Proximate effects of a child sexual abuse prevention program in elementary school children

Engaging Parents in Child-Focused Child Sexual Abuse Prevention Education Strategies: A Systematic Review

Parents are their children's first teachers and there are long-standing calls for their involvement in child sexual abuse prevention. In this rapid systematic review, we asked the following questions: what rationales are used to justify parental involvement in child-focused child sexual abuse (CSA) prevention programs? what approaches are used for parental engagement in child-focused CSA prevention programs? and what are the facilitators and barriers to parental involvement in child-focused CSA prevention programs? We searched CINAHL, Cochrane, ERIC, Medline, PsycInfo, Scopus, and SocINDEX in May 2021. A total of 57 papers met our inclusion criteria, comprised of 50 empirical studies, and 7 program descriptions. Rationales for parental involvement included monitoring and shaping parental attitudes toward CSA program delivery in schools; reinforcing children's learning at home; promoting parent-child communication about CSA prevention; building parent capacity to respond to child disclosures; and supporting program delivery for preschoolers. Types of parental involvement included the following: communication, learning at home, volunteering, decision-making, and collaboration with the community. Barriers to parent involvement included ineffective program engagement modalities, and parental fears and misconceptions.

Enhancing Child Sexual Abuse Prevention Knowledge With an Educational Toolkit -Evaluation of the Chinese Doll Program

Objective: In countries with conservative attitudes towards sex and limited resources to prevent child sexual abuse, culturally adapted CSA prevention programs are essential. This study outlines a randomized controlled trial evaluating the effectiveness of the Doll program for preventing CSA in the specific context of China. Method: 181 children were pre-tested and post-tested (5 weeks later) for knowledge of sexual abuse prevention. Children were assigned to one of three groups; 1) child only (n = 60); 2) child and parent (n = 60); and 3) control (n = 61). Results: Children in groups 1 and 2 showed significant increases (p < 0.001) in scores on the Appropriate Touch Scale (ATS) and the Inappropriate Touch Scale (ITS), whereas those in the control group did not show a significant increase in ATS scores, but their scores on ITS significantly increased (p < 0.001). Children in group 2 showed significantly increased ITS scores compared to group 1 (p = 0.016). Conclusion: Doll program effectively enhances children's CSA prevention knowledge, with parental engagement demonstrating a positive impact on the program.

Association between emotional abuse and depressive symptoms in Chinese children: The mediating role of emotion regulation

BACKGROUND

Emotional abuse has been identified as a risk factor for children's depressive symptoms. However, the specific psychological mechanisms mediating this relation are not well understood.

OBJECTIVE

This longitudinal study examined the relation of emotional abuse to subsequent depressive symptoms and the possible mediating role of emotion regulation among Chinese children.

PARTICIPANTS AND SETTING

The sample included 3633 children (45.5 % girls) with an average age of 9.96 years from a large city in southern China.

METHOD

Participants completed multiple measurements of emotional abuse, emotion regulation, and depressive symptoms on five occasions at six-month intervals, controlling for sex, age, and physical abuse and emotional neglect at Time 1. Latent growth curve modeling was applied to examine the longitudinal relations among the variables.

RESULTS

Results showed (a) emotional abuse was significantly positively associated with subsequent depressive symptoms; (b) cognitive reappraisal mediated the relation between emotional abuse and depressive symptoms, but expressive suppression did not.

CONCLUSIONS

The results highlighted the mediating role of cognitive reappraisal in the relation between emotional abuse and depressive symptoms, suggesting that intervention programs targeting cognitive reappraisal may be effective to reduce the likelihood of depressive symptoms among Chinese children.

Knowledge, Skills, and Self-Disclosure Following a Sexual Abuse Prevention Program Among Iranian Preschoolers: A Cluster Quasi-Experimental Controlled Study

Standard empirical studies are needed despite three decades of research on child sexual abuse prevention programs (CSAPPs). This study aimed to investigate the effects of CSAPP on the child's sexual safety. A multicenter, random cluster, quasi-experimental controlled survey was conducted in a 1:1 ratio in Tehran, Iran, from May to December 2019 in seventy 5- to 6-years-old children from 10 kindergartens. In groups of 7 to 8, the intervention group participated in four sessions of 45 minutes of face-to-face sexual self-care training, 3 to 4 days apart. The control groups received one session on accident safety. Knowledge, self-protective skills, fear, and self-disclosure were assessed respectively by the "Personal Safety Questionnaire (PSQ)," "What If Situation Test (WIST)," "Fear Assessment Thermometer Scale (FATS)," and researcher-made questions before and 8 weeks after the intervention. At the baseline, children obtained 70% of knowledge and 45% of protective skills scores. After the intervention, knowledge, protective skills, and detection of "appropriate requests" were significantly promoted (p < .001). Detecting "inappropriate requests" did not differ; however, all quadruple skills (Say, Do, Tell, and Report) improved significantly. "Girl sex" and "parents' education" were related factors promoting children's protective skills. Sexual abuse self-disclosure was 4.2% (n = 3), and one child reported child sexual abuse (CSA) only after the intervention. Despite the lack of formal education, children's basic knowledge reflects the importance of parents in preventing CSA. However, the CSAPP significantly improved children's skills and revealed one CSA case. CSAPP should not focus solely on risky scenarios because if children cannot distinguish between safe and unsafe situations, they will experience unnecessary anxiety. Even after recognizing the dangerous conditions, CSA prevention will practically fail without appropriate reactions such as escaping and reporting. CSAPP should emphasize individual rights such as body ownership and assertiveness skills and explain the "danger of known people" with detailed scenarios, especially in collectivistic and traditional societies.

Facilitators and Barriers to Child Sexual Abuse Interventions: A Qualitative Study of Interventions in Iran

Background: Child sexual abuse is a public health problem in most countries. Sensitization, research, and programs for identifying and preventing child sexual abuse have been carried out at the national level with increased political and social awareness and international commitments to decline its consequences. Objectives: This study investigated the facilitators and barriers to community-based interventions for child sexual abuse. Methods: Semi-structured interviews were conducted between September 2021 and March 2022 with 15 purposefully selected experts. The interviews were audio-recorded, transcribed, and analyzed using the content analysis method. Results: Several barriers and facilitators affected child sexual abuse interventions. The barriers included: (1) sociocultural challenges; (2) legal challenges and gaps; and (3) managerial-structural challenges, while the facilitators were: (1) the improvement of the quality of provided services; and (2) facilitative role of the law. Conclusions: Social interventions for child sexual abuse could consider some items to improve implementation, namely as follow: (1) the intersectional cooperation of organizations and beneficiaries to conduct child abuse interventions for children and their families at the local and national levels; (2) the implementation of empowerment activities for the return of children and parents to the community after child sexual abuse; and (3) the revision of the laws and establishment of more deterrent punishments.

Child sexual abuse prevention involving mothers: A Quasi-experimental study with Protection Motivation Theory-based intervention

Child sexual abuse (CSA) is a worldwide problem. The safety of children is everybody's responsibility. Parental and family involvement is crucial in the CSA prevention process. Parental lack of knowledge may increase the risk of abuse among children. Educating parents is crucial as children are mostly dependent on them. The role of mothers in educating children on CSA is of relevance as they are identified as more sensitive and responsible caregivers. The present study aimed to promote knowledge and attitude towards CSA prevention among mothers through a psychoeducation program. A pre- and posttest design (n = 67) was used with an intervention based on Protection Motivation Theory (PMT). A CSA knowledge and attitude scale was developed for the assessment of the participants for the study. There were significant changes in knowledge and attitude among the participants after the intervention. The prevention of CSA will be effective with knowledge gains after the PMT-based intervention. The intervention programs that involve mothers in CSA education have benefits. The findings of this study can be helpful to incorporate public health approaches to devise evidence-based parental programs in community settings.

An Evaluation of the "I am Learning to Protect Myself with Mika" Program Using the "What If" Situations Test

Despite the recent development of a plethora of child sexual abuse prevention programs in recent years, few studies have attempted to evaluate their effectiveness using a standardized measure. Therefore, we attempted to test the effectiveness of the "I am learning to protect myself with Mika" program using a valid and reliable tool: the "What If" Situations Test (WIST). Eighty-one preschool children and their parents and teachers participated in this study. Ultimately, we compared the data of 43 children (M =  66.78, SD =  8.84) in the intervention group and 38 children (M =  69.28, SD =  6.78) in the wait-list group. The findings revealed that the intervention group had increased knowledge of inappropriate touching recognition and personal safety. The say, tell, report, and WIST total skill scores also increased in the intervention group. These findings are promising and may pave the way for disseminating the program in Turkish preschools.

Mothers Attitudes Toward Child Sexual Abuse Prevention in Schools: A Preliminary Examination

Providing school-based child sexual abuse (CSA) prevention programs ensures that the majority of children will participate in programming. Since many parents may feel ill equipped to have such discussions with their children, programs offered in education settings can bring awareness to this issue. A sample of mothers (N = 268) from across the United States completed an online survey related to their experiences with and attitudes toward school-based CSA prevention programs. Most mothers (70%) had no exposure to prevention programs during their childhood, but the majority (95%) had a positive attitude toward programming for their children. Most mothers believed that offering CSA prevention in schools was important and could provide a safety net. Mothers desired programming that was age appropriate, involved parents and was activity based. These results can help inform schools' prevention programming.

"I am Learning to Protect Myself with Mika:" A Teacher-based Child Sexual Abuse Prevention Program in Turkey

This study aimed to explore the effectiveness of a teacher-based child sexual abuse prevention program entitled "I am learning to protect myself with Mika." The sample consisted of 290 children, their parents, and their classroom teachers. The participants were randomly assigned to intervention (n = 137) or wait-list comparison groups (n = 153) by classroom. The age of the children ranged from 46 to 71 months (M = 58.99, SD = 6.64). The prevention program was a 5-week program that consisted of five modules, including emotional awareness, good touch-bad touch, and body safety rules. To investigate the effectiveness of the prevention program, a latent Markov analysis was conducted. A three-class solution was identified as the best model: Status-1 (self-protecting group), Status-2 (risky secret keepers), and Status-3 (risk group). Following the intervention, members of the two at-risk groups (Statuses 2 and 3) were more likely to move into the Status-1 group than were those participants who had not received the intervention (wait-list comparison). Self-protection skills were analyzed using a 2 × 2 ANOVA with repeated measures. The increase in self-protection skills was greater for participants in the intervention group than for those in the wait-list comparison group from pre-test to post-test. Two-month follow-up analysis showed that gain in knowledge and skills was maintained. This program should be considered as a potential approach to meeting the need for child sexual abuse preventive efforts in Turkish preschool curriculum.

Child Safety Matters: Randomized Control Trial of a School-Based, Child Victimization Prevention Curriculum

Recognizing the potential of classrooms as a context for identifying and addressing child victimization, several U.S. states now mandate the inclusion of child abuse prevention in school curricula. There are, however, a limited number of evidence-based and developmentally appropriate curricula designed for elementary. This study utilized a randomized control trial (RCT) design to evaluate the knowledge acquisition of children who received the Monique Burr Foundation's Child Safety Matters curriculum, a program designed to educate kindergarten to Grade 5 children about bullying, cyberbullying, four types of abuse (physical, sexual, emotional, and neglect), and digital dangers. Participants included 1,176 students from 72 classrooms in 12 Florida schools across eight counties. Schools were matched in pairs and randomly assigned to receive the program or be in a wait-list control. Knowledge was assessed with a questionnaire administered prior to the curriculum (T1) as well as approximately 3 weeks (T2) and approximately 7 months (T3) after implementation. Analyses were conducted with class means examining grade, treatment condition, and time. The interaction of treatment and time was significant, F(2, 90) = 17.024, p < .000. Children who received the curriculum increased their knowledge about potentially risky situations, and this knowledge was sustained over 7 months to the follow-up assessment. Children in the control schools did not have similar gains. The current classroom-based child maltreatment prevention education is a promising strategy to address children's vulnerability to abuse and its consequences.

Effective Components of School-Based Prevention Programs for Child Abuse: A Meta-Analytic Review

School-based programs seem promising for child abuse prevention. However, research mainly focused on sexual child abuse and knowledge is lacking on how individual program components contribute to the effectiveness of school-based prevention programs for any form of child abuse. This study aimed to examine the overall effect of these school-based programs on (a) children’s child abuse-related knowledge and (b) self-protection skills by conducting two three-level meta-analyses. Furthermore, moderator analyses were performed to identify how program components and delivery techniques were associated with effectiveness. A literature search yielded 34 studies (158 effect sizes; N = 11,798) examining knowledge of child abuse and 22 studies (99 effect sizes; N = 7804) examining self-protection skills. A significant overall effect was found of school-based programs on both knowledge (d = 0.572, 95% CI [0.408, 0.737], p < 0.001) and self-protection skills (d = 0.528, 95% CI [0.262, 0.794], p < 0.001). The results of the first meta-analysis on children’s child abuse knowledge suggest that program effects were larger in programs addressing social–emotional skills of children (d = 0.909 for programs with this component versus d = 0.489 for programs without this component) and self-blame (d = 0.776 versus d = 0.412), and when puppets (d = 1.096 versus d = 0.500) and games or quizzes (d = 0.966 versus d = 0.494) were used. The second meta-analysis on children’s self-protections skills revealed that no individual components or techniques were associated with increased effectiveness. Several other study and program characteristics did moderate the overall effects and are discussed. In general, school-based prevention programs show positive effects on both knowledge and self-protection skills, and the results imply that program effectiveness can be improved by implementing specific components and techniques.

The effect of preventive psychosocial interventions directed towards mothers and children on children's knowledge about protection from sexual abuse

PROBLEM

Sexual abuse is a multidimensional public health problem that concerns all communities. Primary-level preventive approaches in the fight against sexual abuse have an important place. However, research involving parents in sexual abuse prevention interventions with children is limited. The aim of this study is to determine the effect of preventive psychosocial interventions directed towards mothers and their children on children's knowledge about protection from sexual abuse.

METHODS

The study has a quasi-experimental, comparative design with a control group and a pretest/posttest. The participants were assigned into four groups; namely, control, mother psychoeducation, child psychoeducation and mother-child psychoeducation.

FINDINGS

Significant difference was determined within and between the groups in the mean scores of the Good Touch Bad Touch Curriculum test (p < 0.001).

CONCLUSION

The preventive psychosocial intervention simplemented to mothers and their children increase children's knowledge about protection from sexual abuse.

Interventions that address institutional child maltreatment: An evidence and gap map

Background

Child maltreatment has serious short and long-term negative impacts for those experiencing it. Child maltreatment occurring in institutional settings has recently received substantial attention. However, evidence about the effectiveness of interventions that prevent, disclose, respond to, or treat maltreatment that has occurred in these environments is fragmented and can be difficult to access. This evidence and gap map (EGM) collates this research evidence. It was developed as a resource for stakeholders operating in the child health, welfare and protection sectors, including practitioners, organisational leaders, policy developers and researchers, wanting to access high quality evidence on interventions addressing institutional child maltreatment.

Objectives

The objectives of this EGM were twofold: (a) To provide a structured and accessible collection of existing evidence from finalised and ongoing overviews of systematic reviews, systematic reviews and effectiveness studies of interventions addressing institutional child maltreatment-for those who work to fund, develop, implement and evaluate interventions aimed at ensuring children's safety in institutional settings; (b) to identify gaps in the available evidence on interventions addressing institutional child maltreatment-thereby helping to inform the research agendas of funders and other organisations.

Search Methods

A comprehensive search strategy identified relevant studies from published and grey literature, comprising: (1) 10 electronic academic databases; (2) five trial and systematic review registries; (3) nine organisational websites; (4) websites and reference lists of inquiry reports associated with seven international inquiries into child abuse and (4) the lists of included studies within systematic reviews identified by the search strategy. Members of this EGM's Subject Matter Experts group were also invited to forward relevant unpublished studies or grey literature.

Selection Criteria

The selection criteria were developed to identify finalised and ongoing overviews of reviews, systematic reviews and primary studies that reported on the effectiveness of interventions addressing child maltreatment (including sexual abuse, physical abuse, neglect and emotional abuse) within institutional settings. Eligible effectiveness study designs included: randomised controlled trials (RCTs), nonrandomised trials, controlled before-and-after studies and quasi-experimental studies. Reviews were eligible if they reported a systematic literature search strategy.

Data Collection and Analysis

All screening, data extraction, coding and critical appraisals were undertaken by two or more reviewers working independently, with discrepancies resolved via consensus or by a third reviewer. The titles and abstracts of studies identified by the search strategy were screened, and each full text of potentially relevant studies was further assessed for inclusion. Key data were extracted from all included studies and reviews. This included information about: publication details (e.g., year, author, country), inclusion/exclusion criteria (for reviews), study design, institutional setting, target population, type of maltreatment, intervention type and outcomes. Critical appraisal of included systematic reviews was achieved using the AMSTAR 2 tool, and completed RCTs were assessed using the updated Cochrane Risk of Bias 2.0 tool.

Main Results

Number of studies The electronic database search yielded 6318 citations, and a further 2375 records were identified from additional sources. Following deduplication and title/abstract screening, 256 studies remained for full text review. A total of 73 eligible studies (reported across 84 publications) met the inclusion criteria, including: 11 systematic reviews (plus, one update); 62 primary studies (including, three protocols for primary studies). Study characteristics The studies were conducted across 18 countries, however more than half (52%) were undertaken in the United States. Overall, most studies evaluated curriculum-based interventions delivered in educational settings, primarily aimed at the prevention of sexual abuse. Institutional setting: Most studies evaluated interventions in school or early learning environments (n = 8 systematic reviews; n = 58 primary studies). Far fewer studies examined other organisational settings. Out of home care (including foster care, residential care and orphanages), and social service organisations servicing children were minimally represented. No studies were identified where the primary setting was sports clubs, churches/religious organisations, summer/vacation camps, detention centres/juvenile justice settings, or primary/secondary health care facilities. Target population: Most interventions targeted children rather than adults (n = 7 systematic reviews; n = 47 primary studies) from the general population. Fewer studies included populations known to be at an increased risk, or those already exposed to maltreatment. Just over a third of the primary studies conducted an analysis to ascertain differences in the effect of an intervention between the genders. Intervention type: Prevention interventions were the most studied (n = 5 systematic reviews; n = 57 primary studies), with additional studies including prevention approaches alongside other intervention types. Fewer studies evaluated interventions targeting disclosure, institutional responses, or treatment interventions. Type of maltreatment: The vast majority of the studies assessed interventions solely addressing the sexual abuse of children (n = 8 systematic reviews; n = 45 primary studies). The remaining studies addressed other forms of maltreatment, including physical and emotional abuse, or neglect, either in combination or as a sole focus. Outcomes: Primary reported outcomes reflected the bias toward child targeted interventions. Outcome measures captured child wellbeing and knowledge outcomes, including measures of mental health, children's knowledge retention and/or self-protective skills. Measures of maltreatment disclosure or maltreatment occurrence/reoccurrence were less common, and all other outcome categories included in the EGM were minimally or not reported. A third of studies reported on some measure of implementation. Study quality The overall quality of the studies was low to moderate. Most systematic reviews were low-quality (n = 10), with only one high quality review (and update) identified. Most completed RCTs had some concerns relating to the risk of bias (n = 30), and the remainder were considered to be at a high risk of bias (n = 19).

Authors' Conclusions

This EGM has highlighted a substantial need for more high quality studies that evaluate interventions across a broader range of institutional contexts and maltreatment types. The current evidence base does not represent countries with large populations and the greatest incidence of child maltreatment. Few studies focussed on perpetrators or the organisational environment. Further evidence gaps were identified for interventions relating to disclosure, organisational responses and treatment, and few studies assessed interventions targeting perpetrators' maltreatment behaviours, recidivism or desistence. Future studies should also include measure of programme implementation.

Children's Knowledge of Abuse Questionnaires (CKAQ)-Short: Two Brief Ten-Item Measures of Knowledge about Child Sexual Abuse Concepts

Child-focused sexual abuse prevention programs were developed in the 1970s in response to significant concerns across North America with respect to children being sexually abused. While program evaluations are common, measures to evaluate these programs, most of which are offered to children in elementary schools, are not widely available. This article reviews the key concepts covered in CSA prevention education programs that comprise the constructs used to measure knowledge/attitude gains post-program. Available measures are reviewed and the psychometrics of two new 10-item versions (one for students in grades 1-2; the other for grades 3-6) of the CKAQ-33, a commonly used tool, are presented and psychometrically assessed with a sample of 7646 elementary school students.

School and program related factors influencing disclosure among children participating in a school-based childhood physical and sexual abuse prevention program

BACKGROUND

School-based child abuse prevention programs were created to provide knowledge so that children can recognize abuse, teach skills that decrease children's risk for abuse, normalize the disclosure process, and provide a pathway for children who may be experiencing abuse to report the abuse.

OBJECTIVE

The purpose of this study was to explore school and program factors that trainers in a school-based prevention program believed were associated with disclosure among youth from kindergarten through 12th grade.

PARTICIPANTS AND SETTING

This study is based on eighteen trainers and administrators who work with the Play it Safe!® school-based program in Dallas-Fort Worth area.

METHODS

Using the qualitative case study method, in-depth interviews were conducted.

RESULTS

Data analysis revealed three factors that influenced disclosure: school, school personnel, and program features. The school-related factor was time allotted to the training. The school personnel-related factors were disengagement, ambiguity concerning abuse, prior history with children, and professionals' personal history of abuse. Finally, the program-related factors were the core messages of the training, providing specific examples, and repetition of the program. To date, there is a dearth of studies that explore the role that schools and school personnel play in the disclosure process.

CONCLUSION

Child abuse has devastating effects on children's physical, social, emotional, and psychological well-being. Understanding more about schools, personnel, and program-related factors that lead to disclosure, which are more amenable to change, is critical to ensuring the safety of children.

Adaptation and Psychometric Evaluation of the Children's Knowledge of Abuse Questionnaire (CKAQ-RIII) in Greek Elementary School Children

The purpose of the present study was to culturally adapt and validate the Children's Knowledge of Abuse Questionnaire-RIII (CKAQ-RIII), a tool that examines children's understanding of sexual abuse concepts, for use in Greek elementary schools. A sample of 467 Greek school children between the ages of 6-9 was recruited from a private school. The CKAQ-RIII was administrated three times, before and immediately after a Child Sexual Abuse (CSA) prevention intervention program, as well as during a one-year follow-up evaluation. A subsample of the original population (N = 113) completed the one year follow up administration of CKAQ-RIII, along with the Body Awareness (BA) and the Emotional Differentiation (ED) subscales of the Emotion Awareness Questionnaire (EAQ). Internal consistency was high for the inappropriate touch scale (ITS) of the CKAQ-RIII and moderate for the appropriate touch subscale (ATS). Inter-item analysis showed that the majority of items were in an acceptable range. Pearson correlation coefficients analyses revealed strong associations between the two subscales of ITS and ATS, and the overall scores of the questionnaire. A mixed-subjects analysis of variance on the ITS showed an increase in knowledge post intervention, with third graders (8-9 year olds) generally scoring higher at baseline and demonstrating greater knowledge gains post intervention. A mixed-subjects analysis of variance was also conducted for the ATS where no significant increase in knowledge was found. Furthermore, analysis revealed a good concurrent criterion validity with good levels of agreement between CKAQ-RIII and ED, whereas no relationship was established between CKAQ-RIII and BA.

Fidelity in school-based child sexual abuse prevention programs: A systematic review

The aim of this study was to systematically review and evaluate the quality of the school-based child sexual abuse prevention education research in terms of implementation fidelity. A comprehensive literature search in PsycINFO, Medline, Education Resource Information Centre (ERIC) and the Cochrane Central Register of Controlled Trials was conducted. Articles included peer-reviewed, primary research studies related to the delivery of child sexual abuse prevention education programs within school settings published since 1996. In total, 3993 articles were identified and screened by two raters. Of those, 17 articles met the inclusion criteria. Implementation fidelity quality was assessed across the domains of: Intervention Design, Training Providers, Intervention Delivery, Intervention Receipt and Enactment of Skills, using the National Institute of Health Behavioral Change Consortium (NIHBCC) Fidelity Checklist. No study was identified as achieving high fidelity. Five studies (29%) reported including measures or processes to monitor implementation fidelity. There is an opportunity to improve the reporting of implementation fidelity related information within the school-based child sexual abuse prevention literature. This will allow more meaningful interpretations of treatment effects and increase confidence that changes attributed to the intervention are due to the intervention itself. Recommendations for such improvements are provided.

Edutainment as a Strategy for Parental Discussion With Israeli Children: The Potential of a Children's Play in Preventing Sexual Abuse

Edutainment is a communication strategy to influence attitudes and behaviors through the use of the media. Through the children's play "Yael Learns to Take Care of Her Body," designed for joint viewing by children aged 5-8 and their parents, sexual abuse is raised. This qualitative study findings indicate that parents from low socioeconomic subgroups from the secular sector reported that their awareness had been raised by viewing the play and that they received tools for holding a conversation. Conversely, parents from high socioeconomic subgroups in the secular sector and parents from the national-religious sector were more ambivalent regarding the play's effectiveness. In order to make the conversation meaningful, the play has to tailor different messages to different audiences. A single program is not enough but should be part of a series of customized intervention programs for different subpopulations and separate programs for parents and children accompanied by professionals.

An Investigation of Socially Advantaged and Disadvantaged Turkish Mothers' Views About Training on Preventing Children From Sexual Abuse

This study aims to investigate the views of socially advantaged (N = 8) and disadvantaged mothers (N = 8) whose children are aged between 48 and 66 months old about the issue of sexual abuse before and after the training provided to them. The views of mothers in both groups were investigated before and after the 5-week experience-based training about my body belongs to me, knowing and expressing feelings, good and bad touch, good and bad secrets, knowing how to say no, and help resources. The data were analyzed using content analysis methods. The study showed that the mothers have inaccurate or insufficient information and approaches about preventing sexual abuse. However, short-term training provided to the mothers changed their views, and the mothers in the disadvantaged group gained more awareness. The mothers in both groups stated that sexual abuse prevention trainings should be disseminated in preschool institutions.

Community-level moderators of a school-based childhood sexual assault prevention program

Childhood sexual abuse (CSA) is highly prevalent and associated with a wide variety of negative mental and physical health outcomes. School-based CSA education and prevention programs have shown promise, but it is unclear to what extent community-level characteristics are related to their effectiveness. The present cluster randomized controlled trial evaluated community-level moderators of the Safe@Lastprogramcomparedtoawaitlistcontrolcondition.(*) Knowledge gains from pre- to post-intervention were assessed in 5 domains: safe versus unsafe people; safe choices; problem-solving; clear disclosure; and assertiveness. Participants were 1177 students (46% White, 26% African American, 15% Hispanic, 4% Asian American, 6% Other) in grades 1 through 6 from 14 public schools in Tennessee. Multilevel models accounting for the nesting of children within schools revealed large effect sizes for the intervention versus control across all knowledge domains (d's ranged from 1.56 to 2.13). The effectiveness of the program was moderated by mean per capita income and rates of substantiated cases of child abuse and neglect in the community. Intervention effects were stronger for youth living in lower as compared to higher income counties, and for youth attending schools in counties with lower as compared to higher abuse/neglect rates. Child characteristics (sex, race) did not moderate intervention effects. This research identified two community-level factors that predicted the effectiveness of a CSA education and prevention program designed to improve children's knowledge of personal safety skills. School-based CSA prevention programs may require modification for communities with higher rates of child abuse and neglect.

Acute Sexual Assault in the Pediatric and Adolescent Population

Children and adolescents are at high risk for sexual assault. Early medical and mental health evaluation by professionals with advanced training in sexual victimization is imperative to assure appropriate assessment, forensic evidence collection, and follow-up. Moreover, continued research and outreach programs are needed for the development of preventative strategies that focus on this vulnerable population. In this review we highlight key concepts for assessment and include a discussion of risk factors, disclosure, sequelae, follow-up, and prevention.

What Works to Reduce Victimization? Synthesizing What We Know and Where to Go From Here

While some attention has been paid to "what works" to reduce crime, little is known about the effectiveness of programs designed to reduce victimization. This study systematically reviews 83 program evaluations to identify what works to (a) reduce victimization, (b) enhance beliefs/attitudes about victims, and (c) improve knowledge/awareness of victimization issues. Evidence-based findings are organized around 4 major forms of victimization, including bullying, intimate partner violence, sexual abuse, and other general forms of victimization. Determining whether certain types of programs can reduce the risk of victimization has important implications for improving people's quality of life. Based on our findings, we offer several promising directions for the next generation of research on evaluating victimization programs. The goal of this study is to improve the strength of future program evaluations, replications, and other systematic reviews as researchers and practitioners continue to learn what works to reduce victimization.

Empowering and protecting children by enhancing knowledge, skills and well-being: A randomized trial of Learn to BE SAFE with Emmy

Australia needs effective programs to protect children and prevent abuse, but there is little information available for policymakers or families. Using a randomized controlled trial, Learn to BE SAFE with Emmy, a school-based protection program for young children designed by Act for Kids, was evaluated to determine its effectiveness for promoting young children's knowledge and skills. Grade one children (n=245) from 15 classrooms across 5 primary schools completed assessment measures. A subset of these children received the program (n=131) or acted as a comparison group (n=114). Parents (n=72) completed questionnaires about their child's participation in the program. When compared with children who had not received the program, children who completed Learn to BE SAFE with Emmy demonstrated increased knowledge of interpersonal safety and were more likely to choose a safe response option to hypothetical unsafe scenarios 6 months after participation than at both pre- and post-intervention. Parents reported their children who participated used more safety strategies immediately and 6 months after participation compared to pre-intervention. Outcomes can assist in guiding future policies around the prevention of child abuse and protect the well-being of Australian children.

"As Time Went On, I Just Forgot About It": Thematic Analysis of Spontaneous Disclosures of Recovered Memories of Childhood Sexual Abuse

This study was a thematic analysis of transcripts of interviews of child sexual abuse survivors discussing their experiences of recovered memories. This study included 27 English-speaking participants from 3 major Canadian cities: Montreal, Toronto, and Ottawa. Seven participants identified as male and 20 as female. Participants ranged in age from 31 to 69 with a mean age of 47. The educational background of participants ranged from 9th grade to doctoral levels. Out of the sample of 27, 21 participants reported some period of amnesia for their CSA experiences. Three primary global themes emerged in the transcripts of participants describing adult emergent recovered memories: flashbacks, triggers, and denial. Three global themes emerged in the transcripts of participants describing partially discontinuous memories: dreams/nightmares as the "how" of memory recovery, triggers, and active processes of forgetting.

Knowledge Gains Following a Child Sexual Abuse Prevention Program Among Urban Students: A Cluster-Randomized Evaluation

OBJECTIVES

We evaluated a school-based child sexual abuse (CSA) prevention program, Safe Touches, in a low-socioeconomic status, racially diverse sample.

METHODS

Participants were 492 second- and third-grade students at 6 public elementary schools in New York City. The study period spanned fall 2012 through summer 2014. We cluster-randomized classrooms to the Safe Touches intervention or control groups and assessed outcomes with the Children's Knowledge of Abuse Questionnaire. Hierarchical models tested change in children's knowledge of inappropriate and appropriate touch.

RESULTS

The intervention group showed significantly greater improvement than the control group on knowledge of inappropriate touch. Children in second grade and children in schools with a greater proportion of students in general (vs special) education showed greater gains than other participants in knowledge of inappropriate touch. We observed no significant change in knowledge of appropriate touch among control or intervention groups.

CONCLUSIONS

Young children benefited from a school-based, 1-time CSA prevention program. Future research should explore the efficacy of CSA prevention programs with children before the second grade to determine optimal age for participation.

School-based education programmes for the prevention of child sexual abuse

BACKGROUND

Child sexual abuse is a significant global problem in both magnitude and sequelae. The most widely used primary prevention strategy has been the provision of school-based education programmes. Although programmes have been taught in schools since the 1980s, their effectiveness requires ongoing scrutiny.

OBJECTIVES

To systematically assess evidence of the effectiveness of school-based education programmes for the prevention of child sexual abuse. Specifically, to assess whether: programmes are effective in improving students' protective behaviours and knowledge about sexual abuse prevention; behaviours and skills are retained over time; and participation results in disclosures of sexual abuse, produces harms, or both.

SEARCH METHODS

In September 2014, we searched CENTRAL, Ovid MEDLINE, EMBASE and 11 other databases. We also searched two trials registers and screened the reference lists of previous reviews for additional trials.

SELECTION CRITERIA

We selected randomised controlled trials (RCTs), cluster-RCTs, and quasi-RCTs of school-based education interventions for the prevention of child sexual abuse compared with another intervention or no intervention.

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed the eligibility of trials for inclusion, extracted data, and assessed risk of bias. We summarised data for six outcomes: protective behaviours; knowledge of sexual abuse or sexual abuse prevention concepts; retention of protective behaviours over time; retention of knowledge over time; harm; and disclosures of sexual abuse.

MAIN RESULTS

This is an update of a Cochrane Review that included 15 trials (up to August 2006). We identified 10 additional trials for the period to September 2014. We excluded one trial from the original review. Therefore, this update includes a total of 24 trials (5802 participants). We conducted several meta-analyses. More than half of the trials in each meta-analysis contained unit of analysis errors.1. Meta-analysis of two trials (n = 102) evaluating protective behaviours favoured intervention (odds ratio (OR) 5.71, 95% confidence interval (CI) 1.98 to 16.51), with borderline low to moderate heterogeneity (Chi² = 1.37, df = 1, P value = 0.24, I² = 27%, Tau² = 0.16). The results did not change when we made adjustments using intraclass correlation coefficients (ICCs) to correct errors made in studies where data were analysed without accounting for the clustering of students in classes or schools.2. Meta-analysis of 18 trials (n = 4657) evaluating questionnaire-based knowledge favoured intervention (standardised mean difference (SMD) 0.61, 95% CI 0.45 to 0.78), but there was substantial heterogeneity (Chi² = 104.76, df = 17, P value < 0.00001, I² = 84%, Tau² = 0.10). The results did not change when adjusted for clustering (ICC: 0.1 SMD 0.66, 95% CI 0.51 to 0.81; ICC: 0.2 SMD 0.63, 95% CI 0.50 to 0.77).3. Meta-analysis of 11 trials (n =1688) evaluating vignette-based knowledge favoured intervention (SMD 0.45, 95% CI 0.24 to 0.65), but there was substantial heterogeneity (Chi² = 34.25, df = 10, P value < 0.0002, I² = 71%, Tau² = 0.08). The results did not change when adjusted for clustering (ICC: 0.1 SMD 0.53, 95% CI 0.32 to 0.74; ICC: 0.2 SMD 0.60, 95% CI 0.31 to 0.89).4. We included four trials in the meta-analysis for retention of knowledge over time. The effect of intervention seemed to persist beyond the immediate assessment (SMD 0.78, 95% CI 0.38 to 1.17; I² = 84%, Tau² = 0.13, P value = 0.0003; n = 956) to six months (SMD 0.69, 95% CI 0.51 to 0.87; I² = 25%; Tau² = 0.01, P value = 0.26; n = 929). The results did not change when adjustments were made using ICCs.5. We included three studies in the meta-analysis for adverse effects (harm) manifesting as child anxiety or fear. The results showed no increase or decrease in anxiety or fear in intervention participants (SMD -0.08, 95% CI -0.22 to 0.07; n = 795) and there was no heterogeneity (I² = 0%, P value = 0.79; n=795). The results did not change when adjustments were made using ICCs.6. We included three studies (n = 1788) in the meta-analysis for disclosure of previous or current sexual abuse. The results favoured intervention (OR 3.56, 95% CI 1.13 to 11.24), with no heterogeneity (I² = 0%, P value = 0.84). However, adjusting for the effect of clustering had the effect of widening the confidence intervals around the OR (ICC: 0.1 OR 3.04, 95% CI 0.75 to 12.33; ICC: 0.2 OR 2.95, 95% CI 0.69 to 12.61).Insufficient information was provided in the included studies to conduct planned subgroup analyses and there were insufficient studies to conduct meaningful analyses.The quality of evidence for all outcomes included in the meta-analyses was moderate owing to unclear risk of selection bias across most studies, high or unclear risk of detection bias across over half of included studies, and high or unclear risk of attrition bias across most studies. The results should be interpreted cautiously.

AUTHORS' CONCLUSIONS

The studies included in this review show evidence of improvements in protective behaviours and knowledge among children exposed to school-based programmes, regardless of the type of programme. The results might have differed had the true ICCs or cluster-adjusted results been available. There is evidence that children's knowledge does not deteriorate over time, although this requires further research with longer-term follow-up. Programme participation does not generate increased or decreased child anxiety or fear, however there is a need for ongoing monitoring of both positive and negative short- and long-term effects. The results show that programme participation may increase the odds of disclosure, however there is a need for more programme evaluations to routinely collect such data. Further investigation of the moderators of programme effects is required along with longitudinal or data linkage studies that can assess actual prevention of child sexual abuse.

School-based child sexual abuse prevention programs: moving toward resiliency-informed evaluation

Although recent years have seen an increase in the range of child sexual abuse prevention programs delivered in schools, there have been relatively few efficacy studies. Those conducted have focused primarily on intrinsic child factors and have often lacked an explicit theoretical framework. We offer resiliency theory as a useful and apposite theoretical framework for program evaluation. Resiliency theory suggests that a wider range of factors should be considered, including intrinsic (personal characteristics) and extrinsic (environmental) factors. Such factors may increase risk or, alternatively, protect children from the negative effects of adversity. We argue that a resiliency perspective to efficacy studies should recognize a long-term view on children's capacity to cope and can employ both standardized and contextual resiliency-informed measures.

School-based childhood sexual abuse prevention programs: an integrative review

One prevention strategy for childhood sexual abuse (CSA) involves educational programs delivered to children in the school environment. The purpose of this integrative literature review was to determine the state of the science on school-based CSA prevention programs. The authors extracted data from 26 articles that fit inclusion criteria to answer research questions on types of programs, methods used to evaluate programs, and program success. Analysis of the extracted data led to the identification of seven categories of teaching learning content. Delivery methods included films, plays, discussion, and role play. Most authors used an untreated or placebo control group pretest/posttest design for evaluation. According to the child outcome measures chosen, the majority of programs were successful. The review also found school nurses rarely involved in these programs. Although not a traditional aspect of their responsibilities, information from this review can help school nurses implement a school-based CSA prevention program.

Listen to the children: kids' impressions of Who Do You Tell ™

School-based programs have been the central strategy to educate children about the serious nature of child sexual abuse in the hope of prevention or early intervention. Virtually all evaluations have been quantitative, seldom allowing children to directly comment on their experiences. This article presents the results of qualitative research with 116 students (51 boys and 65 girls) ranging from age 6 to 12 who had participated in the Who Do You Tell child sexual abuse education program. Ten focus groups were conducted with students in separate grades, from kindergarten through sixth grade, two to three months after program participation. The core themes that emerged from the focus group interviews are presented, as are implications for child sexual abuse prevention programs.

Survivor experience of a child sexual abuse prevention program: a pilot study

Addressing gaps in the research, the current study assesses the impact of a community-based child sexual abuse prevention program on known survivor knowledge/skills, disclosures, and subjective experience. Methodologically, novel measures of program fidelity and implementation cost are applied. A pre- posttest wait-list control design was utilized with intervention (n = 10) and comparison groups (n = 10). Measures included a standardized knowledge/skill questionnaire, coding of disclosures, subjective experience questionnaires, in-depth interviews, video analysis of program adherence, and a measure of cost. Analysis involved nonparametric tests and thematic analysis of interview and video data. Cost was calculated for the group and per survivor. Survivors achieved significant gains in knowledge/skills, made further disclosures, and were positive about their program experience. No gains were identified in the control group. Costs were small. Future studies need to explore survivor experience of programs delivered in classrooms.

Lessons learned from child sexual abuse research: prevalence, outcomes, and preventive strategies

Although child sexual abuse (CSA) is recognized as a serious violation of human well-being and of the law, no community has yet developed mechanisms that ensure that none of their youth will be sexually abused. CSA is, sadly, an international problem of great magnitude that can affect children of all ages, sexes, races, ethnicities, and socioeconomic classes. Upon invitation, this current publication aims at providing a brief overview of a few lessons we have learned from CSA scholarly research as to heighten awareness of mental health professionals on this utmost important and widespread social problem. This overview will focus on the prevalence of CSA, the associated mental health outcomes, and the preventive strategies to prevent CSA from happening in the first place.

Exploratory evaluation of a school-based child sexual abuse prevention program

Internationally, efficacy studies of school-based child sexual abuse prevention programs display a series of methodological shortcomings. Few studies include adolescent participants, recording of disclosures has been inconsistent, and no studies to date have assessed presenter adherence to program protocols or summated the costs of program implementation. A pretest-posttest waitlist control design was used to evaluate the Tweenees program delivered to grade 6 (n = 88) and grade 7/8 students (n = 117) compared to a control (n = 185). Outcome measures included a knowledge/skills questionnaire, systematic coding of disclosures, and video interaction analysis of lessons. Costs were calculated per student, class, and school. Adolescents made small knowledge and skills gains indicating a program ceiling effect. Implementation analysis suggests low levels of adult control facilitated disclosures. Program costs were relatively inexpensive. Recommendations are made for future research.

Evaluation of a personal safety program with Latino preschoolers

This study evaluated a personal safety educational program designed for Latino families attending preschools in a large metropolis. Seventy-eight children who participated in the Kids Learning About Safety program were compared to 45 control children. Compared with controls, participating children demonstrated enhanced ability to recognize inappropriate touches, learned correct genital terminology, were able to recognize the inappropriateness of touch requests made by "good" people, demonstrated higher levels of personal safety skills, and learned general safety rules. Gains in knowledge were maintained at three-month follow-up testing for all content areas except genital terminology. Although feedback provided by participating families was positive, recruiting participants and maintaining attendance at sessions was difficult. Discussion includes recommendations for future research and engagement of this population.

Mother-child communication about sexual abuse prevention

Two hundred and twelve Australian mothers completed an online survey examining features of mother-child communication about child sexual abuse prevention. Two-thirds (67.5%) of respondents had discussed child sexual abuse prevention with their children, with proportions varying according to age range (highest for mothers with children aged 5-12 years) and only-child status (lowest for mothers of only children). The number of topics discussed with their children differed according to child gender (greater number of topics discussed by mothers with both girls and boys) and age range (greater number of topics discussed by mothers with children aged 5-12 years). These findings provide new insights into mother-child communication about child sexual abuse prevention.

The Evolving Evidence Base for Child Protection in Chinese Societies

Child maltreatment is a substantial public health problem worldwide. Although extensively studied in Western countries, until recently little systematic research had been published about the situation in the world's most populous nation and ethnic diaspora. In this review, we examine trends from community-based research with Chinese young people and parents in mainland China, Hong Kong SAR, Taiwan, Singapore, and Malaysia. It is clear that many Chinese adolescents experience a substantial burden from various forms of maltreatment and the psychological and behavioral correlates are similar to those found in other cultures. However, the research reveals a large gap between this reality and Chinese adults' perceptions about emotional, physical, and sexual abuse. Comprehensive awareness programs are needed to close this information gap and thereby mobilize support for prevention and care initiatives.

Primary prevention of child physical abuse and neglect: gaps and promising directions

Reviews on primary prevention have identified effective strategies to prevent child maltreatment but have ignored potentially promising interventions that have not yet been evaluated as well as gaps in the development of programs. The goal of this review was to identify these gaps and recommend future directions for developing interventions from a public health perspective. To this end, a systematic review of the literature for 1980-2004 utilizing existing databases and found 188 primary prevention interventions that addressed a broad range of risk factors was conducted. However, few had been rigorously evaluated, and only a handful demonstrated impact on child maltreatment or its risk factors. From a public health perspective, interventions that target prevalent and neglected risk factors such as poverty, partner violence, teenage pregnancy, and social norms tolerating violence toward children need to be developed and evaluated. In addition, more attention should be given to low cost interventions delivered to the public, by society, or that require minimal effort from recipients.

School-based education programmes for the prevention of child sexual abuse

BACKGROUND

Child sexual abuse is a significant problem that requires an effective means of prevention.

OBJECTIVES

To assess: if school-based programmes are effective in improving knowledge about sexual abuse and self-protective behaviours; whether participation results in an increase in disclosure of sexual abuse and/or produces any harm; knowledge retention and the effect of programme type or setting.

SEARCH STRATEGY

Electronic searches of Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, PsycINFO, CINAHL, Sociological Abstracts, Dissertation Abstracts and other databases using MESH headings and text words specific for child sexual assault and randomised controlled trials (RCTs) were conducted in August 2006.

SELECTION CRITERIA

RCTs or quasi-RCTs of school-based interventions to prevent child sexual abuse compared with another intervention or no intervention.

DATA COLLECTION AND ANALYSIS

Meta-analyses and sensitivity analysis, using two imputed intraclass correlation coefficients (ICC) (0.1, 0.2), were used for four outcomes: protective behaviours, questionnaire-based knowledge, vignette-based knowledge and disclosure of abuse. Meta-analysis was not possible for retention of knowledge, likelihood of harm, or effect of programme type and setting.

MAIN RESULTS

Fifteen trials measuring knowledge and behaviour change as a result of school-based child sexual abuse intervention programmes were included. Over half the studies in each initial meta-analysis contained unit of analysis errors. For behaviour change, two studies had data suitable for meta-analysis; results favoured intervention (OR 6.76, 95% CI 1.44, 31.84) with moderate heterogeneity (I(2)=56.0%) and did not change significantly when adjustments using intraclass coefficients were made. Nine studies were included in a meta-analysis evaluating questionnaire-based knowledge. An increase in knowledge was found (SMD 0.59; 0.44, 0.74, heterogeneity (I2=66.4%). When adjusted for an ICC of 0.1 and 0.2 the results were SMD 0.6 (0.45, 0.75) and 0.57 (0.44, 0.71) respectively. Heterogeneity decreased with increasing ICC. A meta-analysis of four studies evaluating vignette-based knowledge favoured intervention (SMD 0.37 (0.18, 0.55)) with low heterogeneity (I(2)=0.0%) and no significant change when ICC adjustments were made. Meta-analysis of between-group differences of reported disclosures did not show a statistically significant difference.

AUTHORS' CONCLUSIONS

Studies evaluated in this review report significant improvements in knowledge measures and protective behaviours. Results might have differed had the true ICCs from studies been available or cluster-adjusted results been available. Several studies reported harms, suggesting a need to monitor the impact of similar interventions. Retention of knowledge should be measured beyond 3-12 months. Further investigation of the best forms of presentation and optimal age of programme delivery is required.

Prevention of child sexual abuse in China: knowledge, attitudes, and communication practices of parents of elementary school children

OBJECTIVE

Active involvement by parents may contribute substantially to the success of school-based programs to prevent child sexual abuse (CSA). In China, little is known about parental understanding of CSA. This study investigated Chinese parents' knowledge, attitudes, and communication practices with their children about CSA.

METHOD

Six hundred and fifty-two parents of Grade 3 pupils of seven elementary schools in Jingzhou city, Hubei province (central China), completed an anonymous questionnaire (response rate=81%).

RESULTS

More than 95% of respondents agreed that elementary schools should provide programs to prevent CSA and were willing to have their children participate in such programs. Although nearly all parents talked with their children about stranger danger, they were much less likely to talk specifically about sexual abuse. Many parents personally lacked basic knowledge about characteristics of perpetrators, the sexual abuse of boys, and nonphysical consequences of CSA. About half (46.8%) expressed some concern that CSA preventive education could cause their children to know "too much about sex." Contrary to expectations from research in western nations, parents who talked with their children about CSA did not have better knowledge or more supportive attitudes to CSA prevention than did parents who said they never discussed CSA with their children.

CONCLUSION

This study confirms and extends two recent surveys indicating strong support for the concept of school-based CSA prevention in China. However, given the apparently low levels of knowledge about CSA, even among those who talk about this problem with their children, future prevention programs should include community-wide efforts to educate adults to ensure that parental advice is accurate and hopefully, effective.

Child sexual abuse

Child sexual abuse is a worldwide concern. It is an insidious, persistent, and serious problem that, depending on the population studied and definition used, affects 2-62% of women and 3-16% of men as victims. Pain and tissue injury from child sexual abuse can completely heal in time, but psychological and medical consequences can persist through adulthood. Associated sexually transmitted diseases (such as HIV) and suicide attempts can be fatal. All physicians who treat children should be aware of the manifestations and consequences of child sexual abuse, and should be familiar with normal and abnormal genital and anal anatomy of children. This aim is best accomplished through training and routine examination of the anus and genitalia of children. Because as many as 96% of children assessed for suspected sexual abuse will have normal genital and anal examinations, a forensic interview by a trained professional must be relied on to document suspicion of abuse.

An assessment of outcomes following parents' participation in a child abuse prevention program

The purpose of this study was to evaluate the outcomes following participation in the ESPACE parents' workshop. A group of 55 parents who participated in the program, implemented in elementary schools in the Quebec city region, was compared to a group of 217 parents who did not attend the prevention workshop. The results revealed that attending parents suggested more adequate interventions to the vignette depicting a hypothetical situation of sexual abuse compared to nonattending parents. Attending parents are found to be more likely to suggest interventions sustaining the child in her own problem-solving process, seek help from specialized agencies, and attempt to offer emotional support to the victim. Data also reveal that the parents workshop has a positive outcome on knowledge. While the workshop is associated with beneficial outcomes, attendance rates are low. The findings are discussed in the context of identifying means to foster parent involvement in the prevention of child abuse.