a local survivors’ group Eighteen and Under. At the point of beginning the review, Dundee City Council Education Department in partnership with Eighteen and Under had delivered the VIP programme to one secondary school and to the six related feeder primary schools. Other local authorities in Scotland had purchased the materials for schools and interest had been shown further a field in England and Europe. No systematic evaluation of the programme had taken place. However, an earlier project, where the VIP programme was delivered to a small number of preschool establishments in Edinburgh City Council, had surveyed teachers, childrens and parents’ views on the experience of receiving the programme (Edinburgh City Council, 1999).
The aims of the review, in relation to an empirical evaluation of the VIP programme, were to:
· Clarify the theory underpinning child sexual abuse prevention programmes
· Identify the methodological characteristics of the efficacy studies of abuse prevention programmes
· Identify the outcomes of the efficacy studies
· Identify the gaps in the research,
· Explore the issue of cost effectiveness,
· Identify implications for day to day practice in schools and local authorities
· Contribute to international research,
· Provide a context for interpreting findings of the empirical study,
· Sharpen the future empirical evaluation questions,
· Identify methodologies and/or enable the development of alternative methodologies for evaluation,