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Child Sexual Abuse Victimization Prevention Programs in Preschool and Kindergarten: Implications For Practice
Child Sexual Abuse Victimization Prevention Programs in Preschool and Kindergarten: Implications For Practice
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
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:
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.
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.
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.
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.
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