Practice Profile: School-Based Child Sexual Abuse Prevention Programs

Evidence Rating for Outcomes

Victimization | Child abuse/neglect/maltreatment

Victimization | Protective behavior skills

Victimization | Prevention-related knowledge and skills

Mental Health & Behavioral Health | Internalizing behavior

Date: This profile was posted on July 29, 2014

This practice comprises school-based programs that are designed to reduce the occurrence of sexual abuse in children and adolescents. The practice is rated Promising for increasing children’s prevention-related knowledge and Effective for increasing protective behaviors and disclosures of previous or current sexual abuse. The practice is rated Ineffective for decreasing child self-reported anxiety or fear.

Practice Goals/Target Population

School-based child sexual abuse (CSA) prevention programs are designed to reduce the occurrence of sexual abuse in children and adolescents. These prevention programs seek to 1) improve students’ prevention-related knowledge, 2) increase students’ protective skills in order to help them avoid unsafe situations, 3) increase students’ willingness to disclose incidences of sexual abuse, and 4) decrease child self-reports of anxiety or fear. The programs target school-aged children and teach them about CSA and how to protect themselves from it.

Unfortunately, there is no agreed-on definition of CSA. Some research defines sexual abuse as instances of sexual body contact with a child, while other definitions include any sexual behavior in a child’s presence (Zwi et al. 2007). CSA may include child prostitution, child pornography, child molestation, child exposure to sexually explicit materials, and attempted or threatened sexual abuse (Chen, Fortson, and Tseng 2012). Experiencing sexual abuse can have serious short- and long-term repercussions for children. For example, individuals with a history of CSA are at higher risk for alcohol and substance use, suicidal attempts, risky sexual behavior, and mental health difficulties, such as depression or posttraumatic stress disorder (Chen, Fortson, and Tseng 2012). School-based CSA prevention programs are one strategy that can be used to teach children the knowledge and skills to avoid and report abuse.

Practice Components

Generally, school-based CSA prevention programs teach children information about appropriate or inappropriate touches and ways to identify abusive situations, how to refuse inappropriate touches or get out of abusive situations, and how to tell a trusted adult about the incident. Although there are some basic concepts common to all CSA prevention programs, the programs can differ on numerous components, such as the format or method of presentation, the age of the targeted population, and the length of the program.

CSA prevention programs can use a variety of methods to present the information to children. Programs can be divided into two categories: information-based training and behavioral skills training (Chen, Fortson, and Tseng 2012). With behavioral skills training, the modes of presentation can be more active—for example, role playing or active skills rehearsal of self-protection skills, and modeling of skills by the presenter. With information-based training, the modes of presentation can be less active and include using methods such as videos or films, written materials, discussions or lectures, puppet shows, and dolls or stuffed animals.

The targeted population of the school-based prevention programs can also vary. Some programs target children as young as 3 in preschool, while other programs target older youths, such as those in fifth or sixth grade. CSA prevention programs usually target children in kindergarten and elementary school; only a few studies have looked at programs targeting adolescents in middle or high school (Zwi et al. 2007).

School-based CSA prevention programs tend to be implemented by teachers, but they may also be delivered by mental health professional, psychologists, college students, police officers, researchers, or other types of volunteers.

Victimization | Child abuse/neglect/maltreatment

Victimization | Child abuse/neglect/maltreatment
Walsh and colleagues (2015) aggregated the results from three studies and found that children in the treatment group experienced statistically significant increases in the ability to disclosure previous or current incidences of sexual abuse, compared with the control group (OR = 2.95). This finding indicates that children who participated in a school-based CSA prevention program were more likely to disclose prior or current incidences of sexual abuse following participation in the program, compared with children in the control group. However, this result should be interpreted with caution because of the small number of studies included in the analysis.

Victimization | Protective behavior skills

Victimization | Protective behavior skills
Walsh and colleagues (2015) aggregated the results from two studies and found that children in the treatment group experienced a statistically significant increase in acquiring protective behavior skills, compared with the control group (OR = 5.16). This finding indicates that children who participated in a school-based CSA prevention program were more likely to demonstrate protective behaviors (i.e., whether they could follow the rules they were taught and not interact if approached by a stranger) in a simulated situation, compared with children in the control group. However, this result should be interpreted with caution because of the small number of studies included in the analysis.

Victimization | Prevention-related knowledge and skills

Victimization | Prevention-related knowledge and skills
Looking at the results from 26 studies evaluating school-based child sexual abuse (CSA) prevention programs, Davis and Gidycz (2000) found a significant, large effect of 0.81. This finding means that children who participated in CSA prevention programs performed significantly higher on measures of prevention-related knowledge and skills compared with children in the control groups.

Mental Health & Behavioral Health | Internalizing behavior

Mental Health & Behavioral Health | Internalizing behavior
Walsh and colleagues (2015) aggregated the results from three studies and found no statistically significant differences between children in the treatment and control groups in child-reported anxiety or fear. However, this result should be interpreted with caution because of the small number of studies included in the analysis.

Meta-Analysis Snapshot
	Literature Coverage Dates	Number of Studies	Number of Study Participants
Meta Analysis 1	1985-1996	27	8115
Meta Analysis 2	1986-2014	24	5802

Meta Analysis 1

Davis and Gidycz (2000) conducted a meta-analysis of evaluations that looked at the effectiveness of school-based child abuse–prevention programs. Studies were included in the analysis if they 1) evaluated a school-based prevention program focusing on sexual abuse, 2) examined children ages 3 to 13, 3) rated effectiveness of the program using a knowledge-based or behavioral outcome measure, 4) included a control group comparison, and 5) were written in English. The research team conducted a comprehensive search of databases, article references, and relevant journals.

Twenty-seven studies that collectively included more than 8,000 participants were located for inclusion in the review. Of the 27 studies, 21 were published journal articles, 3 were unpublished doctoral dissertations, 2 were unpublished internal program evaluations, and 1 was an unpublished master’s thesis. The age groups ranged from 3 to 12 years old. However, no other information was provided on study characteristics or the characteristics of study participants.

The outcome of interest was prevention-related knowledge and skills of children. The outcomes from the studies were measured using questionnaires, vignette interviews, or behavioral observations. Effect sizes and their variances were calculated as d values for posttest comparison of control and treatment groups. The calculations used one effect size for each individual construct presented in each study. However, one study (Nemerofsky, Carran, and Rosenberg 1994) was removed from the analysis because of its unusually large effect size and very large sample size, causing the study to be heavily weighted. Moderator variables were also examined by breaking the studies into subsets based on the proposed variable and conducting a meta-analysis on each subset separately.

Meta Analysis 2

Walsh and colleagues (2015) conducted a new review of the literature to update the meta-analysis by Zwi and colleagues (2007) that assessed whether school-based child sexual abuse prevention programs were effective in increasing protective behaviors and disclosures of previous or current sexual abuse as well as decreasing child self-reported anxiety or fear. The comprehensive search strategy included a keyword search of electronic databases (such as MEDLINE, ERIC, and PsycINFO) between September and December 2015. To identify unpublished studies, the research team contacted experts in the field by email and searched the following program databases: Promising Practices Network and Blueprints for Healthy Youth Development.

Overall, the literature included in the meta-analysis was drawn from published and unpublished studies from 1986 through 2015. Only studies with interventions that met the following criteria were included: 1) were randomized controlled trials (RCTs), cluster-RCTs, or quasi-RCTs where participants were allocated to the intervention or control group by day of the week, alphabetical order, or other sequential allocation such as class or school; 2) the study population included children (5 to 12 years) and adolescents (13 to 18 years) attending primary (elementary) or secondary (high) schools; 3) school-based education programs focusing on knowledge of sexual abuse and sexual abuse prevention concepts or skill acquisition in protective behaviors or both, compared with no intervention or the standard school curriculum; and 4) measured at least one of the outcomes of interest (i.e., protective behaviors and retention over time; knowledge of sexual abuse or knowledge of sexual abuse prevention concepts and retention over time; harm, manifest as parental or child anxiety or fear; and disclosure of sexual abuse by child or adolescent during or after programs).

Of the 24 included studies, 7 were RCTs, 11 were cluster-RCTs, and 6 were quasi-RCTs. In 14 studies, RCT, randomization took place at the school, district, or classroom level; in 10 studies, randomization took place at the student level. Of the 24 studies, 16 were conducted in the United States, 3 were conducted in Canada, and 1 study apiece was conducted in China, Germany, Spain, Taiwan, and Turkey. All studies were conducted in school settings: 23 in primary (elementary) schools and one in a special school for adolescents with intellectual disabilities. Only 6 studies were undertaken in single grades (1 in kindergarten, 1 in grade one, 2 in grade three, and 2 in grade four), and all other studies involved various combinations of grades. A total of 5,802 school-aged participants were included in the 24 trials. The average age of the sample at baseline was 5.8 years. The proportion of females in the included studies ranged from 45 to 55 percent. Ethnicity data was reported in only 13 of the 24 studies, including white, Black, Hispanic, Asian, Middle Eastern, and other backgrounds.

The outcomes of interest for all interventions included in the meta-analysis were the 1) acquisition of protective behaviors skills (stranger simulation test), 2) knowledge of sexual abuse and abuse prevention concepts (measured by questionnaires), 3) child anxiety or fear (child self-reports), and 4) disclosure of sexual abuse by a child or adolescent during or after participating in the CSA prevention program. The effect sizes were calculated as standardized mean differences, and a random effects model was assumed in the analysis.

Date Modified: June 1, 2020

This practice review has been updated to reflect findings from a more recent meta-analysis. In 2014, this practice was reviewed with two meta-analyses by Davis and Gidycz (2000) and Zwi and colleagues (2007). At that time, the practice was rated Effective for increasing prevention-related knowledge and skills and rated Ineffective for impacting the odds of children disclosing or reporting their sexual abuse. In 2015, Walsh and colleagues updated the original meta-analysis by Zwi and colleagues (2007). With the inclusion of the updated meta-analysis by Walsh and colleagues (2015) in 2020, the Ineffective rating for impacting the odds of children disclosing or reporting their sexual abuse was changed to Effective and the Effective rating for increasing prevention-related knowledge and skills was changed to Promising. In addition, two new outcomes were added to the practice evidence base: protective behavior skills and child self-reported anxiety or fear. Based on the results of the updated meta-analysis (Walsh et al. 2015), the protective behavior skills outcome was rated Effective, and child-reported anxiety or fear outcome was rated Ineffective. However, these results should be interpreted with caution because of the small number of studies included in the analyses.

Date Created: July 17, 2024

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Practice Snapshot

Age: 3 - 12

Gender: Male, Female

Race/Ethnicity: White, Black, Hispanic, American Indians/Alaska Native, Other

Setting (Delivery): School

Practice Type: Classroom Curricula, Victim Programs

Unit of Analysis: Persons

Practice Profile: School-Based Child Sexual Abuse Prevention Programs

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Practice Summary

Practice Description

Practice Goals/Target Population

Practice Components

Meta-Analysis Outcomes

Meta-Analysis Methodology

Cost

Other Information

Evidence-Base (Meta-Analyses Reviewed)

Additional References