What works.

Improving children’s knowledge and awareness on sexual abuse prevention.

School-based interventions show significant improvements in children’s knowledge and awareness about sexual abuse, and empower children to recognise, prevent, avoid, and report sexual abuse (if it happens).

Programmes such as ESPACE, a sexual abuse prevention workshop conducted in Canada, are delivered in classrooms, during school hours for a short time. The short format makes them low-cost. These programmes combine classroom-based education to increase knowledge in preventing sexual abuse, and gave necessary skills to identify, avoid and respond to sexual abuse.

This cell includes 63 primary studies. More than half of the studies in this cell come from the US with the rest from Canada, the UK, Europe, Australia, Central America, Africa, and East Asia.

School-based sexual abuse prevention programmes do not increase anxiety.

Anxiety is often considered a potential side effect of sexual abuse prevention interventions. In fact, evidence from several school-based sexual abuse prevention programmes indicates that children’s knowledge and awareness about sexual abuse grew, and feelings of fear and vulnerability decreased.

The cell includes 25 primary studies – 19 RCTs and 6 quasi-experimental designs. Most of the programmes are from the US. 3 protocols for 3 new RCTs are also in the cell.

Improving the organisation’s environment to protect children.

Staff training programmes include the IRIE classroom toolbox and Second Step Child Protection Unit (CPU) to improve teachers’ knowledge, attitudes, and behaviours when working with children. These programmes have also shown promise in identifying maltreatment and avoiding violent behaviours by teachers.

The cell has six studies: four RCTs (two from the USA and two from Jamaica), one RCT protocol (from the USA) and a systematic review

Structured training programmes have reduced violence against children by adult caregivers such as teachers and parents.

By fostering positive parenting practices and non-violent discipline strategies, these training programmes can significantly reduce violence against children.

Programmes such as, Irie Classroom Toolbox, Irie Home Toolbox and Interaction Competencies with Children-for These programmes educate parents, teachers and other caregivers about the harms of using harsh punishment against children. These programmes have been effective in improving caregiver-child relationships and reducing children’s behavioural difficulties.

This cell includes 4 primary studies, all RCTs. One study is from Tanzania, the rest are from Jamaica.

Response-focused interventions to improve the environment of institutions that care for children can help safeguard children under their care.

Programmes such as, the Step Child Protection Unit (CPU), which addresses child sexual abuse through school policies, procedures, staff training, student lessons, and family education, has raised teachers’ knowledge, attitude, and ability to recognise indicators of child sexual abuse, respond effectively, and report instances of abuse.

CPU training also contributed to students’ knowledge in preventing abuse. It helped them recognise, report, and refuse unsafe touches and provided an insight into healthy student-teacher relationship.

The cell includes 3 primary studies – all RCTs. One study came from Portugal and 2 from the US.

Increasing disclosure of child abuse among children.

School-based programmes have been successful in raising children’s awareness about physical and sexual abuse, training them on what to do, and increasing disclosure. One such program, called Red Flag, Green Flag People, was studied in 1987 and 1989. Every child who did the programme disclosed, whereas none in the control group did.

Another example is the Good School Toolkit, run in Uganda. Despite the small sample sizes, the Toolkit has led to over 400 additional referrals. This shows that it can create a safer and more supportive environment that encourages children to speak up and disclose relevant information.

There are 10 primary studies in this cell (5 from USA, 1 each from Australia, Canada, Germany, Spain, UK & Uganda).

School-based interventions to improve the environment of institutions that care for children can help safeguard children under their care.

Parents and teachers informed by these interventions show less chance of using violence against children. Parental attitudes toward prevention programmes improved through programmes like Stay Safe, which led to better understanding of how to seek assistance and a greater belief in children’s statements.

The cell has 8 primary studies assessing 7 different programmes. 2 programmes came from the US, and one each was Jamaica, Uganda, South Africa, Northern Ireland (UK) and the Republic of Ireland.

It is unclear whether training people who look after children in institutions can protect children from maltreatment and sexual abuse.

It remains unclear which interventions are successful in improving institutional operations to protect children. Studies reported intermediate outcomes of improved knowledge about identifying abuse, but the long-term effects on child safety are not known.

The cell includes 3 primary studies – 2 from the US and 1 from Spain. 2 protocols for studies in the US and Kenya and Tanzania were also included.

We do not know whether school-based sexual abuse prevention interventions affect students’ mental health.

While prevention programmes appear to not increase anxiety among children, their impact on other mental health issues is unclear. This highlights the need for further research and the development of more comprehensive and trauma-informed approaches to address the psychological needs of survivors.

The cell includes 25 primary studies – 19 RCTs and six quasi-experimental designs. The majority of the programmes are from the US. Protocols for three new RCTs are also present.

Research examining the effect of school-based interventions on preventing peer violence has shown only unclear results to date.

The evidence suggests limited or no significant effect of these programmes in reducing peer violence. Some studies noted small changes in instances of violence, but these changes were insignificant and the sample size was often too small for the findings to be definitive. Research is needed to better understand and develop evidence-based interventions that effectively address and prevent peer violence and gender-based violence in schools.

The cell includes 3 studies – RCTs from the US, South Africa and Pakistan.

We are uncertain about the effect of disclosure-based initiatives in reducing child abuse.

Disclosure programmes are often focused on helping students identify and avoid dangerous situations, and creating a supportive environment that encourages children to discuss potential abuse. Some studies suggest that these programmes could facilitate an environment where children can disclose potential abuse, but the limited number of studies and their mixed results make the findings unreliable.

The cell includes 3 primary studies and 1 systematic review. All were studies conducted in high-income countries.

There is no clear evidence that reforming responses to cases of child abuse can encourage disclosure about potential abuse.

Differential Response and MIST are 2 programmes that work towards transforming responses to child abuse cases to enable a safer environment where children can discuss instances of potential abuse. Few studies and mixed results again prevent a definitive statement on the impact of programmes.

The cell has 2 quasi-experimental studies (Australia and the US) and 1 systematic review from high-income countries.

Rigorous evaluations from low-income countries.

A significant chunk of the world’s population lives in low- and middle-income countries, creating a need to understand what works in them.

There are very few studies from Africa (10, covering only four interventions, all of them in prevention: none in encouraging disclosure, response or treatment). There is only one study from South Asia (in Pakistan), and only one from South East Asia (Indonesia).

This matters because programmes which succeed in high-income countries may not work elsewhere.

Limited evidence on institutional response to violence and abuse against children.

There is insufficient evidence that response-focused interventions such as the Multi-Agency Investigation & Support Team (MIST) and the Clinical Decision Tool for Paediatric Intensive Care Unit (PICU) doctors can reduce child maltreatment. This is because the studies used small sample sizes and had limited follow-up periods. Additionally, the studies failed to adequately measure the effectiveness of the interventions in preventing child maltreatment.

Studies focused on clergy and faith-organisations.

No studies look at programmes related to clergy, churches, synagogues or other religious communities. That is remarkable given the number and severity of clerical abuse cases.

(One study includes priests amongst other child-serving professionals but does not break out the data for them.)

We know little about encouraging disclosure and treatment.

There are few studies about encouraging disclosure: only three completed primary studies.

There are also few studies about ‘what works’ in treating survivors who have experienced abuse: there are completed primary studies for only three interventions (though for one study, there are multiple papers).

Effects on adult perpetrators of child abuse and children and young people breaking the law is rarely studied.

There is a lack of evidence on outcomes related to adult perpetrator and outcomes related to child/youth offender. There is a need for more evidence to understand how policies and programmes designed to protect children affect the behaviour of adult perpetrators. Similarly, what policies work in helping bring a change among children and young people who end up breaking the law?