Practice Profile: School-Based Child Sexual Abuse Prevention Programs

Davis and Gidycz (2000) conducted a meta-analysis of evaluations that looked at the effectiveness of school-based child abuse–prevention programs. Studies were included in the analysis if they 1) evaluated a school-based prevention program focusing on sexual abuse, 2) examined children ages 3 to 13, 3) rated effectiveness of the program using a knowledge-based or behavioral outcome measure, 4) included a control group comparison, and 5) were written in English. The research team conducted a comprehensive search of databases, article references, and relevant journals.

Twenty-seven studies that collectively included more than 8,000 participants were located for inclusion in the review. Of the 27 studies, 21 were published journal articles, 3 were unpublished doctoral dissertations, 2 were unpublished internal program evaluations, and 1 was an unpublished master’s thesis. The age groups ranged from 3 to 12 years old. However, no other information was provided on study characteristics or the characteristics of study participants.

The outcome of interest was prevention-related knowledge and skills of children. The outcomes from the studies were measured using questionnaires, vignette interviews, or behavioral observations. Effect sizes and their variances were calculated as d values for posttest comparison of control and treatment groups. The calculations used one effect size for each individual construct presented in each study. However, one study (Nemerofsky, Carran, and Rosenberg 1994) was removed from the analysis because of its unusually large effect size and very large sample size, causing the study to be heavily weighted. Moderator variables were also examined by breaking the studies into subsets based on the proposed variable and conducting a meta-analysis on each subset separately.

Walsh and colleagues (2015) conducted a new review of the literature to update the meta-analysis by Zwi and colleagues (2007) that assessed whether school-based child sexual abuse prevention programs were effective in increasing protective behaviors and disclosures of previous or current sexual abuse as well as decreasing child self-reported anxiety or fear. The comprehensive search strategy included a keyword search of electronic databases (such as MEDLINE, ERIC, and PsycINFO) between September and December 2015. To identify unpublished studies, the research team contacted experts in the field by email and searched the following program databases: Promising Practices Network and Blueprints for Healthy Youth Development.

Overall, the literature included in the meta-analysis was drawn from published and unpublished studies from 1986 through 2015. Only studies with interventions that met the following criteria were included: 1) were randomized controlled trials (RCTs), cluster-RCTs, or quasi-RCTs where participants were allocated to the intervention or control group by day of the week, alphabetical order, or other sequential allocation such as class or school; 2) the study population included children (5 to 12 years) and adolescents (13 to 18 years) attending primary (elementary) or secondary (high) schools; 3) school-based education programs focusing on knowledge of sexual abuse and sexual abuse prevention concepts or skill acquisition in protective behaviors or both, compared with no intervention or the standard school curriculum; and 4) measured at least one of the outcomes of interest (i.e., protective behaviors and retention over time; knowledge of sexual abuse or knowledge of sexual abuse prevention concepts and retention over time; harm, manifest as parental or child anxiety or fear; and disclosure of sexual abuse by child or adolescent during or after programs).

Of the 24 included studies, 7 were RCTs, 11 were cluster-RCTs, and 6 were quasi-RCTs. In 14 studies, RCT, randomization took place at the school, district, or classroom level; in 10 studies, randomization took place at the student level. Of the 24 studies, 16 were conducted in the United States, 3 were conducted in Canada, and 1 study apiece was conducted in China, Germany, Spain, Taiwan, and Turkey. All studies were conducted in school settings: 23 in primary (elementary) schools and one in a special school for adolescents with intellectual disabilities. Only 6 studies were undertaken in single grades (1 in kindergarten, 1 in grade one, 2 in grade three, and 2 in grade four), and all other studies involved various combinations of grades. A total of 5,802 school-aged participants were included in the 24 trials. The average age of the sample at baseline was 5.8 years. The proportion of females in the included studies ranged from 45 to 55 percent. Ethnicity data was reported in only 13 of the 24 studies, including white, Black, Hispanic, Asian, Middle Eastern, and other backgrounds.

The outcomes of interest for all interventions included in the meta-analysis were the 1) acquisition of protective behaviors skills (stranger simulation test), 2) knowledge of sexual abuse and abuse prevention concepts (measured by questionnaires), 3) child anxiety or fear (child self-reports), and 4) disclosure of sexual abuse by a child or adolescent during or after participating in the CSA prevention program. The effect sizes were calculated as standardized mean differences, and a random effects model was assumed in the analysis.