School Psychology Review Volume 17, No. 4, 1988, pp. 614-634

PREVENTION OF CHILD SEXUAL ABUSE: AN ANALYSIS OF ISSUES, EDUCATIONAL PROGRAMS, AND RESEARCH FINDINGS

Deborah J. Tharinger James J. Krivacska The University of Texas at Austin Educational Programs Consultants, Milltown, NJ Marsha Laye-McDonough, Linda Jamison, Gayle G. Vincent, and Andrew D. Hedlund, The University of Texas at Austin

ABSTRACT Although the main targets of the effort toward the prevention of child sexual abuse need to be the conditions that cause and support it, a prominent and popular aspect of the prevention effort that has emerged in the past decade involves educational programs aimed at children. Most of these programs are implemented in the schools. The goals of these programs are to provide children with knowledge about sex ual abuse, including ways to respond to abusive approaches, an d to aid child ren in disclosing abuse if they have been victimized. Although well intentioned, there is no published research support for the conceptual assumptions (largely involving empowerment) upon which the prevention education programs are based and as yet, sparse empirical support for their effectiveness. Thus, the decision of a school district to adopt and implement a sexual abuse prevention education program is a serious one. School psychologists are in a key position to inform decision makers about the potential and the limitations of child sexual abuse prevention programs and to assist in developing, implementing, and evaluating more effective school-based programs. In addition to discussing general issues about the etiology of child sexual abuse and the relationship of etiology to prevention efforts, five questions are addressed: (a) What is the nature of child sexual abuse prevention programs? (b) Do prevention programs prevent children from being sexually abused? (c) Do prevention programs identify children who have been sexually abused by facilitating disclosure? (d) Is it fair and reasonable to expect children to participate in efforts to prevent their own sexual abuse? (e) What issues do school psychologists need to consider in developing, implementing, and evaluating school- based child sexual abuse prevention programs? Data are presented on the nature of child sexual abuse prevention programs from a research study that systematically evaluated 41 commercially available written materials on child sexual abuse prevention.

Child sexual abuse has been widely abuse (Browne & Finkelhor, 1986). Pri- recognized in the past decade as a mary emotional effects include feelings of prevalent and detrimental traumatization guilt, fear, depression, anger, and hostility. of children. Although estimates vary, it has Behavioral effects include persistent, been reported that as many as 22% of inappropriate sexual behavior with self, Americans report being sexually abused peers, younger children, or toys; detailed as children (Crewdson, 1988). Serious and precocious understanding of sexual initial and long term emotional and behavior; regressive behaviors; sleep behavioral effects result from child sexual problems; inadequate peer relations or

This research project was supported by a grant from the University Research Institute at The University of Texas at Austin. Requests for reprints should be directed to Deborah J. Tharinger, Department of Educational Psychology, Education Building 504, University of Texas at Austin, Austin, TX 78712-1296.

614 Prevention of Child Sexual Abuse 615 inability to make friends; overly compliant empirical support for their effectiveness or acting-out behavior; pseudo-mature (Conte, 1984; Finkelhor, 1986; Wurtele, behavior; school problems, including 1987). Although it commonly has been inability to concentrate and sudden maintained by the implementers of pre- decreased school achievement; running vention programs that child sexual abuse away from home; suicidal ideation or prevention programs are effective and actual attempts; and in girls, an extraor- that their total effects cannot accurately dinary fear of men or overtly seductive be measured (Plummer, 1986), it is behavior. Long term effects include a lack professionally irresponsible to ignore the of basic trust, low self-esteem, pervasive need for systematic development, imple- feelings of helplessness and depression, mentation and evaluation of these pro- and self-destructive forms of behavior grams, including attending to possible (Vevier & Tharinger, 1986). unintended effects of the programs on Fortunately, steps have been taken in children, implementers, and society as a many communities to identify children whole. In the rush to respond to the who have been sexually abused and to prevalence of child sexual abuse, it secure resources and therapeutic pro- appears that many essential preliminary grams to assist these children and their steps in the construction of prevention families with the recovery process. School education programs have been ignored or psychologists and teachers have been skipped. The result is that there is a need challenged to be involved in the response to examine critically the assumptions, to child sexual abuse (Brassard, Tyler, & effects, and unintended consequences of Kehle, 1983; Caterino, 1987; Downer, 1986; child sexual abuse prevention programs Tharinger & Vevier, 1987; Vevier & Tha- (Conte, Rosen & Saperstein, 1986; Krazier, ringer, 1986). An additional movement 1987; Trudell & Whatley, 1988). has grown out of the awareness of the Teachers have been the school per- common and traumatic nature of child sonnel primarily targeted in terms of sexual abuse - a movement designed to prevention efforts (Davis, 1986; Downer, try to prevent it (Finkelhor, 1986; Nelson 1986; Trudell & Whatley, 1988). However, & Clark, 1986). Although the most impor- school psychologists, given their rather tant targets for prevention of child sexual extensive backgrounds in psychological abuse are the conditions that cause and and educational theory and research, as support it (Conte, Rosen, & Saperstein, well as in measurement, assessment, and 1986), much of the initial effort has been intervention, are in a unique position to aimed at educating children about ways educate policy makers in the public they can resist and escape sexual abuse schools about the potential and the and at promoting disclosure. Programs limitations of child sexual abuse preven- designed for children began to appear in tion programs. School psychologists also the late 197Os, and federal funds for the are key personnel to be involved in study of such programs were provided in developing, implementing, and evaluating 1980 (Plummer, 1986). Currently, child more effective school-based child sexual sexual abuse prevention education pro- abuse education programs. In addition, grams are being implemented across the school psychologists can play a central nation, most within the schools. It has role in reinforcing the idea that programs been estimated that school-based pro- aimed at children are merely one compo- grams have reached over one million nent of a whole array of needed prevention children (Plummer, 1986). efforts. Although the intentions of the devel- The aim of this article is to increase opers and implementers of child sexual school psychologists’ knowledge of the abuse prevention programs are to be complex issues involved in preventing applauded, the movement is in its infancy child sexual abuse, to review and present and there is no research support for the findings on the nature of sexual abuse conceptual assumptions upon which the prevention programs aimed at children, programs are based and as yet, sparse to review empirical research findings on 616 Mauol Ps@dog~ Review, 1988, Vol. 17, No. 0 the effectiveness of the programs, and to abuse a child; and Precondition 4 - a address the significance of unintended potential offender must overcome or consequences of the programs. The follow- undermine the resistance of the child. It ing five questions explicitly are addressed: is proposed that all four preconditions (a) What is the nature of child sexual must exist for abuse of a child to occur. abuse prevention programs? (b) Do For Precondition 1, individual/psy- prevention programs prevent children chological explanations include the pos- from being sexually abused? (c) Do sibilities that the offender may have prevention programs identify children arrested emotional development, may be who have been sexually abused by facil- re-enacting childhood trauma, may have itating disclosure? (d) Is it fair and been exposed to modeling of sexual reasonable to expect children to partic- interest in children by someone else, and ipate in efforts to prevent their own sexual may have inadequate social skills. On the abuse? (e) What issues do school psychol- sociological/cultural level, it is offered that ogists need to consider in developing, there is a societal requirement for men implementing, and evaluating a school- to be dominant and powerful in sexual based child sexual abuse prevention relationships, that child pornography is program? available, and that children are portrayed erotically in advertisement. ETIOLOGY OF CHILD For Precondition 2, individual/psy- SEXUAL ABUSE AND ITS NECESSARY chological explanations include the pos- RELATION TO PREVENTION EFFORTS sibilities that the offender may use alcohol What will lead to a decrease in the or have an impulse disorder, and on the incidence of child sexual abuse? To sociological/cultural level, social tolera- prevent an act form occurring or to tion of sexual interest in children, weak decrease its incidence, it is necessary to criminal sanctions against offenders, and understand the causes or factors that lead social toleration for deviance committed to the occurrence of the event. The model while intoxicated. of etiology that has been most helpful in For Precondition 3, possible individ- promoting an understanding of what ual/psychological explanations include factors contribute to child sexual abuse, that the child’s mother may be physically and influential in directing prevention or psychologically absent and that the efforts is that of Finkelhor (1984). child may not be adequately supervised, and on the sociological/cultural level, an erosion of social networks and lack of social supports for the mother. Finkelhor’s model was developed For Precondition 4, individual/psy- from an extensive review of the individ- chological explanations include the pos- ual/psychological and sociological/cul- sibilities that the child may be emotionally tural factors that have been proposed as insecure or deprived, may lack knowledge contributing to child sexual abuse. The about sexual abuse, that there may be a model hypothesizes four preconditions situation of unusual trust between the that need to be met for the sexual abuse child and the offender, or that coercion of a child to occur: Precondition 1 - a may be in effect. On the sociological/ potential offender must have motivation cultural level, unavailability of sex educa- to sexually abuse a child; Precondition 2 tion for children and social powerlessness - a potential offender must overcome of children are offered as explanations. internal inhibitions against acting on the Finkelhor’s model emphasizes the point motivation to sexually abuse a child; that the etiology of child sexual abuse Precondition 3 - a potential offender involves the transactions of aspects of the must overcome external inhibitions offender, the child, the offender’s family, against acting on motivation to sexually the child’s family, and society. Prevention of Child Sexual Abuse 617

VVhatEfforts Will Lead to a Decrease in parents (who also may be victims) so they the Incidence of Child Sexual Abuse? can begin to recover and protect and support their children; and identifying According to the above model, the and providing intervention to youth who incidence of child sexual abuse will be present with early indication of becoming decreased by targeting the individual and offenders. societal conditions that lead to motivation to sexually abuse a child, that allow for a potential offender to overcome internal Prevention Efforts Aimed at and external inhibitions to sexually abuse Gaildren Examined a child, and that allow for a potential It is proposed in Precondition 4 of offender to overcome or undermine the Finkelhor’s model (i.e., that a potential resistances of a child. Some of the needed offender must overcome or undermine the changes are societally-based and would resistance of the child) that the child’s lack seem to include the following actions: of knowledge of sexual abuse and the obtaining federal or state government social powerlessness of children are support and funding to provide children contributing factors in the etiology of and the adults who care for them the sexual abuse. In response to these factors, resources necessary to be safe; providing programs have focused on children them- the message that children are not the selves with the message that sexual abuse property of adults and that child sexual is partially a function of children’s igno- abuse is not acceptable; providing the rance, their lack of assertiveness, and their message that alcohol or drug use does not lack of power. Although the effort focused excuse behavior; promoting women’s on children always has been somewhat equality and social influence; promoting controversial, it also has been viewed as healthy families where children feel having the potential of reaching a large emotionally secure. Changes in societal number of children, short-circuiting some conditions are difficult and slow in coming abuse before it occurs, increasing the as they are deeply embedded in American number of victims who get help, and being culture (Conte et al., 1986). In addition, cost efficient (Finkelhor, 1986). In addi- “While many prevention professionals tion, Finkelhor states that the logic of recognize that fundamental change in prevention has grown out of experience power relationships in families and in working clinically with victims of sexual society from a sexist to egalitarian abuse and that such experience has distribution will be necessary to prevent suggested that many children could have sexual victimization, not enough has been been spared substantial vulnerability and done to link political and cultural life and suffering if they had had simple pieces of sexual victimization” (Conte et al., 1986, information, for example, about their right p. 153). to refuse sexual advances or about the Other needed changes are individu- inappropriateness of the behavior in ally and interpersonally based, although which an adult was engaged (no empirical they are influenced by societal attitudes findings are given or referenced). Thus, and economic priorities. They include this hopefulness has been a catalyst for such efforts as: encouraging disclosure by many of the prevention education pro- children so offenders (who also may be grams targeted at children. victims) can be identified, prosecuted, and * As is demonstrated in detail in a later convicted; providing treatment for offend- section, the typical method of these ers with the goal that they will not re- programs is to provide children with offend; providing treatment for victims so knowledge about sexual abuse, often they can begin to recover from the trauma without providing knowledge and educa- and not become offenders, be revictimized, tion about sexuality, and to empower or fail to protect their own children from children to escape or resist abusive being victimized; providing intervention approaches. However, the concern is for caretaking, non-sexually offending raised (and discussed more fully later) 618 Maool Psg&&g~ Review, 1988, Vol. 17, No. 4 that it may not be appropriate or effective because reviews of program materials to to empower children to prevent them- date have been limited to broad descrip- selves from being sexually victimized. An tions of program dimensions (Conte et al., examination of the explanations offered 1986; Finkelhor, 1986; Wurtele, 1987) and under Precondition 4 of Finkelhor’s model a more systematic and specific analysis reveals that the child’s lack of knowledge was desired. For the review, 46 written about sexual abuse and the social pow- programs (books and curricula), targeted erlessness of children are only two of the for children, teenagers, parents, teachers, six contributing factors presented in the and mental health professionals were model. The other factors include a child evaluated systematically, using a protocol who is emotionally insecure, needy, developed explicitly for the project (avail- unsupported or deprived, a child who has able from the first author). Materials for an unusually trusting relationship with a the review were obtained primarily by potential offender (e.g., a parent-child writing to authors and publishers. Most relationship), a child who is being coerced, of the materials were purchased, although and a child who has not been educated some were donated. about sexuality. A child under these The materials reviewed are not pre- conditions is likely to be more at risk than sented as being an exhaustive sample, as a child who lacks knowledge about sexual it was not possible to review all materials abuse and who is among the ranks of the currently in existence in that an estimated powerless. In other words, it is doubtful 400 to 500 cu.rricula have been developed that providing knowledge about sexual (Plummer, 1986). The results of the abuse and instruction about saying no will quantitative analysis presented below (see counter the emotional insecurity, trusting Table 1) are based on 41 of the 46 program relationship, possible coercion, and lack materials; 22 (16 books and 6 curricula) of knowledge about sexual thoughts, designed to be used by children with feelings, and behavior that are the expe- adults, 8 (5 books and 3 curricula) to be riences of many vulnerable children. used by teenagers with adults, and 10 (all Furthermore, children who are emotion- books) to be used by adults alone. The ally abused, who are disabled or disad- remaining five materials were designed to vantaged, or who have poor relationships be used by children or teens alone, and with their parents are all thought to be were not included in the quantitative even more at risk (Finkelhor, 1986). analysis because of the small group sample Attempts to empower vulnerable children size. Materials for adults were included to resist abusive approaches may even be because they are designed to provide an harmful, as it may place them in increased adult, typically a parent, teacher, or danger and may contribute to self-blame mental health professional, with informa- if they are unable to prevent or stop the tion about communicating with children abuse. These concerns, as well as an or adolescents about sexual abuse. The emerging cautious approach to sexual titles, authors, and publishers of all of the abuse educational programs for children, 46 materials reviewed, organized by are discussed below. targeted audience, are listed in an adden- dum at the end of this article. In addition, a narrative summary of each of the 46 A CLOSER EXAMINATION OF materials is available from the first author PREVENTION PROGRAMS (Tharinger, Laye-McDonough, Jamison, In this section, five essential questions Vincent, Hedlund, & Friend, 1988). for school psychologists are addressed. In The 41 materials for the quantitative responding to Question 1 about the nature analysis were reviewed and scored by four of child sexual abuse programs, results of graduate students in Educational Psychol- a research study are reported that ogy who were familiar with the child evaluated 4 1 commercially available sexual abuse prevention literature and written materials on prevention of child who had helped to create the protocol. sexual abuse. The study was undertaken To obtain information on the reliability of Prevention of Child Sexual Abuse 619 the review process, 50% of the materials of the features of the above reviews are were reviewed by two reviewers, and 91% incorporated. However, particular atten- agreement was obtained. Data analyses tion is given to the content and conceptual were descriptive, consisting of computing framework of the sexual abuse prevention frequencies of the nature of sexual abuse, education programs, and data from the the concepts, the conceptual framework, study of written materials is presented. and the sexual language presented in the The goals of this analysis are (a) to materials (see Table 1). A developmental, describe the information that is being descriptive analysis of the definitions of presented to children, adolescents, and sexual abuse specified in the materials adults about sexual abuse, (b) to discern also was conducted. the conceptual framework underlying the prevention materials, (c) to examine the Question 1: wliat is the Nature of Child concepts of trust and responsibility, and Sexual Abuse Prevention Programs? (d) to discuss the issue of child sexual abuse prevention education that is void Three recent, descriptive reviews of of sexuality education. sexual abuse education programs di- rected at children are available in the The description of sexual abuse in literature (Conte et al., 1986; Finkelhor, prevention education programs. The 1986; Wurtele, 1987). The review of Conte current set of concepts and skills taught et al. addressed program dimensions such in prevention programs are based upon as content, length of the program, occu- what adults believe will prevent sexual pation of the trainer, array of materials victimization. Although this prevention and training formats, types of abuse knowledge is based in part on anecdotal covered, assertiveness and self-defense clinical experience, there exists no system- skills, the cognitive focus of the programs, atic investigation and report of the appropriateness of the content, and processes adults use to engage and quality assurance of the programs. Fin- maintain children in sexual abuse situa- kelhor’s review included a description of tions (Conte et al., 1986). Sexual abuse the intended audience (i.e., children, is a very complex and frightening concept, parents, and professionals), a discussion even for adults and professionals. To of the relationship between sexual abuse evaluate the accuracy of the information prevention and sex education, conceptual presented in prevention programs, it is dilemmas, and organization issues. Wur- useful to keep in mind the following data tele’s article covered mode of presentation about child sexual abuse. Sexual abuse (printed materials, theatrical perfor- may consist of any one or a progression mance, lecture/discussion, audiovisual of the following acts: nudity, disrobing, materials), content (terminology, chil- genital exposure, observation of the child, dren’s rights, and skills training), audience kissing, fondling, masturbation, oral- characteristics (age, sex, SES,culture, and genital contact, digital penetration, and providing for children who have been vaginal or anal intercourse (Finkelhor, abused), program length, trainer charac- 1986). In addition, children usually know teristics, and results of program evalua- the people who sexually abuse them tion research. In addition, a recent article (Mrazek, 1981). An estimated 77% of by Trudell and Whatley (1988) focused on reported abusers are parents (57% of the the dilemmas present for teachers in total being natural parents), 16% are other implementing school-based sexual abuse relatives, and 6% are “other” (NCCAN, prevention programs. The authors de- 1982). In addition, males are reported to scribed problems inherent for teachers in be the abusers in 80 to 95% of cases using predeveloped materials and ad- (American Humane Association [AHA], dressed the issue of teaching sexual abuse 1982; Conte & Berliner, 1981; NCCAN, prevention without providing sexuality 1982). Victims of sexual abuse are most education. often children of school age (Berliner, In the analysis presented here, some 1977; Schultz & Jones, 1983), although TABLE 1 Content of Sexual Abuse Prevention Materials

Materials Materials Materials Materials Materials Materials for for for for for for Children Adolescents Adults Children Adolescents Adults (n = 23) (n=8) (n = 10) (n = 23) (n=$) (n = 10)

Nature of Sexual Abuse Concepts Term “SexualAbuse” Used 30% 75% 50% Body Ownership 86% 88% 90% Term “SexualAssault” Used 17% 75% 70% Trust Feelings 64% 75% 100% Term “Incest” Used 9% 75% 70% “Say No” 100% 100% 90% “Touch Continuum”Used 74% 75% 60% AssertivenessSkills 73% 100% 70% “ConfusingTouch” Used 59% 87% 60% Secrets 92% 87% 80% Intrafamiiial Abuse 74% 100% 60% Support Network 100% 100% 100% Covered “Not Your Fault” 78% 100% 100% Extrafamilial KnownAbuse 83% 100% 60% Covered Conceptual Framework StrangerAbuse Covered 65% 88% 40% Empowerment 65% 50% 80% OffenderPortrayed as 87% 100% 50% “Normal” LearningTheory 4% 0% 0% OffenderPortrayed as 22% 25% 10% DevelopmentalTheory 0% 0% 10% Stereotypic Offender- Male 96% 100% 80% Sexual Language Offender- Female 65% 63% 30% Body LanguageStressed 45% 13% 60% Offender- Youth 74% 100% 80% *PrivateParts” 65% 63% 30% Male AbusingFemale 96% 100% 80% “Parts UnderSwim Suit” 44% 13% 0% Male AbusingMale 74% 63% 50% Penis 35% 63% 60% FemaleAbusing Male 48% 50% 30% Vagina 30% 88% 30% FemaleAbusing Female 24% 40% 20% Breasts 17% 63% 60% Abusedat Home 61% 100% 60% Buttocks 13% 38% 30% Abusedin Neighborhood 65% 100% 50% Anus 13% 50% 50% Abusedat School 35% 38% 20% Genitals 4% 50% 50% Prevention of Child Sexual Abuse 621 cases have been documented from infancy private areas); 3 included touching and to adulthood (De Francis, 1969). Girls are concerns about motivation or intention- reported victims of sexual abuse at ality, i.e., secret touching, touching or significantly higher rates than boys, four looking at another’s private parts without to one (AHA, 1982; Conte &Berliner, 1981; their permission, using touching for one’s Kempe & Kempe, 1984; NCCAN, 1982), pleasure when the other doesn’t want it; although data are emerging suggesting 1 defined sexual abuse as the use of a child that boys may be victims of sexual abuse for the sexual gratification of an adult or more often than frequencies based on adolescent; and 1 defined sexual abuse as cases indicate, and that they are abused using force, trickery, or coercion to touch more often by non-family members than or obtain other sexual contact. family members (Vander Mey, 1988). Of the eight materials for teenagers, One of the most difficult issues in the definitions included aspects of con- prevention education programs is how to sent, coercion, aggression, and power: (a) present the complex phenomena of sexual when another person forces, threatens, or abuse to children. Its presentation needs bribes you into any kind of sexual contact; to be meaningful and responsive to (b) when an adult or older teenager forces, children’s developmental levels and must threatens or bribes you into sexual be sensitive to their need to be protected. contact; (c) sexual contact with no To get an indication of how sexual abuse consent, possibly with force being used; has been described, key terms used and (d) forced, tricked, or manipulated touch the definitions of sexual abuse provided or sexual contact; (e) any form of forced were examined in the materials reviewed (overtly or by threats) sexual activity, not to provide a contrast among descriptions just intercourse; (f) any sexual contact for children, adolescents, and adults. It with a person without his or her consent was found that in the materials for - it could be seeing a person exposing children, 30% used the term “sexual himself, handling of genitals, oral-genital abuse,” 17% used the term “sexual assault,” contact, or intercourse; (g) any unwanted, and 9% used the term “incest” (see Table forced sexual contact, e.g., harassment, 1). In the materials for adolescents, 75% exposing, flashing, forcing to pose for used the terms “sexual abuse,n “sexual pictures, fondling, or rape; and (h) non- assault,” and “incest.” In the materials for mutual sexual contact as a weapon - an adults, 50% used the term “sexual abuse,” expression of hostility, control, aggression, and 70% used the terms “sexual assault” and violence. and “incest.” Of the 10 materials for adults, the Of the 10 programs designated for definitions were similar to those provided children aged 4 or under (some of the for teenagers, although in one case more programs extended into the next age depth was included. In a book for teachers, range), 6 provided no definition and 4 sexual abuse was defined as the exploi- defined sexual abuse as involving touch- tation of a child by an older person for ing, i.e., touching that makes you feel the sexual gratification of the older funny, improper touching, someone trying person. It also was described as a con- to touch your private parts, and unsafe tinuum of behavior from verbal abuse to touching (touching private parts or being forcible touching offenses ranging from a made to touch adult’s private parts). Of single encounter with an exhibitionist to the 13 materials designed for children ages confusing occasional fondling by a casual 5 to 12 (some of the programs extended acquaintance, and from years of ongoing into the next age range), 5 provided no abuse by a relative or family member to definition; 3 defined sexual abuse as rape and/or exploitation through prosti- involving touching, i.e., touching private tution or pornography. parts, touch in the private zone, and From this descriptive portrayal of sexual hurt (a grown-up touching the definitions, it may be seen that as the ages sexual or private parts of your body and of the targeted audience increase, so do a grown-up having you touch his or her the accuracy and depth of the definitions. 622 S&w1 Psycholq~y Review, 1988, Vol. 17, No. 4

The greatest difficulty appears to be the described as stereotypical “dirty old men” depiction of the nature of sexual abuse (see Table 1). In addition, in keeping with at a level children can understand. Most current knowledge, offenders were de- of the definitions for children utilized the picted as primarily male, often a young concept of “touch” to explain sexual abuse. adult, and less often female. The most This concept is borrowed from the touch common depiction was a male abusing a continuum developed by Anderson female, with males abusing males next (1986). The touch continuum includes frequently, then females abusing males, three categories of touch: good touch and least frequently, females abusing (which includes hugs, light ticklings, and females. Sexual abuse was depicted in all kisses), bad touch (which includes kicking, the materials as taking place typically in punching or otherwise causing physical the home and in the neighborhood, with pain), and confusing touch (which in- school related sexual abuse portrayed cludes sexual contact and could leave the much less frequently. In the materials child confused because sexual contact reviewed, the ages of the victims of sexual may feel bad and it also may feel good). abuse were portrayed to match the ages The concept of touch and the touch of children toward whom the materials continuum have been influential in a were targeted. majority of the prevention materials reviewed, regardless of the targeted The conceptual nature of sexual audience. As can be seen in Table 1, 74% abuse prevention programs - Empower- of the programs for children talked about ment. In addition to defining sexual abuse the touch continuum and 59% included or “touching” in some form and describing a discussion of confusing touch. Of the possible offenders, nearly all sexual abuse programs for adolescents, 75% included prevention programs attempt to establish the touch continuum and 87% covered three fundamental ideas: that a child’s confusing touch. Of the programs for body is the child’s “property” over which adults, 60% covered the touch continuum the child has control (often called body and confusing touch. It remains to be seen ownership); that a child should trust his if the touch continuum is an effective or her feelings or intuition as a way of method of educating children about the determining whether or not certain complexity inherent in sexual abuse. touching is appropriate or not; and that A concern about sexual abuse preven- a child who is approached or molested tion materials has been that they focus must take action, typically described as on “stranger danger” and depict offenders “saying non to an abusive adult. In the as sleazy strangers abusing children in a sexual abuse prevention materials re- park. However, most of the reviewed viewed for children, 86% mentioned body prevention materials acknowledged that ownership, 64% included trusting one’s a family member or other trusted or feelings or intuitions, 100% stressed known person may be the perpetrator of “saying no,” and 73% included teaching sexual abuse. In the materials for children, other assertiveness skills, such as yelling 74% mentioned intrafamilial abuse, 83% and running away for younger children covered extrafamilial abuse by a known and decision making skills for older offender, and 65% included stranger abuse children and adolescents (see Table 1). In (see Table 1). In the materials for ado- the materials reviewed for adolescents, lescents, all of the programs addressed 88% mentioned body ownership, 75% intrafamilial and extrafamilial sexual included trusting one’s feelings or intui- abuse, and 88% included stranger abuse. tions, and 100% stressed “saying no,” and In the materials for adults, 60% included teaching other assertiveness skills. In the intrafamilial and extrafamilial abuse and materials reviewed for adults, 90% covered 40% mentioned stranger abuse. In all the body ownership, 100% included trusting materials reviewed, offenders most often one’s feelings or intuitions, 90% stressed were described as people you would find “saying no,” and 70% included teaching in normal walks of life and seldom were other assertiveness skills. Prevention of Child Sexual Abuse 623

Theoretical or conceptual frame- and the resultant confusion inhibits works are not stated explicitly in most serious work on its further development. sexual abuse prevention programs. How- Empowerment has been discussed ever, the implicit conceptual framework explicitly by several abuse prevention underlying the majority of the prevention professionals (Butler, 1986; Plummer, programs described in the literature and 1986; Sanford, 1980). Sanford, in her 1980 in the materials reviewed is that of book for parents on the prevention of child “empowerment.” Empowerment is repre- sexual abuse, maintains that “crimes of sented by the concepts reviewed above, child sexual abuse are considered in the that is, body ownership, trusting feelings context of the great discrepancies be- and intuitions, and “saying no” and being tween the victim’s and the offender’s assertive. Averaging across al1 of the 41 power, knowledge, and resources” (p. 36). materials reviewed, the theoretical base She goes on to state that the child’s best in 61% of the programs was identified as defense against sexual abuse is a sense empowerment (see Table 1). With the of his or her own power, knowledge of exception of 2% of the programs being what constitutes sexual abuse, and re- guided by developmental theory and 2% sources available for support and protec- by learning theory, no conceptual frame- tion. Sanford asserts that since the work could be identified for the remainder offender plans on an imbalance in each of the materials. Considering its promi- of these areas, without this imbalance nence in guiding child sexual abuse abuse cannot take place. Plummer main- prevention programs, an examination of tains that if children can be informed the construct of empowerment is about sexual abuse and ways to prevent necessary. it, they can sometimes be empowered to It is not surprising that empowerment help avoid or interrupt their own victim- is at the base of most of the child sexual ization. Plummer contends that it is an abuse prevention programs since many adult’s responsibility to empower children initial developers of the programs had so if all other prevention methods fail, experience in rape crisis centers or children will have a last defense against centers for battered women, where em- sexual abuse. She believes that “those who powerment has been a popular construct are given knowledge, a sense of personal for enabling women to affect choices in power, and a list of community resources their lives. The term empowerment has will be enabled to assist in their own self appeared with increasing frequency in protection” (p. 4). Butler similarly main- psychology and mental health literature tains that children must be allowed to feel over the past decade (Swift & Levin, 1987). more powerful in the world. She states The concept has captured the imagination that “Programs that teach prevention of scholars and social activists across within the framework of empowerment multiple disciplines. However, empower- are premised on the belief that one ment has no clearly operationalized or primary reason children are abused and consensual definition within the mental molested is because they are powerless. health field. It has been suggested that the Children are potential victims because term “empowerment” has become a they are small, vulnerable, without many catchword among social activists and is resources, and with insufficient informa- applied to a host of political tactics, tion or skills to protect themselves” (p. 8). therapeutic techniques and political There have been no published re- principles (Kautzer, cited in Swift & search studies examining the effects of Levin), and this appears to be the case empowering children to ward off sexual in the area of child sexual abuse preven- abuse and no published research was tion. The imprecision in the definition of found by the authors on the effects of empowerment and its emotional appeal empowering children in any domain, leads to its use to support many different although an exhaustive computer search social programs. Unfortunately, the con- was made of both Psychological and cept has become overused, even abused, Sociological Abstracts. In addition, no 624 School Psychology Review, 1988, Vol. 17, No. 4 research or discussion examining devel- Concepts related to trust and respon- opmentally appropriate empowerment sibility. In addition to addressing sexual behaviors was found in the conceptual abuse or “touching,” and the concepts papers on sexual abuse prevention edu- related to empowerment (i.e., body owner- cation (e.g., Butler, 1986; Plummer, 1986; ship, trusting one’s feelings or intuition, Sanford, 1980). It seems extremely prob- “saying no” and being assertive), most lematic that key conceptual assumptions child sexual abuse prevention programs of child sexual abuse prevention programs include the redefinition of secrets, the aimed at children are based on a construct availability of support systems, and the that has been borrowed from the adult understanding that sexual abuse is not the child’s fault or responsibility. Secrets are literature, has mixed conceptual support described as sometimes needing to be in the adult literature, and has undergone shared, not kept. The “secrets” concept is little conceptual and no developmental coupled with instruction about support analyses. Until further conceptual analysis systems, that is, the idea that children can and research has been conducted, aspects turn to a range of persons for help. In of child sexual abuse prevention programs the child sexual abuse prevention mate- based on interpretations of empowerment rials reviewed, 92% of the programs for should not be used or used with extreme children included secrets, as did 87% of caution. the programs for adolescents and 80% of Swift and Levin (1987) cite an exam- the programs for adults. All of the ple of an unsuccessful empowerment programs included instruction on the effort involving an alternative high school availability of support systems, and 78% which attempted to empower students of the programs for children and 100% of and parents through participative deci- the programs for adolescents and adults sion-making. The failure was cited as due addressed the issue that sexual abuse is to role inequalities, organizational dynam- not the child’s fault or responsibility. ics, and a fundamental paradox in the idea In this analysis, the three commonly of people empowering others, that power taught concepts of secrets, support given can also be power withheld. It is not systems, and victim innocence purposely difficult to imagine similar difficulties were differentiated from the previous ones being involved in empowering children to dealing with “empowerment.” They each prevent sexual abuse within their own concern behaviors related to trust and dysfunctional families. One of the conse- they each promote disclosure. Consider- quences of failed efforts cited by Swift and ation of these three concepts and the Levin is the risk of endangering the target empowerment-based concepts gives a population. The risk is especially high if picture of the complexities inherent in the changes in the power balances are materials that children are being pre- sented. Children are taught not to be silent pursued without a full understanding of about sexual abuse, although perpetra- the formidable and complex forces ar- tors often demand secrecy. Children also rayed against the intended changes. are taught to tell someone they trust about Again, children are the ones who will be the sexual abuse, and if that person does endangered by rhetoric to be empowered not believe them, to tell someone else. in situations where they will not be given Children are being asked to determine power. Swift and Levin also caution that whom they can trust, in the face of a because most professionals are among this betrayal of trust by at least one person society’s empowered, they must monitor they thought they could trust. Then they themselves closely so that their efforts to are taught that if children are sexually empower others do not, in the end, only abused, it is not their fault or responsi- serve to empower themselves. This mes- bility. Each of these concepts is essential sage seems key to professionals who are to promoting disclosure, an essential goal attempting to empower children who are of sexual abuse education programs. actual or Dotential victims of sexual abuse. However. in addition. children are taught, Prevention of Child Sexual Abuse 625 or “empowered,” to believe that they own sexuality education? their bodies, that they will intuitively know It has been suggested that to contend if they have been victimized, and that they with public squeamishness about sexual- should say no and be assertive to ward ity education in the schools, prevention off sexual abuse. Children in the audience programs have devised various ways for who are victims may feel overwhelmed, skirting more direct sexual references and confused, and guilty by the content of discussions (Finkelhor, 1986). It also has prevention education programs that been maintained that as part of the attempt to teach them about empower- attempt to avoid controversy, many ment and disclosure. Again, teaching materials are marketed under the title of empowerment-based concepts may nega- safety education, facilitating their use tively affect the vulnerable children they where sexuality education is not accepted were designed to protect. (Trudell& Whatley 1988). Of the materials reviewed, 80% of the programs for chil- Child sexual abuse education void of dren, 100% of the programs for adoles- sexuality education. Allowing children cents, and 90% of the programs for adults access to age appropriate information emphasized personal safety. It appears about sexual behavior, thoughts, and that sexual abuse prevention educators feelings is crucial to their ability to and publishers are realistic and recognize integrate information about child sexual that if sexual abuse prevention programs abuse. Although most people associate were to be linked too closely to sex sexuality solely with adolescence and education, fewer schools would adopt adulthood, infants and children are them and fewer children would be edu- developing sexual beings and they express cated. However, this separation can natural interest and curiosity about their become a problem when sexual abuse sexuality. However, most adults, in both prevention programs, with vague refer- home and school settings, find it difficult ences to “private parts” and an emphasis to accept and to allow expression of on “saying no,n constitute the fust and childhood sexuality, to communicate with possibly only classroom reference to children about sexuality, and to provide sexuality (Trudell & Whatley, 1988). A a positive sexual socialization experience sexual abuse prevention program may be for children (Tharinger, 1987). Given the the child’s first exposure to any sexuality absence of a context for many children education. The appropriateness of a for understanding sexual abuse, genuine child’s first exposure to the concept of concern can be raised about how children sexual behavior taking place in the process the information presented in context of sexual abuse is highly unfor- prevention programs. The literature on tunate. There is the potential for children children’s understanding of sex and to learn that sexuality is essentially reproduction suggests that young children service, negative, and even dangerous. In have considerable difficulty integrating addition, the avoidance of explicit sexual this information and frequently distort, content is likely to be confusing to children from an adult perspective, the concepts because in spite of what adults say, they involved (Bernstein & Cowan, 1975). still do not want to talk in a straight Prevention programs usually have as their forward manner about sex (Finkelhor, goals personal safety, assault prevention, 1986). Lastly, since children often have no and/or personal empowerment, not sex practice using words and phrases to talk or sexuality education (Finkelhor, 1986). about sexual activity, disclosure may be But can children effectively be taught hindered. about sexual abuse and inappropriate In the sexual abuse prevention ma- sexual approaches without being taught, terials reviewed, only 45% of the programs in a developmentally appropriate way, for children, 13% of the programs for about sexual thoughts, feelings, and adolescents, and 60% of the programs for behavior? Why have so many prevention adults stressed the importance of provid- curricula, especially for children, avoided ing body knowledge (see Table 1). In terms 626 M/ool Ps@u%!ogg~ Review, 1988, Vol. 17 No. 4 of language used for sexual body parts, Plummer, 1984; Wurtele et al., 1986). Some in the materials for children, the term research projects have designed their own “private parts” was used by 65%, “parts dependent measures and a few have under a swim suit” was used by 44%, reported reliability coefficients for inter- “penis” was used by 35%, Vagina” by 30%, nal consistency on questionnaires and “breasts” by 17%, “buttocks” or “bottom” inter-rater reliability for interviews and by 13%, “anus” by 13%, and “genitals” by vignettes (Binder & McNiel, 1987; Downer, 4%. In the materials for adolescents, the 1984; Saslawsky & Wurtele, 1986; Wurtele term “private parts” was used by 63%, et al., 1986). Earlier studies addressed only “parts under a swim suit” was used by 13%, questions of knowledge gains made by “penis” was used by 63%, Vagina” by 88%, child participants and age and gender “breasts” by 63%, “buttocks” or “bottom” effects. More recent investigations have by 38%, “anus” by 50%, and “genitals” by examined additional variables, including 50%. These data support the concern a comparison of two types of treatment previously raised that sexual abuse (Wurtele et al., 1986), the inclusion of a prevention programs do not sufficiently distress scale (Binder & McNiel, 1987), provide labels for children or adolescents data from parents as well as children to use when communicating about sexual (Miller-Perrin & Wurtele, 1986), and data parts of their bodies. from teachers, parents, and children (Binder & McNiel, 1987). Question 2: Do Educational Programs With one exception (Fryer et al., Prevent children from Being Abused? 1987), the outcome measures have tar- geted knowledge, attitudes, or intentions If the ultimate goal of any program to use self-protective actions measured by to prevent child sexual abuse is to teach questionnaires, structured interviews, or behaviors so that when an adult makes vignettes to elicit responses from children a sexual advance toward a child, the child and adults. Considering that prevention will act in an appropriate manner by programs teach knowledge, attitudes, and saying no and telling a responsible adult behavioral rehearsal through role playing, what happened, as is stated by Leventhal it is not surprising that what is measured (1987), there is no evidence to date that in research studies is knowledge. However, programs have accomplished this goal. In addition, it is not known if sexual abuse it is erroneous to assume that if children programs targeted at children are helping have knowledge they will be able to to decrease the incidence of sexual abuse. intervene on their own behalf. Results Research that examines the effectiveness indicate that from participation in sexual of child sexual abuse prevention programs abuse prevention programs, children gain is still sparse and limited. Available in their knowledge about self-protective research findings (currently there are 10 responses (Conte et al., 1985; Fryer et al., empirical, published studies) have been 1987; Swan, Press, & Briggs, 1985; Wolfe, reviewed by Conte (1984), Finkelhor MacPherson, Blount, & Wolfe, 1986; Wur- (1986), and Wurtele (1987). Findings and tele, et al., 1986); older elementary-aged concerns are summarized briefly here. children make greater knowledge gains The populations sampled for preven- (Conte et al., 1985; Wurtele et al., 1987); tion research have been children grades children retain knowledge over a 3 month K to 6. Boys and girls have been repre- period (Wurtele et al., 1987); parents talk sented fairly #equally in all studies. Many with their children about sexual abuse samples have been small and non-ran- more following joint participation in a domized (Downer, 1984; Plummer, 1984; prevention program (Binder & McNiel, Ray, 1984) and most designs have used 1987); and a behavioral skills training pre- and post-testing for both experimen- program is more effective than a film alone tal and control groups. A few included in enhancing knowledge about sexual post-tests to examine retention of knowl- abuse (Wurtele et al., 1986). edge (Fryer, Krazier, & Miyoshi, 1987; Fryer et al. (1987) went beyond Prevention of Child Sexual Abuse 627 measuring knowledge only and measured Question 4: Is it Fair and Reasonable to changes in the children’s behaviors by Emect Children to Participate in Eff& using a simulated stranger to approach to Prevent their Own Sexual Abuse? the child in a setting in the school. This question gets to the heart of Potential hazards of using simulated perhaps the most controversial issue in strangers are discussed by Conte (1987). the prevention movement. The basic issues Those children who were exposed to the continue to be whether children can teaching program were less likely than understand the complex concept of controls to go with strangers. In addition, sexual abuse in a way that is useful to children in the group who refused to go them and if it is reasonable to expect with the stranger had better pre-interven- children to be empowered to respond to tion scores on a self-esteem measure and approaches of sexual abuse, especially in better post-intervention scores on a test situations that involve family members of knowledge than the children in the and/or threats or coercion. As Krazier group who went with the stranger. This (1986) has stated, children are unable to finding regarding self-esteem is not reconcile “bad” touch from “good” people, surprising in light of the earlier discussion that is, from people they love. on factors that increase children’s vulner- An analysis of the trends in the past ability to sexual abuse. decade of sexual abuse prevention efforts aimed at children suggests that the first response to this question of “Is it fair and Question 3: Do Educational reasonable to expect children to partic- Programs Identify Children ipate in efforts to prevent their own sexual Who Have Been Sexually Abused abuse?” was a firm “Yes,” anchored in by Encouraging L&closure? enthusiasm and concern rather than in As a secondary prevention outcome, a systematic conceptual and research most programs encourage disclosure of base. However, experiencing the complex- previous or ongoing abuse. Although it is ities and dilemmas inherent in asking commonly believed and assumed that children to participate in efforts to prevention programs lead to disclosure prevent their own sexual abuse is leading and there are many antecdotes about to a second response from prevention educators and researchers; a more tem- children disclosing following participation pered and cautious response, such as “It in a prevention program, findings are rare is not fair and reasonable, at least not as and usually not published (Beland, 1985; it currently is being done.” At the Wing- Kent, 1979; Wall, 1983). However, it has spread Meeting of major figures in the field been reported that one-sixth of the in 1985 reported by Crewdson (1988), all children attending a particular classroom of the leaders were reported to agree that presentation subsequently revealed a it was unfair to put the burden of prior sexual assault; of these, one-half had preventing sexual abuse on children. never reported the incident before (Kent, Although Conte et al., (1986) stated that 1979). In addition, Beland (1985) reports “Many professionals involved in sexual that the disclosure rate in schools par- abuse prevention programs recognize that ticipating in preventing programs was ultimately all materials and programs significantly higher compared to schools should be viewed as temporary efforts to not participating. Although these results help children resist and escape abuse until are encouraging, rigorous and reliable such time as other activities can be data are needed to convincingly state that successful in changing the conditions sexual abuse prevention programs consis- which cause and support sexual abuse of tently lead to disclosure and thus iden- children” (p. 153), the question becomes tification. Systematic data collection on for how long should these temporary rates of disclosure needs to be imple- efforts be carried out and in what form? mented in school-base.d programs. As recently stated by Krazier (1986), SMmol Psychology Review, 1988, Vol. l?‘, No. $

“Prevention programs for children are abuse issue in 1985 by Marvel Comics in very often created by well meaning association with the National Committee professionals as an isolated response to for Prevention of Child Abuse. He reported a specific problem without adequately that 17 to 50% of the children responded considering or understanding the overall that they were worried or scared needs of children. They are created from afterwards. concepts and beliefs that make sense to In contrast, of a group of K-6th adults but which consistently are misun- graders who either watched a film aimed derstood by children” (p. 259). Also stated at teaching sexual abuse prevention skills by Krazier, ‘We need to recognize that or participated in a behavioral skills prevention efforts can support or damage training program in which the skills were children in the most fundamental way” (p. actively rehearsed, the parents of the 259). An examination of unintended or children reported relatively few negative negative side effects of sexual abuse behavioral changes as a result of the prevention programs may explicate some program - 11% of the parents reported of the new found concern and caution. negative changes (Miller-Perrin & Wurtele, 1986). Another study evaluated children’s Possible unintended consequences. and parents’ reactions to the 30-minute Practitioners and researchers have recog- sexual abuse prevention play entitled nized that sexual abuse prevention pro- Bubbylonian Encounters (Swan et al., grams targeted at children may have 1985). The children were ages 8 to 11. Only unintended effects or consequences, often 7% of the parents reported that their child termed negative side effects. Although did not like the play, only 5% reported that most of the attention has been focused their child was upset, and none reported on unintended effects for the children that their child felt negative about attend- themselves, such as being distressed or ing the play. Lastly, and the most free of frightened by a prevention program, negative effects, Binder and McNeil (1987) unintended effects, with serious conse- evaluated a school-based child sexual quences, also may affect implementers of abuse prevention program that consisted prevention programs, for example of separate 2-hour workshops for children teachers, and society as a whole. ages 5 to 12, parents and teachers. The examination of unintended con- Following the program, both parents and sequences or negative side effects for children reported feeling more confident children typically has involved observed in the children’s capacity for coping with behavioral changes in children following potential abuse situations and no increase presentation of a prevention program, in emotional distress was reported by such as reluctance to engage in physical parents following their child’s participa- contact with adults or changes in chil- tion in the program. In addition, most of dren’s emotional states (heightened levels the children reported feeling much or of fear or anxiety). Five empirical studies somewhat safer following the program have reported data addressing possible (89%), although 8% of the children re- negative effects and the findings are ported feeling neither safer nor more inconsistent. Each study evaluated a scared and 3% reported feeling somewhat different prevention program and used more scared. In addition, 94% of the different outcome measures. In a study children reported feeling somewhat or that utilized a control group and multiple much better able to protect themselves, outcome measures, 35% of the children while 6% reported feeling neither more or displayed negative emotional reactions less able to protect themselves. and 20% exhibited negative behavioral In evaluating “negative effects” of reactions, based on a parental question- programs on children, it is important to naire (Kleemeier & Webb, 1986). Along assess more than the presence of behav- similar lines, Garbarino (1987) studied ioral or emotional changes or parental children in grades 2, 4, and 6 who read satisfaction. There are two other possible the Spiderman comic addressing sexual unintended effects on children that have Prevention of Child Sexual Abuse 629 been mentioned in the literature and were addressed. One concern is that “A single- referred to earlier. Trudell and Whatley minded pursuit of school sexual abuse (1988) maintain that to the extent that prevention programs as a solution can sexual abuse prevention programs focus turn attention away from other, perhaps on teaching children to protect them- more effective, ways to address the selves, they can have the unanticipated problem” (Trudell & Whatley, 1988, p. consequence of contributing to blaming 105). A related concern is that by targeting the victim. The concern is that teaching much of the prevention effort at programs children to protect themselves may teach for children, a false security will develop. them that they are responsible if they That is, society will slip into the false cannot or could not protect themselves. security that teaching children to say no Considering the number of children in to sexual abuse approaches is the answer each audience that have been or will be to an extraordinarily complex problem sexually abused, the concern about victim (Crewdson, 1988). Also related is the self-blame is a serious one. Even if concern that by targeting children, society programs stress that it is never the child’s is promoting denial that sexual abuse of fault, that message may be hard to children is a complex societal problem in reconcile with the message that you can need of major societal change. This last (and should?) say no or take actions to point seems ironic in that the existence escape. The other unintended effect is that of child sexual abuse was denied for so due to all too common separation of long that to deny that extensive efforts sexual abuse prevention and sexuality and resources are needed to combat the education, there are concerns that chil- problem sounds too familiar. If these dren will learn that sexuality is essentially unintended consequences to the child, the secretive, negative, and even dangerous. implementers, and society are not ad- Unintended consequences or negative dressed, it is likely that little will be side effects for implementers of sexual accomplished in decreasing the incidence abuse prevention programs rarely are of child sexual abuse. discussed. However, considering that most prevention programs are being presented in the schools and that most often Question 5: What Issues Do School Psycholcqists Need to Consider When teachers are the implementers, it is Developing, Implementing, and important to address possible concerns Evaluating School-based Child (see Trudell & Whatley, 1988). Even when Sexual Abuse Prevention Education outside experts are used as implementers, Programs? school staff must deal with the aftermath of the programs. Unintended consequen- Many of the issues that school psy- ces for implementers include the possibil- chologists need to consider have been ity that they may feel overwhelmed and discussed throughout this article. They are unprepared for the responsibility of examined here in the context of school- presenting a program and providing the based practice. As reviewed, child sexual necessary follow-up, including possibly abuse prevention education programs, reporting. Training may not be adequate typically void of sexuality education and and support from other personnel and the with a goal of empowering children to administration may not be forthcoming. protect themselves from abusive ap- In addition, fears of angry parents, of proaches, are standing on tenuous con- involvement in the criminal justice system, ceptual and empirical ground. In addition, or of being wrong abound, perhaps although research on prevention educa- rendering school staff unavailable to the tion programs reports unintended effects response to child sexual abuse. consisting of mild to moderate negative Unintended consequences or negative emotional and behavioral reactions in side effects for society as a result of sexual children, distressed reactions may not abuse prevention programs targeted at necessarily constitute an undesired side children are only beginning to be explicitly effect that programs can successfully 630 School Psydwlogy Review, 1988, WA. 17, No. 4 eliminate. Rather, distress may be part of teachers, to provide direct interventions the process of understanding the serious for children, to educate and consult with nature of sexual abuse. Most adults are parents, and to make referrals to commu- upset emotionally when they first learn nity programs for treatment and support. about child sexual abuse. The goal that In short, schools need to be prepared to information be able to be presented to respond to children who have been children about sexual abuse, including sexually abused before they implement intrafamilial sexual abuse, in a way that prevention education programs (Tharin- creates no distressed reactions is perplex- ger & Vevier, 1987; Vevier & Tharinger, ing. Regardless of the targeted audience, 1986). being educated about the sexual abuse of Following preparatory activities and children is disturbing. Thus, the decision the determination that a sexual abuse of a school district to adopt or to develop education program is desired, numerous and implement a sexual abuse education decisions need to be made in the process prevention program targeted at children of planning a program. The format, is a serious one because of the disturbing content, and length of the program must nature of child sexual abuse and the lack be considered, along with the choice of of adequate conceptual and empirical implementer, means of parent involve- support for prevention education pro- ment, special population considerations, grams. With these points in mind, it is and targets of evaluation. It is important recommended that the goal of school- to avoid being at the mercy of commer- based sexual abuse education programs cially produced programs. A good practice clearly be disclosure and identification. is first to determine what features are The following guidelines are intended desired in a program, then to review a to alert school psychologists to major number of available curricula and films, considerations that must be addressed in choosing aspects of existing programs reaching a decision to provide sexual that match the plan and developing abuse education programs. First, the additional features that are not available. issues must be examined, the local base In terms of specific content of the pro- of support ascertained, and goals set, grams, controversy dominates. A key issue perhaps by a committee of school admin- to be resolved is the relationship between istrators, psychologists, counselors, sexual abuse education and sexuality teachers, parents, and community special- education. As was reviewed earlier, it is ists. It is essential that a school district important to provide children with the not provide prevention education pro- language necessary to communicate about grams in isolation. For example, it is sexual behavior and not to give the professionally irresponsible to ask a message that sexual behavior is usually teacher to show a sexual abuse education bad, secretive, or dangerous. film in his or her classroom and to A basic goal of most education efforts consider the job complete. Much prepa- is to provide information about the ration needs to occur to set the stage for concept of child sexual abuse. However, an effective sexual abuse education effort. one of the weaknesses of available pro- School personnel need to be informed grams for children, as opposed to adoles- about child sexual abuse. They need to cents, is the lack of methods available to be able to recognize signs and identify present information in a way that is suspected cases, as well as to feel com- understandable and applicable. Although petent and comfortable responding to the touch continuum has been prominent, disclosures. Administrators need to set other avenues need to be proposed and and support a clear policy for reporting researched. Of the concepts reviewed abuse. School mental health professionals earlier, it is recommended that the need to be able to respond to disclosures programs include the concepts of body with crisis counseling, to work with knowledge, secrets, using a support protective service and law enforcement network, and that sexual abuse is not the agencies, to support and consult with child’s fault or responsibility. Further, it Prevention of Child Sexual Abuse 631

is recommended that programs not in- following the program, and tests of clude concepts based on empowering knowledge gains, as well as the consider- children to trust their feelings, to say no, ation of unintended effects. Gathering and to be assertive. Empowerment-based baseline data on attitudes and on disclo- concepts may be more applicable with sure and reporting rates prior to the adolescents, although adolescents who implementation of programs is advised as are victims are extremely vulnerable and may not be capable of making appropriate a means to measure change. The key to judgments and decisions on their own implementing and evaluating a program behalf to stop the abuse. Again, adolescent is to develop and follow a plan carefully, victims need to be encouraged to disclose analyze the evaluation data systemati- to and receive help. cally, and make subsequent program The length and duration of a program changes based on the evaluation results. needs to be considered carefully. One or two presentations is not adequate. Just as teachers rely upon principles based on developmental, learning, and instruc- SUMMARYANDCONCLUSIONS tional theories, implementers of sexual Child sexual abuse is a traumatic and abuse programs must remember that solid complex phenomena. If a decrease in the learning requires a breakdown and se- quencing of skills over time, as well as incidence of child sexual abuse is to occur, reinforcement, review, and practice. prevention efforts must be targeted at the Possible program implementers may individual and societal conditions that include staff members, such as teachers cause and support it. Sexual abuse or counselors, or consultants or volun- education programs aimed at children teers from local community-based sexual must be only one, and perhaps a tempo- abuse prevention or treatment groups. A rary, component of a whole array of major consideration with choosing imple- prevention efforts that are needed. In the menters is the adequacy of their training rush to respond to the tragedy of child and whether or not they are in a position sexual abuse, many essential preliminary to provide ongoing support (see Conte et steps in the development of prevention al., 1986; Finkelhor, 1986; Trudell & education programs have been ignored or Whatley, 1988; Wurtele, 1987). In addition, skipped. Consequently, the decision of a involvement and education of parents is crucial. In healthy families, parents will school district to develop or adopt and want to be a part of educating their implement a sexual abuse education children about this sensitive topic. In program is a difficult one. School psychol- addition, there is some hope that in ogists who are aware of the issues and dysfunctional families at risk for or research findings on the prevention of engaging in sexual abuse, widely educating sexual abuse and of the foundation and parents, teachers, and children about effectiveness of sexual abuse prevention sexual abuse may serve as a deterrent. programs aimed at children are in a Furthermore, providing education for position to prevent programs from being handicapped or disabled children and implemented that are conceptually and adolescents and their parents is essential, developmentally inappropriate for chil- as this population is thought to be even dren. School psychologists are challenged more at risk for sexual abuse (Tharinger, Burrows Horton, & Millea, 1988). Lastly, to participate in the development, imple- explicit plans need to be made about mentation, and evaluation of programs evaluation procedures for developed that more effectively address the needs programs. Possible targets for evaluation and capacity of children to understand include attitudes of school personnel sexual abuse and that promote disclosure toward responding to sexual abuse, and identification of children who have numbers of disclosures and reports been victimized. 632 S&ool Psychiolq~~y Review, 1988, Vol. 17, No. 4

REFERENCES the sexual victimization of young children. child Abuse & Neglect, 9,319-328. American Humane Society. (1982). Estimated number of sexual maltreatment victims in the Crewdson, J. (1988). By silence betrayed: Sexual United States reported to child protective services. abuse of children in America. Little, Brown & Denver: American Humane Society. Company: Boston. Anderson, C. (1986). A history of the touch Davis, L. L. (1986). The role of the teacher in continuum. In Nelson, M. & Clark, K. (Eds.), 7%e preventing child sexual abuse. In Nelson, M. & educator’s guide to preventing child sexual abuse Clark, K. (Eds.), 7% educator’s guide to preventing (pp. 15-25). Santa Cruz: Network Publications. child sexual abuse (pp. 87-92). Santa Cruz: Network Publications. Beiand, K. (1985). Prevention of child sexual vict~mixation:A school based statewidepwventti DeFrancis, V. (1969). Protecting the child victim of model (Summary Report). Seattle: Committee for sex cyrimes committed by adults. Denver: American Children. Humane Society. Berliner, L. (1977). Child sexual abuse: What happens Downer, A. (1984). Evaluating of Talking about next? Victimology, 2,327-331. touching. Available from author, c/o Committee for Children, P.O. Box 15190, Seattle, WA 98115. Bernstein, A. C., & Cowan, P. A. (1975). Children’s concepts of how people get babies. Child Devel- Downer, A. (1986). Teaching teachers to be partners qpnaent, 46, 77-91. in prevention. In Nelson, M. & Clark, K. (Eds.), The Binder, R. L., & McNiel, D. E. (1987). Evaluation of educator’s guide to preventing child sexual abuse a school-based sexual abuse prevention program: (pp. 80-86). Santa Cruz: Network Publications. Cognitive and emotional effects. Child Abuse & Finkelhor, D. (1984). Child sexual abuse: Neglect, 11,497-506. and research. New rYork: Free Press. Brassard, M. R., Tyler, A. H., & Kehle, T. J. (1983). Finkelhor, D. (1986). A source book on child sexual School programs to prevent intrafamilial child abuse. Sage Publications: Beverly Hills. sexual abuse. Child Abuse & Neglect, 7,241-245. Browne, A. B., & Finkelhor, D. (1986). Impact of child Fryer, G. E., Krazier, S. K., & Miyoshi, T. (1987). sexual abuse: A review of the research. Psycho- Measuring actual reduction of risk to child abuse: logical Bulletin, 99,66-77. A new approach. Child Abuse & Neglect, 11, 173- 179. Butler, S. (1986). Thinking about prevention: A critical look. ( 1986). In Nelson, M. 8~Clark, K. (Eds.), Garbarino, J. (1987). Children response to a sexual The educator’s guide to preventing child sexual abuse prevention program: A study of the S&id- abuse (pp. 6-14). Santa Crux: Network errnan comic. Child Abuse & Neglect, l&143-148. Publications. Kempe, R. S., & Kempe (1984). l%e common secrd= Caterino, L. C. ( 1987). Children and sexual abuse. Sexual abuse of children and adolescents. New In A. Thomas & J. Grimes (Eds.), Children’s needs: York: W. H. Freeman. Psychological perspe&ives (pp. 522-532). NASP: Kent, C. A. (1979). Child sexual abuse prqject: An Kent, Ohio. educational program for children. Hennepin Conte, J. R. (1984). Research on the prevention of County Attorney’s Office Sexual Assault Services, sexual abuse of children. Paper presented at the Minneapolis, MN. Second National Conference for Family Violence Researchers, Durham, NH. Kleemeier, C. & Webb, C. (1986). Evaluation of a school bused prevention program. Paper presented Conte, J. R. (1987). Commentaries: Programs to at the American Psychological Association Conven- prevent sexual abuse: What outcomes should be tion, Washington, DC. measured? Child Abuse &Neglect, 11,171-172. Krazier, S. K. (1986). Rethinking prevention. Child Conte, J. R., & Berliner, L. (1981). Sexual abuse of Abuse &Nsglect, 10,259-261. children: Implications for practice. Social Case- zuork, 62,601-606. Leventhal, J. M. (1987). Commentaries: Programs to prevent sexual abuse: What outcomes should be Conte, J. R., Rosen, C., & Saperstein, L. (1986). An measured? Child Abuse & Nt@&, l&169-171. analysis of programs to prevent the sexual victimization of children. Journal of Primary Miller-Perrin, L. L., & Wurtele, S. K. (1986). Ham&l Prmtion, 6(3), 141-155. effit of school based sexual abuse prevention programs. Paper presented at the American Conte, J. R., Rosen, C., Saperstein, L., & Shermack, Psychological Association Convention, Washington, R. (1985). An evaluation of a program to prevent DC. Prevention of Child Sexual Abuse 633

Mrazek, P. B. (1981). The nature of incest: A review teacher. Journal of Researchand Developmentin of contributing factors in P. B. Mrazek & C. H. Education, 20, 12-24. Kempe (Eds.), S&xually abused children and their families (pp. 97-107). New York: Pergamon. Trudell, B., & Whatley, M. H. (1988). School sexual abuse prevention: Unintended consequences and Nelson, M., & Clark, K. (Eds.) (1986). The educator’s dilemmas. Child Abuse& N@ect, 12,103-l 15. guide to prewnting child sexualabuse. Santa Cruz: Network Publications. Vander Mey, B. J. (1988). The sexual victimization of male children: A review of previous research. National Center on Child Abuse and Neglect Child Abuse& Neglect,12,61-72. (NCCAN). (1982). Profile of child sexual abuse. Rockville, MA: Clearinghouse on Child Abuse and Vevier, E., & Tharinger, D. (1986). Child sexual abuse: Neglect Information. A review and intervention framework for the school psychologist. Journal of school Psychology, Plummer, C. (1984). Pwventing sexual abuse: What 24,293-311. in-school programs teach children. Unpublished manuscript available from author at P. 0. Box 421, Wall, H. R. (1983). Child assault/abuse prevention Kalamazoo, MI 49005. project: Pilot program evaluation. Mt. Diablo Untied School District, 1936 Carlotta Dr., Concord, Plummer, C. (1986). Prevention education in CA 94519. perspective. In Nelson, M. & Clark, K. (Eds.), “17Le educator’s guide to preventing child sexual abuse Wolfe, D. A., MacPherson, T., Blount, R., & Wolfe, V. (pp. l-5). Santa Cruz: Network Publications. V. (1986). Evaluation of brief interventions for educating school children in awareness of physical Ray, J. (1984). Evaluation of the child sexual abuse prevention program. Unpublished manuscript and sexual abuse. Child Abuse& Neglect,10, 85- available from author at Rape Crisis Network, 92. N1226 Howard St., Spokane, WA 98201. Wurtele, S. K. (1987). School-based sexual abuse Sanford, L. T. (1980). The silent children: A book prevention programs: A review. Child Abuse & fwparents about prevention of child sexual abuse. Neglect,11,483-495. New York: Doubleday. Wurtele, S. K., Saslawsky, D. A., Miller, C. L., Marrs, Saslawsky, D. A., & Wurtele, S. K. (1986). Educating S. R., & Britcher, J. C. (1986). Teaching personal children about sexual abuse: Implications for safety skills for potential prevention of sexual pediatric intervention and possible prevention. abuse: A comparison of treatments. Journal of Journal of Pediatric Psychology, l&235-245. Consulting and Clinical Psychology, 54,688-692. Schultz, L. G., & Jones, P. (1983). Sexual abuse of children: Issues of social and health professionals. SEXUAL ABUSE PREVENTION EDUCATION Child Welfare, 62,99-108. MATERIALS REVIEWED Swan, H. L., Press, A. N., Briggs, S. L. ( 1985). Child Materials for Children sexual abuse prevention: Does it work? Child Welfare, 64, 196-405. Meyer, L. D., I take good care of me/I take good care of us. (1986). Chas. Franklin Press. Swift, C., & Levin, G. (1987). Empowerment: An emerging mental health technology. Journal of Rutt, P., & Salicrup, J. Spider-man and power pack. Primary Prevention, 8,71-93. (1984). Marvel Comics, A New World Company. Tharinger, D. (1987). Children and sexual interest. White, L., & Spencer, S. Take care with yourself: In A. Thomas & J. Grimes (Eds.), Children’s needs: (1984). DayStar Press. Psychological perspectives (pp. 532-542). NASP: Kent, Ohio. Materials for Adolescents Tharinger, D., Burrows Horton, C., Millea, S. (1988). Sexuul a.buse of mentally retarded children and Fay, J. J., & Flerchinger, B. J. Top secret: Sexual adults: The need for professional and societal assault information for teenagers only. (1982). response. Manuscript under review. King County Rape Relief. Tharinger, D., Laye-McDonough, M., Jamison, L., Stringer, G., & Rants-Rodriguez, D. So what’s it to Vincent, G., Hedlund, A., Friend, J. (1988). An in me? (1987). King County Rape Relief. depth descriptive analysis of 46 child sexual abuse prevention materials. Unpublished manuscript, available from first author. Materials for Parents Tharinger, D. & Vevier, E. (1987). Child sexual abuse: Adams, C., & Fay, J. No me secrets. (1981). Impact A review and intervention framework for the Publishers. 634 Miool Ps@ology Review, 1988, Vol. 17, No. 4

Kraxier, S. The safe child book. (1985). Dell Publishing l&&r$& for C?&lren and Company, Inc. Their Teachers or Group Leaders Turner, R.About thesexual abuseof children. (1984). Beland, K. Talking about touching II - Personal Pierce County Rape Relief. safety for preschoolers. (1986). Committee for Materials for C;lhildren and Their Parents Children. Bassett, K. &@ very own special body book. (1980). Downer, A. & Beland, K. Personal safety and decision Hawthorne Press. making (grades 5-8). (1984). Beck, T. G. The talking and telling about touching Grimm, G. & Montgomery, B. Red flag, green jZag game. (1984). Safety Time Games. and facilitator’s program guide. (1980). Rape and Dayee, F. S. Private zones. (1982). Warner Books. Abuse Crisis Center. Fay, J. He told me not to tell. (1979). King County Plummer, C. A. Preventing sexual abuse. (1984). Rape Relief. Lerner Publications, Inc. Gordon, S., & Gordon, S. A better safe than sorry Seattle Institute for Child Advocacy. Talking about book. (1984 j. Ed-U Press, Inc. touching: A personal safety curriculum. (1985). Hindman, J.A very touching book. (1983). McClure- Seattle Institute for Child Advocacy. Hindman Associates. Soukoup, R., Wickerner, S. & Carbett, J. l%ree in every Hubbard, K., & Berlin, E. Help yoursew to safety. classroom. (1984). Richards Publications (1985). Chas. Frankhn Press. Company. It !s O.K. to say no! - Activity book. (1984). Playmore, Inc. Publishers and Waldman, Publishing Materials for Adolescents and Corp. 27ieir Teachers or Group Leaders It’s O.K. to say no? - Coloring book. (1984). Playmore, Inc. Publishers and Waldman, Publishing deAlcorn, S. Sourcebook for educators: Sexual Corp. assault prevention for ad&scents. (1982). Pierce Jance, J. A. It’s not your fault. (1985). Chas. County Rape Relief. Franklin Press. Fortune, M. M. Sexual abuse prevention - A study Kleven, S. Ibuching. (1985). Whatcom County fw teens. (1984). United Church Press. Opportunity Council Kent, C. A. No easy answers. (1982). Network Krause, E. For Pete’s sake tell! Second in a series Publications. of books for parents to help children awid sexual abuse. (1983). Krause House. Wong, D., & Wittet, S. Be aware, be safe. ( 1987). King County Rape Relief. Krause, E. Speak up, say no! A book for adults to help children avoid sexual abuse. (1983). Krause House. Materials for Mental Health Stowell, J., & Dietzel, M. My very own book about ~Of~SSb'ZdS me. (1982). Rape Crisis Resource Library. Anderson, C. Child sexual abuse prevention: How Terkel, S. N., & Rench, J. E. Feeling safe, feeling to take thefirst stqx. (1986). Network Publications. strong. (1984). Lerner Publications Company. Baird, K. Iwy body belongs 2;ome. (1986). American Wachter, 0. No moTe secTets for me. (1983). Little, Guidance Service. Brown and Company. Wittet, S., & Wong, D. Helping your child be safe. Baird, K., & Kile, M. Body rights - DUSO. (1986). (1987). King County Rape Relief. American Guidance Services. Loontjens, L. Talking to children/Talking to parents Materials for Adolescents and about sexual assault. (1984). Network Their Parents Publications. Adams, C., & Fay, J. Nobody t Id me it was rape. Sweet, P. E. Something happened to me. (1981). ( 1984). Impact Publishers. Mother Courage Press. Adams, C., Fay, J., & Loreen-Martin, J. No is not enough. (1984). Impact Publishers. Materials for Program Implenaentws Bateman, P., & Stringer, G. Where do I start? A parent’s guide to talking to teens about acquaint- Aiello, B. l%e kids on the block. (1985). Kids on the ante rape. (1984). King County Rape Relief. Block. Flerchinger, B. J., & Fay, J. !lbp secret; A discuss&m Anderson, C. Child sexual abuse prevention: How guide. (1985). Network Publications. to tahz thefirst steps. (1983). Network Publications.