Prevention of Child Sexual Abuse: Special Issue of the Journal of Interpersonal Violence

By Marcus Erooga &Keith Kaufman (Co-Editors)


Evidence suggests that child sexual abuse remains a significant public health concern across the world. For example, the World Health Organization (2018) reported in 2018 that 20% of women and 8% of men worldwide report having been sexually abused as a child. At the same time, it is widely understood that these and other prevalence estimates represent underestimates of the true incidence of abuse (Royal Commission into Institutional Responses to Child Sexual Abuse, 2017). Of concern are the short- (Beitchman, Zucker, Hood, daCosta, & Akman, 1991) and long-term (Beitchman et al., 1992) adverse effects that are associated with many victims of child sexual abuse. Despite the prevalence and the significant consequences, there has been a relative paucity of prevention efforts to address child sexual abuse.

As part of the efforts to address this, we were invited to edit a designed to highlight a broad international sampling of cutting-edge child sexual abuse prevention articles, in the hope of both spurring additional prevention research and sharing these creative approaches to prevention. The following is a brief synopsis of the content.

In 2017, the Australian Royal Commission into Institutional Responses to Child Sexual Abuse (CSA) published a final report detailing its 5-year investigation process, which represents the most comprehensive public inquiry of its kind ever conducted. The Journal opens with an article based on findings from co-principal investigators’ Professor Keith Kaufman (USA) and Marcus Erooga (UK) comprehensive international literature review examining risk and protective factors related to CSA in institution settings for the Commission (Kaufman et al., 2016), with additional material from Professor Ben Mathews (Australia) and supported by Erin McConnell from Portland State University. This provides suggested preventive directions to address the safety risks identified in the authors’ review of more than 400 publications and reports garnered from research literature in the United States, the United Kingdom, and Australasia.

Second is a study authored by Billie Jo Grant, Ryan Shields, Joan Tabachnick, and Jenny Coleman examining data from Stop It Now!’s U.S. helpline over a 5-year period. This offers insights into the needs of the hidden population of individuals who are at risk to sexually abuse, those who have abused, as well as offenders’ and potential offenders’ friends and family members seeking support.

On the related topic of services for those seeking preventive treatment, Sarah Beggs Christofferson’s New Zealand study explores whether such provision is viable in a discretionary reporting context, that is, in jurisdictions without mandatory reporting, but where risk-related disclosures to authorities are permitted at therapists’ discretion. Based on a survey of New Zealand health professionals, she concludes that if policies and expectations are clearly defined, this could be the best way forward for viable preventive treatment.

This is followed by Professors Jill Levenson and Melissa Grady’s report on a U.S. pilot study to investigate whether it is possible to improve the provision of clinical services to individuals who self-identify as sexually attracted to minors, but who have not yet acted on their attraction. The authors describe the use of an innovative prevention approach designed to alter the knowledge and attitudes of mental health professionals to increase the pool of competent practitioners willing to provide services to this challenging population.

The subsequent article, by Professors Richard Wortley, Benoit Leclerc, Danielle Reynald, and Stephen Smallbone (from the United Kingdom and Australia, respectively), takes a different approach to the prevention of child sexual abuse. It focuses on strategies intended to alter situational dynamics in ways that make CSA less likely to occur, rather than attempting to treat individual factors in the offender (e.g., to change their inappropriate motivations and behavior). The authors suggest that by considering the perspective of the offenders themselves, they can identify significant situational safety risks that can guide the design and implementation of more effective offense-focused CSA prevention approaches.

Finally, the Special Issue concludes with a report detailing a national survey of CSA prevention education programs in Australian primary schools conducted by Professor Kerryann Walsh, Donna Berthelsen, Kirstine Hand, Leisa Brandon, and Jan Nicholson. The survey was distributed to all providers of child sexual abuse prevention programs in Australian primary schools and provides new information about the nature and scope of school-based education programming for the prevention of child sexual abuse. It also provides a template for the development of similar prevention programs in other settings internationally.

It was a real pleasure to be able to work with such highly experienced and knowledgeable authors, each an expert in their respective field and we are excited by the breadth and depth of prevention perspectives reflected in their contributions.

Don’t wait for them to tell us: recognising and responding to signs of child sexual abuse

By Jane Wiffin, Practice improvement advisor, Centre for Expertise in CSA

(Note: This blog was originally posted on the Centre for Expertise on Child Sexual Abuse – Kieran)

The Centre of Expertise on Child Sexual Abuse recently published ‘Key messages from research on identifying and responding to disclosures of child sexual abuse’. In this blog the CSA Centre’s Practice Improvement Advisor for Social Work, Jane Wiffin, reflects on what those key messages mean for the safety of children and young people and what needs to be done within the statutory child protection system to best respond when children signal or speak out about the abuse and harm they are experiencing.

The first major issue raised by current research (and indeed the safeguarding practice environment) is that it is very clear that far more children are being sexually abused and harmed than we are currently identifying or safeguarding.  This should be of major concern.

The current statutory child protection approach to responding to concerns that a child is being sexually abused puts too much responsibility on children and young people to recognise the abuse they are experiencing and then to seek a trusted adult to talk about what is happening to them. This is a heavy, and frankly unrealistic responsibility. Children cannot and should not be the only witnesses to the harm they experience; it is the responsibility of the adults around the child to respond to help-seeking behaviour and to safeguard them.

Talking openly about child sexual abuse

Most professionals work very hard to notice and understand what is happening to the children they are in contact with and to enable them to talk about their concerns and worries including those that relate to experiences of abuse. Children are not always able to recognise that what is happening to them is abuse and so it is important that they are encouraged to speak to a trusted adult whenever something doesn’t feel right or something is upsetting or hurting them. Despite the need for professionals to support and encourage children to tell us when something is worrying or upsetting them, we also know that many children may not be able to articulate their concerns and may demonstrate their unhappiness and discomfort in other ways.  Professionals need to recognise when children might be telling us something is wrong (through their actions as well as their words) and support them to help us understand so we can respond appropriately. 

However, while the importance of identifying and responding to concerns of CSA is embedded in practice, interpretations of child protection guidance which encourages practitioners to avoid asking ‘leading or suggestive questions’ often drives a cautious response which in reality means many practitioners avoid questions altogether.

When professionals notice a child or young person with a bruise or a burn, they would not hesitate to ask what had happened and how the child or young person was feeling. The resulting response would likely lead to a multi-agency holistic assessment process where all aspects of a child and their family’s life and circumstances would be considered; why is child sexual abuse treated differently?

Messages from many serious case reviews find that these concepts of asking leading questions or contaminating evidence (“avoid encouraging a child to talk about the alleged offence” – p28 Achieving Best Evidence in Criminal Proceedings) are not fully explained in guidance or training, and the limitations not explored. It is therefore unclear to practitioners what the difference is between what the guidance warns against and asking professionally curious questions, being child focussed and exploring the child’s lived experience. This caution also introduces a natural uncertainty or hesitancy in the professional response, hardly conducive to creating an environment which supports and enables children to articulate what is happening and feel able to talk openly about such a sensitive and complicated issue. Ultimately this can result in children’s help-seeking behaviour going unidentified, their voices remaining unheard and the child not being safeguarded.

In recent years guidance has been introduced to ensure that professionals ask women about whether they have been subjected to domestic violence when they are pregnant, have small children or where there are safeguarding concerns. This is because there is recognition of the culture of secrecy that surrounds domestic abuse and the implication of coercion and control; why is child sexual abuse treated differently?

Barriers to disclosure

We know that children rarely verbally disclose to professionals (particularly social workers and police officers) that they are being sexually abused; they often wait until adulthood before telling professionals.  In many cases children are more likely to tell a friend, a safe parent or another trusted adult and their reaction and ability to respond to protect the child will impact upon whether the child feels able to repeat their disclosure. Sadly, some children are never able to tell anyone. This should be of concern to us all.

The reasons for not disclosing are many; children may not recognise that abuse is happening; they may not be able to articulate what is wrong but demonstrate their discomfort through their behaviours, they may communicate non-verbally because of their disabilities or cognitive impairments and English may not be their first language. Those who perpetrate abuse may have normalised sexual abuse, children may have been groomed in such a way that they do not recognise the abuse and tactics of threats, coercion, and control that may have been used.

Victims and survivors also say that there are many barriers to telling adults about the harm and abuse they are experiencing. This includes shame, self-blame, fear of what will happen to them and their family after disclosures, fear of reprisals, fear of getting into trouble and not trusting anyone.

Asking the right questions

Research suggests that in order to identify CSA children need to be asked direct questions about what is happening to them and what they are worried about. Children report they did not disclose sexual abuse because they were not asked direct questions. Children want professionals to notice their emotional distress, behavioural difficulties, self-harm, eating disorders, anti-social behaviour, depression, mental health difficulties, social isolation, disruption and criminal behaviour as potential indictors of early trauma, abuse and specifically sexual abuse.  Professionals need to be aware of how their own and wider society’s bias and stereotypes, about different children and different forms of abuse, can result in abuse being minimised or dismissed.  These are not unreasonable requests.

The concept of asking direct questions was endorsed by the 2000 Department of Health publication “Communicating with Vulnerable Children”. This publication advised professionals to ask children:

  • Has anybody done anything that upset you/makes you unhappy?
  • Has any person hurt you/or touched you in a way that you don’t like?
  • Some children talk about being upset or hurt in some way. Has anything like this happened to you?

This is a long way from how the current advice is often interpreted: as a need to be guarded and cautious. This caution appears to have been driven by a belief that professionals could put ideas into children’s heads and criminal proceedings could be compromised. There is currently little evidence that children report sexual abuse when it is not so and it is often a long and painful journey from disclosure to any sort of safeguarding action or criminal conviction. The reality is that very few cases of child sexual abuse currently progress to a prosecution for many reasons and yet we allow a fear of possibly affecting a criminal case, which is unlikely to happen, limit our proactive steps to understand what is happening to a child and act to protect them from that harm.

Improving practice

It is important that everyone who has a stake in working to protect children has the skills and confidence to identify, talk about and act on verbal and non-verbal disclosures from children in order to best safeguard them from further harm and ensure that they feel believed and supported.

When responding to a disclosure of child sexual abuse, practitioners should aim for child-centred practice and ensure that outcomes and next steps are clearly communicated to the child: when children disclose they are not wondering what protection order they will come under or which agency is leading an investigation, they want concern, compassion, action, and protection and that is a joint responsibility for all agencies and adults around the child.

The CSA Centre is working to build the confidence, knowledge, and skills amongst frontline practitioners working with children in order to best identify and respond to children’s help-seeking behaviours and disclosures of sexual abuse. As well as the Key messages from research paper released this week, we have developed and piloted a Practice Leads’ Programme to help ‘lead workers’ in Children’s Services further develop their understanding and confidence around child sexual abuse. One of the core topics of this programme focuses on the disclosure process, the barriers, and enablers. We are also now planning a practice development project looking specifically at how to best support children to disclose abuse and respond effectively to help-seeking behavior.