Wednesday, January 27, 2021

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.



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