Rapid Evidence Assessment: What can be learnt from other jurisdictions about preventing and responding to child sexual abuse

Abstract

This Rapid Evidence Assessment was commissioned by the Independent Inquiry into Child Sexual Abuse in England and Wales which is investigating whether public bodies and other non-state institutions have taken seriously their duties to care for and protect children and young people from child sexual abuse and exploitation. The question for the review was: What can be learnt from jurisdictions, outside of England and Wales, about the role of institutions, including accountable state and non-state organisations with responsibility for children in preventing and responding to child sexual abuse and exploitation?
Key messages

● No jurisdiction has everything ‘right’. While overall robust research on what is effective is limited, there is plenty of promising evidence that can be developed further to inform work in England and Wales.
● Adequately resourced, comprehensive, multi sector approaches that aim to prevent and respond to child sexual abuse and exploitation are likely to be the most effective approaches.
● Effective responses are those able to meet the complexity and diversity of the needs of children and young people who are vulnerable or affected.
● Work with sexual offenders could broaden out to include earlier intervention to prevent offending by adults and adolescents who have not been convicted.

Findings

Primary prevention

None of the jurisdictions1 included in the review had a comprehensive approach combining primary prevention and response but we found more evidence of prevention efforts in Australia, Finland, Norway, Sweden and the USA.

Changing attitudes and behaviour by education or awareness raising - There is moderately good evidence from Canada and the USA that pre-school and school based education programmes on child sexual abuse are effective at teaching children to recognise inappropriate behaviour and improving their knowledge of self protection. Research in Australia and the USA supports whole school approaches and involving parents, faith and community groups. Public education and social marketing campaigns to prevent abuse are commonly used but poorly evaluated.

1 Wales, Scotland, Northern Ireland, Ireland, EU 28 countries, Norway, Iceland, USA, Canada, Australia, New Zealand

Situational prevention – The UK has led primary prevention and early identification efforts online and there is evidence of successful take-down, site blocking, extensive take up of online safety resources and considerable international collaboration through the work of CEOP, the National Crime Agency, and participation in the Global Alliance and WePROTECT. In other organisational contexts, efforts have been more limited covering pre-employment checks, vetting and barring. While important, these only exclude the minority of offenders already known or convicted. Inquiries in the USA, Germany, the Netherlands, Belgium and Ireland on institutional child abuse in churches show we need a wider focus on organisational safety and the opportunities for unmonitored contact.

Reducing vulnerabilities - Very little evidence could be found on the best approaches to reduce the vulnerabilities of children to sexual abuse and exploitation in the jurisdictions covered. Some promising evidence from the UK, Canada and the Netherlands was found from Stop It Now which aims to reduce offending among those not previously identified as offenders.

Disclosure, identification, reporting and response

Professionals need to be aware of the barriers children face in disclosing abuse and trained to recognise signs of abuse other than the child’s disclosure. Identification in children’s social services, education and health particularly needs to be recognised as a process of proactively asking, building a relationship with a vulnerable child or young person and collecting information from a range of sources over time.

Research in Australia confirms that mandatory reporting can increase reports of child sexual abuse but that resources are needed to manage these. The number of cases investigated but not then substantiated also increased.

From Australia and the USA, there is evidence that training, proactive identification and promoting expertise and good practice through specialist mobile teams or task forces in health, justice and child protection can have a positive impact. For health, use of new technologies such as telemedicine can give access to specialist skills. Also in Australia, proactive approaches to involve the wider community in identification and reporting had a positive impact on reporting rates, arrests, prosecution and convictions for child sexual abuse cases.

Support for children through prosecution and the court process is generally poor but there is promising evidence on the effectiveness of co-located multi-disciplinary services such as the National Children’s Advocacy Centers in the USA and the Children’s Houses (or Barnahus) in Iceland and other parts of Europe.

Managing offenders

Management of offenders has focused largely on those high risk sexual offenders against children already convicted. In the UK, Germany and Sweden, attention is shifting to look at offenders at lower levels of assessed risk, including those not convicted. More work is needed on effective responses for health, education and social work; on managing peer abusers; on improving prosecution and the use of appropriate sanctions for offenders in organisations such as churches and faith groups.

Commonly used policies such as sexual offender registration, notification schemes and residency restrictions evaluated in the USA found these have not been effective in reducing recidivism and may work against efforts to rehabilitate offenders. Sex offender treatment responses are more likely to be effective if they can address the type of offence and level of risk, the offender’s criminogenic needs, learning style and abilities. Restorative justice approaches to sex offender treatment such as Circles of Support and Accountability show promising results from Australia and the US, but have high levels of programme drop out. Treatment responses developed for adults are less relevant for young people who present with harmful sexual behaviour. There is more evidence to support the use of MST than CBT based treatment approaches for young people who present with harmful sexual behaviour.

Supporting victims and survivors

There are significant gaps in the availability of relevant support and therapeutic services for child victims of sexual abuse in the UK and funding for services addressing significant risks such as domestic abuse has declined.

Research from Scotland on guardianship schemes shows positive results improving support for trafficked young people. Advocacy schemes do not prevent sexually exploited young people from going missing, but can ensure there is a coordinated response should this happen.

The evidence on victim support and recovery focuses mostly on child sexual abuse, while needs of those who have been sexually exploited may differ. Best evidence on therapeutic treatment for children exists for trauma focused CBT although a variety of therapeutic methods, for example those using drama or EMDR, also show promise. Therapy approaches may be more effective when tailored to the individual needs of the child or young person, taking into account their specific symptom constellation, development, context, and background.

Evidence from other jurisdictions on the effectiveness of victim redress, compensation schemes, no fault insurance, publicly available insurance registers and the structure and source of different funding streams could not be found.

Implications

● A wider focus on prevention and response is needed, with prevention moving beyond teaching children to protect themselves and beyond the regulation of convicted sexual offenders to focus on wider prevention efforts targeting risks and vulnerabilities.

● Prevention and response needs to be comprehensive, cover the complexity and diversity of children’s experiences and be guided by leadership promoting an outcome focused theory of change.

● Responsibility for preventing and responding to child sexual abuse and exploitation needs to extend beyond specialist and child protection services to include the wider range of organisations, particularly faith groups, industry, the private sector, sport and leisure. The National Response Unit and proposed Centre for Excellence (in the UK) could play an important role in partnerships.

● Research from the USA and Canada provides evidence for prevention delivered in schools to increase children’s knowledge and awareness and starting to change the attitudes and environments that contribute to abuse. A strong argument could be made for compulsory PSHE for all schools and academies on safety and respectful relationships.

● Additional resources will be needed to deal with increased reports and additional screening procedures that will result if mandatory reporting is introduced.

● The gaps in knowledge identified in this review could be used to inform priorities for future funding.

Approach

The project was desk based using recognised methods for rapid evidence assessment. Rapid evidence assessments, like systematic reviews, aim to thoroughly and transparently identify and assess the evidence on a particular topic but within a more limited time frame and with restrictions on the breadth of literature included.

Using agreed search terms, we searched online databases (Embase, ASSIA, PsychInfo, Social Work Abstracts and Criminal Justice Abstracts) and websites for relevant peer reviewed articles and research reports on effective responses delivered by different institutions from jurisdictions outside of, but similar to, those in England and Wales. Grey literature and references in publications included were additionally searched. We rated 1,460 relevant studies for quality and included 88 high quality studies in the review. To address gaps in the research, we were asked to identify examples of responses where the evidence was promising but did not yet meet quality

standards. We were also asked to discuss the findings with reference to the current context of research, policy and practice in England and Wales. This meant reading a large body of additional materials which we included in the report bibliography. A full description of the methods are in the research report.

Limitations

The scope of the Rapid Evidence Assessment was narrow and might not have identified all the relevant evidence. The search was limited to articles published in English, between 2004- 2016, in peer reviewed journals and online in ‘grey literature’ research reports. We were unable to consult with international academic or practice experts to check whether all significant research evidence had been covered, but the draft report was reviewed by the IICSA advisory groups, including academic experts, who made suggestions on research to include (mostly from the UK).