Implementation of a Universal School-Based Child Sexual Abuse Prevention Program: A Longitudinal Cohort Study

Abstract

Child sexual abuse (CSA) is a public health problem of considerable magnitude. The prevailing primary prevention strategies are universal, school-based CSA prevention programs, some of which have been designated as evidence-based, such as Safe Touches. However, to reach their public health impact potential, effective universal school-based CSA prevention programs require effective and efficient dissemination and implementation strategies. The purpose of this study was to demonstrate the reach and effectiveness of a school-based CSA prevention curriculum, Safe Touches, when implemented on a wide scale. Using a longitudinal cohort design, children in second grade classrooms in public elementary schools in five counties received the Safe Touches workshop and completed surveys designed to assess gains in knowledge at four timepoints (one week prior, immediately post-workshop, 6- and 12-months post-workshop). In total, the Safe Touches workshop was delivered in 718 classrooms in 92% of school districts, reaching ~14,235 second graders. Multilevel models ( n = 3,673) revealed that Safe Touches significantly increased CSA-related knowledge, and that these gains were maintained 12-months post-workshop ( ps < .001). There were some small but significant time-varying effects among participants in schools with a greater percentage of low income and minority students, but these effects largely disappeared 12-months post workshop. This study demonstrates that a single-session, universal school-based CSA prevention program can effectively increase children’s knowledge when implemented and disseminated on a wide scale and knowledge gains can be retained 12-months post intervention.

Piloting an Alternative Implementation Modality for a School-Based Child Sexual Abuse Prevention Curriculum

“…Related to this, the study was limited to post-workshop program evaluation surveys. It is unclear if the retention of knowledge would be replicated over the long term, up to 12-months post-workshop, as has been demonstrated with the workshop delivered as designed [22]. It remains unclear if students are able to retain the knowledge over a longer period of time as they move into middle school and experience situations that are developmentally significant for sexual development (e.g., at the onset of puberty).…”

“…The primary outcome was the CSA-related knowledge questionnaire, adapted from the Children's Knowledge of Abuse Questionnaire (CKAQ; see [30]) that has been used in previous evaluations of Safe Touches [22]. The modified version includes six items related to appropriate and inappropriate touches, collected on a 3-point scale ranging from 0 (false) to 1 (in between) to 2 (true), with a higher score indicating a higher degree of knowledge [28].…”

“…The original trial of Safe Touches (N = 492) conducted in New York City public schools demonstrated a significant increase in children's CSA-related knowledge among those who received the workshop compared to those who did not, and the observed gains were highest among second graders (approximately 7-8 years old) [23,24]. A longitudinal cohort study (N = 2029) conducted across five counties in a mid-Atlantic state replicated students' improvement of CSA-related knowledge after the Safe Touches workshop, and added to the evidence by demonstrating that gains were maintained at 6-and 12-months post-workshop [22,25]. Since 2007, Safe Touches has been implemented in the New York City public school system and has been scaled up across the mid-Atlantic state, as well as in Greece.…”

“…CSA prevention programs have also been implemented in schools, specifically elementary schools [21]. Programs offered in schools broadly aim to increase students' knowledge and use of protective skills to prevent abuse, and several universal school-based programs have been successful in improving children's knowledge of self-protection skills [22][23][24], including Safe Touches.…”

Introductory Chapter: Addressing Sexual Violence Issues

“…Prevention should be the first approach in addressing the issue of sexual violence. Despite many good programs that demonstrated the ability of prevention to diminish the numbers of victims for children, not enough funding is provided to institutionalize prevention efforts [6]. Prevention advocates are now calling for programs not only addressed at children, e.g., Good Touch/Bad Touch, but also for prevention programs targeted at perpetrators of sexual violence [5,7].…”