Web Exclusive

Teaching Children and Parents About Child Sexual Abuse Prevention With the Safe Touches Program
By Mary L. Pulido, PhD

Childhood sexual abuse is a public health problem of epidemic proportions and an alarming and serious concern for both the social work and the medical fields. One in five children is expected to be a victim of sexual assault by age 18 (Sandberg, Lynn, & Green, 1994; Snyder, 2000). Nearly one in four children in the United States were victimized in 2005 (Sedlak, Mettenburg, Basena, Petta, McPherson, Greene, et al., 2010).

Victims of childhood sexual abuse experience myriad physical and mental health problems, often persisting through adulthood. More than two decades of research has linked childhood sexual abuse to increased rates of pregnancy, promiscuity, low self-esteem, obesity, anxiety, depression, anger and aggression, posttraumatic stress, dissociation, hallucinations, sexual difficulties, sexually transmitted diseases, self-injurious behaviors, substance abuse, coronary artery disease, and permanent changes in neurobiological functioning (Noll, Zeller, Trickett, & Putnam, 2007; Finkelhor, 1990; Neumann, Houskamp, Pollock, & Briere, 1996; Putnam, 2003). As adults, victims of childhood sexual abuse are at increased risk of sexual revictimization and persistent engagement in sexual risk-taking behavior (van Roode, Dickson, Herbison, & Paul, 2009). For all these reasons, the social work field should galvanize to prevent childhood sexual abuse.

Lately, the media has been covering this topic on a more regular and detailed basis. The New York Society for the Prevention of Cruelty to Children (NYSPCC) is thankful for the media’s spotlight on these issues. The NYSPCC encourages parents to use these stories as teachable moments—to sit their children down and talk to them about sexual abuse, especially the range of behaviors that could be characterized as sexual abuse, including fondling and inappropriate tickling/touching of genitals to child pornography and rape.

Prevention Measures With Children
In keeping with its mission to prevent child abuse and neglect, The NYSPCC developed a curriculum called “Safe Touches: A Personal Safety Training for Children” with the intent of preventing child sexual abuse. The training has four goals:

• to provide information on the difference between safe and unsafe touching;

• to define for children the body parts that are considered private;

• to teach children who to go to when they feel unsafe or confused; and

• to teach children assertive language skills.

The NYSPCC’s sexual abuse prevention workshop in the New York City public schools is specifically designed to reach children in kindergarten through third grade. Using colorful, culturally appropriate puppets, The NYSPCC’s clinicians use role-play scenarios to help children learn about the private parts of their body, recognize safe and unsafe touches, and identify whom to tell if they have experienced an unsafe touch. Students are encouraged to identify more than one adult whom they could turn to if they experience an unsafe touch. If they do experience an unsafe touch, the children are instructed to keep telling the adults on their list until one person takes action to protect them.

During the workshop, children also are encouraged to ask questions and voice concerns. The workshop emphasizes that if a child has been touched inappropriately, it is never the child’s fault, thereby reducing the guilt or shame many child victims experience.

To keep children’s attention, the workshop runs for only 45 minutes. The NYSPCC’s clinicians are available to stay longer for follow-up questions from students and teachers. At the end of the workshop, each student is given a copy of Your Body Belongs to You! or Keeping my Body Safe! These activity and coloring books are designed to reinforce the messages from the workshop and are to be completed at home with parents or other adult caregivers. Workbooks are provided in both English and Spanish.

If a child makes statements during or after the workshops that warrant follow-up and questioning by the presenters, the NYSPCC clinicians work with the school guidance counselor, and appropriate calls are made either to the state central registry or the police. If a child has endured sexual abuse, The NYSPCC can serve as a therapy referral source after the investigation is complete. All of The NYSPCC’s mental health clinicians are specially trained in a phase-oriented treatment for child sexual and physical abuse.

Training for Parent Associations on Child Sexual Abuse Prevention
Following the recent Penn State sex abuse allegations, The NYSPCC experienced an increase in calls from parent associations asking for training in child sexual abuse prevention. The NYSPCC developed a workshop for parents aimed at educating them about the signs and symptoms of abuse and how to respond if their child tells them they have received an unsafe touch. (The NYSPCC prefers the term “safe” and “unsafe” instead of “good” and “bad,” as some touches that are good, such a vaccination, can feel bad and some bad touches, such fondling, can feel good.)

The NYSPCC encourages parents to have a conversation with their children about their private parts, protecting their body, actions they can take if they receive an unsafe touch, and whom they can tell, identifying two or three trusted adults that they can turn to if they are upset. Finally, parents are encouraged to reinforce with their children that it is never their fault if they receive an unsafe touch; the blame always rests with the adult. Parents need to instill confidence that if something does happen to their child, the parents will be understanding and supportive.

Parents’ reactions if a child does disclose abuse really count. Among the saddest cases that I have encountered over my career are those when a parent does not believe a child or when a parent is furious at the child for telling the truth. I recall one case where the child was abused by her mother’s boyfriend. The mother called the child a liar. The child, scared and devastated by her mother’s betrayal, was removed from her home and placed in foster care, as it was obvious that the mother could not guarantee her safety.

Though this case is extreme, research has shown that if there is a disclosure, the child’s healing process can be either aided or stunted by the parent’s reaction to the sexual abuse. I’ve witnessed a range of parental behaviors, from shock, anger, and worry to shame, guilt, confusion, or even jealousy. Parents are counseled that the best way to respond is to remain calm and try to get the child to tell them what happened in his or her own words. Parents should ask open-ended questions and let the child tell them the details. Parents are also instructed to not ask leading questions as this can confuse the child.

Once the parents have the information, they are instructed to take action. If the alleged perpetrator is a parent or guardian, the state child abuse hotline must be called. Every state has a hotline number, and parents are taught how to access that number. If the alleged perpetrator was someone outside the home, such as a family friend, neighbor, or teacher, the police should be contacted. Parents are instructed to call 911.

The NYSPCC reassures parents that in either instance, officials are trained in responding to these types of situations. And the parents will have taken action to protect their child, and probably other children, from the perpetrator. The NYSPCC encourages parents to seek counseling for their child and family following an incident of sexual abuse. Children do heal from abuse, and they do best when a trusted adult supports and believes them.

Research Agenda
With funding from the National Institutes of Health, The NYSPCC is currently evaluating the effectiveness of its Safe Touches workshops. Puppet shows for abuse prevention are utilized nationwide, but are they really working? Do children retain the concepts they learned during the workshops? This research project will be completed in 2014, and its findings should help the social work field with its quest to reduce the incidence of child sexual abuse.

For more information on protecting children, visit www.NYSPCC.org.

— Mary L. Pulido, PhD, is the executive director of The New York Society for the Prevention of Cruelty to Children.

References
Finkelhor, D. (1990). Early and long-term effects of child sexual abuse: An update. Professional Psychology Research and Practice, 21(5), 325-330.

Neumann, D. A., Houskamp, B. M., Pollock, V. E., & Briere, J. (1996). The long-term sequelae of childhood sexual abuse in women: A meta-analytic review. Child Maltreatment, 1(1), 6-16.

Noll, J. G., Zeller, M. H., Trickett, P. K., & Putnam, F. W. (2007). Obesity risk for female victims of childhood sexual abuse: A prospective study. Pediatrics, 120(1), e61-e67.

Putnam, F. W. (2003). Ten-year research update review: Child sexual abuse. Journal of the American Academy of Child & Adolescent Psychiatry. 42(2), 269-278.

Sandberg, D., Lynn, S. J., & Green, J. P. (1994). Sexual abuse and revictimization: Mastery, dysfunctional learning, and dissociation. In: Lynn, S. J., & Rhue, J. W. (Eds.), Dissociation: Clinical and theoretical perspectives. New York: Guilford Press.

Sedlak, A. J., Mettenburg, J., Basena, M., Petta, I., McPherson, K., Greene, A., et al. (2010). Fourth national incidence study of child abuse and neglect (NIS-4). Washington, DC: U.S. Department of Health and Human Services Administration for Children and Families.

Snyder, H. N. (2000). Sexual assault of young children as reported to law enforcement: Victim, incident, and offender characteristics. Annapolis Junction, MD: Bureau of Justice Statistics Clearinghouse.

van Roode, T., Dickson, N., Herbison, P., & Paul, C. (2009). Child sexual abuse and persistence of risk sexual behaviors and negative sexual outcomes over adulthood: Findings from a birth cohort. Child Abuse & Neglect, 33(3), 161-172.