Prevention of Sexual Offending Among Adolescents By Robert E. Longo and Geral T. Blanchard

Using the public health model, there are three levels of sexual abuse prevention - primary, secondary, and tertiary. The goal of primary prevention is to prevent sexual abuse before it occurs. Primary prevention puts responsibility on the would-be abuser to not sexually abuse others. Primary prevention invites those who believe they have a problem to seek help and treatment, promoting a message of hope and recovery.

The goal of secondary prevention is to teach people how to avoid becoming victims. In its most familiar forms, secondary prevention consists of child sexual abuse prevention and awareness programs in schools, rape awareness, prevention, and education, and self-defense classes. Although crime prevention programs and efforts are valuable, secondary prevention programs place the responsibility for sexual abuse prevention on the potential victim. Another form of secondary prevention identifies "at risk" individuals who may be susceptible to becoming either abusive or abused, and intervenes to reduce that risk.

The goal of tertiary prevention is to stop the abuse from continuing. This may involve treating victims of sexual abuse and teaching them ways to avoid and/or prevent sexual abuse from happening again. Treating sexual abusers and helping them learn ways to not sexually abuse again is another form of tertiary prevention. While treatment is a valuable and worthwhile effort, the problem with this level of prevention is that it occurs after someone has been abused. The goal of this article is to highlight current child sexual abuse prevention efforts using the public health model.

PRIMARY PREVENTION Sex Education Many people do not consider sex education as a tool for preventing sexual abuse of children. But sex education is a cornerstone for preventing sexual abuse and especially the sexual abuse of children. Sex education should be taught both at home and as a core subject of school curricula. Children need to learn from an early age that their bodies, especially the sexual parts, are personal and private. Four-year-olds don't need to have information about procreation, but they do need information about how to be safe and to know they can talk to adults about sexual thoughts, feelings, and behaviors.

Sex education should provide children with age appropriate information about anatomy, social customs, sexual feelings and behavior, and reproduction. Children need accurate and honest information to counter the messages and images they are subjected to through television, advertisements, movies, and pornography. That information should never be delivered in a way that associates bodies or sex with shame or fear; those methods have been shown to be ineffective.

In addition, sex education should provide children and adolescents with information that might deter them from engaging in sexually abusive acts. Many abusers have had no formal sex education and their beliefs, attitudes, and knowledge are based upon inaccurate information and distortions.

SECONDARY PREVENTION Child Sexual Abuse Prevention Programs Child sexual abuse prevention programs and education efforts have been available for less than two decades. Many of these educational efforts teach children about appropriate and inappropriate touch, being assertive, and saying "no" to people who touch or want to touch them in a sexual manner. Although child sexual abuse prevention education is a valuable aspect of prevention, questions remain pertaining to children's abilities to learn and retain the materials. In addition, researchers remain concerned about whether children with less physical power and knowledge of consequences are capable of resisting sexual abuse attempts by stronger and/or older abusers.

Concern also exists about the potential for negative effects from these efforts. Although many children have benefitted from sexual abuse prevention and education programs, some children report (and their parents confirm) negative effects. In fact, there is some criticism that these programs may cause the children who participate in them increased anxiety or fear about potential abuse, or they may become oversensitive to appropriate situations, or may develop negative attitudes toward sexuality. Another negative effect of teaching children prevention strategies may be that children and parents become overly confident and fail to employ other reasonable protection strategies.

Child sexual abuse education and prevention programs are an important component in child sexual abuse prevention. However, these approaches place 100% of the responsibility for personal safety on children who can not be expected to defend themselves from stronger, more sophisticated adolescent and adult abusers. Adults must ultimately retain responsibility for keeping children safe.

Sexual Abuse Victim Treatment No one is exempt from being the possible victim of sexual abuse. After someone is sexually abused, it is important for them to be evaluated for needed treatment. Sometimes, short-term counseling is sufficient, but in other cases, long-term counseling or residential treatment is indicated. Without evaluation and treatment, the victim of sexual abuse may experience acute and/or chronic problems that decrease the quality of their lives. This is especially true for child victims of sexual abuse. Children's ability to form trusting relationships with others, develop positive self-esteem, empathy, self-confidence, identify and effectively express emotions, and function well in daily life may be affected significantly. Fortunately, children can be highly resilient and are likely to respond well to early interventions which offer validation, protection, and reassurance.

Understanding the potential for repeat victimization is also important to prevention because of the high incidence of repeated sexual abuse by abusers on their victims. Sexual abusers will often tell their victims, "If you tell, I'll go to prison." The victims' feelings of guilt and sense of responsibility for this horrendous outcome decreases their likelihood of reporting. If society approached sexual abuse as a treatable and preventable public health problem, such threats would likely be less effective in silencing the victims and the abusers would likely be more open to the idea of seeking treatment. In many cases sexual abuse would have been reported much sooner if such threats to the families did not exist.

TERTIARY PREVENTION Sexual Offender Treatment Programs People often ask us if there is a "cure" for sexual abusers. People define cure differently and we do not want to debate the definition. However, when people ask about cures for sexual abusers, they generally mean a treatment that renders the person safe and no longer at risk to engage in sexually abusive behavior. What we can say today is that hundreds of thousands of individuals have participated in specialized treatment programs and have gone on to lead productive lives and have not been rearrested. The quality of their lives has improved and it appears they are avoiding further sexually abusive behaviors.

The Pre-Sentence Alternative Program Through a local collaboration between a law enforcement officer, a treatment provider, a state's attorney, a social service director, and a diversion director, the Pre-Sentence Alternative Program (PSAP) was created in a Vermont community. This program allows citizens to participate in preventing future incidents of child sexual abuse.

The incentive behind the program is that it offers the abuser the freedom to admit responsibility and get the treatment needed without earning a conviction record. Through treatment PSAP offers restitution to victims, gives abusers the tools needed to understand and manage their abusive behavior, and keeps the community safe.

All juveniles referred to PSAP must admit responsibility for the offense and a parent or guardian of the abuser must agree to be involved in the treatment process. This involvement usually entails attendance at a monthly support group with the purpose of opening the channels of communication and offering education about sexual abuse issues. The PSAP program also encourages victims to give input regarding the impact of the offense on them. It requires the offender to reimburse the victim for any treatment or other service they have had to pay for.

The PSAP legally mandates treatment, holds the abuser accountable, and gives the abuser the opportunity to avoid criminal conviction. This program is in need of a formal evaluation before it is replicated elsewhere, however, to the knowledge of the people working at PSAP, the program has not had one reoffense from the clients that have successfully completed the treatment program.

Transformative Justice Canadians, along with Australians and New Zealanders, make reference to restorative justice, transformation justice, and satisfying justice. All are quite similar and argue in support of greater victim and community involvement. Just as important is a diminished emphasis on adversarial court proceedings that increase tensions and do little to heal victims or abusers. Reconciliation and restitution are important components of most programs based on these ideas of justice. Mediation is encouraged. Punishment is seen as a measure of despair that has little to do with justice and even less to do with healing the injured parties. Whenever reasonably possible, it is the desire of community justice teams to keep offenders in the community where "reintegrative'' shame can be experienced. Abusers are expected to face the pain and humiliation brought on by their crimes and not have incarceration serve as an escape.

Restorative Justice The restorative justice model seeks to redefine crime and punishment and counters the retributive model we have been following for many years. It considers crime as an injury to the victim and the community not primarily to the state. Restorative justice considers imprisonment as punishment with no restorative value to the victim of crime or the criminal.

Restorative justice seeks to heal victims and abusers while holding the abuser responsible for his or her actions and accountable to others. Communities become involved and the abuser is confronted with the fact that his or her behavior impacts the victim(s) and the community.

Assessment and treatment of sexual abusers is a component of a restorative justice model. Once a sexual abuser has pled guilty or has been found guilty of committing a sexual offense, and before sentencing, a comprehensive specialized psychosexual assessment should be performed by an experienced clinician who specializes in sexual abuser assessment and treatment. Summary To reduce sexual abuse, citizens must work on preventing it from occurring. Prevention requires public education. We believe this is best accomplished by addressing it as a public health issue. Using a public health model holds tremendous promise today for reducing sexual abuse tomorrow. Prevention is not punishing a behavior after it occurs. Prevention is stopping the problem before it occurs.