All you need to know about preventing the perpetration of child sexual abuse

By Joan Tabachnick and David Prescott

What is the current state of prevention?  Stop It Now! hosted an engaging hour-long conversation with many leaders in our field about preventing the perpetration of sexual abuse.  This is particularly useful for you, as ATSA members, because you have such deep knowledge of the adults, adolescents and children who have sexually abused.  What you will hear is how YOUR knowledge is something the rest of the world needs to know.   

The discussion was part of an award ceremony, but what it offered was a rare insight from colleagues who have been doing this work for as many as 30-40 years. 

Karen Baker (former executive director of PCAR and the NSVRC), Cordelia Anderson (Preventionist extraordinaire), and David Prescott (ATSA co-blogger and past president of ATSA) spoke about what was known about sexual abuse 30 to 40 years ago.  Cordelia spoke about the profound silence around child sexual abuse.  There was nothing in the news, TV shows, or the movies that addressed this issue.   Nothing existed for treatment and the only prevention strategy was focused on stranger danger.  David talked about the lack of any general training for anyone working with children or adolescents or even adults engaging in problematic sexual behavior.  Karen echoed the comments from Cordelia and David and added that our only avenue for survivors was through crime reporting and yet these courageous individuals often faced victim blaming, shame, and the complete lack of resources for survivors.  Furthermore, the messaging was both incomplete and misleading in many ways.  Rather than convey hopelessness, these perspectives from the past decades showed us just how far we have come and the progress we have made.  There is no longer silence about this issue.  Information, training, programs, related to prevention and the focus on trauma-informed care has become the norm.  We now offer prevention strategies that reflect the reality of sexual abuse in families and communities. 

The other speakers focused their remarks on the future and what can be accomplished in the next three years.  Although Stop It Now! and ATSA have focused on the importance of preventing the perpetration of sexual abuse, the following four panel members spoke about how this perspective, especially in the last 10 years, has finally been embraced by the larger prevention community.  Ryan Shields (Assistant Professor of Criminology and Co-Chair of MASOC), Tyffani Dent (clinician, educator and Immediate Past President of ATSA), Elizabeth Letourneau (Director of the Moore Center and a past president of ATSA), and Jane Silvosky (Director of the National Center on the Sexual Behavior of Youth) each shared their insights on where the field needs to go. 

Ryan started us off, blending his background in public health and criminal justice.  Given that “we humans are story-telling creatures” he said, “part of our challenge is to describe what prevention looks like”.  It is easy to visualize how the criminal justice system works with arrests, court, judges and jails.  We need concrete stories of prevention as well.  Tyffani continued the thread that Ryan began and challenged us to tell “our” prevention stories in a way that can meet the diverse needs of diverse communities.  We need to create an overlay of these stories , our policies, and our funding to reach beyond the one solution of punishment.  She also emphasized the need to build our community efforts in collaboration with survivors.  It is so much more powerful if we tell our stories together and it can also break the isolation so many of us feel.   

Elizabeth spoke about the explosion of science and research on preventing the perpetration of sexual violence.  This means that we not only have developed perpetration prevention programs, but we are in the process of evaluating what is working.  She noted the concentration of prevention programs in the global north, not something that we had connected with before.  Even though it may not be a short term initiative, she spoke about the necessity of having government funding of these prevention programs.  Jane spoke eloquently and passionately about the need to align our work on the ground – families are not in silos like our professional communities.  They need our resources regarding sexual violence prevention but also suicide, child abuse, mental heath issues and so much more.  And we as adults need to align all of our resources around the children and around the trusted adults.  If we do want to address the complexity of these issues, families need to be able to talk about sex and relationships and the complexity of our human interactions, including pornography.  This is a multilayered conversation that needs to address spaces, both physical and electronic, that interweave the protective factors of each family and each program.  She ended with a message from youth – “This is serious and we need hope to get through.” 

The Q&A was equally engaging and multi-layered.  If you care about prevention, this is an easy hour to spend listening and learning from some of the best in our field.  Here is the LINK and you can watch the discussion starting at 20:07.

 

Blogger’s note: Joan is being modest. Although the discussion happened as described, it all took place in the context of celebrating Joan’s career as she received Stop It Now’s Founder’s Award. Congratulations, Joan!

 

Preventing Our Systems from Causing Further Harm

By David S. Prescott, LCSW, LICSW

There have been several news items recently that should cause anyone concern. Fortunately, they illuminate activities that can be improved under the right conditions. Just as sexual abuse is preventable, so we can also ensure that our interventions do not cause further harm to clients who have sexually abused and/or been abused. In this author’s opinion, it is crucial that we recognize what we’re up against, where our failures are, and talk about them.

On August 1, 2024, the US Justice Department issued a report finding unconstitutional conditions at five Texas juvenile justice facilities. The report can be heartbreaking to read (including failure to protect children from sexual abuse and exposing them to excessive force). However, it is not the only report of its kind. Lawsuits involving numerous other facilities around the country are ongoing.

On September 4, 2024, the US Justice Department announced a civil rights investigation into sexual abuse by correctional staff at two California prisons for women. From the press release: “Concern about the physical safety of people inside California women’s prisons is not new,” said U.S. Attorney Phillip A. Talbert for the Eastern District of California. “Media coverage, state audits, advocates’ efforts and private litigation have sought to draw attention to an issue often unseen by many in the community. This investigation responds to those concerns and will aim to ensure that California is meeting its constitutional duty to incarcerated individuals.” Whatever the crimes that led to their incarceration, it is difficult to imagine a more vulnerable group of individuals in the absence of the proper policies and supervisory practices.

On September 9, 2024, the New York Times ran a piece titled, To the World, He Is an Anti-Trafficking Hero. Women Tell a Different Story. It involves Tim Ballard, who, as the article describes, is a former Homeland Security agent. The article points out that Mr. Ballard built his nonprofit, Operation Underground Railroad, at a time when awareness of child sex trafficking was gaining greater currency: “High-profile cases — some of them appallingly real, some of them inventions of conspiracy theorists — drove outrage about minors being forced into sexual servitude.” At the same time, the Times reports, he was grooming, manipulating, harassing, and sexually assaulting women. The Mormon Church described his activities as “morally unacceptable.”

Perhaps of interest to professionals skilled in identifying client excuse-making, Mr. Ballard is quoted as responding to these allegations, saying “I just find it so sad that everybody who has come out with negative smears, lies, lawfare — they are accomplices to child trafficking,” he said in an online video. “Their actions are causing children to suffer, to be raped, to be tortured.” It is as though he is the hero of his own story, and it is his detractors who are the abusers.

A striking aspect of these news items of recent weeks is how they have occurred in diverse locations. These abuses appear not to be bound to one location or political jurisdiction. Meanwhile, other shocking situations have come to light that should concern therapists seeking to serve virtually any client.

On August 25, 2024, ProPublica published an investigation into the activities of insurance companies, titled “Why I left the network.” It outlines the numerous difficulties that psychotherapists have had trying to be reimbursed for their services. The article describes payment delays and “claw backs” (in which the insurers determine that they are unhappy with the therapist’s documentation and take their payment back, sometimes long after the service was provided), among other activities that to an outsider would appear to be a nearly hostile work environment. As many have observed, it may be that there is not a shortage of therapists so much as a shortage of therapists willing to work in accordance with insurers’ demands.

In a similar vein, a September 10, 2024, media account describes how therapy patients are stopping treatment after insurance companies have required “pre-payment reviews.” To paraphrase from the article: The interruption in treatment comes after one insurance company began subjecting thousands of payments to a “pre-payment audit” in the last several months. After the session takes place, the out-of-network psychiatrist or therapist is paid by the patient (usually) and the patient submits the bill for reimbursement, to the insurance company. But the subsidiary managing health services for the insurer, sends a letter to clinician and patient saying it wants detailed records for a “pre-payment review” before sending money. No reason is given.

Meanwhile, a September 9, 2024 data breach has resulted in notification of nearly one million Medicare recipients that their medical information was compromised. Perhaps the most frightening recent news item, however, was a September 1, 2024, exposé in the New York Times, titled How a Leading Chain of Psychiatric Hospitals Traps Patients. It describes how these hospitals conspire to keep patients in their care for considerable sums of money, often using legal actions to extend stays.

Why blog about these things? All these events point to opportunities for us to improve practice as well as the ease with which clients and clinicians alike can suffer. In an era when so many professionals are seeking out evidence-based approaches for ending abuse, we also need to acknowledge how our clients’ environments are sometimes traumagenic and our funding sources less reliable. As one ATSA progenitor once observed, “I’d like to retire from this field someday because I want to and not because I’m forced out by circumstances.”

Every reader cares about preventing sexual abuse, and across the recent decades, we’ve seen just how possible this is. Many forms of prevention exist, including by focusing on society at large, on people who are at-risk to abuse or be abused, and on preventing further abuse through empirically sound supervision and treatment. Now it’s time to aid prevention efforts by focusing on preventing our whole field from becoming abusive to clients and ensuring that professionals have the opportunity to actually do the work without excessive and unnecessary obstruction.

It has been over 50 years since the Stanford Prison Experiment illustrated what can happen under the wrong circumstances. My hope is that we can take what we’ve learned and better advocate for safe spaces for clients and professionals alike.