Emerging Issues in the Research on Child Sexual Abuse Prevention.

Emerging Issues in the Research on Child Sexual Abuse Prevention. Abstract It is estimated that nearly one-quarter of the United States United States,officially United States of America, republic (2005 est. pop. 295,734,000), 3,539,227 sq mi (9,166,598 sq km), North America. The United States is the world's third largest country in population and the fourth largest country in area. population have been victims of child sexual abuse Child sexual abuse is an umbrella term describing criminal and civil offenses in which an adult engages in sexual activity with a minor or exploits a minor for the purpose of sexual gratification. . Due to increases inthe rates at which sexual abuse has been reported over the past fewdecades, researchers have put forth major efforts at preventing childsexual abuse. Programs are widely available and utilize a variety ofassessment measures, modes of presentation, and presenters. Within thegrowing body of research on child sexual abuse prevention, a number ofimportant issues have emerged. These issues include the effectiveness ofassessment methods, potential side-effects of prevention programs, thedevelopmental appropriateness of programs, the differentialeffectiveness of presenters of prevention materials, parentalinvolvement in sexual abuse prevention efforts, and the perspectives ofoffenders and victims. This paper discusses and integrates these issuesand makes recommendations for future research. Due to alarmingly high rates of child sexual abuse, there isincreasing attention on prevention research. In the first nationalsurvey of prevalence and risk factors of child sexual abuse, Finkelhorand colleagues found that 22% of the United States population reportedthey were victims of sexual abuse (Finkelhor, Hotaling, Lewis, &Smith, 1990). Although definitions vary across studies, Finkelhor et al.(1990) defined child sexual abuse as including any of the following actscommitted by an adult upon a child at age 18 or under: attempted orcompleted sexual intercourse sexual intercourseor coitus or copulationAct in which the male reproductive organ enters the female reproductive tract (see reproductive system). (i.e., oral, anal, vaginal vag��i��naladj.1. Of or relating to the vagina.2. Relating to or resembling a sheath.vaginalpertaining to the vagina, the tunica vaginalis testis, or to any sheath. ); touching,grabbing, kissing, or rubbing rubbing,v creating friction and heat by drawing the hands across the body at varying speeds, rhythms, and depths. Benefits include muscle elongation, tension release, and increased flexibility. up against the child in the context of asexual abuse situation; photographing the child nude; exhibiting theirbody parts to the child; or having the child view any type of sex act(Finkelhor et al., 1990). In Finkelhor et al. (1990), 16% of men and 27%of women reported being sexually abused as children, although priorresearch suggests a male to female ratio of 1:3 (Mian, Wehrspann,Klajner-Diamond, LeBaron, & Winder, 1986). It is thought that theaverage age of first abuse is between the ages of 7 and 9 years (Briere& Runtz, 1988; Dube & Hebert, 1988; Finkelhor et al., 1990),however, children aged 6 and under may account for up to one-third ofreported sexual abuse cases (Mian et al., 1986). Younger children (i.e., preschoolers) are more likely to be victimsof intrafamilial abuse (72%), while school aged children are more likelyto experience extrafamilial abuse (73%) (Dube & Hebert, 1988; Mianet at., 1986). According to according toprep.1. As stated or indicated by; on the authority of: according to historians.2. In keeping with: according to instructions.3. Dube and Hebert (1988), as many as 78% ofall child victims know the perpetrator A term commonly used by law enforcement officers to designate a person who actually commits a crime. . Finkelhor et al. (1990) reportedmore males than females are victimized by strangers. Not surprisingly,76% of victimizations occur in the victim's or perpetrator'shome (Dube & Hebert, 1988). Perpetrators of sexual abuse againstboth boys and girls boys and girlsmercurialisannua. are most likely to be men, over the age of 20, whoare often perceived as authority figures (Dube & Hebert, 1988;Finkelhor et al, 1990). Research suggests that the number one risk factor for both boys andgirls is growing up in an "unhappy" home (Finkeihor et al.,1990; Mian et al., 1986). Although a variety of factors can contributeto an "unhappy" home, some factors that may contribute includefamilies separated by divorce, families with only one natural parent, orfamilies in which there is discord DiscordSee also Confusion.Andrasdemon of discord. [Occultism: Jobes, 93]discord, apple ofcaused conflict among goddesses; Trojan War ultimate result. [Gk. Myth. . Finkelhor and associates also foundthat women who received inadequate sex education as children were moreat risk for sexual abuse. Sexual abuse can occur once or over a period of many years beforethe relationship is disclosed and discontinued dis��con��tin��ue?v. dis��con��tin��ued, dis��con��tin��u��ing, dis��con��tin��uesv.tr.1. To stop doing or providing (something); end or abandon: (Dube & Hebert,1988). From the moment an abusive Tending to deceive; practicing abuse; prone to ill-treat by coarse, insulting words or harmful acts. Using ill treatment; injurious, improper, hurtful, offensive, reproachful. act takes place, children mayexperience a variety of physical, emotional, and behavioral symptoms behavioral symptomNeurology In Alzheimer's disease, any of the Sx that relate to action or emotion, such as wandering, depression, anxiety, hostility, sleep disturbances. See Alzheimer's disease. .Physical symptoms of child sexual abuse can include sexually transmitteddiseases Sexually transmitted diseasesInfections that are acquired and transmitted by sexual contact. Although virtually any infection may be transmitted during intimate contact, the term sexually transmitted disease is restricted to conditions that are largely , vaginal or rectal bleeding Rectal bleeding can refer to: Fecal occult blood Hematochezia Melena , abdominal pain Abdominal pain can be one of the symptoms associated with transient disorders or serious disease. Making a definitive diagnosis of the cause of abdominal pain can be difficult, because many diseases can result in this symptom. Abdominal pain is a common problem. , and bruised bruise?v. bruised, bruis��ing, bruis��esv.tr.1. a. To injure the underlying soft tissue or bone of (part of the body) without breaking the skin, as by a blow.b. genitalia genitalia/gen��i��ta��lia/ (jen?i-tal��e-ah) [L.] the reproductive organs.ambiguous genitalia (De Jong De Jong is the most common Dutch surname. Many people bear this name, including many important historical figures. Some of these people are mentioned below.De Jong may mean: Petrus de Jong, prime minister of the Netherlands from 1967 until 1971 , 1985; Mian et al., 1986). Many young victims ofsexual abuse also display specific sexual behavior sexual behaviorA person's sexual practices–ie, whether he/she engages in heterosexual or homosexual activity. See Sex life, Sexual life. that is inappropriatefor their age, such as: putting objects into genitals gen��i��talspl.n.Genitalia. and / or anus,requesting sexual stimulation Sexual stimulation is any stimulus that leads to sexual arousal or orgasm. The term often implies stimulation of the genitals but may also include stimulation of other areas of the body, stimulation of the senses (such as sight or hearing), and mental stimulation (such as that , and sexual play with dolls (Mian et al.,1986). Several studies have suggested that, in general, the more severethe abuse (i.e., incest incest,sexual relations between persons to whom marriage is prohibited by custom or law because of their close kinship. Ideas of kinship, however, vary widely from group to group, hence the definition of incest also varies. , penetration, longer duration), the more severethe resulting behavioral behavioralpertaining to behavior.behavioral disorderssee vice.behavioral seizuresee psychomotor seizure. problems (Briere & Runtz, 1988; Browne& Finkeihor, 1986; Friedrich Friedrich may refer to:In politics: Carl Joachim Friedrich, political scientist Ingo Friedrich, German MEP Istv��n Friedrich, Hungarian politician In artistry: Caspar David Friedrich, German Romantic painter , Urquiza Urquiza can refer to the following: Justo Jos�� de Urquiza, an Argentine caudillo. Named after the general: Villa Urquiza, a neighborhood of Buenos Aires named after the general. , & Beilke, 1986). Behaviorproblems associated with child sexual abuse can include nightmares,disruptive disruptive/dis��rup��tive/ (-tiv)1. bursting apart; rending.2. causing confusion or disorder. behaviors (e.g., physical and verbal aggression aggression,a form of behavior characterized by physical or verbal attack. It may appear either appropriate and self-protective, even constructive, as in healthy self-assertiveness, or inappropriate and destructive. ), dinginess din��gy?1?adj. din��gi��er, din��gi��est1. Darkened with smoke and grime; dirty or discolored.2. Shabby, drab, or squalid. ,and fearfulness. As the child reaches adulthood, other psychologicalsymptoms have been reported. Depression appears to be the most commonlyreported effect of child sexual abuse (Browne & Finkelhor, 1986).Other long term effects include self-destructive self-de��struc��tiveadj.1. Tending to do harm to oneself.2. Marked by an impulse or tendency to harm or kill oneself.self behavior (e.g.,"cutting") (Browne & Finkelhor, 1986), higher levels ofanxiety than normal (Briere & Runtz, 1988; Browne & Finkeihor,1986; Friedrich et al., 1986), substance abuse (Browne & Finkelhor,1986; Singer, Petchers, & Hussey Hussey is a surname, and may refer to Christopher Hussey, British architectural historian David Hussey, Australian cricketer Dyneley Hussey, British war poet and music critic Edward Hussey-Montagu, 1st Earl of Beaulieu, British politician , 1989), bulimia nervosa bulimia nervosaEating disorder, mostly in women, in which excessive concern with weight and body shape leads to binge eating followed by compensatory behaviour such as self-induced vomiting or the excessive use of laxatives or diuretics. (Wonderlich, Brewerton, Jocic, Dansky, & Abbott Ab��bott? , Berenice 1898-1991.American photographer known especially for her series of black-and-white portraits of New York City.Abbott, George 1887-1995. , 1997), and problemsrelated to sexual functioning (Browne & Finkelhor, 1986). In response to the problem of sexual abuse, research efforts havebeen aimed at developing effective prevention programs for children.Numerous sexual abuse prevention programs have been developed andimplemented, and several have been evaluated (Kohl kohl?n.A cosmetic preparation, such as powdered antimony sulfide, used especially in the Middle East to darken the rims of the eyelids.[Arabic ku , 1993). This paperprovides a brief overview of prevention efforts currently in use and adiscussion of important issues in sexual abuse prevention. Overview of Sexual Abuse Prevention Programs Sexual abuse prevention programs began in the early to middle1970's following increasing awareness of the problem of childsexual abuse (Kohl, 1993). Although prevention programs differ invarious ways, the majority teach concepts relating to relating torelate prep → concernantrelating torelate prep → bez��glich +gen, mit Bezug auf +accself-esteem self-esteemSense of personal worth and ability that is fundamental to an individual's identity. Family relationships during childhood are believed to play a crucial role in its development. , theappropriateness of saying "no," personal safety and bodysafety, and discrimination between acceptable and unacceptable touch.The most frequently taught skills are to say "no" in responseto a sexual abuse lure lurethe skin-covered object which runs on a monorail on a Greyhound racing track and which the dogs are schooled to chase. The lure must be kept 30 to 40 ft ahead of the leading dog so that the field is stretched out. , leave the situation, and tell a trusted adult(Kohl, 1993). Sexual abuse prevention programs have been developed forchildren from preschool to high school, yet programs are typicallyimplemented at the elementary school elementary school:see school. level. Prevention programs arepresented to large and small groups of children. Program length andmaterials typically depend upon the age of the participants. However,school-based sexual abuse prevention programs are most likely to occurwithin a single day, with sessions lasting between 30 minutes and 2hours. Most trainers of school-based prevention programs are experts whodevelop the programs or, to a lesser extent, teachers and volunteers(Kohl, 1993). Behavioral skills training (BST (convention) BST - British Summer Time. The name for daylight-saving time in the UK GMT time zone. ; instructions, modeling, rehearsal re��hears��aln.The process of repeating information, such as a name or a list of words, in order to remember it.re��hearse v. ,and feedback) is one of the more frequently used formats for teachingsexual abuse prevention skills, often in conjunction with groupdiscussions and plays or puppet puppet,human or animal figure, generally of a small size and performing on a miniature stage, manipulated by an unseen operator who usually speaks the dialogue. shows. Handouts, films, and videos arealso commonly employed for conveying prevention information (Kohl,1993). Research suggests that a BST approach to prevention results inthe greatest improvement in sexual abuse knowledge and prevention skillsrelative to approaches involving plays, films, lecture/discussion, andwritten materials (Carroll Car��roll, James 1854-1907.British-born American physician noted for his research on yellow fever. In 1900 he deliberately infected himself with the disease for experimental purposes. , Miltenberger, & O'Neill, 1992). A prototypic BST program is delivered to a relatively small numberof children in a group format over a period of 3-5 consecutive days(Wurtele, 1990). The program typically begins with instructions fordiscriminating dis��crim��i��nat��ing?adj.1. a. Able to recognize or draw fine distinctions; perceptive.b. Showing careful judgment or fine taste: between appropriate and inappropriate touches. Childrenare then taught, using BST procedures, to say no, get away, and tell atrusted adult in response to a potentially abusive situation. Often,researchers program for generalization gen��er��al��i��za��tionn.1. The act or an instance of generalizing.2. A principle, a statement, or an idea having general application. by incorporating descriptions ofa variety of sexually abusive and benign benign/be��nign/ (be-nin��) not malignant; not recurrent; favorable for recovery. be��nignadj.Of no danger to health, especially relating to a tumorous growth; not malignant. situations with severaldifferent types of people (i.e., strangers, known adults). Kohl (1993) reports that 90% of programs utilize some evaluationprocedure. Most adopt a pre/post questionnaire aimed at assessing theparticipant's knowledge and retention of sexual abuse information.Although the outcomes of these studies suggest minimal to modest gainsin knowledge and verbal report of preventive preventive/pre��ven��tive/ (pre-vent��iv) prophylactic. pre��ven��tiveor pre��ven��ta��tiveadj.Preventing or slowing the course of an illness or disease; prophylactic.n. skills, none of theprevention programs evaluated to date have shown that they haveaccomplished their primary goal of prevention by reducing the number ofchild sexual abuse cases among the individuals who have participated insuch programs (Berrick & Barth Barth? , John Simmons Born 1930.American writer whose novels, including The Sot-Weed Factor (1960, revised 1967), often examine the relationship between language and reality.Noun 1. , 1992). Issues Involved in Sexual Abuse Prevention Research Several issues have emerged in the research on child sexual abuseprevention. These issues include the effectiveness of current assessmentstrategies (Berrick & Barth, 1992; Carroll et al., 1992; Kohl,1993), potential side-effects of prevention programs (Carroll et al.,1992; Wurtele, 1987), the developmental appropriateness of preventionprograms (Berrick & Barth, 1992; Carroll et al., 1992; Wurtele,1987), the effectiveness of different presenters of prevention materials(Carroll et al., 1992; Wurtele, 1987), parental involvement inprevention efforts (Carroll et al., 1992), and perspectives of offendersand victims (Wurtele, 1987). This paper will provide a discussion ofthese topics and suggestions for further research. Assessment Methods in Sexual Abuse Prevention Programs The importance of determining if sexual abuse prevention programsproduce behavior change Behavior change refers to any transformation or modification of human behavior. Such changes can occur intentionally, through behavior modification, without intention, or change rapidly in situations of mental illness. underscores the need for adequate assessmentmethods. Most evaluative studies assume a connection between knowledgeand behavior (Leventhal John Leventhal Harold Leventhal Norman B. Leventhal Adam Leventhal Rick Leventhal Paul Leventhal, nuclear protester & Conte, 1987). Therefore, preventionprograms typically assess the child's knowledge (i.e., verbalreport) of prevention skills with the implicit assumption that greaterknowledge will ultimately serve to reduce sexual abuse. The Children's Knowledge of Abuse Questionnaire (CKAQ; Tutty tut��ty?n. pl. tut��tiesAn impure zinc oxide obtained as a sublimate from the flues of zinc-smelting furnaces and used as a polishing powder. ,1992) is a recently developed measure demonstrated to have goodreliability (i.e., test-retest Test-retest is a statistical method used to examine how reliable a test is: A test is performed twice, e.g., the same test is given to a group of subjects at two different times. , internal consistency In statistics and research, internal consistency is a measure based on the correlations between different items on the same test (or the same subscale on a larger test). It measures whether several items that propose to measure the same general construct produce similar scores. ) and concurrentvalidity concurrent validity,n the degree to which results from one test agree with results from other, different tests. . A similar questionnaire, the Personal Safety Questionnaire(PSQ PSQ Political Science Quarterly (journal)PSQ PyrosequencingPSQ Pipsqueak (gene)PSQ Patient Satisfaction QuestionnairePSQ Presidential Studies Quarterly ; Saslawsky & Wurtele, 1986), has been shown to be reliable andhas been utilized in several investigations of sexual abuse preventionprograms (Wurtele, 1990; Wurtele, Currier, Gillispie, & Franklin,1991; Wurtele, Kast, & Melzer Melzer may refer to the following: Hagen Melzer (b. 1959), German long-distance runner Hanna Melzer (1904-1960), German anti-Nazi activist, see Jean Melzer (b. 1926), Australian senator J��rgen Melzer (b. 1981), Austrian tennis player Manfred Melzer (b. , 1992; Wurtele, Saslawsky, Miller,Marrs, & Britcher, 1986). Both the PSQ and the CKAQ assess achild's knowledge regarding sexual and non-sexual touch,assertiveness assertiveness/as��ser��tive��ness/ (ah-ser��tiv-nes) the quality or state of bold or confident self-expression, neither aggressive nor submissive. , and include more specific items regarding responses tosexual abuse situations. Measuring a child's verbal report of preventive behaviors inresponse to sexual abuse scenarios is another common assessmenttechnique. In general, the child either listens to a verbal descriptionor views a video depicting a potentially abusive situation. Followingthe description, the child is asked to verbally report what she/he woulddo. A point system is typically used in which the child receives anumber of points depending on which skills (i.e., say "no,"get away, tell) are correctly reported. A commonly used measure ofchildren's verbal report of preventive behavior is the "WhatIf" Situations Test (WIST wist?v.Past tense and past participle of wit2. ; Saslawsky & Wurtele, 1986), whichdescribes both benign and sexually abusive hypothetical Hypothetical is an adjective, meaning of or pertaining to a hypothesis. See: Hypothesis HypotheticalHypothetical (album) situations tochildren. The child then reports what he or she would do in response toeach situation. Role-plays represent another assessment technique, in which theprogram participant actively demonstrates behavioral responses tosimulated situations. Although role-plays are widely used in training(Wurtele, 1990; Wurtele et al., 1991; Wurtele et al., 1986). they arerarely utilized in assessment. Miltenberger and Thiesse-Duffy (1988)utilized role-plays to measure prevention skills in young children whoparticipated in a sexual abuse prevention program. The use of role-playsallowed these authors to evaluate whether or not the prevention programproduced actual behavior changes. All of the participants learned theprevention skills (i.e., "get away, tell) and demonstrated theskills in role-plays. In situ In place. When something is "in situ," it is in its original location. probes, an assessment method that evaluates thechild's behavior in response to a simulated sexual abuse lurewithout the child's knowledge, may be the best measure of behaviorchange. However, the ethical constraints CONSTRAINTS - A language for solving constraints using value inference.["CONSTRAINTS: A Language for Expressing Almost-Hierarchical Descriptions", G.J. Sussman et al, Artif Intell 14(1):1-39 (Aug 1980)]. of simulating sexual abuselures hamper the utility of in situ assessments in sexual abuseprevention efforts. Nonetheless, in situ probes are commonly used inabduction AbductionBalfour, Davidexpecting inheritance, kidnapped by uncle. [Br. Lit.: Kidnapped]Bertram, Henrykidnapped at age five; taken from Scotland. [Br. Lit. prevention research (Miltenberger & Olsen Olsen may refer to: Fred. Olsen & Co., a large shipping company with worldwide headquarters based in Oslo, Norway Olsen (surname), people with the surname Olsen See alsoOlsen Brothers, a Danish rock/pop music duo Olsen Gang , 1996).Miltenberger and Thiesse-Duffy (1988) used in situ probes following asexual abuse prevention program; however, they assessed abductionprevention skills (responses to abduction lures) rather than sexualabuse prevention skills (responses to sexual abuse solicitations). Morerecently, Lumley Lumley may refer to: PeopleAldred Lumley, 10th Earl of Scarbrough Benjamin Lumley, theatre manager Brian Lumley, writer Charles Lumley, soldier Dan Lumley Ed Lumley Edward Lumley, Canadian politician , Miltenberger, Rapp RAPP Relatives As Parents ProgramRAPP Rajasthan Atomic Power Project (Canadian-designed nuclear reactor built in Rajasthan state in India in 1960s)RAPP ROI Analysis of Pharmaceutical PromotionRAPP Registered Air Parcel Post , Long, and Roberts (1998)demonstrated the value of in situ probes for assessing skill acquisitionas part of an evaluation of a sexual abuse prevention program for womenwith developmental disabilities developmental disabilities (DD),n.pl the pathologic conditions that have their origin in the embryology and growth and development of an individual. DDs usually appear clinically before 18 years of age. . These researchers tested theparticipants via verbal report, role-play role-playv.To assume deliberately the part or role of; act out.n.Role-playing. , and in situ assessments. Animportant finding from this study was that the three differentassessment measures evaluated different behaviors. In general, the womenwere often unable to exhibit the sexual abuse prevention skills duringin situ testing but performed all of the necessary skills (i.e., no, go,tell) during the role-play assessments. The authors suggested thatfurther research is needed to evaluate the correspondence amongdifferent assessment procedures used to evaluate sexual abuse preventionprograms. Leventhal and Conte (1987) also stress the importance of measuringactual behavior following prevention programs. The authors proposeassessing the disclosure rates of child participants of sexual abuseprevention programs in comparison to representative samples of same agechildren. Recent studies have begun to assess disclosure rates followingsexual abuse prevention programs (Araji, Fenton PlacenamesFenton is the name of the following places: EnglandFenton, Cumbria Fenton, South Kesteven, Lincolnshire Fenton, West Lindsey, Lincolnshire Fenton, Northumberland Fenton, Staffordshire (Stoke-on-Trent) , & Staugh, 1995;Hazzard, 1993; Hazzard, Kleemeier, & Webb, 1990). For example, Arajiet al. (1995) reported that since introducing a sexual abuse preventionprogram, the school district noticed an increase in disclosures ofsexual abuse, although the actual rates were not provided. Disclosurerates are typically assessed at post-training only or retrospectively ret��ro��spec��tive?adj.1. Looking back on, contemplating, or directed to the past.2. Looking or directed backward.3. Applying to or influencing the past; retroactive.4. and then compared to pre-training statistics gathered from socialservices social servicesNoun, plwelfare services provided by local authorities or a state agency for people with particular social needssocial servicesnpl → servicios mpl sociales. Adequate measurement of sexual abuse prevention skills is criticalfor the valid assessment of prevention programs. Assessment of knowledgeor self-report of skills is not adequate because knowledge does notcorrespond well to behavior. Several authors advocate the use of actualbehavioral measures (Carroll et al., 1992; Hazzard, 1993; Kohl, 1993;Lumley et at, 1998; Miltenberger & Thiesse-Duffy, 1988; Nibert,Cooper, Ford, Fitch fitch:see polecat. , & Robinson, 1989; Pelcovitz, Adler Ad��ler, Alfred 1870-1937.Austrian psychiatrist. He rejected Sigmund Freud's emphasis on sexuality and theorized that neurotic behavior is an overcompensation for feelings of inferiority. , Kaplan Kaplan may refer to one of the following: An individual with the surname of Kaplan The origin and history of the surname Kaplan Kaplan, Inc., an education company ,Packman, & Krieger, 1992), yet few researchers have actuallyassessed behavior change resulting from sexual abuse prevention programs(Lumley et al., 1998; Miltenberger & Thiesse-Duffy, 1988). There isa need for prevention researchers to develop effective behavioralassessment measures acceptable to professionals, review boards, parents,and children. At a minimum, researchers should assess disclosure ratesprior to and following sexual abuse prevention programs and employrole-play assessments to measure behavior change resulting from se xualabuse prevention programs as alternatives to self-report measures. Potential Side Effects Side effectsEffects of a proposed project on other parts of the firm. Following Sexual Abuse Prevention Programs A second issue related to sexual abuse prevention programs is thepotential for such programs to produce harmful effects on childparticipants. Kraizer (1986) suggests that prevention efforts may causechildren to be more afraid, mistrustful, and unsure of the world andadults in general. In addition, parents, teachers, and schooladministrators may be apprehensive of potentially harmful effects ofsexual abuse prevention programs (i.e., fear of strangers,behavioral/emotional problems, difficulty accepting physical affection;Wurtele & Miller-Perrin, 1987). Several studies have assessed potential negative side-effects, suchas changes in eating and sleeping, nightmares, fear of adults or leavinghome, or changes in reactions to physical affection, following programimplementation (Binder binder:see combine. An earlier Microsoft Office workbook file that let users combine related documents from different Office applications. The documents could be viewed, saved, opened, e-mailed and printed as a group. & McNiel, 1987; Hazzard, 1993; Miltenberger& Thiesse-Duffy, 1988; Wurtele et al., 1991). In general, thesestudies suggest that negative effects, typically assessed via parentreport, are not produced in the child participants. Those studiesreporting negative behavioral change suggest that they occur in aminority of children (typically fewer than 5%; Hazzard, Webb, &Kleemeier, 1988; Nibert, Cooper, & Ford, 1989). Hazzard et al. (1988) utilized the State-Trait Anxiety Inventoryfor Children and asked parents about emotional/behavioral problemsexhibited by their children following participation in a sexual abuseprevention program. Results suggested that the program did not produceany overall negative effects. No differences were obtained on theanxiety measure or the parent ratings following training between thetreatment group and a control group. Wurtele and Miller-Perrin (1987) had children involved in a sexualabuse prevention program rate the degree to which they fear variouspeople and situations. Parents also completed a questionnaire to assesstheir perceptions of their child's fears and their child'sreaction to the program. There was no increase in fear reported by thechildren or their parents from pre-test to post-test. Seventy-fivepercent of parents reported the sexual abuse prevention program had apositive effect on their child and no parent reported the program had anegative effect. The authors concluded that sexual abuse preventionprograms may not result in the negative side-effects many parents andeducators fear. Current research suggests that sexual abuse prevention programs arenot harmful to most child participants and may actually produceunexpected positive effects (i.e., increased discussions of child sexualabuse between parent and child, decrease in behavioral problems,opportunity for children to disclose sexual abuse; Wurtele &Miller-Perrin, 1987). Moreover, it has been reported that negativeside-effects of prevention programs last only as long as the duration ofthe particular program being implemented (Daro, 1989; 1991). Futureresearch should investigate the factors that may contribute to thedevelopment of negative effects for some children during sexual abuseprevention programs, so that programs can be modified to eliminate theside-effects. Developmental Appropriateness of Sexual Abuse Prevention Programs In her 1987 review of school-based sexual abuse preventionprograms, Wurtele emphasized the need for age-appropriate trainingmaterials. Much of the recent evaluative research in which different agelevels are compared has shown that a child's acquisition of sexualabuse knowledge is at least partially dependent on the child's age(Bogat & McGrath McGrath or MacGrath may refer to: GeographyMcGrath, Alaska McGrath, Minnesota McGrath Elementary ChristianityAlister McGrath (born 1953), Anglican theologian Desmond McGrath, Canadian politician and Catholic priest , 1993; Nemerofsky, Carran . Carran is the midst of The Burren area.For other places called Carron, see .Carran (Irish: Carn, meaning The Cairn , & Rosenberg Rosenberg(rō`zənbərg), city (1990 pop. 20,183), Fort Bend co., S Tex., on the Brazos River, in an oil and natural gas area; inc. 1902. Rosenberg and its sister city of Richmond are physically one community. , 1994;Tuttys, 1992). As expected, older children typically show greaterknowledge gains than younger children when given the same sexual abuseprevention curriculum. Such results point to the necessity of developingsexual abuse prevention programs that are age appropriate, so that bothyounger and older children can benefit fully from prevention efforts. Following the implementation of a sexual abuse prevention program,Tutty (1992) found a significant age effect on both pre and postmeasures showing a trend of increasing knowledge as a function of thechild's age. The same program was presented to children fromkindergarten kindergarten[Ger.,=garden of children], system of preschool education. Friedrich Froebel designed (1837) the kindergarten to provide an educational situation less formal than that of the elementary school but one in which children's creative play instincts would be to Grade 6. She concluded that younger children need morerepetition REPETITION, construction of wills. A repetition takes place when the same testator, by the same testamentary instrument, gives to the same legatee legacies of equal amount and of the same kind; in such case the latter is considered a repetition of the former, and the legatee is entitled when learning child sexual abuse information. She alsorecommended a focus on concrete skills and concepts due to the inabilityof younger children to comprehend abstract information. Berrick (1989) agreed with the notion that many concepts conveyedto children during sexual abuse prevention efforts are too abstract.Abstract terms those which express abstract ideas, as beauty, whiteness, roundness, without regarding any object in which they exist; or abstract terms are the names of orders, genera or species of things, in which there is a combination of similar qualities.See also: Abstract , such as "good" and "bad," are oftenconfusing con��fuse?v. con��fused, con��fus��ing, con��fus��esv.tr.1. a. To cause to be unable to think with clarity or act with intelligence or understanding; throw off.b. to children, especially when considering that sexual abuseoften begins with what is recognized as "good" touching (e.g.,pat on the back, hug, squeeze of the shoulder). To complicate com��pli��cate?tr. & intr.v. com��pli��cat��ed, com��pli��cat��ing, com��pli��cates1. To make or become complex or perplexing.2. To twist or become twisted together.adj.1. thingseven more, children are often unable to understand the concept that"good" people may provide "bad" touching (Kraizer,1986). Berrick (1989) suggested that these abstract concepts should beunderstood by parents and teachers who work with children (not childrenthemselves), so that the responsibility for identifying a situation as"good" or "bad" or a touch as "right" or"wrong" will lie with those adults in charge of the safety ofchildren. Berrick (1989) further advocated the use of active learning such asrole-plays for young children. In addition to role-playing role-play��ingn.A psychotherapeutic technique, designed to reduce the conflict inherent in various social situations, in which participants act out particular behavioral roles in order to expand their awareness of differing points of view. , modeling,rehearsal, and repetition are important teaching methods to be included.In fact, utilizing a behavioral skills training approach may be morelikely to result in actual preventive behavior changes than the moretraditional efforts which focus on simply providing information(Wurtele, 1987). Another developmental issue is the sequence in which typicalprevention skills are taught. In general, sexual abuse preventionprograms teach children to (a) recognize a situation as sexuallyabusive, (b) say no, (c) get away from the situation, and (d) tell anadult they trust exactly what occurred. It is thought that teachingskills in this order will proceed from easier skills to more difficultskills. Although this sequence rarely varies, Liang, Bogat, and McGrath(1993) suggest that we may need to reconsider re��con��sid��er?v. re��con��sid��ered, re��con��sid��er��ing, re��con��sid��ersv.tr.1. To consider again, especially with intent to alter or modify a previous decision.2. this typical succession.Liang et al. (1993) tested 3 to 7 year olds to assess whether or notthey understood basic prevention skills taught in the order previouslydescribed. The two youngest age groups (3 and 4 year olds) had the mostdifficulty with the discrimination skill, even though it is thought tobe the easiest and thus the first skill typically taught. This findingmay reflect the difficulty younger children experience with morecognitively based skills. Because it is assumed that learning isfacilitated by teaching easier concepts while progressing to moredifficult concepts, discrimination skills may need to be taught afterbasic prevention skills (i.e., say "no," go, tell) have beenacquired. Teachers, parents, and others who work with children try to conveythe message that adults should be respected, listened to, and obeyed.Although this message is appropriate in many situations, such ideas ofauthority may indirectly harm the child who is submissive sub��mis��sive?adj.Inclined or willing to submit.sub��missive��ly adv.sub��mis and obeys theperpetrator of sexual abuse. One study addressed this developmentalissue by studying preschoolers' cognitions of authority in relationto child sexual abuse (Bogat & McGrath, 1993). Following training,children demonstrated an increased ability to recognize limits ofauthority in sexually abusive situations. Children who received trainingshowed higher scores from pre-test to post-test on the authoritymeasure, while the children who did not receive training showed noincreases from pre-test to post-test. Despite an inability to fullyunderstand authority, the preschoolers were able to say "no"to potentially abusive situations when given a clear and concise scriptof what to do. Bogat and McGrath (1993) suggest that teaching youngerchildren one specific way to behave in dangerous situations may prove tobe the most developmentally appropriate approach to sexual abuseprevention. Araji et al. (1995) designed a sexual abuse prevention program withdevelopmentally appropriate materials and demonstrated positivepreliminary results. The program was designed for grades K-6,encompassing progressively more difficult skills and concepts and longerpresentations as the grade level of the children increased. Knowledgegains (in terms of the percentage of information participants at eachgrade level were to learn) were relatively equal across grade levels,suggesting the importance of developmentally appropriate preventionmaterials. Araji et al. (1995) recommended that kindergartners befollowed through 6th grade to test the potential benefits of repetitionof sexual abuse prevention materials. The information presented in this section emphasizes the need todesign sexual abuse prevention programs to fit the developmental levelof the child participant. Outcomes of prevention studies show thatchildren of younger ages learn many of the skills and concepts conveyedduring training programs. It is important to provide programming thatresults in optimum benefits for all children, which may best be achievedin the context of the developmental level of the child. Presenters of Prevention Materials In recent years, researchers have studied the question of whoshould implement sexual abuse prevention programs. Several studies haveattempted to determine if programs are best presented by teachers,experts, parents, or some combination. Hazzard (1993) and Hazzard et al.(1990) assessed the effectiveness of teachers and experts as presentersof a sexual abuse prevention program for elementary school children.They found that groups trained by teachers and groups trained by expertsdemonstrated no differences in knowledge gains, number of disclosures,and program side-effects. However, the authors concluded that teachersshould be utilized in prevention efforts for cost effectiveness (i.e.,outside consultants would not need to be hired). Other researchers have addressed the issue of parents as trainersof sexual abuse prevention skills. Although several benefits ofincorporating parents into sexual abuse prevention efforts are assumed(e.g., daily contact, opportunities to rehearse re��hearse?v. re��hearsed, re��hears��ing, re��hears��esv.tr.1. a. To practice (a part in a play, for example) in preparation for a public performance.b. and reinforce preventionskills), research results are mixed on the efficacy of parents aspresenters. Miltenberger and Thiesse-Duffy (1988) concluded that parents may beineffective trainers of sexual abuse prevention materials to their youngchildren. The authors compared a home-based program implemented byparents with a program presented by experts. Results showed that nochild reached criterion performance on prevention skills in theparent-trainer condition. However, all subjects exhibited criterionskills and knowledge when taught by experts using BST procedures. Theseresults were replicated by Miltenberger, Thiesse-Duffy, Suda, Kozak,Bruellman (1990) who found that parents were not effective teachers evenwhen the home-based program had explicit instructions for parents tofollow during training. Wurtele et al. (1991) also evaluated the efficacy of aparent-implemented sexual abuse prevention program utilizing highlystructured BST procedures. All participants displayed an increase inknowledge of sexual abuse and prevention; however, they made only modestgains on the ability to discriminate dis��crim��i��nate?v. dis��crim��i��nat��ed, dis��crim��i��nat��ing, dis��crim��i��natesv.intr.1. a. a sexual abuse situation. Resultsfrom this study suggest that, with a BST approach and adequatecompliance checks, parents can effectively teach sexual abuse preventionconcepts to their preschool aged children. Wurtele, Kast, and Melzer (1992) demonstrated that children whoreceived sexual abuse prevention training from both their teacher andtheir parent(s) showed greater treatment gains than children whoreceived training from only one trainer. Children who received trainingfrom their parent(s) and their teacher were better at discriminatingappropriate from inappropriate touch requests and achieved higher scoreson a prevention skill measure than other program participants. Repeatedexposure to the prevention material as well as an increase in the numberof opportunities to rehearse and receive feedback may have beenresponsible for the results. Wurtele and her colleagues identified anumber of benefits of utilizing parents in the trainer role: the childbecomes more comfortable disclosing potential sexual abuse situations tothe parent, there may be a potential decrease in the secrecy secrecysee confidentiality. around theissue of child sexual abuse, and utilizing parents as trainers maypromote ongoing prevention efforts. Both teachers and experts have proven to be effective change agentsin child sexual abuse prevention programs. Because teachers havesubstantial contact and an established relationship with their students,it may be preferable to utilize teachers versus experts in the role oftrainers. Training and utilizing parents as presenters of preventionmaterials may have a number of benefits as well. Due to the mixedresults of outcome studies, further research is needed to determine whatmethods would be most effective for teaching parents to teach preventionskills and which methods parents should use when presenting theprevention curricula to their children. Parental Involvement in Prevention Efforts The previous section addressed the issue of parent involvement intraining sexual abuse prevention skills to children, however it may benecessary to assess other areas of parent involvement in preventionefforts prior to establishing parents as program trainers. Severalauthors have addressed the issue of parental involvement. Wilson and Golub (1993) had parents rate their preference forspecific prevention materials. Fifty-seven percent of parents rated theuse of video and role plays as the most acceptable modes of trainingchildren. Although books are a commonly utilized home-based approach toprevention, only 5% of parents rated books as the most acceptableapproach. With regard to content, Elrod and Rubin (1993) and Wurtele,Kvaternick, and Franklin (1992) found that the majority of parentsbelieve that children should not be taught that known adults can beperpetrators (especially family members), and that sexual abuse couldhappen to their child. Furthermore, parents believe that descriptions ofsexually abusive behaviors abusive behaviorPublic health Any of various behaviors–aggressive, coercive or controlling, destructive, harassing, intimidating, isolating, threatening–which a batterer may use to control a domestic partner/victim. See Domestic violence. should not be used in training. In spite of in opposition to all efforts of; in defiance or contempt of; notwithstanding.See also: Spite these views, parents did endorse To sign a paper or document, thereby making it possible for the rights represented therein to pass to another individual. Also spelled indorse. endorse (indorse)v. the idea that sexual abuse preventionprograms should be taught in schools and day care settings and shouldbegin as early as the age of three (Elrod & Rubin, 1993). Wurtele, Kvaternick, and Franklin (1992) found that 59% of parentssurveyed reported discussing sexual abuse with their preschoolers.However, because parents may leave out important information, they mayunknowingly mislead mis��lead?tr.v. mis��led , mis��lead��ing, mis��leads1. To lead in the wrong direction.2. To lead into error of thought or action, especially by intentionally deceiving. See Synonyms at deceive. their children. For instance, parents appear toteach their children that strangers are perpetrators of sexual abuse,when in fact they are not the most likely perpetrators. Parents alsotend to omit o��mit?tr.v. o��mit��ted, o��mit��ting, o��mits1. To fail to include or mention; leave out: omit a word.2. a. To pass over; neglect.b. topics such as the types of behaviors perpetrators use tolure children (i.e., tricks, bribes, threats). As a result the child mayacquire false perceptions about sexual abuse (Wurtele, Kvaternick, &Franklin, 1992). In terms of program content, the majority of parentsagreed that children should be taught to say "no" and toreport a potentially abusive situation, that sexual abuse is never thechild's fault, and that children have the right not to be touched.In general, parents from this sample favored sexual abuse preventionprograms and wanted to be involved in prevention efforts. However ,results from this survey suggest that, before parents become moreinvolved in prevention efforts, they need to be better informed aboutwho perpetrators are and the methods they use to perpetrate per��pe��trate?tr.v. per��pe��trat��ed, per��pe��trat��ing, per��pe��tratesTo be responsible for; commit: perpetrate a crime; perpetrate a practical joke. sexualabuse. Tutty (1993) also found that 62% of parents reported talking withtheir child about sexual abuse. These children scored significantlyhigher on a knowledge measure prior to program involvement than didchildren whose parents had not discussed sexual abuse. Tutty (1993)along with several other researchers (Berrick, 1988; Elrod & Rubin,1993; Reppucci, Jones, & Cook, 1994) found that more than two thirdsof parents underestimated the prevalence and seriousness of sexual abuseto the extent that they believe that their child is not at risk. Parentsalso tend to overestimate o��ver��es��ti��mate?tr.v. o��ver��es��ti��mat��ed, o��ver��es��ti��mat��ing, o��ver��es��ti��mates1. To estimate too highly.2. To esteem too greatly. their younger child's knowledge of sexualabuse and, as a result, may not believe their child needs training(Tutty, 1993). Researchers are increasingly advocating parental involvement inprevention efforts as a means to increase parental knowledge (Elrod& Rubin, 1993; Tutty, 1992; Wurtele, Kvaternick, & Franklin,1992). Elrod and Rubin (1993) found that parents scored an average of41% correct on a sexual abuse knowledge measure. Parents incorrectlyidentified the incidence and prevalence of child sexual abuse,characteristics of victims, and the age at which children are abused.Parents were able to correctly identify the perpetrators andconsequences of sexual abuse. Berrick (1988) conducted a parent education meeting along with asexual abuse prevention program for children and found virtually noincreases in parents' knowledge of sexual abuse issues. Berrickalso found troubling results regarding parents' knowledge ofindicators of abuse and responses to abuse disclosures. When asked forspecific indicators of abuse, parents typically responded that theywould "just know." Parents reported that, in response to achild who discloses sexual abuse, they would "be shocked" orwould not know what to do. Several parents took a more violent stance,reporting "I'd kill 'em" or "I'd go afterany abuser," while other parents reported a fear of allowing theirown child to interact with a potentially abused child. In thisparticular study, education efforts for parents about child sexual abuseand prevention appeared ineffective. Possibly with the use of morefrequent discussion groups, strategies aimed at increasing attendance,and active learning approaches, parents may learn mor e effectively andacquire the correct information, thus enabling parents to better educatetheir own children. Involving parents in sexual abuse prevention efforts is a desirablegoal that should be approached with caution. The benefits of involvingparents include: equipping e��quip?tr.v. e��quipped, e��quip��ping, e��quips1. a. To supply with necessities such as tools or provisions.b. them to educate their own children so thatprevention concepts and skills can be repeatedly reinforced throughoutchildhood, increasing the parents' ability to recognize verbal andbehavioral signs of abuse in their own children, and enabling parents todevelop appropriate ways to communicate with their children if a sexualabuse situation is ever encountered (Whatley & Trudell, 1988).Results from the survey research presented here suggest that parents maynot have adequate means to convey appropriate and correct sexual abuseinformation and prevention knowledge to their children. However, studieshave shown that parents do express a strong desire to be involved inprevention efforts (Elrod & Rubin, 1993; Reppucci et al., 1994).Perhaps prevention researchers should increase the amount of energyspent on parent education efforts, which will ulti mately benefit thechild for whom prevention efforts are aimed. Offenders' and Victims' Views Toward Sexual AbusePrevention When developing sexual abuse prevention programs, it is importantto obtain information from those most directly involved, namelyoffenders and victims. Prevention researchers have recently begun toobtain such information in an attempt to strengthen prevention efforts. Studies have found that offenders look for characteristic patternsof potential victims during the selection phase of abuse (Budin &Johnson, 1989; Conte, Wolf, & Smith, 1989; Elliot, Browne, &Kilcoyne, 1995). Perpetrators, whether known or unknown to the victim,are more likely to choose children who appear lonely, quiet, andpassive, and who are experiencing family difficulties. Elliot et al.(1995) found that a child's behavior was the most important factorin determining if a child would become a victim. The researchers foundthat 49% of offenders focused on the children who behaved in ways tosuggest a lack of self-esteem and self-confidence (i.e., playing andwalking alone, quiet), along with the other characteristics previouslylisted. Conte et al. (1989) suggest a need for identifying potentialvictims through these specific behavioral characteristics. Conte et al. (1989) found that the majority of convicted sexoffenders sex offendern. generic term for all persons convicted of crimes involving sex, including rape, molestation, sexual harassment and pornography production or distribution. surveyed established a non-sexual relationship with theirvictim prior to any sexual contact. This sequence of events typicallybegan with a gradual introduction of non-sexual touching (i.e., pat onthe back, shoulder squeeze). Perpetrators may then use sexualdiscussions with the child (which they may call sex education) toinitiate sexual contact once the non-sexual relationship is in place.Due to this desensitization desensitizationor hyposensitizationTreatment to eliminate allergic reactions (see allergy) by injecting increasing strengths of purified extracts of the substance that causes the reaction. process, children may not realize they arebeing victimized. Furthermore, the authors suggest that children maybelieve that they have already agreed to the perpetrator'sactivities. Therefore, prevention programs may need to teach childrenthat agreeing to one activity does not mean that they must agree toanother, even similar activity. Conte et al. (1989) found that themajority of sex offenders used threats to maintain the sexualrelationship. The authors conclude that children need to learn aboutthis grooming Combining, consolidating and segregating network traffic using devices such as digital cross-connects, add/drop multiplexers and SONET switches. Grooming is a telephone term that typically refers to managing high-capacity lines between central offices, carriers, ISPs and very large process . However, this may prove to be a very difficulttask because there is not a clear line between "normal"relationship building and "victim-perpetrator" relationshipbuilding. Results from Elliot et al. (1995) strongly suggested that childrenshould be taught to "tell" at early warning signs (i.e., adultwho approaches alone, adult who acts too friendly). The authors alsowarned against the current prevention efforts that teach children toyell "no" or to threaten to "tell" because thesestrategies may encourage the offender offendern. an accused defendant in a criminal case or one convicted of a crime. (See: defendant, accused) to use violence or physical force.Over one-third of the offenders were prepared to use threats andviolence if a child resisted their approach, while only 26% of offenderssaid they would discontinue dis��con��tin��ue?v. dis��con��tin��ued, dis��con��tin��u��ing, dis��con��tin��uesv.tr.1. To stop doing or providing (something); end or abandon: abuse if a child said "no." Hence,prevention programs which focus primarily on teaching a child to resistwhen encountered with a sexual abuse situation may not be effective. According to offender surveys, it also appears that children needto be taught the methods used by perpetrators to gain victims. Elliot etal. (1995) found that only 9% of offenders surveyed used a "helpme" lure, which is emphasized in many prevention programs. The mostcommon types of strategies were play or teaching activities,baby-sitting, offers to go on outings, affection and understanding, andengaging a child in story telling (Elliot et al., 1995). Over two-thirdsof offenders who victimized children outside their immediate familiessecured their victims by soliciting in community areas where childrenwere likely to be (i.e., public rest rooms, family restaurants,playgrounds, shopping malls) and by befriending the entire family.Forty-eight percent of offenders used baby-sitting as a way to initiateabuse, and 44% of offenders victimized children in public places (Elliotet al., 1995). Another approach to identifying prevention strategies is to gainvictims' perspectives on sexual abuse prevention efforts. Berlinerand Conte (1990) used a semi-structured interview A semi-structured interview is a method of research used in the social sciences. While a structured interview has a formalized, limited set questions, a semi-structured interview is flexible, allowing new questions to be brought up during the interview as a result of what the for 10-18 year oldvictims of child sexual abuse. The majority of warning indicatorsexperienced by the victims included: the abuser provided differentialtreatment of the victim compared to other children, the abuser told thevictim not to tell anyone about anything the two did (abusive or not),the abuser "accidentally" entered into bathrooms and bedroomswhen the victim was undressed, the abuser "accidentally"touched the victim's private areas, the abuser granted extraprivileges to the victim, and the abuser purposely pur��pose��ly?adv.With specific purpose.purposelyAdverbon purposeUSAGE:See at purposeful.Adv. 1. kept all doors open.Clearly, it is important to teach children to "tell" aboutthese early warning signs so that further investigation can be done. Thevictims of this study stressed that describing sexually abusivebehaviors is important, so that children realize that the behavior isnot "OK." The majority of the victims reported that when thefirst abusive act was committed, they were unaware that it was wrong.More often than not, the victims from this study did not initiatedisclosure, and virtually all of the victims reported that they wishthey had told someone about the abuse right away. Pelcovitz et al. (1992) found that a brief film presentation wasnot effective in preventing child sexual abuse. The program waspresented to children attending two elementary schools within the samedistrict. Of these children, 22 6-10 year olds who participated in thesexual abuse prevention program were subsequently victimized by the sameperpetrator. None of the children generalized gen��er��al��izedadj.1. Involving an entire organ, as when an epileptic seizure involves all parts of the brain.2. Not specifically adapted to a particular environment or function; not specialized.3. from what was taught inthe film to their own abuse. Even though the topics covered in the filmwere directly related to the specific abuse the children endured, noneof the children disclosed information pertaining per��tain?intr.v. per��tained, per��tain��ing, per��tains1. To have reference; relate: evidence that pertains to the accident.2. to their situation. Theresults of this study strongly suggest that prevention programs shouldpersonalize per��son��al��ize?tr.v. per��son��al��ized, per��son��al��iz��ing, per��son��al��iz��es1. To take (a general remark or characterization) in a personal manner.2. To attribute human or personal qualities to; personify. the information taught, so that children are better able tounderstand that sexual abuse may happen to them. Furthermore, programsshould promote generalization by incorporating role plays with a varietyof sexual abuse lures, responses, situations, and potentialperpetrators, so that the skills taught may pro ve useful to thechildren at some point in time. Assessing the perspectives of offenders and victims providesvaluable insight on how to develop sexual abuse prevention programs. Theimportance of teaching children about the early grooming behaviors ofoffenders is clear from both the offenders' and victims'perspectives. In addition, teaching children to effectively tell when awarning sign is present or when an abusive act has been committedwarrants emphasis in prevention efforts. The literature on victims'and offenders' perspectives on sexual abuse prevention is stillrelatively small. With further research into these areas, programdevelopers may be better equipped to develop effective materials. Summary The problem of child sexual abuse warrants serious consideration bysociety as a whole. Prevalence of the problem has been suggested toinclude almost one-quarter of the nation's population (Finkelhor etal., 1990). As a result of sexual abuse, a variety of emotional andbehavioral problems may develop and continue into the youngvictim's adulthood. Due to the traumatizing nature of sexual abuse,effective treatment approaches and prevention strategies have recentlybeen developed. Sexual abuse prevention programs can be safely implemented. Theyoften result in increased knowledge of sexual abuse and preventionskills and increased rates of disclosure. However, evaluations of sexualabuse prevention programs suggest that child participants are notgaining optimum benefits. Consequently, prevention researchers haverecently begun to address several issues in sexual abuse prevention todetermine more effective approaches. There is a strong need for betterevaluative procedures that assess actual behavior change followingprogram implementation. Researchers should consider the use of role-playassessments for measuring sexual abuse prevention skills, and shouldfurther evaluate the relationship between knowledge and skills. Because prevention efforts may be modestly effective for mostchildren in a wide range of age groups, several studies suggest a needfor developmentally-appropriate materials for all ages (Araji et al.,1995; Nemerofsky et al., 1994; Wurtele, 1987). The use of fewer abstractconcepts and more skill-related behaviors may enhance preventionprograms, especially for preschool-aged children. Currently, teachers and experts appear to be the most effectivepresenters of prevention materials (Hazzard et al., 1990). However, withadequate parent education and training, parents may effectively traintheir own children to resist sexual abuse (Wurtele, Kast, & Melzer,1992). Further research is needed to address the issue of who shouldpresent prevention programs to children. In general, parents want to be involved in sexual abuse prevention.However, recent research suggests that parents need to be bettereducated before they can assume the role of prevention educator. As awhole, parents do not believe their child is at risk (Elrod & Rubin,1993; Reppucci et al., 1994). Although parents appear to have someknowledge of child sexual abuse, they often do not provide accurateinformation during discussions of sexual abuse with their children(Wurtele, Kvaternick, & Franklin, 1992). Parents typically neglectthe more important aspects of prevention such as; accurate descriptionsof perpetrators, grooming behaviors, and warning signs (Wurtele,Kvaternick, & Franklin, 1992). However, these are the kind of topicsoffenders, victims, and prevention researchers identify as necessarywhen training prevention skills to children. To expand parent educationefforts, communities should provide extensive opportunities for parentsto obtain accurate information about sexual abuse, possibly throughschools, daycares, churches, or the media. Researchers should strive to improve current prevention effortstargeted for children, but should expand prevention efforts in differentdirections. Sexual abuse prevention efforts aimed at educating parentsmay supply parents with information needed to discontinue or preventabusive situations, and to stop the abuse perpetrated by the otherparent (Whatley & Trudell, 1988). Researchers should also considerdeveloping programs for potential offenders. Forty-eight percent ofoffenders are younger than 20 years of age (Dube & Hebert, 1988),yet the average age of conviction is 31 (Elliot et al., 1995). Thus,many years exist in which a perpetrator may repeatedly abuse withoutconsequence. Researchers should evaluate programs implemented at thehigh school level incorporating discussions of appropriate andinappropriate sexual behavior and the grave consequences of sexual abusein an attempt to deter potential juvenile offenders. As evident from both offender and victim perspectives, it appearsthat the skill of "telling" needs emphasis, especially whenconsidering that only 42% of abused girls and 33% of abused boysdisclose sexual abuse (Finkelhor et al., 1990). The skill of"telling" is also an important aspect of prevention effortsfor those children who are unable to escape and resist a perpetrator whois physically bigger and stronger. This is particularly importantconsidering that up to 51% of victims endure some type of force orthreat from their abuser (Briere & Runtz, 1988). The issues discussed in this paper can be brought together toprovide suggestions to optimize optimize - optimisation sexual abuse prevention programs. 1. The content of prevention programs should incorporateinformation obtained from offenders and victims of sexual abuse. Thus,prevention programs should focus on teaching children to recognizegrooming behaviors and warning signs and teach children to tellimmediately following their recognition of early indicators of abuse. 2. Subtle distinctions between appropriate and inappropriatebehaviors may prove difficult for younger children. Therefore, it isimportant to consider the developmental differences in children'sabilities to learn prevention concepts and skills so that children ofall ages will benefit from prevention materials. 3. Children at all levels may best benefit from the use of BST andactive learning approaches as modes of presenting prevention materials,regardless of who is presenting the sexual abuse prevention program. 4. Sexual abuse prevention programs need to be evaluated todetermine their effectiveness at teaching children prevention skills.Behavioral assessment measures, such as role-plays and disclosure rates,should be the primary methods for evaluating programs. Such measurestaken pre and post-training will allow the assessor to determine whetherthe children can and do exhibit the skills taught. 5. Finally, not only should communities enhance their efforts ateducating parents on sexual abuse and sexual abuse prevention butefforts (through the media, churches, schools, etc.) should be aimed atall individuals who are concerned with the welfare of children. Currently, prevention efforts are not succeeding at their ultimategoal of reducing the number of cases of child sexual abuse (Berrick& Barth, 1992). Conceivably con��ceive?v. con��ceived, con��ceiv��ing, con��ceivesv.tr.1. To become pregnant with (offspring).2. , with better parent education, betterassessment methods, and programs that utilize age appropriate materialsand incorporate suggestions from those most directly affected by childsexual abuse, prevention efforts may better achieve their objective. References Araji, S. K, Fenton, F., & Staugh, T. (1995). Child sexualabuse: Description and evaluation of a K-6 prevention curriculum.Journal of Primary Prevention, 16, 149-164. Berliner, L., & Conte, J. R. (1990). The process ofvictimization victimizationSocial medicine The abuse of the disenfranchised–eg, those underage, elderly, ♀, mentally retarded, illegal aliens, or other, by coercing them into illegal activities–eg, drug trade, pornography, prostitution. : The victims' perspective. Child Abuse and Neglect,14, 29-40. Berrick, J. D. (1988). Parental involvement in child abuseprevention training: What do they learn? Child Abuse and Neglect,12,543-553. Berrick, J. D. (1989). 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