Child Sexual Abuse Prevention Programs and Accusations of Child Sexual Abuse: An AnalysisJames Krivacska*ABSTRACT: Child sexual abuse prevention programs have grown dramatically in recent years but the literature on these programs has not adequately addressed the relationship between prevention programs and accusations of child sexual abuse. This paper reviews child sexual abuse prevention programs as they are currently structured. The current programs are actually secondary prevention programs aimed at teaching children how to recognize abuse and respond to it when it occurs. Such programs are therefore early intervention programs and identification programs rather than prevention programs. However, there is little data indicating a change in the rates of reporting sexual abuse following exposure to these pro grams. The potential positive and negative effects of the
current prevention programs are discussed and it is concluded that
attempts at wholesale exposure of children to these programs is
premature. A more sensible approach is a primary prevention
approach geared towards improving overall mental health and
problem-solving skills in children. Child Sexual Abuse Prevention Programs (CSAP) have proliferated in recent years partly in response to drastic increases in the numbers of children reported to be sexually abused. Given the presumed negative sequelae of sexual abuse (Browne & Finkelhor, 1986), attention has been drawn to factors which promote or support the abuse of children. Finkelhor (1984) described four preconditions which must be present for sexual abuse to occur, which he further breaks down into 47 individual and social/cultural factors which support or promote the occurrence of sexual abuse. Of those 47 factors, one deals with a child's lack of knowledge regarding sexual abuse. Because of the easy availability of children in schools, there has been a tendency to focus on sexual abuse prevention programs directed at that population (Krivacska, 1988). Unfortunately, similar attempts have not been made to intervene with regard to the remaining 46 factors and it is questionable whether the focusing of prevention efforts solely at children can ever be successful at preventing abuse (Crewdson, 1988; Tharinger & Krivacska, 1988). Nevertheless, CSAP programs are currently being
implemented across the nation and one million children are estimated to
have been exposed to them (Plummer, 1986). To date, the literature on
CSAP has not sufficiently addressed the relationship between CSAP and
accusations of child sexual abuse. The focus of this paper will be then,
to first briefly review CSAP programs as they are currently structured
and to discuss the extent to which they are really prevention programs.
The impact such programs may be expected to have on child sexual abuse
accusations will then be discussed. CSAP Program Design CSAP programs are generally of two types: single presentations (usually sponsored and conducted by organizations from outside the school or agency in which the children are found) and curriculum-based programs which are integrated into the school curriculum and are usually presented by school or agency staff. In either case, several concepts are commonly found to be present in most of these programs. Conte, Rosen, Saperstein, and Shermack (1985) in reviewing CSAP programs found six concepts to be commonly present in most programs: (1) Body Ownership — that a child's body belongs to him/her and (s)he has the right to control access to his/her body; (2) Touch Continuum — that touch may be categorized into two types; good and bad (some earlier versions included a third type — confused); (3) Secrecy — that secrets are things that you are never supposed to tell anyone, are bad and should be told versus surprises which eventually are told; (4) Intuition — that children have an innate sense of what is appropriate and inappropriate touch and that children should "trust their feelings"; (5) Saying NO — that children should respond to abusing situations by saying no (some programs include the instruction to also run away and tell someone); and (6) Support Systems — that there are many different people the child can turn to for help. Also frequently present in CSAP programs is the
concept that the child is not to blame for the abuse. Overall, most of
these program concepts suffer from significant problems in both the
assumptions upon which they are based and with respect to their
appropriateness for children at young ages. Within the structure of our
society today, concepts such as body ownership, secrecy and touch
continuums are problematic since children are exposed to so many
disconfirming experiences (having to take baths when they don't want to,
having to keep a secret about a family illness, childhood peer sex
experiences, etc.). Secondly, most of these concepts have not been
defined in such a way as to permit easy classification of events a child
may experience. Third, assumptions are made about children's abilities
that have no support in the literature (e.g. that children have an
intuitive sense of good/had touch). Nevertheless, it is upon these
concepts that instruction in CSAP programs is based and it is beyond the
scope of this paper to thoroughly analyze each of these. CSAP as Prevention Programs Primary prevention has been defined as the administration of a program (1) targeted at well people, (2) applied before the onset of the condition to be prevented, and (3) intentional in its application and predicated upon a sound knowledge base and supporting rationale (Cowen, 1980; Cowen, 1984). Whether CSAP programs, as they are currently designed and implemented, can be considered primary prevention programs is open to debate. Though in most cases CSAP meet the first condition, how well they meet the second condition is less clear. CSAP programs teach children how to recognize abuse and respond to its occurrence. While such training may, in most cases, precede any attempt at abuse, the abuse must logically occur prior to the child being able to recognize it and respond to it (i.e., the abuse must occur to some degree before the child can prevent it). Thus, it can be argued that CSAP programs are nothing more than early intervention programs. Secondly, for children who are being abused or have been abused, presentation of CSAP programs is too late to be considered preventive and can only serve the function of identification. The third condition states the importance of prevention programs having as their foundation a sound knowledge base and supporting rationale. The literature on CSAP programs has not, to date, provided a sound foundation upon which to develop prevention programs, an issue which has been discussed elsewhere (Tharinger & Krivacska, 1988). One of the preconditions noted by Finkelhor in his model is that the perpetrator must overcome the resistance of the child (1984). Finkelhor discusses characteristics of children who may be more vulnerable to sexual abuse by virtue of their emotional insecurity, high levels of trust, poor self-esteem, and emotional deprivation. Programs which seek to decrease a child's vulnerability by addressing these issues are more likely to prevent abuse by fostering in the child a 'front of invulnerability' (Finkelhor, 1984, p. 60) which may discourage a potential abuser from making an approach. There is also the potential that CSAP programs, by their mere presence, may divert some abuse if perpetrators are aware that a potential victim has been exposed to such a program. Programs directed at teaching children directly about
sexual abuse and how to prevent it are at best programs designed to
catch abuse in its earliest stages. Programs which promote healthy, less
vulnerable children by fostering improved self-esteem and self-worth,
and by increasing emotional stability are more likely to be preventive.
For the purpose of this paper, the latter will be referred to as primary
prevention programs, and the former (more common) as secondary programs.
Secondary prevention programs directed at children currently being
abused or who have been abused in the past serve the purpose of
identification and will be referred to as identification programs. Primary CSAP Programs and Sexual Abuse Accusations What implications might primary prevention CSAP programs have for sexual abuse accusations and the occurrence of sexual abuse? A program which focuses on the promotion of a psychologically healthy child is likely to increase the number of children who will be perceived as "untouchable" by prospective abusers. Finkelhor describes how some abusers have observed that they can intuitively pick out the vulnerable child. If a child can be made to appear less vulnerable, the likelihood that that child will be the target of abuse is reduced. If, in spite of being made less vulnerable, the child is still abused, the likelihood of significant psychological damage is substantially reduced. No such course of prevention can insure that every child exposed to it will be made invulnerable. In many cases much emotional damage has to be overcome, and children who come from homes where they lack emotional security will continue to be at risk. In fact, as the pool of children who are exposed to such programs increases, perpetrators could then seek out the most obviously vulnerable children as the targets of their abuse. Unfortunately such children are the ones most likely
to suffer the most severe psychological damage and the ones least likely
to report the abuse, regardless of their previous exposure to CSAP
programs inasmuch as the perpetrator is usually fulfilling some
important psychic need as well (Tharinger & Krivacska, 1988;
Tharinger, Krivacska, Laye-McDonough, Jamison, Vincent & Hedland,
1988). Also, most false allegations (outside of custody litigations) are
made by children with significant emotional difficulties (Wakefield
& Underwager, 1988; Gardner, 1987). Thus, the same population which
is most likely to be abused will also be the population most likely to
generate false allegations thus heightening the need for ways to
discriminate between true and false allegations. Secondary CSAP Programs and Sexual Abuse Accusations These programs assume that teaching children about sexual abuse and about how to respond to sexually abusive situations will result in children rejecting early sexual advances and reporting the abuse. This represents a secondary prevention program since the initial advance to which the child is responding must be assumed to be abusive itself. Two populations of students are exposed to these programs: those who sometime in the future will be sexually abused; and those who will never be sexually abused (note that the students who are currently abused or who have been abused are discussed under Identification Programs). For the children who will subsequently be exposed to abusive situations, several potential positive effects may be hypothesized. Children who are previously exposed to CSAP programs may become desensitized to the issue and feel greater permission to talk about and discuss abusive situations. Having learned that they are not alone in their experience of abuse and given some course of action to take, children against whom an abusive act is attempted may be better able to respond to that act and make a report of the abuse. The justification for CSAP programs is, of course, predicated on just that presumption; that children exposed to CSAP programs will, if subsequently involved in an attempt at sexual abuse, be able to intervene in their own behalf and stop and report the abuse. Currently, there is little data indicating a change in the rate of reporting of child sexual abuse by children. There is no data which links reports of sexual abuse made by children to their exposure to CSAP programs. For some children CSAP will probably serve as an impetus to report abuse that they are experiencing. To what extent this may occur is unknown. Neither are the factors which may impact on whether a report is made understood. CSAP programs have presumed the positive effects described above. Little consideration has been given to the potential negative effects arising from CSAP programs for children who, having been exposed to them, are later abused. The greatest risks associated with CSAP programs comes from our lack of understanding of the dynamics of child sexual abuse, particularly intrafamilial. At this time CSAP programs represent our best guesses about how to teach children about sexual abuse (Conte, e al., 1985). There is some evidence from other types of prevention programs suggesting that if children feel unable to carry out the preventive measures they've been taught, they become more vulnerable to the condition to be prevented (Kleinot & Rogers 1982). Additionally, one study regarding CSAP showed that children who had been abused were more vulnerable after the CSAP exposure (Toal, 1985). Implicit in most CSAP programs is the message that children should take responsibility for their own body (Body Ownership). This message is in conflict, however, with the concept that a child is not to blame for sexual abuse. If a child is sexually abused but is also responsible for his own body, and that child feels incapable of preventing the abuse or reporting it, the child could easily conclude that he is partially responsible for the abuse, or at least responsible for not stopping it (NCPCA, 1986; Tharinger & Krivacska, 1988). Thus, children who have been taught about sexual abuse, who have learned that they have the right to control access to their bodies by adults, and who are then subsequently exposed to an act of sexual abuse which they feel unable to prevent or report are left with the inevitable conclusion that they have failed in their responsibility to protect their own bodies (Trudell &Whatley, 1988). Finally, while increasing their awareness of the fact that they might not be alone in their experiences, such a program may also heighten children's awareness of the social inappropriateness of the sexual activity. If children derive any sensate pleasure from the act, this may heighten feelings of guilt or shame. What of the child who is exposed to CSAP programs but who is never subsequently abused (obviously constituting the largest percentage of children to be exposed to CSAP programs)? It has been argued that several positive effects will accrue to these children in spite of the fact that they may never need the specific information related to sexual abuse. Since most programs attempt to engender a greater awareness of body rights, to empower children in their relationship with their parents and other adults, and to increase their assertiveness in situations where they feel their basic rights may be threatened (Tharinger & Krivacska, in press), it has been argued that these programs have positive benefits for all children. There is, however, no data to indicate whether children are learning these messages, whether they are correctly interpreting and acting on these concepts, whether they are even capable of learning such abstract concepts, and whether these concepts are within the mainstream of American culture and values with regard to the family unit and parental values of child rearing. Nevertheless, some anecdotal reports suggest that with some children, this message may be coming across and may be helping them in their interpersonal interactions with family, friends and others. In some cases such a child, by virtue of appearing less vulnerable, may be less susceptible to abuse. Of critical importance when any prevention concept is introduced to the general population, is that the efforts prove innocuous for the part of the population who will never be subjected to the target condition to be prevented. The great failing of the swine flu inoculation program of the late 1970s arose from the fact that many people who probably would not have suffered from the swine flu itself were inoculated and became ill as a consequence of the inoculation. Similarly, prevention programs should not have significant negative effects on the vast majority of children who will not be sexually abused. Unfortunately, some very clear dangers can be inferred from CSAP programs. For example, in the absence of general sex education, CSAP programs will probably represent a child's first exposure to the concepts of sex and sexuality. These programs are likely to be presented prior to the onset of puberty and the accompanying sexual awakening of that period. The long-term implications of a pre-pubescent first exposure to sex and human sexuality, and a child's own sexuality, occurring within the extremely negative context of sexual abuse is unknown but should not be assumed to be benign (Trudell & Whatley, 1988). Many concepts presented in CSAP programs are abstract and poorly defined (touch continuum, body ownership, secrets, etc.) (Tharinger & Krivacska, 1988) and are likely beyond the developmental level of the children to whom they are being taught. The greatest concern, however, involves the introduction of intrafamilial sexual abuse with the usual portrayal of the victim as the daughter and the perpetrator as the father. Consider that underlying CSAP programs directed at preventing intrafamilial abuse is the need to convince the child that her father is a potential sexual abuser. For a prevention program to be effective, the target group must accept the existence of the risk of the behavior or event to be prevented. For example, teen pregnancy prevention programs fail when the target adolescents don't accept the possibility that they could become pregnant. The potential negative impact on father/daughter bonds is obvious for the child who accepts such a message. Certainly if the child is subsequently abused, she will be much more likely to report the abuse. Unfortunately, the child who accepts this message is more likely to begin to view the father's behaviors through a sort of "incest sensor." The likelihood of the child subsequently misinterpreting innocent behavior of the father is substantially increased and may result in a false allegation. Even if the child doesn't report the misinterpreted behavior, the doubts that have been created in the child's mind will damage fragile father/child bonds. It has been argued in the past that false allegations
of sexual abuse are rare because children lack the knowledge to
fabricate a story of abuse. CSAP programs have essentially nullified
that argument. Children are sometimes given incredibly explicit descriptions of sexually abusive situations,
including graphic illustrations of a hand in the genital area or
explicit descriptions of such events (e.g. Alice Doesn't Babysit
Anymore, McGovern, 1985). Additionally, such programs may desensitize
children to the issue of sexual abuse. Whereas, previously such a
concept was absolutely foreign to most children, this author has
recently heard incest jokes being told on middle and even elementary
school playgrounds and parents are reporting that their children are
threatening to falsely report them for abuse as a means of manipulation
(Gardner, 1987; Wakefield & Underwager, 1988). All of these factors
suggest that false allegations may increase given increased exposure to
CSAP programs and increased media attention to cases of sexual abuse. Identification Programs and Sexual Abuse Allegations Identification programs are, in reality, secondary prevention programs which, by virtue of their target (children who have been or are currently being abused), become identification programs. The potential positive effects for children who are being abused or have been abused can be assumed to be the same as for children exposed to secondary programs and who are subsequently abused. By receiving implicit and explicit permission to talk about sexual abuse, by seeing that they are not alone, and by being encouraged that they are not to blame for the abuse, children who are being abused are more likely to report the abuse than if they had not been exposed to the CSAP programs. Many reports on CSAP programs include a reference to children who, during the course of the CSAP presentations, reported that they were victims of sexual abuse themselves. This factor has probably been one of the strongest sustaining factors in the maintenance and growth of the CSAP program movement. The lack of an adequate means of identifying children who are being sexually abused and a sincere and genuine desire to identify and help such children has lead to reliance on a very inaccurate and intrusive method of identification (presentations of CSAP programs) in the hope that these programs will encourage children who are being abused to report the abuse. Unfortunately, because of possible emotional ties to
the abuser, or fear of consequences, even a child who has been sexually
abused and exposed to CSAP programs, may be unable to make a report.
In
fact, it has been suggested that prevention programs may be doing something wrong since, beyond the
question of whether they prevent abuse, rates of reporting of sexual
abuse by those exposed to the program are well below reported incidence
rates (Conte, et al., 1985). The danger of CSAP programs for such
children is that of heightening the crisis for the child, of increasing
levels of guilt or blame because the child is unable to carry out the
instructions of the CSAP program presenter to report the abuse. Conclusions There is at this time a conspicuous lack of solid research evidence in the area of CSAP programs and attempts at wholesale exposure of children to these programs is premature. The potential negative consequences that have been outlined here as well as other potential negative and observed effects outlined elsewhere (Garbarino, 1987; Herndon, 1984 Kleemeier & Webb, 1986; Kraizer, 1986; Miller Perrin & Wurtele, 1986; Swan, Press & Brigg, 1985 Tharinger & Krivacska, 1988; Tharinger & Krivacska, in press) argue for a more cautious approach to CSAP programs. Attempts at using secondary CSAP programs as identification programs represents the metaphorical equivalent of shooting at a tin can with a cannon filled with lead pellets (one figure the odds are in favor of one of the pellets hitting the can and the hope is that nothing else of consequence will be damaged). A more sensible approach would be a primary prevention approach geared toward improving over all mental health and problem-solving skills among children. Given the broad-based benefits that may accrue even beyond prevention of sexual abuse, and the lack of any discernible negative sequelae, such an approach has clear advantages. Such a program may include some exposure to the concept of sexual abuse but only after some general sexual education. In any event, introduction of the concept of intrafamilial (father-daughter) sexual abuse does not appear feasible given the high risk of negative effects. For those who insist on the presence of the concept of
incest in such curricula, the focus must remain on the present rather
than on attempting to anticipate future events. Under such a
program
children who are being currently abused by a family member are getting
the information they may need while the other children are not being
compelled to view non-abusive relationships as potentially abusive.
Thus, secondary prevention programs would be eliminated and efforts would
be focused at primary prevention and identification. Conceived in this
way, the desire to identify children who are being abused can co-exist
with concern about unnecessary indoctrination of concepts and ideas that
will be foreign to most of them. At the same time, the development of
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