Moving Towards a “Public Wisdom Model” of Prevention

By David S. Prescott, LICSW, & Kieran McCartan, PhD

In 1998, Rob Freeman-Longo and Geral Blanchard published a book titled, Sexual Abuse in America: Epidemic of the 21st Century. Four years later, Blanchard and Joan Tabachnick penned, The prevention of sexual abuse: Psychological and public health perspectives. Along with other publications, the rallying cry of viewing sexual abuse through the lens of public health emerged. ATSA has championed the idea that society will better be able to end sexual abuse when it adopts this perspective as well as other relevant ways of understanding the issues and preventing the behaviors and subsequent harm. ATSA has long counted the above authors as among its many friends.

Along with this approach came new ways of thinking about prevention: Primary prevention focuses on preventing abuse within the general population (an analogy might be to vaccinating people to prevent illness or public education efforts aimed at preventing abuse). Secondary prevention involves prevention with people who are at risk for a condition (for example, starting vaccination rollouts with health care workers and other vulnerable populations or psychoeducation aimed at students who are entering university about risk factors for abuse and victimization). Tertiary prevention aims to prevent the persistence of a condition after it has happened (for example, medical care for the sick; treatment aimed at preventing further sexual offending). More recently, there has been discussion in the literature about Quaternary prevention, or efforts to prevent unintended harmful effects of other attempts at prevention through the introduction and maintenance of harm reduction and supportive pathways. Although recently introduced to the field of criminal justice and sexual abuse, quaternary prevention is actually not a new idea. Professionals have sought to prevent harm from interventions for a long time. Ultimately, desistence, harm-reduction assisted risk management, and the streamlining of services to reduce the negative impact of over-criminalization have all been important considerations in prevention.

This all seems so simple! The next problem was how to get the word out. Plenary addresses at ATSA conferences (for example an unforgettable speech given with no notes by Suzanne Brown-McBride) focused on how we can best frame the message that abuse is preventable. More recently, ATSA member Apryl Alexander gave an inspiring TED Talk titled, Sexual violence is preventable: Here’s how. Between our knowledge, our expertise, and our framing of the issues, all policymakers should have leaned in and listened. Many have and many others have not. The recent publication of the new England and Wales “Tacking Child Sexual Abuse Strategy” tries to balance prevention and punishment. While there is still a distance to be traveled, it’s a start. Of course, it took centuries to get to this point; we cannot expect our efforts to bear fruit overnight. Just the same, some others have used this public health issue for their own ends.

Recently, we blogged on the rise of QAnon, a collection of conspiracy theories and theorists centering on the idea that there is a cabal involving top-level politicians, financiers, and politicians who are involved in child sex-trafficking. Whatever one’s political beliefs (and we have to note that although it is not our desire to enter the political fray), QAnon appears to have garnered considerable influence over the imagination of millions of people in and outside of the USA. As we write this blog, at least one influential commentator has apparently come to their defense. To be clear, our motivation in mentioning this is not to take sides in a political arena, but to point out how quickly the work of sexual abuse prevention can be unraveled even without any meaningful or credible evidence. Perhaps even more fascinating is that these kinds of beliefs have propagated after years of true-crime television programming highlighting the importance of forensic evidence. Whatever the case, empirically supported attempts to prevent child abuse are not being helped by the likes of QAnon.

In our opinion, it’s time to refine our beloved public health perspective with wisdom. Dictionaries such as Merriam-Webster define wisdom differently, with all definitions coalescing at a combination of knowledge, experience, and good judgment. Interestingly, these three points are reminiscent of the American Psychological Association’s definition of evidence-based practice, which includes the integration of the best available research, clinical expertise, and accommodation to the client’s unique characteristics (including culture).

Why do we also need a “public wisdom model” in addition to our health perspective? Simply put, because there are so many factors required to address sexual abuse as a public health as well as criminological problem. In the age of QAnon, when so many people no longer wish to defer to experts presenting data, we may need to re-brand what we have to offer as knowledge accumulated over years of work at the front lines as well that acquired through scientific study. Instead of using terminology such as “evidence-based practices” we can simply offer tools to communities for their own good judgment, based on the benefit of our shared knowledge and experience. We may also have to replace “here’s the evidence” with, “Here’s what meaningful evidence is and how it can make a difference to you and your loved ones.” In other words, we can offer translation of research and evidence to communities, because if people do not understand the content or the conversation in ways that appeal to them the message and practice will never get across. Wisdom is about being informed and knowledgeable but discussing it a plain-spoken fashion.

A public wisdom model could appeal both to our research and methods for prevention while relying on “what works” in knowledge transfer and implementation science. It could contain empirically supported approaches such as connecting with a community’s safety goals and offering information, all the while taking care not to appear as experts who need to be listened to. In addition to building itself on the principles of knowledge, education, and good judgment, it could also appeal to the good judgment that is inherent to all communities but often not heard in the pandemonium of media narratives

Perhaps the most important aspect of a public wisdom model is that in an era of distrust towards science and experts (for example, the science of political polling may be good, but few people trust it just as others do not trust vaccinations), those with real expertise need to take exceptional care in how we frame the message to others. Instead of implying that we are the experts who should be trusted, it’s time to discuss how we can communicate that we have the experience and knowledge to help communities make good judgments about the safety of their citizens. Therefore, as experts, we must play to our audience so that they can hear and respect what we are saying. It’s time for Muhammad to go to the mountain as the mountain is not coming to him.

 

 

Perpetration, Victimization, and Gender

 By Kieran McCartan, David S. Prescott, LICSW, and Kasia Uzieblo, PhD

Past editions of this blog have explored direct and indirect effects of sexual abuse on those who experience it. However, it can be difficult to quantify this impact; everyone responds to abuse differently, and one size never fits all.  While the individual impact of sexual abuse, varies with every incident, regardless of the gender, race, culture, or identity of the person who commits it. What we have seen over the years, however, is that who the perpetrator is can profoundly impact the narrative of the victim. This week the BBC published a story talking about how sexual abuse by females is still a taboo subject and that their victims do not get the support and help that they need. Unfortunately, this is all too true. 

Cross-culturally and transnationally we tend to have static views of people convicted of sexual offenses:  typically that they are deviant, abnormal, and an “other”—in other words not one of us. However, we know from research and practice that this is not true, as demonstrated by the prevalence of sexual abuse and the array of people arrested and convicted of it. We also see a gender divide in the way that we talk about people who commit sexual abuse with men often being predatory, violent, and aggressive. Females may be perceived as mentally and emotionally unwell, often portrayed as radically abnormal or victims unable to control their behavior. All of this adds up to an often-unspoken perception that the gender of the perpetrator matters in determining how damaging the abuse is to the victim/survivor.

This false distinction is made worse when we realize that the gender of the people victimized is perceived as mattering as well, with boys and young men often being viewed differently from girls and young women.  The media often presents stories about girls being groomed and manipulated by men for sex, whereas the same story with a female perpetrator may suggest that the boy initiated it, wanted it, or just got lucky. Ultimately, this skews the public’s perception of the role of gender, grooming, abuse, and the consequences of these issues by implying that boys are less damaged by female abusers than girls are by male abusers. This suggests that in terms of the perpetrator/victim relationship the female victim of a male perpetrator is more deserving of sympathy than the male victim of a female perpetrator. A false perception of who the real victims are is problematic in the reporting and conviction of people who commit sexual abuse, and their eventual treatment, because it means that boys will be less likely to report sexual abuse by a female and ultimately less likely to get the support they need. 

How do we fix this? How do we level the playing field so that all victimization and perpetration is seen for what it is, regardless of the gender of either party? More research is one place to start: Empirical studies are highly needed to feed an evidence-based discussion on the topic of female sexual abusers. Interestingly, a recent study emphasizes the lack of differences regarding the motivations, characteristics of the abuse, and the modus operandi of male and female teachers who have sexually abused students. Such insights may start changing our perception. But this is a slow process that may not have a tangible effect on this conversation for long. This is proven by the fact that empirical insights on the effect of female sexual abuse of boys have been there for a while now but are still too often ignored or forgotten.

One of the most important and simplest things that we can do is recognize the abuse for what it is and its impact upon the victim, not how the demographics of who the victim and the perpetrator are. It’s not that these factors do not matter, but the focus should be on the abuse. As individuals and communities, we must stop inferring additional contexts, issues, and reasons for abuse. We need to stop implying there’s any difference in what victims and perpetrators are “worthy” of our sympathy, help, and support. How do we do this? We listen, understand, and speak up. We treat all victims the same and we talk with and to them in a way that they want and can hear. 

 

Race Power and Privilege Social Media Campaign

#ATSARPP #ATSAPrevention

By Joan Tabachnick and Jannine Hébert

ATSA’s Race, Power and Privilege (RPP) subcommittee (a part of the ATSA Prevention Committee) has explored ATSA members’ relationship to these important issues.  Over the years, we have discovered a rich conversation that we want to share with ATSA members and others interested in how RPP may affect our work through a new social media campaign. 

Although many ATSA members have been talking about the impact of RPP on clients’ needs, interventions, and their engagement in services for decades, the more intentional conversations as an organization began in earnest in 2017.  ATSA’s Prevention Committee sponsored an evening panel at that 2017 conference titled “Dismantling Racism:  The Relevance to Prevention.”  We heard from attendees that these conversations are important and should not be relegated to a workshop or two at our national conference.  In response, the Prevention Committee formed a workgroup to further explore RPP in our work.  In 2018, we conducted a targeted survey of the ATSA membership and found that 87% of members agreed that issues of RPP had an impact on perpetration, survivor’s healing process and prevention.  Furthermore, just over three quarters (76%) agreed that ATSA should address RPP.  In 2018, the Board of Directors of ATSA responded with the following commitment. 

The board formally “recognized that race and privilege impact ATSA’s work and the work of ATSA members.  Furthermore, the board voted to ensure that ATSA commits to incorporate privilege and race issues into all of its strategic goals.” 

Each of ATSA’s committees also made a commitment to look at how RPP affect their mission and its’ implementation.   

The Prevention Committee subcommittee on RPP did not stop there and continued with weekly meetings, conducting surveys and interviews with ATSA members, and ultimately developing a series of infographics that we are now disseminating through social media.

The attached infographics contain quotes from ATSA members who were interviewed regarding RPP. We invite you to share the infographics via social media and in your personal/professional networks.  You can use either #AtsaRPP or #ATSAPreventon.  You can also join the conversations through any of our handles: 

·         Twitter: @MakeSocietySafe https://twitter.com/MakeSocietySafe

·         Facebook: https://www.facebook.com/MakingSocietySafer

·         LinkedIn: https://www.linkedin.com/company/makesocietysafe/

We hope that some of these reflections inspire you to share and reflect on how RPP impacts your work.  Please take the time to share, retweet, or like these infographics and conversations.  Please help us dive into this important conversation more deeply. 

Here are some example social media posts.    

We would like to acknowledge the ATSA members who have been meeting weekly for the last year to make this happen.  In addition to the authors of this article, we want to acknowledge a fantastic group of individuals including Charles Flinton, Tyffani Dent, Ariel Berman, Lori Ho-Cheng, Maia Christopher, and Aniss Benelmouffok.

 

2021: Building the new “Normal”?

 By Kieran McCartan, Ph.D., David Prescott, LICSW, & Kasia Uzieblo, Ph.D.

 

2020 was a challenging and difficult year all around, with 2021 having some teething issues (i.e., Brexit and the riots on Capitol Hill in the USA) as well as rays of hope (i.e., the COVID-19 vaccine). 2021 provides opportunities to redefine the socio-political landscape and develop a new “normal” with the positive aspects of the previous normal as well as the chance to change the problematic aspects. In this blog, we will each offer our perspectives on what we should focus on moving into 2021.

KIERAN: 2020 highlighted the centrality of community, collaboration, and coalition to our everyday life. The COVID-19 pandemic and resultant vaccine have demonstrated, very clearly, that we all need to consider other people in our actions and behaviors. The COVID-19 virus is spread through contact and interaction. Therefore, “Hands, Face, Space”, and lockdown is as much about self-protection as it is about protecting other more vulnerable people. We are being asked to say away from others to protect them and not spread the virus. This reminds us that we are part of a community and that we need to think beyond others beyond ourselves and the unintentional consequences of our behavior. This resonates with the field of sexual abuse in terms of how we prevent abuse, rehabilitate those who offend, and integrate them back into the community. The most effective way to tackle sexual abuse is to create a supportive, inclusive, and proactive community. In 2021, we need to develop more inclusive communities that recognize the importance of individual actions and their impact on collective wellbeing. Therefore, the more that society recognizes the reality of sexual abuse, its impact, and has knowledge of how they can build safer communities with those who have abused as well as those who have been victimized, the better.

DAVID: If there was anyone series of events that shaped (or should shape) our research and practice agenda for the future, it would be the shootings of George Floyd, Breonna Taylor, and Jacob Blake (and others) by police officers. The lack of accountability manifested by few if any, charges or corrective practices by the police has laid bare the realities that many of our client’s face – and have faced – since long before there were technologies such as smartphones to record them. It doesn’t need to be like this; the city of Newark, NJ, where police officers received effective training in de-escalation techniques saw no shots fired by police this past year.

Our field has a wealth of research and knowledge about disparities in arrest, sentencing, probation and parole that people from minority backgrounds face every day. Practitioners are rightly coming to consider racism and discrimination its own category of trauma and adverse childhood experience. Still, we have been ineffective at getting policymakers to understand and act on the widespread disparities that exist. Even the word “disparity” seems a cruel understatement when people are dying, communities are experiencing more poverty and violence and not less, and the US Justice Department is seeking to undermine (at the 11th hour of the current administration) to undermine the Civil Rights act. Of critical importance is that the US is not the only nation ambivalent about addressing its abusive past. 

Although this may seem a purely a political statement, the effects of the current climate on our clients in treatment, many practitioners, and our practices themselves can no longer be denied. While we may differ on the end game of combating these inequities, the events of 2020 have shown that the time to act is long past due. 

KASIA: One of the most confronting issues that arose during the pandemic was the fact that despite all our efforts we still fail to protect numerous children and adults from (sexual) violence. In order to protect society members from a deadly virus, authorities across the world have imposed curfews and lockdowns. However, these measures seem to have unwittingly elicited a rise in domestic violence cases, including a rise in sexual abuse cases. The combination of exacerbating stressors at home and at work, self-isolation, and fear are believed to underly this surge. Victims were forced to stay home with an abuser to avoid contracting the virus. Many perpetrators have also abused the situation by threatening their victim(s) to throw them out onto the streets if they would not obey and by using the public safety measures to isolate their victim(s) even more. Consequently, the measures have led to more limited opportunities for victims of violence to seek out and receive support from formal and/or informal resources. Police officers tell me that several adolescents -victims of domestic violence- are reluctant to seek help during the pandemic out of fear that this action would tip off their abuser and would only result in retribution. Many victims also fear to leave the house to seek help after the curfew out of fear of being arrested.

Thanks to early warnings of numerous organizations, including the World Health Organization (WHO), services, and advocates we have seen many initiatives at local and national levels is swiftly implemented. For instance, in Belgium, additional space was created in a hotel for females and children who needed to escape their violent home situation. In several countries, including France, Spain, and Belgium, codewords for victims of domestic violence were being implemented so they could discretely summon police help in pharmacies. These efforts were widely applauded in the media; policymakers were immediately patting themselves on the back. It’s not my intention to spoil the party here, but I’m afraid it is just far too soon to be blowing our trumpets. The fight is clearly not over yet and many concerns remain. To name a few: These initiatives are accessible for many victims but not for all. Many victims do not know of these initiatives; they do not read papers or listen to the news or don’t have any access to the internet. Also, the pandemic has revealed our stereotypical thinking about domestic violence even more. During (but also before) the pandemic, males are consistently portrayed as perpetrators of domestic violence and females and children as victims, even by leading organizations like the WHO. Such portraying will not encourage male nor female victims from female violence to step up and seek help. In addition, media coverage and the calls for initiatives are mainly focused on cases of intimate partner violence and child abuse, often neglecting other types of domestic violence, like sibling and elder abuse. Consequently, victims of these types of abuse will not feel addressed by these initiatives.

As the world remains under siege from the pandemic, it is high time for us to tackle the challenges ahead. We need to be more creative and to be more critical about our efforts to prevent violence. Professionals, researchers, and policymakers should clearly invest in evaluations of our campaigns and initiatives: How can we reach more victims? How can we facilitate their help-seeking behavior? Is what we are doing enough? How can we protect public health without causing this much collateral damage? We should also invest more in primary and secondary prevention. It goes without saying that all the tertiary prevention strategies being implemented, are highly needed. But shouldn’t we also prevent violence before it happens, even during a pandemic? So how can we help vulnerable couples and families in developing non-violent conflict resolution strategies and proper coping behaviors to address stress and negative feelings? How can we facilitate help-seeking behavior in violent perpetrators and in people who are at risk of becoming violent?

One thing is certain in these uncertain times: One day we will be able to protect ourselves from the COVID-19 virus and our society will overcome this pandemic. But how wonderful would it be if we could also assure all children and adults that one day we will be able to protect ourselves from the violence that is holding the world hostage for far too long now.