Journal of Child Sexual Abuse

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Child Sexual Abuse Victimization Prevention

Programs in Preschool and Kindergarten:
Implications for Practice

Megan Manheim, Richard Felicetti & Gillian Moloney

To cite this article: Megan Manheim, Richard Felicetti & Gillian Moloney (2019): Child Sexual
Abuse Victimization Prevention Programs in Preschool and Kindergarten: Implications for Practice,
Journal of Child Sexual Abuse, DOI: 10.1080/10538712.2019.1627687

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JOURNAL OF CHILD SEXUAL ABUSE
https://doi.org/10.1080/10538712.2019.1627687

Child Sexual Abuse Victimization Prevention Programs in

Preschool and Kindergarten: Implications for Practice
Megan Manheim, Richard Felicetti, and Gillian Moloney
Department of Psychology, Fairleigh Dickinson University, Teaneck, NJ, USA

ABSTRACT ARTICLE HISTORY

With the alarming rates of child sexual abuse in the United Received 9 November 2018
Revised 26 February 2019
States, there have been several attempts to develop and Accepted 1 June 2019
implement child abuse victimization programs in elementary
schools across the country. Many programs have targeted KEYWORDS
older school-age children, but research shows that these Victimization prevention;
programs can be effective for children of preschool and kin- program development;
dergarten age. This paper will review the literature that pro- sexual abuse; child sexual
vides the rationale behind offering these types programs to abuse; early elementary
programming
the youngest of school-children, what these programs can
offer, and describe specific programs that have been vali-
dated for preschool and kindergarten-aged children, using
the best practice guidelines in the field of early childhood
education. Recommendations for future programs and
research needs are also offered.

According to the Children’s Bureau of the U.S. Department of Health and

Human Services (2017), in the 2015 federal fiscal year, there were approxi-
mately 683,000 reported victims of child abuse and neglect, or 9.2 victims per
1,000 children in the population. Of these 683,000 reported victims, 8.4% had
been sexually abused, and the youngest of children are at highest risk of
sexual abuse, such that 20% of victims report experiencing sexual abuse
before turning eight years old (Child Sexual Abuse Statistics, 2015). These
numbers have prompted the Centers for Disease Control to identify child
sexual abuse (CSA) as a priority concern for prevention in the United States
(Hammond, 2003; Satcher, 2001).
In an attempt to combat this issue, the U.S. began implementing child
sexual abuse prevention programs in the 1980s (Wurtele & Owens, 1997).
The programs are constructed with the idea of educating children, par-
ents, and the community about CSA before it occurs (Anderson, Mangels,
& Langsam, 2004). Miller-Perrin and Wurtele (1988) believed these pro-
grams fell into three distinct categories: primary, secondary, and tertiary.
Primary prevention attempts to provide children with safety information
and skills. Secondary prevention efforts include educating professionals on

CONTACT Megan Manheim [email protected] Fairleigh Dickinson University, 1000 River Road,
Teaneck, NJ 07666, USA, Mailing Code: T-WH1-01.
© 2019 Taylor & Francis
2 M. MANHEIM ET AL.

CSA and how to recognize it. The tertiary prevention involves therapeutic
interventions. Many programs until this time have been directed at adults
and focused on the prevention of child abuse/neglect/mistreatment
(Wurtele & Owens, 1997). Unlike these programs, many CSA prevention
programs have targeted children, usually in school-like settings (Wurtele
& Owens, 1997). One of the issues with these programs is that many were
researched in the 1990s, and have been examined very minimally since
(see Kenny, 2009). This article presents an overview of the research
regarding preschool and kindergarten-based CSA prevention education
programs, and offers recommendations for improvements to existing
and future programs.
Child sexual abuse has been defined inconsistently in the literature, but for
the purposes of this review, the CSA virtually all-encompassing definition
summarized by Anderson et al. (2004) will be used. Child sexual abuse:

… involves the employment, use, persuasion, inducement, enticement, or coercion

of any child to engage in any sexually explicit conduct for the purpose of produ-
cing any visual depiction of such conduct as rape, molestation, prostitution, or
other form of sexual exploitation of children, or incest with children, under
circumstances which indicate the child’s health or welfare is harmed or thereby
threatened (p. 108).

There is abundant evidence of immediate harmful effects to the psychosocial

development of child victims of sexual abuse (SA) (Cicchetti & Toth, 1995;
Draper et al., 2008; Erickson, Egeland, & Pianta, 1989; Paolucci, Genuis, &
Violato, 2001; Pérez-Fuentes et al., 2013). Victims may experience physical
and psychological injuries (Anderson et al., 2004) including low self-esteem,
aggressive behavior, acting out, withdrawal and social adjustment problems
(Clark, 1993; Putnam, 2003). Other symptoms include fear, hyperactivity,
depression, loss of appetite, somatic complaints and sexually acting out
(Browne & Finkelhor, 1986; Gelinas, 1983; Jehu & Gazan, 1983; Neumann,
Houskamp, Pollock, & Briere, 1996; Noll, Zeller, rickett, Putnam, 2007; van
Roode, Dickson, & Paul, 2009). These effects can and do carryover into
adulthood, correlating with later chemical dependency, legal issues, involve-
ment in abusive relationships, suicide attempts (Smith & Sgarzi, 2003), eating
disorders (Grilo & Masheb, 2001; Oppenheimer, Palmer, & Braden, 1984)
and in some cases years of psychological treatment may be required
(Hammerschlag, 1996). The question is not whether or not to implement
child sexual abuse (CSA) victimization prevention programs, but rather, what
kinds of programs, and to whom?
Almost all CSA victimization prevention programs share three goals: 1)
recognize abusive situations; 2) try and resist by declining and removing self
from situation; and 3) encouraging reports to authority figure (Wurtele,
 JOURNAL OF CHILD SEXUAL ABUSE 3

2008). To achieve these goals, many CSA prevention programs teach about
the “touch continuum” (Anderson, 1986), also known as the discrimination
between what is a “good” and “bad” touch (Conte, Rosen, & Saperstein,
1986). The majority of the programs that use the “touch continuum” have
similar goals: 1) to teach children the inappropriateness of certain kinds of
touching; 2) to explain when/what touches to the “private parts” are appro-
priate; and 3) to teach these topics without creating aversive side effects to
appropriate touching (Blumberg, Chadwick, Fogarty, Speth, & Chadwick,
1991). It is important to note that these trainings are designed to describe
the touch as appropriate versus inappropriate, rather than good versus bad.
The reason being that asking a child to interpret the “goodness” of the touch
could be interpreted based on how the touch feels which can be a misleading
question given that the touch can feel pleasurable for the child while still
being inappropriate (DeYoung, 1988; Wurtele, Kast, Miller-Perrin, &
Kondrick, 1989).
Most programs attempt to prepare children for interactions with strangers;
however, the overwhelming majority of CSA cases are at the hands of those
known to the child (Synder, 2000; Synder & Sickmund, 2006; Wurtele,
Saslawsky, Miller, Marrs, & Britcher, 1986). This often-overlooked concept is
critical in CSA victimization programs, as evidenced by Wurtele’s number one
point above, especially for young children. According to Piaget (1963), chil-
dren are in the preoperational stage of cognitive development between the ages
of two and seven years (preschool and kindergarteners age). During this stage,
children often focus on one aspect of a stimulus, and ignore all other aspects of
it. This principle is very applicable in CSA prevention programs because
without being taught that a person the child sees as “good” (i.e. a relative)
can complete “bad” actions, the child may focus on the “goodness” of the
offender, failing to recognize or report the “bad” actions (Kenny & Wurtele,
2010). While this may be a challenging feat developmentally, research shows it
can be done and can lead to positive outcomes.
Many reviews have consistently found CSA programs helpful in teaching
children personal safety skills and knowledge (Berrick & Barth, 1992; Boyle &
Lutzker, 2005; Rispens, Aleman, & Goudena, 1997; Wurtele & Owens, 1997).
A meta-analysis by Rispens et al. (1997) of 16 school-based child sexual abuse
programs found not only a significant, but large overall effect size at post-
intervention (Cohen, 1977). These findings suggests immediate program
effectiveness such that children learn the materials taught to them in SA
victimization prevention programs. A meta-analysis by Zwi, Woolfenden,
Wheeler, O’Brien & Williams (2007) found children were seven times more
likely to show self-protective behavior in simulated situations when having
participated in a school-based CSA program than those who did not parti-
cipate. These gains are generally maintained at follow-ups between two and
4 M. MANHEIM ET AL.

twelve months after initial evaluation (see Fryer, Kraizer, & Mlyoshi, 1987;
Saslawsky & Wurtele, 1986).
There has been much debate on the idea of providing CSA prevention
programming to children in the younger primary grades (i.e. preschool,
kindergarten, first grade), due to their level of cognitive understanding
(Boyle & Lutzker, 2005; Kohl, 1993; Reppucci & Haugaard, 1991; Webster,
1991). A large portion of the participants examined in the meta-analysis by
Rispens et al. (1997) were under the age of five, signifying that these
programs can be effective even in the youngest of school-aged children.
This meta-analysis found those younger than five and a half years of age
benefitted the most from the programs, although the difference disappears
when evaluated at a follow-up time. This finding was replicated in a meta-
analysis by Davis and Gidycz (2000). Other studies have found that CSA
programs can be effective when teaching core concepts to preschoolers
(Wurtele, 2009).
Providing educational material through information and skills-based learn-
ing is a key factor of effective CSA prevention programs for young children
(Kenny, 2009; Kopp & Miltenberger, 2009; Smothers & Smothers, 2011;
Wurtele et al., 1986). An example of this includes presenting the children
with information followed by their active rehearsal of the skills learned
(Bromberg & Johnson, 1997; Wurtele et al., 1989). Presenting information to
children in this manner allows for modeling and role-playing which has been
shown to increase efficacy of treatments (Davis & Gidycz, 2000; Wurtele,
Marrs, & Miller-Perrin, 1987) through social reinforcement and corrective
feedback (Kopp & Miltenberger, 2009).
Programs that are repetitive or allow for more than one meeting time tend
to be the most effective for extended outcomes (Davis & Gidycz, 2000; Krazier,
1996). Particularly, those programs with three or more meeting sessions are
found to produce the greatest learning (Davis & Gidycz, 2000). It is thought
that the spacing allows for more repetitions of material, and hence, improving
retention (Davis & Gidycz, 2000; Smothers & Smothers, 2011).
Lesson reinforcement is also a crucial component of effective CSA preven-
tion training (Kenny, 2009; Kopp & Miltenberger, 2009; Smothers & Smothers,
2011). In fact, Boyle and Lutzker (2005) found that their young participants
(under the age of 7 years) were able to recognize more abstract content through
repetitions of the materials. When the children are actively involved in the
program, the information becomes clearer and more salient, allowing for the
most gains in acquisition (Davis & Gidycz, 2000). Further, in a study by
Weingarten (2018), participants found role-plays to be of the most help as it
allowed them to practice what they were learning, with live feedback.
Parental involvement plays one of the largest roles in the effectiveness of CSA
prevention programs (Elrod & Rubin, 1993; Reppucci, Jones, & Cook, 1994;
Wurtele & Miller-Perrin, 1992). Providing caregivers with the knowledge and
 JOURNAL OF CHILD SEXUAL ABUSE 5

tools to discuss sexual abuse allows the parents to gain knowledge in the area
themselves, encouraging open discussion when at home. This increases the
child’s feelings of comfortability and confidence in discussing these topics that
can otherwise be uncomfortable or embarrassing to the youth (Kenny, 2009).
Due to children aged 7 to 13 years being at the highest risk of victimization,
involving parents at the earliest stages of intervention and training is of the
utmost importance (Synder, 2000; U.S. Department of Health and Human
Services, Administration on Children, Youth and Families, 2008). Parents and
caregivers are in an ideal position to sustain the impact of CSA prevention
lessons provided at school, and according a public health model, can effectively
aid in the prevention of sexual exploitation (Wurtele & Kenny, 2010).
Up to this point in time, there have been many attempts at the develop-
ment of CSA prevention training programs for children. These programs
have come in various forms, including books, comics, films, videos and
lecture-style presentations. Included in this review are the programs that
have been substantiated for preschool and kindergarten-aged children, and,
as argued above, follow the best practice in the field of early childhood
education which includes: information and skills-based learning, required
repetitions of the program included as part of the instructional protocol,
lesson reinforcement, and parental involvement (Kenny, 2009; Kopp &
Miltenberger, 2009; Smothers & Smothers, 2011).

Programs
Body Safety Training (BST) Program
This program is a personal safety skills program for children with seven
goals: 1) the child is the boss of their own body; 2) to identify their “private
parts”; 3) that self-touch is acceptable if done in private; 4) when it is
appropriate for others to touch their “private parts” (i.e. doctors and parents
for health/hygiene reasons); 5) it is not okay for anyone else to touch them,
especially if asked to keep it a secret; 6) it is not okay to be forced to touch
someone else’s private parts; and 7) learning the body safety rule, “It’s not
okay for a bigger person to touch or look at my private parts.” This five-day
program includes a script with pictures, intended for use by parents or
teachers. With the instructors, children are modeled the appropriate verbal
and physical responses to inappropriate requests and situations, and practice
rehearsing these behaviors, with feedback from the instructors. The beha-
vioral intervention program includes various stories in which the children
need to decide if the situation is appropriate, and what the appropriate
course of action should be. Findings from this program suggest that young
children can benefit from participating in a personal safety program that is
developmentally appropriate for the age group (Wurtele & Owens, 1997).
6 M. MANHEIM ET AL.

Parents as Teachers of Safety (PaTS)

This curriculum was designed to include the parents in training that utilized the
Talking about Touching curriculum. The preschool children complete the Talking
about Touching curriculum while the parents train in the same curriculum, with
the inclusion of more advanced material. The author added a lesson to both sets of
curricula that targets the learning and use of proper names of genitalia. In the
PaTS training parents are given a plethora of information and handouts related to
the topics presented, and subsequent discussion is led by training leaders. All
training leaders held master’s degrees or higher in counseling or related fields, and
were skilled in working with young children (Kenny, 2009). Results show this
program increases communication between parents and children, and children
are more knowledgeable in CSA and CSA safety skills (Kenny, 2009).

Safe Touches: Personal safety training

Created by a nonprofit organization in New York City, Safe Touches is a CSA
prevention curriculum that has been implemented in New York City public school
classrooms since 2007 (Pulido et al., 2015). This program is designed for children
in kindergarten through third grade, and involves a one-time 50-minute inter-
active workshop to help children learn and practice safety skills. The workshop
also provides participants with a book regarding body safety to be completed at
home by the child with their caregivers. The curriculum covered in the workshop
includes names of “private parts”, safe versus unsafe touches, what kinds of people
use unsafe touches (i.e. can be someone the child knows), how to tell an adult, and
that the blame is not on the child. Facilitators, master’s-level counselors, or social
workers practice these skills with the child. Pulido et al. (2015) found that the Safe
Touches program resulted in a significant increase in inappropriate touch aware-
ness when compared to the control group.

Safer, smarter kids

This curriculum sets out to teach children personal safety information in a way
that is developmentally and age-appropriate. This training aims to teach children
how to recognize risk situations, and allow them opportunity to practice protective
behavior in a safe environment in a series of six 30-minute lessons. The learning
objectives include: 1) understanding safety rules; 2) understanding stranger versus
trusted adult; 3) listening to one’s intuition; 4) body boundaries; 5) understanding
safe versus unsafe; and 6) understanding tattling versus reporting (Brown, 2017).
This program uses modeling videos, interactive activities, role-playing, practice
exercises, and take-home handouts to accomplish these goals. The curriculum is
presented over a course of six weeks, with ample opportunities to repeat the
lessons in-class and at home. This information is available in a “kit” form online.
 JOURNAL OF CHILD SEXUAL ABUSE 7

There is also a kit for parents that provides parents with information about CSA,
as well as additional exercises for practice of each lesson with their child. A review
by Brown (2017) found a significant improvement in student’s knowledge of key
concepts following training.

Talking about Touching

Talking about Touching curriculum consists of 16 lessons lasting between 15
and 30 minutes. These lessons contain photo cards, books, songs, posters and
video that simply teaches children rules for safe decision making. This curri-
culum is intended to be a psychoeducational group experience with the aim of
knowledge enhancement (Kenny, 2009). The first set of lessons focuses on
general safety skills (i.e. gun safety, fire safety) while the second set focuses on
CSA and personal safety skills. Each lesson reviewed previous material learned,
taught new material, and provided opportunities for practice of the skill
(Niemann, 2002). A review by Kenny (2009) found the program resulted in
increased CSA knowledge and protective skills, following the training.

Future program and research recommendations

The programs described above have many strengths including increased
personal safety skills, child sexual abuse knowledge, and communication.
Although these strengths have led to substantial reduction in risk,
a number of gaps in the current programs are also evident. First and fore-
most, it is recommended to start providing CSA victimization prevention
programs to children as early as possible. The more the child is exposed to
this topic, the better armed the child will be with the skills to keep them safe.
Some recommendations for the development of educational programs
include focus on skills training and provide sufficient time to practice these
skills (Rispens et al., 1997; Smothers & Smothers, 2011; Wurtele & Owens,
1997), avoidance of abstract concepts (Smothers & Smothers, 2011; Wurtele
& Owens, 1997), and requiring multiple repetitions of the program (Rispens
et al., 1997; Wurtele & Kenny, 2010; Wurtele & Owens, 1997). Due to the
tendency of young children to be forgetful of what they have learned,
information must be presented in a manner that stimulates the young
minds (Kenny, 2009; Wurtele & Owens, 1997), models desired behaviors
(Kopp & Miltenberger, 2009; Wurtele et al., 1987), and provides opportu-
nities for repeated learning (Rispens et al., 1997; Smothers & Smothers, 2011;
Wurtele et al., 1987; Wurtele & Owens, 1997). The most effective programs
are those that meet more than one time (Kenny, 2009; Kraizer, 1996).
Knowledge and awareness of SA increases the child’s efficacy in reporting
inappropriate advances (Kenny, 2009). As such, it has been highly recom-
mended to include parents in SA education (Elrod & Rubin, 1993; Kopp &
8 M. MANHEIM ET AL.

Miltenberger, 2009; Wurtele & Miller-Perrin, 1992), to encourage

a continuous reinforcement of the concepts at home (Boyle & Lutzker,
2005; Deblinger, Stauffer, & Steer, 2001; Wurtele & Miller-Perrin, 1992).
It is equally important to use an empirically validated program. This
way everyone involved in the prevention process is learning the scientifi-
cally correct material, and all primary adults in the child’s life are on the
same page. Surveys from offenders, parents, and teachers reveal that
teachers are the least knowledgeable and educated about CSA (Renk,
Liljequist, Steinberg, Bosco, & Phares, 2002). To be effective, these pro-
grams should be integrated in the school-based curriculum, and parents
must be a part of the training process (Boyle & Lutzker, 2005; Finkelhor &
Daro, 1997) included as part of the actual training (i.e. practicing protec-
tive skills at home with the child), and receiving the education and
training themselves. Results from Wurtele, Kast, and Melzer (1992) show
that in certain key areas (i.e. recognizing inappropriate touch requests)
children showed greater gains when taught by parents than when taught by
teachers. Most importantly, the program needs to be evaluated empirically
if we want to see any hope of a change. Without empirically evaluating
these programs, schools may be wasting valuable resources, and families
could be wasting precious time. When creating CSA victimization preven-
tion programs, it is important to take note of who is training the children.
Occupation of the program leader is hypothesized to have an effect on the
effectiveness of the program (Finkelhor, Asdigian, & Dziuba-Leatherman,
1995; Smothers & Smothers, 2011). With the amount of time children
spend at school, teachers are significant adults in the lives of children, and
their relationship to the child has the potential to be protective or aversive.
A study by Barron and Topping (2010) found that presenters with high
levels of CSA knowledge and use of child-centered communication were
more successful in facilitating disclosures than teachers who were more
direct in their communication styles. Future research should examine
differences in results of training when completed by teachers versus some-
one more skilled in the training, but unknown to the children, such as
a school counselor, clinical psychologist, social worker, or child advocate.
Research has shown that when children are educated regarding CSA
concepts, reports of incidents do increase (Finkelhor & Strapko, 1992;
Wurtele & Kenny, 2010). Despite this knowledge, research is needed to
determine if these prevention efforts are reducing amounts of victimization
(Anderson et al., 2004). Future research should aim to evaluate the impact
these CSA victimization prevention programs have on incidence of child
sexual abuse. Due to the lasting psychological effects of CSA, its reduction
should be a public health priority for the benefit of not only our children, but
the health of society.
 JOURNAL OF CHILD SEXUAL ABUSE 9

Acknowledgments
All authors would like to acknowledge Eleanor McGlinchey, Ph.D., for her devotion as an
instructor and clinician. It is through her course and guidance that the idea for this manu-
script came to be. We thank you, Dr. McGlinchey, for your continued support.

Disclosure of Interest
All authors declare that they have no conflicts to report.

Ethical Standards and Informed Consent

Due to the nature of a review article, no informed consent was needed.

Notes on contributors
Megan Manheim, B.A., is a doctoral student in clinical psychology with an emphasis in
forensic psychology at Fairleigh Dickinson University in Teaneck, New Jersey.
Richard Felicetti, B.A., is a doctoral student in clinical psychology at Fairleigh Dickinson
University in Teaneck, New Jersey.

Gillian Moloney, B.A., is a doctoral student in clinical psychology at Fairleigh Dickinson

University in Teaneck, New Jersey.

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