Before exploring the issue of sexual abuse prevention programs, it is important to understand the definition of the term sexual abuse. There are several definitions that could be used to define the term. Several researchers conclude that when defining abuse it is important to put age restrictions on what constitutes abuse. Some say, if the perpetrator is five years older than the pre-teen victim, then the act is considered abuse. Whereas, if the victim is a teenager, a 10 year age difference is required for the act to be considered abuse (Knutson, 1995). These age ceilings can vary by research group. In some research studies it is considered sexual abuse with anyone under the age of 18, whereas in others the age range varies between 14 and 16. For the purposes of this paper the following definition will be used: Sexual abuse is when an adult or a child who is five years older than the victim engages in sexual behavior which includes kissing, fondling, touching, petting, oral sex, penetration of anus or vagina, prostitution of the child, taking nude pictures of the child or showing pornography to the child who is under the age of 18 (Conte, 1993). Victimization of children involves abuse of power and control by an adult. Abuse usually occurs in a familiar setting and with someone who the child has already developed a special bond or attachment (Lanning & Ballard & Robinson, 1999).
Most experts would say that sexual abuse occurs much more often than the statistics report. According to the research the estimates range from 6% to 62% for females and 3% to 31% for males (Conte, 1993). There could be several reasons for the wide gaps in these percentages. For example, the methods used to obtain the information such as the attributes of the sample or the wording on the questionnaire. By testing these methods, the margin of error could be reduced resulting in more accurate measures.
Victims of sexual abuse are affected in many ways. In a study of 156 sexually abused preschool students, those that were abused scored higher than a norm group on the Louisville Behavior Checklist (LBC) on 10 out of 16 areas (Conte, 1993). Adolescents scored higher than the norm group on all areas of the LBC (Conte, 1993). Research has shown many children who have been sexually abused have 20 to 30 percent smaller brains than those children who have not been abused (Lowenthal, 1999). Other implications of experiencing sexual abuse include problems with academics, difficulty adjusting to social situations, lower self esteem, lower self image, lack of motivation, some emotional and behavioral problems and attention problems.(Meston et al, 1999). Victims of sexual abuse tend to seek out the approval of the teacher and need constant assurance and approval (Lowenthal, 1996). In addition, these children have a greater tendency to exhibit sexual promiscuity and severe sleeping problems (Conte, 1993).
As public awareness about the severity of sexual abuse increases, it is becoming clear that simply identifying the problem and responding to crises is not the answer. Experts in the field have been trying to develop prevention programs that can empower and educate children about sexual abuse since the 1970's. Due to the regular and long-term contact school has with families and children, the school setting is an ideal forum for empowering and educating children about sexual abuse. These programs give children knowledge about sexual abuse and teach students mechanisms for responding to potential danger and traumatic events. The children learn about "good" and "bad" touching, ideas related to self-esteem and the ability to say "no". In addition, children learn what the definition of child abuse is and the proper steps to take if it ever occurs to them. In addition, they learn the need for safety plans if the child is in an abusive relationship with an adult. Some programs stress the idea that the children themselves are in control of their bodies, and therefore, they control what happens to it. This model attempts to empower children to take control of their lives.
The behavioral model is used in the majority of sexual abuse prevention programs. These programs focus on reframing the ideas of trust, boundaries and control within the child. They often use modeling of appropriate and inappropriate behaviors. This behavioral skills training (BST) focuses on teaching, role-playing and feedback. It is usually used in connection with group discussion, plays, videos and workbooks (Berson & Berson, 1999).
To summarize sexual abuse is a significant problem. There are several definitions that researchers use when defining sexual abuse. Each has different age differentials for determining when an act is considered abuse. There should be a standard definition used so that the research is more consistent. Also, the assessment tools for determining the prevalence of sexual abuse need to be adjusted to elicit more accurate responses. This would help close the wide gaps in statistical percentages. However, from just looking at the lowest percentage, it is clear that sexual abuse affects many children. Prevention programs are to give children information about sexual abuse and ways to avoid uncomfortable situations. The focus is to empower children to take control and stand up for themselves in those certain situations as well as educating the child about the issue.
In the research reviewed for this paper, almost every article mentioned that there are a lot of inconsistencies about the issue of sexual abuse. Research cautions that statistics on child sexual abuse are controversial, and that most statistics will be debated by another expert in the field. (Hopper, 1998). Many of the findings of the sexual abuse research have not been backed up by measurement.
Research that deals with sexual abuse prevention programs in the school system are fairly consistent in their findings. However, there are several issues that research has pointed out regarding prevention programs. These issues include age appropriate material, training of the presenter, side effects of the program and assessment techniques.
It is imperative that the material presented is age appropriate. Sexual abuse prevention programs are available to children from pre-school to high school students. However, the majority of these programs are implemented at the elementary level (Roberts & Miltenberger & Raymond, 1999). Therefore, the information needs to be presented in a way that the children can understand. Material should focus on more concrete ideas rather than abstract ideas and should use repetition when ever possible. It is difficult for younger children to understand the terms "good" and "bad", especially when the person that is abusing the child has been known as a "good" person to them for so long (Roberts & Miltenberger & Raymond, 1999). This makes it difficult for a small child to differentiate what good and bad touching is particularly when the abusers try to use good touching in the beginning to lure the victims. Another age appropriate issue is that adults are constantly telling children to respect their elders, in most cases this is a sound request. However, in instances of abuse many children are getting a mixed message (Conte, 1993). This makes it even harder for children to understand the information presented in the prevention programs. Therefore, it is the responsibility of the program to give a clear definition and assess the student's knowledge after the program to make sure they have a good understanding of the material.
Research points out that the ability of the facilitator and the question of who should facilitate the groups is an important factor in the effectiveness of the program. The facilitator need to be highly trained in the area of sexual abuse. Several programs have had the classroom teacher, parent or an expert in the field present the information. One author questioned the ability of parents to be effective facilitators. In programs where a parent was used to facilitate, the children did not show a good understanding of the information presented (Roberts & Miltenberger & Raymond, 1999). Research has shown that the best combination is when the parent works with the child at home on the information that was presented in the program by a teacher or an expert (Roberts & Miltenberger & Raymond, 1999). Considering that the teacher already has a strong bond with the child, the teacher might be the best facilitator for these programs. However, just because teachers have a close bond with most of the kids in their classes does not mean that they know a lot about sexual abuse. Teachers would have to be trained on facilitating this type of program.
Research does not focus on the school social worker as playing a role in sexual abuse prevention programs. School Social Workers can be trained as facilitators, considering they have a particular interest in children who have been sexually abused and they should already have a background in the area of abuse. They are in contact with the child, parent and teacher and could easily inform and educate all parties involved on the program. This would engage the whole system in the prevention of sexual abuse. Children who are informed about sexual abuse, and have informed parents, are in much more control of the situation. It is important to educate the parents or caretakers about the prevention of sexual abuse and possible signs or symptoms related to it such as: complaints of burning, itching or bruising in the genital area, bloody stools or vaginal bleeding, alluring sexual behavior towards peers or an abrupt behavior change ( Lowenthal, 1996).
Prevention programs could produce side effects in some children who go through the program. Some children who completed a prevention program experienced an increased fear of strangers, increased anxiety, nightmares and behavioral problems. Prevention programs have been trying to combat this issue by implementing assessment tools to ensure that the children understand the basic concepts. Assessment tools that are commonly used are pre and post tests, Lichert scales, giving examples of an abusive or non-abusive situation, and asking the child what they would do in that situation, such as the "What If" questions (Berson & Berson, 1999). Some programs use more sophisticated assessment tools such as the State- Trait Anxiety Inventory for Children, The Children's Knowledge of Abuse Questionnaire (CKAQ) and The Personal Safety Questionnaire (PSQ) (Roberts & Miltenberger & Raymond, 1999).
Though there are a number of factors affecting the outcome of these prevention programs, research has shown that they have met the goal of educating children about sexual abuse and empowering them with mechanisms to combat the problem (Conte, 1993; Roberts & Miltenberger & Raymond, 1999; Lanning & Ballard & Robinson, 1999). Research does not focus on assessing the impacts or knowledge base several years after the child has gone through the program. If the child went through a prevention program when they were in the third grade, it is highly unlikely that they will remember the information when they are in the tenth grade. In order for the program to be effective, the child must be exposed to the program several times throughout their education.
The research did not focus on cultural affects of the program, for instance, whether African American children have better results than Caucasian or Hispanic children. It would be interesting to see if the program is culturally sensitive, by comparing the outcomes of different cultures.
Practice and Policy Implications
Schools need to take some responsibility in preventing the sexual abuse of children. They need to implement sexual abuse prevention programs in the schools. School districts need to encourage each school to implement a prevention program and allocate money in order to fund the program. For example, in the state of Texas, 89 schools out of 110 have implemented a prevention program (Lanning & Ballard & Robinson, 1999).
This issue of preventing sexual abuse is extremely important to school social workers. They come in contact with victims of sexual abuse and have a particular interest in helping them adjust. They should be trained to facilitate these programs, focusing on both teaching and helping children with various problems. They are often in charge of implementing in various programs, such as Peer Mediation Programs, where peers try to work out their own problems with the help of a peer mediator, or programs about dealing with grief and loss like Rainbows. They are usually adept at presenting these programs and could easily fit into the role of facilitator of a sexual abuse prevention program. They collaborate with parents and teachers and can give them tools for assessing abuse in the classroom and at home. This type of training would only add the the social workers knowledge base.
As the research has indicated, teachers and experts in the field have been good facilitators of this type of program. However, teachers already have so much to deal with in the classroom on a daily basis. In addition, there are more behavioral, emotional and attention problems than in years past requiring teachers to spend more time on lesson plans and controlling the climate of the classroom. Many teachers are already implementing so many programs into their curriculum that they do not have time to execute and organize a new program. The school district could hire an expert in the field to facilitate the groups, though the children would not be familiar with that person. When discussing a topic so personal and private, it might be better to utilize a resource in the school setting like the school social worker that the children are already familiar with. In addition, hiring an outside could be costly to the already tight budgets of the school system. Also, it could be too costly to hire an outside expert facilitator to run the groups. Finally, the program needs to have the support of the families and the community. The social worker and the classroom teacher usually have a good working relationship with the parents of the children. This allows them to explain the importance of the program, as well as, describe the curriculum of the program to parents.
In closing, it is important to know that statistics on sexual abuse can be misleading. Many sexual abuse cases are not reported making the stats much lower than actual incidents of sexual abuse. There are often wide gaps in the percentages when dealing with the frequency of abuse. These wide gaps can often be explained by the wording used on assessment tools, varying definitions that define sexual abuse and the under reporting of sexual abuse. Victims experience a wide array of problems ranging from psychological to academic issues in school. Their experience can be manifested by increases in behaviors, emotions and lower self-esteem. Several studies show that children who have been sexually abused tend to score higher on maladaptive behavior scales. Sexual abuse prevention programs help children to learn about sexual abuse and they learn mechanisms to help them in an uncomfortable situation. It is important to implement these programs into school systems. By utilizing the school social worker as facilitators of the program, the school is maximizing its resources.
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