Helpful Ways (Hopefully) to Think About Sexual Abuse Prevention

By Joan Tabachnick & David Prescott

It’s no secret that ATSA has become increasingly focused on its role in preventing sexual abuse. Plenary addresses at the ATSA conference in the early and mid-2000s urged attendees to think about and describe themselves as involved in prevention efforts. Within recent years, ATSA changed its name to the Association for the Treatment and Prevention of sexual abuse (while keeping the familiar ATSA acronym). At this year’s conference, prevention was central to nearly all the plenary addresses. Prevention is an idea whose time has come.

Within ATSA, we typically talk about prevention from a public health point of view.  We speak about primary, secondary, and tertiary prevention.  This powerful framing allows us to consider preventing sexual abuse both before and after someone has been sexually harmed.  It means that all of the work of ATSA and its members is prevention. 

However, we wanted to also offer insights into criminal justice approaches to prevention.  ATSA members are often inextricably tied to criminal justice systems and yet we don’t typically use criminal justice language and approaches when we talk about prevention. 

While there are huge similarities between public health and criminal justice approaches, the differences allow us to amplify other methods.  It can also be helpful to be “bilingual” in discussing these so that we can use the language that is most often familiar to the people we want to fully engage.  In particular, Welsh and Farrington identified two critical approaches to prevention within a criminal justice framework:  Situational prevention and Developmental prevention.  Within a public health framework and the ecological model, these two approaches would refer to the middle two layers – a relational approach and a community approach – both allowing for interventions before anyone is harmed and before someone engages in any problematic sexual behaviors. 

A recent article published by the US National Institute of Justice (and authored by Joan) dives into these criminal justice approaches to prevention: 

Briefly, the goal of situational prevention is to reduce the opportunities for a crime through systemic rather than individual strategies.  It explores the settings to look at factors that increase or decrease the likelihood of someone committing a crime.  It makes common sense.  Why put someone into a setting that encourages or at least does not discourage a behavior?  An extreme (but familiar) example is hiring someone with an active alcohol addiction as a bartender in their local bar.  Perhaps a more common example is to offer parking on campus to freshman, the most vulnerable on campus, furthest from their dorms.  This approach to sexual violence prevention has gained traction for many youth serving organizations as well as campuses. 

In very stark terms, ATSA looks at the complex differences in individuals who have engaged in sexually abusive behaviors or are at risk to do so.  Our mantra is to look at the wide diversity in the people who have committed a crime.  This approach also demands that we look at the environment surrounding that individual – not to take away their responsibility but to offer better opportunities to change their behaviors. 

Developmental crime prevention aims to stop the development of harmful sexual behaviors in children and adolescents in response to risk factors and risky behaviors.  What we do know is that children and teens are more receptive to interventions and will naturally have fewer static risk factors.  Because sexually problematic behaviors often emerge in early adolescence, this is a particularly promising age to intervene.  Programs have been developed to help identify children or teens with a higher number of risk factors.  Programs have also been developed to look at the family systems and intervene earlier to address a high number of risk factors within that family and thereby shifting the balance of risk and protective factors for those children and teens. 

Although further research is needed, both of these approaches have considerable evidence that these are promising practices for our field.  While we can all recognize that we can’t arrest ourselves out of sexual violence alone, having each of our various disciplines committed to preventing is a landmark shift in our approaches. 

Whatever our first language (criminal justice or public health), having a solid grasp of these prevention concepts can take us a long way on our journey towards healthier lives and safer communities for all!

 

Evidence to the Northern Ireland Education Committee on Relationship & Sexualities Education

By Sophie King-Hill, PhD

Editor’s note: This is a transcript of part of Dr King-Hills evidence  to the Northern Ireland Assembly Education Committee mini-inquiry into relationships and sexuality education (RSE) on the 13th November 2024. This evidence focussed on three core issues in RSE. The importance of youth voice in RSE, RSE as a means to prevent child sexual abuse and harmful sexual behaviour in all its forms and the importance of working with boys and young men to support better outcomes for all genders. 

A recording of the proceedings, including the question and answer session can be found here –Committee for Education Meeting, Wednesday 13 November 2024 - Northern Ireland Assembly TV. Kieran

Introduction

I am an Associate Professor at the University of Birmingham in the Health Services Management Centre. My research is focussed on sexual behaviours and assessment in children and young people, sexual health, misogyny, masculinity, relationships & and sex education and the importance of youth voice. Much of my work is cross-sector, cross-disciplinary and centred around participatory and co-design approaches with young people. I have researched and written extensively about sibling sexual behaviour and abuse and led half of the research for the Home Office and Ministry of Justice funded National Sibling Sexual Abuse Project in England and Wales. I have carried out research in a number of fields that link strongly to RSE, for example Incels (exploring online extreme hatred of women), young men and boys and designing resources for schools with young people on Relationships and Sex Education (RSE). I have been an academic for 10 years and I think it is useful to highlight to the committee that I used to work within the third sector. I was the national impact co-ordinator for a leading young persons sexual health charity, used to teach RSE in schools to all ages and and prior to that I worked with teenage parents. These young parents were some of the most inspirational young people I have ever met – and this work demonstrated to me, over 20 years ago, the importance of relationships and sex education and its link to the choices that young people make. I am going to focus upon three components of my work: Young peoples voices, the importance of RSE to safeguarding children in relation to the prevention and early intervention of child sexual abuse in all its forms and the importance of working with boys and young men for the better outcomes of all genders.

Young peoples voices

The research that I have carried out demonstrates that young people are eager to be involved in the design and delivery of the RSE that they need. By doing this schools and leadership teams can ensure that the RSE that is provided is fit for purpose and supports the children and young people in negotiating and making sense of the world that they live in. Consistently young people are telling us that they are being taught what they already know. They also tell us that because of poor RSE they are using other means to learn about relationships and sex. The majority of this learning comes from the internet. This includes going to pornography or various social media platforms or discussion forums. These platforms and forums can be incredibly informative and positive or incredibly damaging and negative. This aspect also links strongly to the opt out aspect of RSE for parents. This is incredibly dangerous. It does not mean that children and young people are not getting information on relationships and sex, it means that they will get information however this may be diluted off their peers or from flawed internet sources. I would also like to highlight here that my research is not stand alone and echoes a wealth of research from a number of fields in this area.

 

I do appreciate that tangible examples are needed of how this may look. Leading RSE with young peoples voices can be carried out by involving children and young people in session planning, school policy design and evaluation. Participatory approaches also support teachers, parents and schools leadership teams in understanding the landscape that children and young people have to negotiate in modern society. This approach works well and ensures that all children and young people can flourish. Children and young people are not passive in their learning, they have agency, and professionals need to work with them to ensure good, robust, realistic and supportive RSE can take place that meets their needs.

 

In relation to this more work with parents and carers does need to take place. It needs to be acknowledged that many parents and carers are not comfortable talking with children and young people about RSE. With this we have to be supportive and bring parents and carers in to the schools to understand the research that underpins good RSE and how it protects, rather than harms, children and young people. In the same vein teachers and educators need to be extended the same understanding in a whole school, proactive approach to RSE.  Good, robust and evidence based training is crucial for teachers and there also needs to be an avenue for them to state when they feel they cannot teach aspects of RSE. As my research with children and young people clearly indicates - if a teacher is uncomfortable teaching certain sessions then no deep learning will take place. It is useful to note that early, evidence based RSE does not encourage sexual activity and abstinence education does not work, this approach fosters shame and shuts down important dialogue. Good RSE has been shown to delay sexual activity in young people by supporting informed choices. This is not only echoed in my research but that of the Sex Education Forum, UNESCO and the National Institute for Health and Care Excellence for example. Despite this evidence, education on developmentally appropriate sexual behaviours in Children & Young People (CYP) is still fraught with issues due to the perceptions of sexual behaviours and the position of CYP and how they are perceived in wider society. However, it is vital to keep in mind that CYP are entitled to robust and evidence based RSE that can support them to negotiate the sexual world around them and make informed decisions about their own sexual behaviour. Schools also require flexibility when responding to urgent contextual needs of children and young people - the sharing of pornography for example. Evidence clearly indicates a need to be led by the context into which the RSE is situated, underpinned by the perspectives of children and young people. Not accounting for this can create inadequate learning environments and prevent the urgent needs of children and young people being met.

 

Safeguarding

Robust, incremental and well planned RSE can also be the first step in combatting and reducing child sexual abuse, sibling sexual abuse and behaviour, child sexual exploitation and harmful sexual behaviour in children and young people. My research and that of others makes a clear link as to why robust, evidence based RSE can work as a vehicle for encouraging young people to engage with safe adults in their lives which fostering early reporting of experiences of harm and abuse. Inhibiting RSE is proven not to work and results in barriers to reporting and compromises safeguarding. Children and young people are more vulnerable when information, concepts and education in RSE is hidden from them. The school should be a safe place to raise awareness of what abuse is and to model healthy relationships. All aspects of harmful sexual behaviour and child sexual abuse can be prevented and recognised early though good, realistic and well taught RSE. An example of this can be seen thought the National Sibling Sexual Abuse Project in England and Wales where I co-led the research. This project found that sibling sexual abuse and behaviour was often contextualised in a dysfunctional family setting and that a large proportion of reporting took place when the survivors were adults. This was due to the lack of recognition of the harm that was taking place as a child. The study found that good RSE can support children and young people in this situation to recognise earlier when they are being sexually harmed – resulting in earlier reporting leading to more positive life-long outcomes. This is also strongly links to Article 34 of the United Nations Convention on the Rights of the Child which states that ‘Governments must protect children from all forms of sexual abuse and exploitation’.

Boys specific work

One of the key components of my recent work relates specifically to young men and boys.

My research and that of others strongly indicates a need for sexual violence prevention strategies that directly engage with young men and boys to reduce violence against women and children by facilitating the inclusion of their voices. Working with young men and boys appears to be the solution when aiming to reduce sexual and gender based violence and negative outcomes for young men and boys. Toxic influencers have gained traction of late – negatively influencing young men and boys – which tells us, as a society we have failed our young men and boys. In England for example, the Ofsted review in 2019 of sexual harassment in schools found that nearly 9 in 10 girls said that they or their peers were sent unwanted explicit pictures or videos, with nearly 50 per cent of boys reporting the same. 92 per cent of girls and 74 per cent of boys said that sexist name-calling happened to them or their peers. Since March 2021, over 50,000 testimonials of young people's experiences of sexual harassment and violence in schools have been shared on the Everyone's Invited website, this includes all of the UK and Ireland. Despite this there is very little work that specifically captures the voice of the boy in relation to sexual harassment. However, there is a wealth of research that states that dialogue, understanding and communication is a key aspect to culture shift. The Women and Equalities Committee (2023) in England, Scotland and Wales suggests an urgent need to directly engage young men and boys. However, in my work and research with young men and boys I have found that blame culture compounds, rather than solves the issue. Blaming boys is counter-productive. I would like to highlight, this is not an apologist position, women are overwhelmingly beaten, raped and murdered by men. However, a new perspective needs to be taken under the RSE umbrella because what we are doing to combat this problem is seemingly not working. Young men and boys need to be supported and empowered to be part of the solution. Violence experienced by boys from boys needs more recognition. Consent education needs to also focus upon young men and boys and whether they consent to sexual activity, as this is not part of the current conversation. Mental health issues in young men and boys needs more attention. At the moment no gender is winning.

Summary

So to summarise, there is a wealth of evidence that supports robust and well-planned RSE that is incremental from a young age. RSE is nuanced and complex. The voices of children and young people should be central to RSE design. Little or no RSE and RSE that is not grounded in robust research results in long term, lifelong negative outcomes for many children and young people. Good, research based, RSE can prevent, reduce and foster early intervention of all aspects of child sexual abuse. Good and realistic RSE can create safe space for children and young people to both recognise and report sexual harm. More training and support for teachers is required. More direct work is needed for young men and boys. This needs to be done with the well-being of all genders in mind and to complement violence against women and children strategies that are in place. This also has to be completed with a positive perspective given to young men and boys to foster successful male mental health outcomes. To conclude, I would like to highlight that it is the right of children and young people to have access to robust and realistic RSE.

 

The utility of developmental perspectives for teens with problematic sexual behaviors as a part of parent and youth counseling

 By Norbert Ralph, PhD, MPH, San Leandro, CA

An important part of treating youth with problematic sexual behaviors (PSB) is helping them and their parents understand contributing factors. Various treatment models have been developed to address causal factors contributing to PSB, including relapse prevention (Steen, 1999), cognitive-behavioral interventions (Hunter, 2011), trauma-focused therapies (NCSBY, 2019), the Good Lives Model (Van Damme et al., 2017), dialectical behavior therapy (Birgersson, 2024), and Multisystemic Therapy (Satodiya, 2024).

The National Center on the Sexual Behavior of Youth identifies factors such as family adversity, child vulnerabilities, modeling of coercion, and modeling of sexual behavior (NCSBY, n.d.). Bonner (2009), in her pamphlet Taking Action: A Support for Families of Adolescents with Illegal Sexual Behavior, identifies contributing factors such as curiosity/experimentation, impulsivity, immaturity, delinquency/aggression, psychological problems, exposure to sexual materials, sexual abuse, and sexual attraction to children. Finkelhor, Ormrod, and Chaffin (2009) mention immature impulse control, cognitive distortions, and delayed moral development. Ralph (2015) emphasizes delays in prosocial reasoning and psychosocial maturity as contributing factors to PSB.

In clinical settings, parents are often in extreme distress, seeking to understand these behaviors and asking, "Did we do something wrong?" They worry whether these behaviors will continue or escalate. Parents benefit from clear, relevant, evidence-based, and compassionate answers about why PSB occurred and how to prevent it.

Framing PSB partly in terms of developmental factors and psychosocial immaturity is useful. Adolescents are developmentally different from adults, as recognized by the juvenile justice system and Supreme Court rulings (Steinberg, 2014). Adolescents, while responsible for their actions, are "less guilty" due to immaturity. Research shows that youth with delayed psychosocial maturity have a higher risk for probation involvement (Férriz et al., 2018). Also, as youth mature psychosocially, they are less likely to engage in criminal behaviors (Steinberg, Cauffman, & Monahan, 2015).

I use a practical example: comparing adults and teens swimming in a pool. Adults stay in their lanes, while teens often swim into others' lanes, motivated by having fun with friends. This behavior illustrates how adolescents may not fully understand social rules or respect others' boundaries. This immaturity is reflected in crime statistics, where the peak rate of PSB in Canadian data occurs at ages 13 and 14 (Allen, 2016). Adolescents' brains are highly responsive to rewards and novelty, but impulse control doesn't fully develop until the mid-20s (Steinberg, 2014). This biological mismatch, combined with heightened sexual development during adolescence, creates a vulnerable period for risky behaviors, including PSB.

Research shows that recidivism rates for PSB are low—around 3–5% in some studies—likely due to increased psychosocial maturity over time (Caldwell, 2016; Lussier et al., 2024). Effective psychosocial interventions that promote prosocial development may help reduce general delinquency and PSB (Kettrey & Lipsey, 2018). The right type and amount of treatment, especially if started promptly, contributes to positive outcomes. Following the Goldilocks principle of "not too much and not too little" treatment is essential (Peck et al., 2023).

In my experience, explaining factors like brain development, psychosocial immaturity, and the potential for positive outcomes with effective treatment has been immensely helpful for parents. They often gain a clearer understanding that their child's immaturity contributed to the behavior, which eases fears and helps them develop a constructive path forward. Shifting from a narrative of fear to a developmental, evidence-based explanation helps parents feel more hopeful and less burdened by pessimistic scenarios.

This developmental perspective is also helpful for adolescents. Many youth express deep regret and confusion about their actions, often saying they don’t know why they did what they did. Like their parents, they are overwhelmed by distressing thoughts about their behavior. By providing a developmental framework, I help them understand that immature thinking and poor judgment contributed to their actions. This understanding doesn't absolve them of responsibility but fosters self-compassion for their younger selves, who lacked awareness of the harm they were causing. It helps them see their history of PSB will not define who they are and understand how treatment will help them develop more effective, prosocial responses.

This approach also provides youth with a more optimistic view of their future. As they engage in treatment and develop problem-solving skills, they build a healthier self-image and hope for a better future. Many youth, through counseling, understand that their actions don’t define their future. With time and support, they develop better decision-making skills, become more prosocial, and reduce the likelihood of harmful behaviors. They see a realistic hope for a positive, rewarding life.

Framing PSB as a result of psychosocial immaturity helps parents understand these behaviors and reduces fear while fostering self-compassion and optimism in youth. With proper treatment and maturation, recidivism rates are very low. This approach shifts families from fear to understanding, providing a realistic basis for hope and a positive, prosocial future for the youth.

 References

Allen, M. (2016). Young adult offenders in Canada, 2014. Juristat, 36(1), 1-8. Statistics Canada. https://www150.statcan.gc.ca/n1/en/pub/85-002-x/2016001/article/14561-eng.pdf?st=ZbsUpckq

Birgersson, A. (2024, April 17). Using dialectical behavior therapy in schools and mental health counseling [On-demand training]. Safer Society Continuing Education Center. https://safersociety.org/using-dialectical-behavior-therapy-in-schools-and-mental-health-counseling-not109-a/

Bonner, B. (2009). Taking action: A support for families of adolescents with illegal sexual behavior. Safer Society Press.

Caldwell, M. F. (2016). Quantifying the decline in juvenile sexual recidivism rates. Psychology, Public Policy, and Law, 22(4), 414–426. https://doi.org/10.1037/law0000094

Férriz Romeral, L., Sobral Fernández, J., & Gómez Fraguela, J. (2018). Moral reasoning in adolescent offenders: A meta-analytic review. Psicothema, 30(3), 289-294.

Finkelhor, D., Ormrod, R., & Chaffin, M. (2009). Juveniles who commit sex offenses against minors (NCJ 227763). Office of Juvenile Justice and Delinquency Prevention. https://www.ojp.gov/pdffiles1/ojjdp/227763.pdf.

Hunter, J. A. (2011). Cognitive-behavioral treatment of adolescent sexual offenders: Theoretical and practical considerations. In M. C. Calder (Ed.), Contemporary practice with young people who sexually abuse: Evidence-based developments (pp. 123-145). Russell House Publishing.

Kettrey, H. H., & Lipsey, M. W. (2018). The effects of specialized treatment on the recidivism of juvenile sex offenders: A systematic review and meta-analysis. Journal of Experimental Criminology, 14(3), 361–387. https://doi.org/10.1007/s11292-018-9329-3

Lussier, P., McCuish, E., Chouinard Thivierge, S., & Frechette, J. (2024). A meta-analysis of trends in general, sexual, and violent recidivism among youth with histories of sex offending. Trauma, Violence, & Abuse, 25(1), 54–72. https://doi.org/10.1177/15248380231162469

National Center on the Sexual Behavior of Youth (NCSBY). (n.d.). Problematic sexual behavior: Protective factors and vulnerabilities [PDF]. https://www.ncsby.org/sites/default/files/Problematic%20Sexual%20Behavior%20-Protective%20Factors%20and%20Vulnerabilities%20(1).pdf

National Center on the Sexual Behavior of Youth (NCSBY). (2019). Implementing trauma-focused cognitive behavioral therapy for children with problematic sexual behavior. Oklahoma TF-CBT. https://oklahomatfcbt.org/wp-content/uploads/2019/05/Implementing-TF-CBT-for-Children-with-PSB-H.pdf

Peck, R. W., Shahin, M. H., & Vinks, A. A. (2023). Precision dosing: The clinical pharmacology of Goldilocks. Clinical Pharmacology & Therapeutics, 113(4), 685–686. https://doi.org/10.1002/cpt.2112

Ralph, N. (2015). A follow-up study of a prosocial intervention for juveniles who sexually offend. Sex Offender Treatment.

Satodiya, R., Bied, A., Shah, K., Parikh, T., & Ash, P. (2024). A systematic review of Multisystemic Therapy in adolescent sex offenders. Journal of the American Academy of Psychiatry and the Law, 52(1), 117-123. https://doi.org/10.29158/JAAPL.230117-23

Steen, C. (1999). The relapse prevention workbook for youth in treatment (guided workbooks for juvenile sex offenders). Safer Society Press.

Steinberg, L. (2014). Age of opportunity: Lessons from the new science of adolescence. Houghton Mifflin Harcourt.

Steinberg, L., Cauffman, E., & Monahan, K. C. (2015). Psychosocial maturity and desistance from crime in a sample of serious juvenile offenders (NCJ No. 248391). Office of Juvenile Justice and Delinquency Prevention, U.S. Department of Justice. https://www.ojjdp.gov/pubs/248391.pdf

Van Damme, L., Fortune, C.-A., Vandevelde, S., & Vanderplasschen, W. (2017). The Good Lives Model among detained female adolescents. Aggression and Violent Behavior, 37, 179-189. https://doi.org/10.1016/j.avb.2017.10.005