Friday, October 28, 2016

Findings from a recent literature review to synthesise international evidence regarding risk and protective factors related to child sexual abuse in institutional contexts


In 2015 we (Keith Kaufman and Marcus Erooga) were commissioned by the Australian Royal Commission into Institutional Responses to Child Sexual Abuse a literature review to synthesise international evidence regarding risk and protective factors related to child sexual abuse in institutional contexts.

Literature review methodology

The methodology for the review was built on the Royal Commission’s broad definition of institutional child sexual abuse. Working with the project team of graduate students Kelly Stewart, Judith Zatkin, Erin McConnell, Hayley Tews and Australian consultant Associate Professor Daryl Higgins the first step was to identify a wide range of relevant search terms that we then circulated among experts in the United States (US), the United Kingdom (UK) and Australia to solicit additional terms. A similar process was conducted to identify databases that would yield the most relevant articles for this review. We then developed final lists of search terms and databases for the review based on feedback.

Simultaneous, independent literature reviews of each of five identified areas were then conducted using the final search terms. These were conducted by the authorial team, the Australian Institute of Family Studies (Australia), the National Child Advocacy Center (US), the National Sexual Violence Resource Center (US) and the National Society for the Prevention of Cruelty to Children (UK) and focused on scientific research literature as well as ‘grey literature’ such as reports, inquiries, evaluations and dissertations.  

The nature of the reviewed literature

The review yielded more than 400 relevant documents, primarily comprising research studies from professional journals. The literature was distributed across the three key review areas of victim, perpetrator and institution and further divided across six specific types of institutional setting including faith-based settings; early childhood education, care and schools; healthcare; out-of-home care; sport; and public inquiries and case reviews. The result was a series of related literature with limited integration - in particular the documents specific to victim, perpetrator and institution are quite distinct, with little overlap and minimal cross‑referencing. Articles describing child sexual abuse in various types of institutional setting are also highly ‘siloed’. The separate nature of these research sub-areas is an important dimension for understanding the strengths and weaknesses of the available literature on child sexual abuse in institutions.


For the purposes of this blog we highlight the ‘big-picture findings’ regarding risk and protective factors pertinent to victims, perpetrators and institutions, as well as the role of prevention of institutional child sexual abuse.


Risk and protective factors regarding victims


Many children spend a significant amount of time in institutional settings and whilst all children are inherently vulnerable to sexual abuse in institutional settings where is a motivated perpetrator, some children are more vulnerable than others.

A majority of child sexual abuse victims overall are female (Finkelhor and Baron, 1986). In institutional settings specifically, Faller (1988) reported that 62 per cent of sexually abused children in a day care setting were female; while Leahy, Pretty and Tenenbaum (2002) found that females in organised competitive sports were at twice the risk of being sexually abused as males (for both elite and youth sports). However, there is concern that the rates of disclosure, while minimal for both genders, may be disproportionately low for boys. This may be due to male socialisation processes, males may possibly not recognising some sexual activity as abusive, a propensity to downplay the impact of abuse, and outright denial that abuse has occurred to avoid social stigma, particularly when the perpetrator is also male (Alaggia & Millington, 2008; Fondacaro, Holt & Powell, 1999; Holmes, Offen & Waller, 1997; Holmes & Slap, 1998; Love, 2016; Parent & Barron, 2012).

Age has been identified as a risk factor for sexual abuse victimisation generally, with younger children particularly at risk (Bohm, Zollner, Fegert & Liebhardt, 2014). In institutional child sexual abuse, the age at which abuse begins seems to vary according to the type of setting. This may be related to the fact that children use different types of institutions at different developmental stages – for example, childcare centres during their pre-school years, and residential camps during their teenage years.

Higgins (2010) suggested that the presence of any disability leads to a higher risk of sexual victimisation, with multiple disabilities further increasing the probability of abuse. Higher rates of sexual victimisation were associated with intellectual disabilities, behavioural disorders and communication disorders.

A number of family characteristics have been identified as risk factors for child sexual abuse. Peter (2009) suggests that children from families with a low socio-economic status are at greater risk of sexual victimisation. This may be because these families have access to fewer resources and often include parents who work multiple jobs, leaving children to spend more time in the care of others. In a sample of children who were abused in a hospital setting, Feldman, Mason and Shugerman (2001) identified risk factors including parental mental illness, parental substance abuse, legal problems and vindictiveness against medical service providers.

Research on child sexual abuse risk and protective factors has several methodological limitations. Perhaps the most significant of these relates to the limited generalisability of study findings. Another significant barrier is the overall lack of empirical research in this area due to the difficulty of studying a phenomenon such as child sexual abuse, which relies on retrospective data and involves significant ethical limitations (Hartill, 2005; Love, 2016).


Risk and protective factors regarding perpetrators

Institutional sexual abuse perpetrators are a sub-category of extrafamilial offenders who abuse children that they have access to by virtue of working, volunteering or otherwise being associated with a particular institution.

There is no ‘type’ or ‘profile’ relating to perpetrators in institutional settings, or elsewhere. However, in general, risk factors for sexual offending include deviant sexual interest, distorted attitudes about sex, poor socio-affective functioning and poor self-management (Sullivan et al., 2010).

Criminal justice staff who work with perpetrators have identified eight broad conceptual categories of perpetration motivation, some possibly causal and others contributory:
·                     developmental issues
·                     poor social competence
·                     sexual motivation
·                     need for power and control
·                     psychopathology
·                     perceived victim characteristics
·                     values and beliefs that enable child sexual abuse
·                     personality deficits (Purvis, Ward & Devilly, 2003).

Longstanding sexual interest in children is not the sole factor for choosing to perpetrate child sexual abuse. There is a useful distinction between those described as preferential offenders, who have a long-term sexual preference for children, and those described as situational offenders, who take advantage of opportunities to offend against minors. These opportunities especially arise in situations where they have access to, privacy with, and authority over children, such as when they are serving in positions of trust in institutions.

Overall, the literature presents a solid basis for identifying the background characteristics of offenders and other risk factors that may lead to institutional child sexual abuse. However, a great deal of work must still be done to further investigate risk factors that facilitate institutional child sexual abuse.


Risk and protective factors regarding institutional settings

Child sexual abuse can occur within any institution where there are children and a motivated perpetrator. Some perpetrators will actively try to manipulate institutional conditions to create an opportunity to sexually abuse. Institutions can act to reduce risk factors and enhance protective factors. This involves considering the role of an institution’s policies, climate, culture and norms.

A major risk factor is that screening processes, used to exclude unsuitable people from joining organisations, are not as effective as widely believed (Erooga et al., 2012a). This is because many perpetrators either have no criminal history or their history does not include sexual offences, meaning they would pass a criminal background screening process (LeClerc & Cale, 2015).

A lack of clearly defined policies, or variability in the comprehensiveness and appropriateness of child-safe policies, also facilitates child sexual abuse in institutions. In the US, for example, each state has a different definition of ‘coercion involving the misuse of authority’, and therefore handles sexual abuse cases differently (Weiss, 2002). This is particularly problematic as there is a gap between research and policy regarding child sexual abuse prevention (Quadara et al., 2015).

Rather than focusing solely on individuals, risk management needs to address environmental factors (Beyer et al., 2005), in what is generally referred to as a situational prevention approach. Research shows that certain characteristics of an institution can increase the risk of staff members committing sexual crimes against children. These characteristics may include the physical condition of the facility, child safety policies and procedures, the training and supervision of staff, and also the less tangible risk factors of institutional culture and environment. It is also important to consider the impact of the power differential between institutional staff or volunteers and the children in contact with the institution.

Organisational culture was cited as a key contributory factor in a significant number of recent inquiries into institutional child sexual abuse in the UK. A proportion of perpetrators surveyed stated that the culture of the organisation in which they offended did not proactively promote child welfare (Erooga et al., 2012a).

Implications for policy and practice

Overall, the literature reflects the promising nature of prevention strategies and policy initiatives for enhancing child safety. Prevention strategies span the continuum from awareness training directed at individual parents or staff members to more systematic, institution-wide efforts to identify and ameliorate environmental or situational conditions that allow child sexual abuse to occur.

In a complementary fashion, the design and implementation of key safety policies foster child safety by helping to establish clear professional boundaries, acceptable practices, and mechanisms for identifying and reporting inappropriate behaviour that places children at risk.

Prevention and policy initiatives should target the types of abuse inhibitors that Finkelhor (1984) refers to in his Four Preconditions model for understanding the conditions under which child sexual abuse can occur. The literature also highlights a compelling need to increase investment in prevention and policy initiatives as well as to better tailor such efforts to the needs and characteristics of particular institutional settings to maximise their effectiveness.

A striking feature of this review is that many of the actions described in the literature aim to implement protective systems and processes more rigorously, thoroughly and consistently.

Another major conclusion that can be drawn is the need for greater attention to be paid to the quantity and quality of research related to child sexual abuse in institutions. Systematic research programs should be tailored to various types of institutions and address key areas of concern, such as identifying risk and protective factors, promoting early disclosures and improving prevention program outcomes.

At the same time, it is important to advocate for more methodologically sound investigations of child sexual abuse in institutions. This includes a greater diversity of study approaches, more quantitative as well as qualitative studies, and approaches with greater generalisability.
The most important action that institutions and those who work in them can take is to become familiar with the key literature contained in this review. They should consider their practices in light of the information contained in this literature, and act accordingly to maximise children’s safety. It is incumbent upon institutions to not only subscribe to these strategies as a matter of policy, but to ensure that their staff adheres to these principles as a matter of routine practice on a daily basis.

In summary, the literature shows the best way to reduce the risk of institutional child sexual abuse is to avoid dangerous practice rather than attempt to screen out allegedly dangerous people. Effective prevention is predicated on creating a positive, open and inclusive organisational culture in which the safety of children is paramount. This culture should be led by senior management and wholeheartedly endorsed and owned by staff at all levels.

Marcus Erooga ( and Keith Kaufman (
October 2016

Friday, October 21, 2016

The Inconceivable Legacy of Jacob Wetterling

If someone had told Jacob, when he was 11 years old, that he was destined to be world-famous someday, he might have dreamed that he was going to become an astronaut, maybe a pro football player, or perhaps a champion for human rights.   Millions of people know him for the latter – a posterchild for the prevention of missing or exploited children.  But fame came at a terrible cost.  On this weekend in 1989, Jacob was abducted and, now we know, murdered. 

On the morning of October 22, 1989, Jerry and Patty Wetterling could not have imagined how the course of their lives would change before the end of the day.  Perhaps not unlike 9/11, 10/22 marked a loss of innocence – families changed the way they lived.  Patty and Jerry asked neighbors to leave their porchlights on at night, with the hope that they might guide Jacob back home, or help protect other kids.  Now, 27 years later, porchlights are still on at night, in St. Joseph, Minnesota, and around the world.

I’ve often wondered, with the thousands of children that go missing every year, why Jacob’s story captured international attention.  I think there are three reasons: (1) Jacob wasn’t just missing; he was abducted, (2) the Wetterlings had great pictures of their winsome son, and (3) Patty’s undefeatable determination to find Jacob and prevent other families from a similar fate.   

New York Times writer David Brooks wrote a column in 2011, based on a commencement speech he titled, “It’s not about you.”  His thesis was that, concurrent with educational goals, people often set out to discover their calling in life, when actually, Brooks writes, a calling finds you… “Most people don’t form a self and then lead a life. They are called by a problem, and the self is constructed gradually by their calling.”

My undergraduate education was at a university in central Minnesota, just miles from the Wetterlings.  I had already been working with victims and offenders for several years, and followed this story from that fateful night.  Like many in this field, my career was influenced by Jacob and Patty.

It took nearly 27 years, but it seems that Patty’s invincible determination, and all those ‘porchlights,’ eventually led to Jacob’s recovery.  What many people don’t know is that Jacob was found as the direct result of the dogged efforts of another individual – a boy from the nearby town of Cold Spring, who had also been abducted 27 years ago, when he was 12.   Jared Scheierl, now 40, was released after being sexually assaulted nine months before Jacob.  Over the years, despite resistance from investigators, Jared believed his attacker was also Jacob’s assailant.  Jared caught a glimpse of his kidnapper’s face, and said he would never forget his voice, but his attacker remained unknown.
That changed in 2015, with a break in the case.  New technology was used to identify a trace amount of DNA on Jared’s sweatshirt, and led authorities to a known suspect.  Law enforcement executed a warrant for 52-year-old Daniel James Heinrich, and found child pornography in his residence.  The statute of limitations had run out for the kidnapping and assault of Jared.  There’s no statute of limitations for murder, but Jacob’s fate was still unknown, so authorities used child pornography charges to apply pressure to Heinrich.  After a year, Heinrich reached a plea agreement with state and federal prosecutors.
On September 3, 2016 authorities announced that Jacob’s remains had been found.   At a press conference on September 6, prosecutors said that, in consultation with the Wetterling family, they had two goals: to bring Heinrich to justice, and to bring Jacob home.  Patty said, “To us Jacob was alive, until… we found him.”  Jacob’s younger brother, Trevor and his friend, Aaron Larson who were biking home with Jacob that tragic evening, were once again gripped with survivor’s guilt.  

When Jared Scheierl got the news, he said he was overcome with emotional ironies - not only had Jared’s kidnapper confessed to also being Jacob’s assailant, but Jacob’s remains laid undiscovered for 27 years in Paynesville, where Jared had moved his young family, including his own son - now 12.   It was Jared and blogger Joy Baker who were relentless in connecting the links between Jared and Jacob.  It seems Jared’s calling had found both Jacob and their mutual assailant. 

As part of a plea agreement (20 years in prison for possession of child pornography), Heinrich provided chilling details in open court to kidnapping and assaulting both Jared and Jacob.  With the Wetterling family, Aaron, and Jared all in the courtroom, Heinrich recounted that, before he murdered Jacob, Jacob had asked, “What did I do wrong?”  Nothing, Jacob – only wrong place, wrong time.  And then you went on to be an unforgettable inspiration for a safer world for kids.

Jacob now has a date of birth and known date of death - bookends for his short but magnificent life.  A public memorial service, attended by thousands, was held on September 25.

No child wants to be the namesake for an Act of Congress to prevent child sexual abuse; and no parent expects to become a champion for the rights of missing and exploited children.  But that is the amazing legacy of Jacob and Patty Wetterling – “Jacob’s Hope.

Patty is well-known to ATSA members.  For 27 years, she has poignantly spoken at numerous state, national, and international conferences on the prevention, treatment and management of sexual abuse.  Most people are surprised, and often tearful, to discover how Patty has turned her tragic loss into both responsible accountability and compassionate treatment for those who have sexually abused.  It’s one thing to be a champion for missing and exploited children; it’s another to be an advocate for sound public policies to effectively address child sexual abuse as a public health initiative.  Patty explains that ‘Jacob’s Hope’ for a better world would include not only prevention, but support and recovery for victims, abusers, their families, and friends.

Patty says that she gets her boundless energy from the indomitable spirit of Jacob, and the vital support of family, friends, and colleagues.  It would be difficult to find anyone who works in the field of the prevention of sexual harm that has not heard of Jacob Wetterling or found inspiration in Patty’s resolute determination.  Sometimes we don’t find a calling in life – a calling finds us.

Jon Brandt, MSW, LICSW

Cordelia Anderson, a colleague and friend of Patty Wetterling, wrote her own tribute to Jacob & Patty.

Friday, October 14, 2016

NOTA Annual Conference, Brighton 2016

The annual NOTA conference took place from the 28th – 30th September in Brighton, this year’s theme was "Sharing Practice and Research: Coming together to become more effective"; however, the underlying theme and narrative of the conference was about the prevention of sexual abuse. The conference was a real mix of research, practice and engagement with colleagues, as well as the general public. In this blog I am going to take you on a whistle stop tour of the event.

The 2016 plenaries combined research, practice and innovate approaches from a very international group of speakers. The plenary sessions covered a range of topics including from online behaviour and Child Sexual Abuse (David Delmonico, Andy Phippen), mental health and sexual offending (Jackie Craissati), the treatment of sexual abusers (Gwenda Willis; Clark Baim), the work of the Independent Inquiry into Child Sexual Abuse (IICSA) (Stephen Webster) and international approaches to sexual abuse prevention (Maia Christopher). Although these plenaries were on different topics, and from a national to an international viewpoint, they all talked to the reality of child sexual abuse and how we as individuals, professionals and a society could prevent it.

The workshops spanned a full range of topics including: Circles of Support and accountability (Martin Clarke and Kerry Earnshaw; Tracey Blackstock; Kieran McCartan Rebecca Milner); public health approaches to sexual abuse and prevention (Stephen Smallbone; Gwenda Willis; Kieran McCartan; Jon Brown); child sexual abuse material and online offenders (Danielle Kettlebrough; Daryl Mead and Mary Sharpe; David Delmonico; Vicky Young and Tom Squire; Marcella Leonard); youth who sexually harm (Pat Brangan; Susannah Bowyer; Simon Hackett; Valerie Sheehan and Eileen Kilpatrick; Helen Whittle; Kathryn Lawrence; Carlene Firmin); female sexual offenders (Andrea Darling); treatment (Clark Baim and Lydia Guthrie; Jacqueline Page), as well as  risk assessment and policing (Marcella Leonard; Duncan Sheppard). The workshops were a good mix of research, evaluation, practical working, professional learning and knowledge exchange.

In addition to the traditional conference activities NOTA 2016 also had a series of special interest activities and bespoke sessions. The conference hosted NOTA's second public engagement event which did not have many members of the public (a real learning point for NOTA 2017 and a different experience to NOTA 2016) but instead welcomed 30+ conference attendees (academics, stakeholders, professionals and therapists from across the UK and beyond to discuss how we can prevent Child Sexual Abuse. The session heard from national (Nina Burrows; Kieran McCartan) and international (Maia Christopher) speakers about the work that they were involved with in preventing child sexual abuse and their ideas for where NOTA and professionals in this arena go next. Interestingly, in the Q & A afterwards there was not consensus between the audience and panel, or even the audience themselves, that we have got prevention correct, that we are using the right language, hitting the target audience and that we as a professional body main need to do more amongst ourselves before moving into working with communities.

NOTA also had a session on the systematic review that the organisation was involved in around the development of the new NICE guidelines (Fiona Campbell and Simon Hackett) relating to assessment and treatment of youths with involved in sexually harmful behaviour. The conference also had the head of research from the IICSA (Stephen Webster) come and talk about the progress of the research strand and talking about some of the early projects and rapid evidence reviews (especially on the church, sex offenders with Learning Difficulties), in closing Stephen though that there was a lot more research to do and had a desire to link the IICSA work to that of the Royal Commission into institutional responses to sexual abuse just concluding in Australia. Last but not least NOTA held its first student event, which was an opportunity for students to meet there contemporaries in the field to discuss their research.

NOTA 2016 fitted a massive amount of material in across three days, which left me informed, refreshed and looking forward to next year’s meeting in Cardiff (20th – 22nd September 2017).

Kieran McCartan, Ph.D

Friday, October 7, 2016

Introducing Raliance – A New Prevention Initiative to End Sexual Violence in One Generation

Three leading national organizations have joined forces to establish a visible presence for sexual violence prevention. With multi-year funding from the National Football League (NFL), the National Sexual Violence Resource Center (NSVRC), PreventConnect/California Coalition Against Sexual Assault (CALCASA), and the National Alliance to End Sexual Violence have established an office in downtown Washington DC. In July, the collaborative announced its new name and tagline – Raliance: Ending Sexual Violence in One Generation. It conveys the conviction and urgency of the mission and the need to “rally” partners and “align” goals.
In July Raliance also announced its first round of grants with nearly $1.2 million being awarded to 27 programs across the country who are helping to advance Raliance goals in a variety of ways and settings.  One thing that is unique about Raliance is that it marks the first time victim advocacy organizations have prioritized funding for projects specifically working to prevent perpetration. Raliance has established reducing the likelihood of perpetration of sexual violence as one of the top three priorities for its grant program. As staff at leading national organizations (NSVRC and PreventConnect/CALCASA) and as members of ATSA, we are excited to see ending perpetration as a key element of our ambitious, yet, important goal to end sexual violence in one generation.
The NFL became interested in learning more about domestic and sexual violence a few years ago as a result of some high profile incidents that attracted media attention. As an institution, they are certainly not alone in dealing with such behaviors; however they took a far different approach than most organizations. They invested considerable time, effort, and resources into learning about the issues and trying to figure out how to best use their influence to become part of the solution. They made internal changes in policies and practices, met with many experts from across the country, provided trainings and resources to staff, teams, and players, provided funding to the Domestic Violence Hotline, and provided start-up funding to Raliance to build capacity in the field for preventing sexual violence. This type of corporate responsibility and leadership is what is needed to change our culture.  We invite other corporate partners to join our efforts. 
ATSA has been at the forefront in collaborative work to bring victim advocates and sex offender treatment providers together to share their expertise in order to develop more comprehensive and effective responses to sexual violence when it occurs.  Through extensive conversations (while exploring definitions, acronyms, and research findings) we have come to realize that we share the same goals – particularly around preventing first-time and subsequent acts of sexual abuse.  Thus the ATSA prevention committee was created and continues to be a lively forum for exploring promising strategies. We are both active members of the ATSA prevention committee where committee members demonstrate that same passion for prevention and commitment to collaboration as Raliance.
Prevention advocates are pleased for the sustained national attention on the issue of sexual violence among young adults (such as college campuses, military, and NFL). The Raliance collaborative knows that in order to make lasting changes in this culture (sometimes referred to as “rape culture”), we must change the behavioral norms at much younger ages.  By doing that, and aligning our collective goals and strategies, we know that we can continue the prevention momentum and, in fact, accelerate the positive changes.
In addition to awarding grants to build capacity in the field, Raliance has several other initiatives in the works including a report on the recent progress made to prevent sexual violence, mapping prevention assets in sports and athletics, a policy think tank, media training, and a youth leadership summit. For a complete list of current grantees visit Additional grants will be awarded annually, with the process opening in May or June and the projects beginning the following April. 

Karen Baker, National Sexual Violence Resource Center,  and David S. Lee, CALCASA-PreventConnect, members of the ATSA Prevention Committee