(3.6)--生殖健康社工医学基础ChildSexualAbuseTheNeedforaPerpe.pdf

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1、Full Terms&Conditions of access and use can be found athttps:/ of Child Sexual AbuseISSN:1053-8712(Print)1547-0679(Online)Journal homepage:https:/ Sexual Abuse:The Need for a PerpetrationPrevention FocusLuciana C.Assini-Meytin,Rebecca L.Fix&Elizabeth J.LetourneauTo cite this article:Luciana C.Assini

2、-Meytin,Rebecca L.Fix&Elizabeth J.Letourneau(2020):Child Sexual Abuse:The Need for a Perpetration Prevention Focus,Journal of Child Sexual Abuse,DOI:10.1080/10538712.2019.1703232To link to this article:https:/doi.org/10.1080/10538712.2019.1703232Published online:03 Jan 2020.Submit your article to th

3、is journal View related articles View Crossmark dataChild Sexual Abuse:The Need for a PerpetrationPrevention FocusLuciana C.Assini-Meytin,Rebecca L.Fix,and Elizabeth J.LetourneauJohns Hopkins Bloomberg School of Public Health,Baltimore,MD,USAABSTRACTIntheevolutionofeffortstoreducechildsexualabuse(CS

4、A)ratesin the United States,there has been a gradual shift to add pre-ventive measures to after-the-fact interventions(i.e.,interven-tions and policies implemented after the abuse has alreadyhappened,suchasservicesandtreatmentforvictimsandpunish-ment,treatment,and management of offenders).Prevention

5、 ofCSA perpetration,however,is often missing from these efforts,despite decades of experts calling for broader prevention solu-tions.The current paper describes the scope of the problem ofCSA,highlights problems with an over-reliance on after-the-factinterventions,anddescribes promising perpetration

6、-focused CSAprevention interventions.While most existing preventive effortsfocus on teaching children to protect themselves from incurringsexual harm,perpetration prevention efforts may hold morepromise by addressing the onset of harmful behavior.As such,perpetration prevention efforts can contribut

7、e to a more robustand comprehensive approach to CSA an approach that focuseson prevention of harm from occurring in the first place,as well asresponding once harm has occurred.ARTICLE HISTORYReceived 29 May 2019Revised 11 November 2019Accepted 13 November 2019KEYWORDSChild sexual abuse;prevention;pu

8、blic healthapproachChild sexual abuse(CSA)is a serious public health issue(Daro&McCurdy,1994;Letourneau,Eaton,Bass,Berlin,&Moore,2014;Mercy,1999;Whitaker et al.,2008),affecting approximately 1017%of girls and 45%of boys in the UnitedStates(Finkelhor,Shattuck,Turner,&Hamby,2014;Stoltenborgh,VanIjzend

9、oorn,Euser,&Bakermans-Kranenburg,2011).CSA victimization increasestheriskforamyriadofphysical,mental,andbehavioralhealthproblemsthrough-outthecourseofoneslife(Hillberg,Hamilton-Giachritsis,&Dixon,2011;Nelsonetal.,2002)andelevatestheriskofsubsequentsexualandnonsexualoffendingandvictimization(Ogloffet

10、al.,2012).Further,theeconomicconsequencesofCSAarevast,with substantiated CSA cases in 2015 estimated to cost approximately$9.3 billion in the U.S.alone(Letourneau,Brown,Fang,Hassan,&Mercy,2018).The World Health Organization recognizes CSA as a preventable public healthissuethatsubstantivelycontribut

11、estotheglobaldiseaseburden(Mathers,Stevens,&Mascarenhas,2009).Consistent with public health experts,we use the termCONTACT Luciana C.Assini-Meytinlassinijhu.eduDepartment of Mental Health,School of Public Health,Johns Hopkins University,415 N.Washington Street,Baltimore,MD,21231JOURNAL OF CHILD SEXU

12、AL ABUSEhttps:/doi.org/10.1080/10538712.2019.1703232 2019 Taylor&Francis“prevention”torefer to effortstoavoid the initial occurrence of harm(OConnell,Boat,&Warner,2009).While we understand the value of tertiary prevention,achieved via treatment,in reducing recidivism,in this paper we use the term“pr

13、evention”to refer to efforts aimed at preventing“children from being sexuallyabused for the first time”or,more specifically,to preventing“potential offendersfrom committing a first CSA offense”(Smallbone,Marshall,&Wortley,2011,p.48).We believe that this clear distinction helps to move the field forw

14、ard in theidentification of efforts aimed at avoiding CSA victimization in the first place.Further,it is likely that interventions targeting individuals who have alreadyoffended may require different strategies than interventions focused on indivi-duals who have never engaged in an offense(Smallbone

15、 et al.,2011).Traditionally,CSA prevention efforts have been concentrated on school-basedchild-focused interventions,which educate children to protect themselves fromvictimization by teaching them to recognize,resist,and report sexually abusivebehaviors(Walsh,Zwi,Woolfenden,&Shlonsky,2015;Wurtele,19

16、87,2002,2009).Their benefits are mostly associated with increases in childrens CSAknowledge,personal safety skills,and CSA disclosure(Fryda&Hulme,2015;Walsh et al.,2015).While these are positive outcomes,there is limited evidencethat such programs are effective in helping children keep themselves sa

17、fe fromsexual victimization(Finkelhor,2009;Walsh et al.,2015;Wurtele,2009).According to Rudolph and Zimmer-Gembeck(2018),child-focused CSA pro-grams are based on the(unrealistic)assumptions that children can(1)effectivelyidentify subtle signs of abuse and appropriately defer perpetrators psychologic

18、almanipulationandthreats,(2)challengeauthority,and(3)reporttheabuse.Astheauthorsnote,thesearecomplexanddifficultbehaviorsevenforadultstoperform.The limitations of a child victim-focused approach warrant the expansion of CSAprevention efforts to include interventions targeting caregivers of youth and

19、people at risk of sexually harming a child(Letourneau,Schaeffer,Bradshaw,&Feder,2017;Mendelson&Letourneau,2015;Rudolph,Zimmer-Gembeck,Shanley,&Hawkins,2018).Growing recognition of the need for a more comprehensive approach to CSAprevention supports inclusion of approaches that specifically target po

20、tentialperpetrators and the onset of offending behaviors(Letourneau et al.,2014;Smallbone,Marshall,&Wortley,2008;Whitaker et al.,2008;Wurtele,2009).Inresponse,the present paper emphasizes the need for a perpetration-focusedpreventative approach to CSA and addresses the potential barriers of such ana

21、pproach.To accomplish this aim,CSA perpetration-focused prevention effortswill be discussed,including self-help interventions for people with sexual interestin children(Beier et al.,2015;Beier et al.,2009;Buckman,Ruzicka,&Shields,2016),universal school-based interventions that address the onset of y

22、outh pro-blemsexualbehavior(Letourneauetal.,2017),andeffortstoreducethelikelihoodof CSA in organizational contexts(Kaufman,Erooga,Higgins,&Zatkin,2019;Mathews,2019;Palmer&Feldman,2018;Wurtele,Mathews,&Kenny,2019).We2L.C.ASSINI-MEYTIN ET AL.alsodiscussaframeworktodevelopevidence-basedCSAinterventions

23、andmove-ments toward obtaining sustainable federal funding for such programming.Thediscussion concludes with recommendations and challenges associated witha perpetration-focused approach to CSA prevention.Perceived barriers to prevention of CSA perpetrationMisconceptions about perpetrators may contr

24、ibute to the lack of support forthe development of CSA prevention measures focused on perpetration.Thecomplexity of CSA contributes to the perception that CSA arises fromunpredictable(unlike child neglect,CSA can be perpetrated by virtuallyanyone of almost any age against any child)and unalterable f

25、orces(Letourneau et al.,2014).Predominant public perceptions hold that CSA isperpetrated by individuals who are resistant to intervention efforts anddestined to reoffend(Levenson,Brannon,Fortney,&Baker,2007)con-tributing to the perception that little can be done to prevent such peoplefrom sexually h

26、arming children,other than by locking them after offenseshave been committed(Levenson et al.,2007;Rogers&Ferguson,2011).Strong and generally unified public reactions to CSA encourage policymakers and law enforcement to enact harsh consequences through policiesdesigned to punish.Extensive resources a

27、re devoted to criminal justiceinterventions focused on the identification,prosecution,punishment,andsubsequent control of adjudicated offenders(Letourneau&Levenson,2010;Letourneau&Shields,2016).Yet,there is little evidence supporting thepreventive efficacy of these policies(Letourneau&Levenson,2011;

28、Levenson&Vicencio,2016),which often were created in response to highlypublicized and alarming cases,and is not informed by scientific evidence(Meloy,Curtis,&Boatwright,2013).For example,several criminal justiceefforts focus on protecting children against sexual crimes perpetrated bystrangers(e.g.,se

29、x offender public registration,residence restrictions).Yet,only a small fraction of children are victimized by someone they do notknow;the majority of CSA cases are perpetrated by family members orsomeone known to the victim(Snyder,2000).Further,even the most effec-tive criminal justice intervention

30、s would prevent only a small percentage ofsexual offenses,as 95%of such crimes are committed by individuals with noprior sex crime convictions(Sandler,Freeman,&Socia,2008).Perceiving offenders as“monsters”(Kitzinger,2004)makes it difficult forpeople to identify concerning behaviors by those they res

31、pect or care for,as itis understandably difficult to imagine that respected and productive com-munity members are also capable of sexually harming children.Such percep-tions might prevent the identification of cues that lead to abuse,as well asand the enactment of mechanisms to address early indicat

32、ors of potentialabuse.A more useful approach would be to move away from a narrow focusJOURNAL OF CHILD SEXUAL ABUSE3on the supposedly intrinsic and unchangeable motivations of perpetrators,and to retrain our efforts around the circumstances that increase or decreasethe likelihood of perpetrating CSA

33、.If we ever hope to substantively reducerates of CSA,the development,rigorous evaluation,and broad disseminationof effective CSA prevention strategies will be critical(Wurtele,2009).Perpetration prevention efforts for CSAIn the past decade,innovative preventative approaches focused on CSA perpetra-t

34、ion have begun to emerge(Beier,2018;Letourneau et al.,2017).The opportu-nities to reduce the likelihood of adolescents and adults to engage in sexualbehavior with children are varied and dependent on the potential perpetratorscharacteristics and the immediate environment where the abuse may occur(Wo

35、rtley&Smallbone,2006).In this review,we focus on three types of perpetra-tion prevention interventions:interventions that target individuals with sexualinterest in children(Beier,2018;Levenson,Willis,&Vicencio,2017;Shields et al.,2019),interventionsthatfocusontheonsetofsexualviolenceperpetrationamon

36、gyoung adolescents(Letourneau et al.,2017;Rothman,2016),and interventionsaimedatcurbingsexualabusewithinyouth-servingorganizations(Kaufmanetal.,2019;Mathews,2019;Palmer&Feldman,2018;Wurtele,2012).Targeted interventions focusing on individuals with sexual interest inchildrenOne innovative prevention

37、intervention focuses on helping adults with sexualattraction to children to refrain from abusing children.Initiated in 2004,Germanys Prevention Project Dunkelfeld targets adults with an attraction tochildren,whether they have never acted on their attraction or have acted ontheir attraction but never

38、 been caught by authorities(The Prevention Network,2018).Staff at Prevention Project Dunkelfeld ensured wide dissemination ofinformation about their program through a large media campaign designed todemonstrate empathy for people with a sexual attraction to children,reducestigmaassociatedwithtalking

39、aboutonessexualattractiontochildren,andassureconfidentiality and anonymity(Beier et al.,2009).The campaign utilized multipleforms of media to advertise the availability of help for people with sexual interestin children,including television,radio,Internet,and print ads(e.g.,billboards,newspapers).St

40、atements in media campaigns included,“You are not guiltybecause of your sexual desire,but you are responsible for your sexual behavior.There is help!Dont become an offender!”and“Dont offend.There is help freeof charge and confidential.”Advertisements encourage people with an attractionto children to

41、 contact Prevention Project Dunkelfeld by telephone,where theyreceive an initial screening for more comprehensive clinical assessment andintervention.4L.C.ASSINI-MEYTIN ET AL.Participants are accepted into one of two programs:one for those who haveacted on their attraction and one for those who have

42、 abstained from sexualoffending.Thetherapeuticcomponentincludesweeklygroupandindividual in-person therapy sessions(incorporating family members when necessary).Thereare nine specific foci of treatment:(1)improving self-esteem,(2)strengtheningresources,(3)learning to develop a future-focused perspect

43、ive,(4)beingaccountable or taking responsibility,(5)developing coping skills to avoid actingononessexualattractiontochildren,(6)increasingabilitytodelaygratification,(7)learning emotion-focused coping,(8)recognizing and responding appro-priately to risky situations,and(9)improving interpersonal skil

44、ls and capacityfor intimacy(The Prevention Network,2018).The Prevention Project Dunkelfeld has proven successful in reaching self-identified and help-seeking men with sexual interest in children in partbecause treatment is confidential;that is,Germany has not implementedmandatory reporting laws that

45、 require professionals to report offenders tothe authorities(Beier et al.,2015;Beier,2018).Outcome data fromPrevention Project Dunkelfeld in Berlin indicated improvement on somerisk factors for CSA offending,including emotional deficits(i.e.,lonelinessand hostility toward women),beliefs that support

46、 or justify sexual offending,and deficits in sexual self-regulation(Beier et al.,2015).An evaluation of thePrevention Project Dunkelfeld in Hannover and Regensburg yielded similarfindings.Specifically,results from a pre-and post-treatment comparisonshowed a reduction in several CSA risk factors,incl

47、uding beliefs that supportor justify sexual offending,deficits in coping self-efficacy,and hypersexualbehavior(Engel,Krner,Schuhmann,Krger,&Hartmann,2018).Recently,Mokros and Banse(2019)conducted a reassessment of Beier et al.(2015)andextended previous analysis by assessing the interventions treatme

48、nt effect.Inthis reassessment,authors found mostly weak treatment effects across variousrisk factors for engaging in CSA.However,the authors noted that the lowstatistical power given the small sample size(n=53 for treatment and n=22for control group)precludes any final conclusions regarding the effe

49、ctiveness(or lack thereof)of the Prevention Project Dunkelfeld.Most of the individuals receiving treatment at the Project Dunkelfeld aremen who have offended against a child(either CSA,use of child pornogra-phy,or both)and remain unknown to the authorities(Beier et al.,2015;Engel et al.,2018).While

50、the Prevention Project Dunkelfeld shows promisingresults in helping to reduce CSA offenses among“undetected help-seekingpedophiles,”its effectiveness in helping individuals who have never offendedto remain offense free is yet to be determined.In a sub-analysis by lifetimeoffense,findings from Beier