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Child Sexual Abuse CHILD SEXUAL ABUSE What does the research tell us? A literature review. Office of the Senior Practitioner NSW Department of Family and Community Services Dr Catherine Esposito and Ellen Field December 2016 Child sexual abuse is a global problem. It has the potential to adversely impact children across the span of their lifetime. The challenges for child protection practitioners when working with children and families who are at risk of or have experienced child sexual abuse are great. Appropriate responses are crucial. This paper reviews the current literature about child sexual abuse with a focus on key messages for child protection workers and their practice. Executive summary .............................................................................................................. 1 1. Introduction ................................................................................................................. 6 1.1. Purpose of the review ............................................................................................... 6 1.2. Structure of the literature review ............................................................................. 7 1.3. Review Methodology ................................................................................................ 7 1.4. Issues in interpreting the literature ........................................................................... 8 2. Chapter Two: An overview of child sexual abuse ....................................................... 10 2.1. Definitional issues: what is child sexual abuse? ....................................................... 10 2.2. What is the prevalence of child sexual abuse? ........................................................ 11 2.3. Models for understanding child sexual abuse ......................................................... 12 2.4. What are some of the short and long-term impacts of child sexual abuse? ............. 13 KEY MESSAGES about prevalence and impacts of child sexual abuse .................................. 13 3. Chapter Three: Victim, family and community-level risk factors associated with child sexual abuse ....................................................................................................................... 17 3.1. Victim related risk factors ....................................................................................... 17 KEY MESSAGES about risk factors at victim level.................................................................. 24 3.2. Family level factors ................................................................................................. 26 3.3. Community level risk factors ................................................................................... 32 KEY MESSAGES about family and community-level risk factors ............................................ 33 4. Chapter Four: The offender in child sexual abuse ...................................................... 49 4.1. Theories about what leads offenders to commit child sexual abuse. ....................... 49 4.2. Are there differences between adults who sexually abuse children and those who sexually abuse adults? ......................................................................................................... 51 4.3. How do child sexual abuse offenders differ from non-sexual abuse offenders and non-offenders? ................................................................................................................... 51 4.4. Risk factors associated with intrafamilial compared to extrafamilial offenders of child sexual abuse ....................................................................................................................... 53 4.5. Are child sex offenders also victims of child abuse? ................................................ 56 4.6. Do child sex offenders have high rates of sexual recidivism? ................................... 58 4.7. Treatment and prevention. What helps to stop male offenders of child sexual abuse from re-abusing? ................................................................................................................. 59 KEY MESSAGES about child sexual abuse by males .............................................................. 63 KEY MESSAGES about the treatment of adult male child sexual abuse offenders ................. 64 4.8. Child sexual abuse committed by females ............................................................... 65 KEY MESSAGES about child sexual abuse committed by females ......................................... 72 4.9. Grooming ............................................................................................................... 74 KEY MESSAGES about grooming .......................................................................................... 78 4.10. Online child sexual abuse and exploitation ............................................................. 78 KEY MESSAGES about online child sexual abuse and exploitation. ....................................... 84 5. Chapter Five: Protective factors ............................................................................... 103 5.1. What do we mean by protective factors?.............................................................. 103 5.2. Do education programs protect children against being abused or re-abused?....... 104 5.3. How do children protect themselves from individual abuse or re-abuse?.............. 105 5.4. How can the family and its members help protect an individual child against sexual abuse? 106 5.5. What is the role of community in protecting and supporting victims of child sexual abuse? 115 KEY MESSAGES about factors that protect children from sexual abuse .............................. 116 6. Chapter Six: Working with children and young people............................................. 127 6.1. Giving voice to the experiences of children and young people .............................. 127 KEY MESSAGES about the perspectives of children and young people ............................... 128 6.2. Treating sexually abused children: what works? ................................................... 129 KEY MESSAGES about the effectiveness of treatment ........................................................ 132 7. Chapter Seven: Sexually harmful behaviour............................................................. 137 7.1. Overview of sexually harmful behaviour ............................................................... 137 7.2. The offenders of sexually harmful behaviour ........................................................ 140 7.3. Risk factors for sexually harmful behaviour ........................................................... 142 7.4. Do young people who sexually abuse continue abusing as adults? ........................ 147 7.5. How can risk be better assessed ? ......................................................................... 148 7.6. What treatments or interventions seem to work? ................................................ 149 KEY MESSAGES about sexually harmful behaviour ............................................................. 154 7.7. Sexually harmful behaviour among children and young people in Aboriginal communities ..................................................................................................................... 156 KEY MESSAGES about sexually harmful behaviour in Aboriginal communities.................... 160 7.8. Sexually harmful behaviour in the context of out-of-home care ............................ 162 KEY MESSAGES about sexually harmful behaviour in out-of-home care ............................. 167 Executive summary Child sexual abuse is a complex practice issue that raises unique challenges for child protection practitioners. This work calls for child protection practitioners that can sit with uncertainty when working with a family where child sexual abuse is suspected, but not yet substantiated; practitioners that can keep all children safe in a family where one child has sexually harmed another; practitioners that can help a parent believe that someone they trust has sexually abused their child; practitioners with the tenacity to support a young person to recognise sexual exploitation; and practitioners that have the courage to bear witness to a child who tells them they have been sexually abused. Child sexual abuse exists in many forms. It is often unwitnessed. It is an act that relies on secrecy, coercion, control and the abuse of power and trust. Child protection practitioners are asked to respond to this abuse and all who are a part of it: the victim, the offender, the non-offending parent and the community. To keep children safe from child sexual abuse, and to help those who have experienced it heal, child protection practitioners must hold a sophisticated knowledge base. Being well read is the basis for skillful practice. Practitioners need to know the evidence, how and where child sexual abuse happens, the factors that increase risk or provide protection, its effects on children, young people and families and what interventions and practices are most effective in keeping children safe. Children and parents need practitioners to respond to child sexual abuse with skill that is backed by a knowledge of what works best to prevent child sexual abuse from occurring, and where it has occurred what works best to help children and families heal. To ensure that practice is grounded in contemporary research, the Office of the Senior Practitioner (OSP) within
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