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

Jeanne Gubbels, Claudia E van der Put, Geert-Jan J M Stams, Mark Assink, Jeanne Gubbels, Claudia E van der Put, Geert-Jan J M Stams, Mark Assink

Abstract

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.

Keywords: Child abuse; Meta-analysis; Prevention; Program components; School-based programs.

Conflict of interest statement

The authors declare that they have no conflict of interest.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
Flowchart of study selection procedure, according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA)
Fig. 2
Fig. 2
Funnel plot of the trim-and-fill analysis knowledge
Fig. 3
Fig. 3
Funnel plot of the trim-and-fill analysis self-protection skills

References

    1. Agrawal, N. (2020, April 7). The coronavirus could cause a child abuse epidemic. The New York Times. Retrieved from
    1. Alink LRA, Cicchetti D, Kim J, Rogosch FA. Longitudinal associations among child maltreatment, social functioning, and cortisol regulation. Developmental Psychology. 2012;48(1):224–236. doi: 10.1037/a0024892.
    1. Asawa LE, Hansen DJ, Flood MF. Early childhood intervention programs: Opportunities and challenges for preventing child maltreatment. Education & Treatment of Children. 2008;31(1):73–110. doi: 10.1353/etc.0.0021.
    1. Assink M, Wibbelink CJM. Fitting three-level meta-analytic models in R: A step-by-step tutorial. The Quantitative Methods for Psychology. 2016;12(3):154–174. doi: 10.20982/tqmp.12.3.p154.
    1. Bailey DH, Duncan G, Odgers CL, Yu W. Persistence and fadeout in the impacts of child and adolescent interventions. Journal of Research on Educational Effectiveness. 2017;10(1):7–39. doi: 10.1080/19345747.2016.1232459.
    1. *Baker, C. K., Gleason, K., Naai, R., Mitchell, J., & Trecker, C. (2012). Increasing knowledge of sexual abuse: A study with elementary school children in Hawai’i. Research on Social Work Practice, 23(2), 167–178. 10.1177/1049731512468796
    1. Berrick JD, Gilbert N. With the best of intentions: The child sexual abuse prevention movement. The Guilford Press; 1991.
    1. Blakey JM, Thigpen JW. Play it safe!®: A school-based childhood physical and sexual abuse prevention program. Journal of Adolescent and Family Health. 2015;7(1):5.
    1. Boyle C, Lutzker J. Teaching young children to discriminate abusive from nonabusive situations using multiple exemplars in a modified discrete trial teaching format. Journal of Family Violence. 2005;20:55–69. doi: 10.1007/s10896-005-3169-4.
    1. *Bustamante, G., Andrade, M. S., Mikesell, C., Cullen, C., Endara, P., & Burneo, V., et al. (2019). “I have the right to feel safe”: Evaluation of a school-based child sexual abuse prevention program in Ecuador. Child Abuse & Neglect, 91, 31–40. 10.1016/j.chiabu.2019.02.009
    1. Carlson EB, Furby L, Armstrong J, Shlaes J. A conceptual framework for the the long-term psychological effects of traumatic childhood abuse. Child Maltreatment. 1997;2:272–295. doi: 10.1177/1077559597002003009.
    1. *Cecen-Erogul, A. R., & Kaf Hasirci, O. (2013). The effectiveness of psycho-educational school-based child sexual abuse prevention training program on Turkish elementary students. Educational Sciences: Theory & Practice, 13(2), 725–729.
    1. *Chen, Y-C., Fortson, B. L., & Tseng, K-W. (2012). Pilot evaluation of a sexual abuse prevention program for Taiwanese children. Journal of Child Sexual Abuse, 21(6), 621–645. 10.1080/10538712.2012.726699
    1. Cicchetti D. Socioemotional, personality, and biological development: Illustrations from a multilevel developmental psychopathology perspective on child maltreatment. Annual Review of Psychology. 2016;67:187–211. doi: 10.1146/annurev-psych-122414-033259.
    1. *Citak Tunc, G., Gorak, G., Ozyazicioglu, N., Ak, B., Isil, O., & Vural, P. (2018). Preventing child sexual abuse: Body safety training for young children in Turkey. Journal of Child Sexual Abuse, 27(4), 347–364. 10.1080/10538712.2018.1477001
    1. Cohen J. Statistical power analysis for the behavioral sciences. Lawrence Erlbaum; 1988.
    1. *Conte, J. R., Rosen, C., Saperstein, L., & Shermack, R. (1985). An evaluation of a program to prevent the sexual victimization of young children. Child Abuse & Neglect, 9(3), 319–328. 10.1016/0145-2134(85)90027-4
    1. *Czerwinski, F., Finne, E., Alfes, J., & Kolip, P. (2018). Effectiveness of a school-based intervention to prevent child sexual abuse-Evaluation of the German IGEL program. Child Abuse & Neglect, 86, 109–122. 10.1016/j.chiabu.2018.08.023
    1. *Daigneault, I., Hébert, M., McDuff, P., & Frappier, J-Y. (2012) Evaluation of a sexual abuse prevention workshop in a multicultural, impoverished urban area. Journal of Child Sexual Abuse, 21(5), 521–542. 10.1080/10538712.2012.703291
    1. *Dake, J. A., Price, J. H., & Murnan, J. (2003). Evaluation of a child abuse prevention curriculum for third-grade students: Assessment of knowledge and efficacy expectations. The Journal of School Health, 73(2), 76–82. 10.1111/j.1746-1561.2003.tb03576.x
    1. Daro D. Child sexual abuse prevention: Separating fact from fiction. Child Abuse & Neglect. 1991;15(1–2):1–4. doi: 10.1016/0145-2134(91)90084-Q.
    1. Daro DA. Prevention of child sexual abuse. The Future of Children. 1994;4(2):198–223. doi: 10.2307/1602531.
    1. Davis MK, Gidycz CA. Child sexual abuse prevention programs: A meta-analysis. Journal of Clinical Child Psychology. 2000;29(2):257–265. doi: 10.1207/s15374424jccp2902_11.
    1. Deblinger E, Stauffer L, Steer R. Comparative efficacies of supportive and cognitive behavioral group therapies for children who were sexually abused and their nonoffending mothers. Child Maltreatment. 2001;6(4):332–343. doi: 10.1177/1077559501006004006.
    1. *Dhooper, S. S., & Schneider, P. L. (1995). Evaluation of a school-based child abuse prevention program. Research on Social Work Practice, 5(1), 36–46. 10.1177/104973159500500104
    1. Duval S, Tweedie R. A nonparametric ‘trim and fill’ method of accounting for publication bias in meta-analysis. Journal of the American Statistical Association. 2000;95(449):89–99. doi: 10.1080/01621459.2000.10473905.
    1. Duval S, Tweedie R. Trim and fill: A simple funnel-plot based method of testing and adjusting for publication bias in meta-analysis. Biometrics. 2000;56(2):455–460. doi: 10.1111/j.0006-341x.2000.00455.x.
    1. Ferguson GA. Statistical analysis in psychology & education. McGraw-Hill; 1966. p. 244.
    1. Finkelhor D. Prevention of sexual abuse through educational programs directed toward children. Pediatrics. 2007;120:640–645. doi: 10.1542/peds.2007-0754.
    1. Finkelhor D, Asidigian N, Dziuba-Leatherman J. Victimization prevention programs for children: A follow-up. American Journal of Public Health. 1995;85(12):1684–1689. doi: 10.2105/ajph.85.12.1684.
    1. Gibson LE, Leitenberg H. Child sexual abuse prevention programs: Do they decrease the occurrence of child sexual abuse? Child Abuse and Neglect. 2000;24(9):1115–1125. doi: 10.1016/s0145-2134(00)00179-4.
    1. Gagnier C, Collin-Vézina D. The disclosure experiences of male child sexual abuse survivors. Journal of Child Sexual Abuse. 2016;25(2):221–241. doi: 10.1080/10538712.2016.1124308.
    1. Grober JS, Bogat GA. Social problem solving in unsafe situations: Implications for sexual abuse education programs. American Journal for Community Psychology. 1994;22(3):399–414. doi: 10.1007/bf02506872.
    1. Harrell FE., Jr . Multivariable modeling strategies. With applications to linear models, logistic regression, and survival analysis. Springer; 2015.
    1. *Hazzard, A., Webb, C., Kleemeier, C., Angert, L., & Pohl, J. (1991). Child sexual abuse prevention: Evaluation and one-year follow-up. Child Abuse & Neglect, 15(1–2), 123–138. 10.1016/0145-2134(91)90097-w
    1. *Hébert, M., Lavoie, F., Piché, C., & Poitras, M. (2001). Proximate effects of a child sexual abuse prevention program in elementary school children. Child Abuse & Neglect, 25(4), 505–522. 10.1016/S0145-2134(01)00223-X
    1. *Jin, Y., Chen, J., Jiang, Y., & Yu, B. (2017). Evaluation of a sexual abuse prevention education program for school-age children in China: A comparison of teachers and parents as instructors. Health Education Research, 32(4), 364–373. 10.1093/her/cyx047
    1. Jonson-Reid M, Kohl PL, Drake B. Child and adult outcomes of chronic child maltreatment. Pediatrics. 2012;129(5):839–845. doi: 10.1542/peds.2011-2529.
    1. Kang SR, Kim SJ, Kang KA. Effects of child sexual abuse prevention education program using hybrid application (CSAPE-H) on fifth-grade students in South Korea. The Journal of School Nursing. 2020 doi: 10.1177/1059840520940377.
    1. Kenny MC, Capri V, Thakkar-Kolar RR, Ryan EE, Runyon MK. Child sexual abuse: from prevention to self-protection. Child Abuse Review. 2008;17(1):36–54. doi: 10.1002/car.1012.
    1. *Kim, S-J., & Kang, K-A. (2017). Effects of the Child Sexual Abuse Prevention Education (C-SAPE) program on South Korean fifth-grade students’ competence in terms of knowledge and self-protective behaviors. The Journal of School Nursing, 33(2), 123–132. 10.1177/1059840516664182
    1. *Ko, S. F., & Cosden, M. A. (2001). Do elementary school-based child abuse prevention programs work? A high school follow-up. Psychology in the Schools, 38(1), 57–66. 10.1002/1520-6807(200101)38:1%3C57::AID-PITS6%;2-W
    1. *Kolko, D. J., Moser, J. T., & Hughes, J. (1989).Classroom training in sexual victimization awareness and prevention skills: An extension of the Red Flag/Green Flag people program. Journal of Family Violence, 4, 25–45. 10.1007/BF00985655
    1. *Kolko, D. J., Moser, J. T., Litz, J., & Hughes, J. (1987). Promoting awareness and prevention of child sexual victimization using the Red Flag/Green Flag program: An evaluation with follow-up. Journal of Family Violence, 2, 11–35. 10.1007/BF00976368
    1. Kovler ML, Ziegfeld S, Ryan LM, Goldstein MA, Gardner R, Garcia AV, et al. Increased proportion of physical child abuse injuries at a level I pediatric trauma center during the Covid-19 pandemic. Child Abuse & Neglect. 2020 doi: 10.1016/j.chiabu.2020.104756.
    1. *Krahé, B., & Knappert, L. (2009), A group‐randomized evaluation of a theatre‐based sexual abuse prevention programme for primary school children in Germany. Journal of Community & Applied Social Psychology, 19(4), 321–329. 10.1002/casp.1009
    1. Lev-Wiesel R, First M. Willingness to disclose child maltreatment: CSA vs other forms of child abuse in relation to gender. Child Abuse & Neglect. 2018;79:183–191. doi: 10.1016/j.chiabu.2018.02.010.
    1. Lipsey MW, Wilson DB. Practical meta-analysis. Sage; 2001.
    1. *MacIntyre, D., & Carr, A. (1999). Evaluation of the effectiveness of the stay safe primary prevention programme for child sexual abuse. Child Abuse & Neglect, 23(12), 1307–1325. 10.1016/S0145-2134(99)00092-7
    1. MacIntyre D, Carr A. Prevention of child sexual abuse: Implications of programme evaluation research. Child Abuse Review. 2000;9(3):183–199. doi: 10.1002/1099-0852(200005/06)9:3<183::AID-CAR595>;2-I.
    1. Messman-Moore TL, Coates AA. The impact of childhood psychological abuse on adult interpersonal conflict: The role of early maladaptive schemas and patterns of interpersonal behavior. Journal of Emotional Abuse. 2007;7(2):75–92. doi: 10.1300/J135v07n02_05.
    1. *Moreno-Manso, J. M., García-Baamonde, E., Blázquez-Alonso, M., & Pozueco-Romero, J. M. (2014). Application of a child abuse prevention programme in an educational context. Anales De Psicologia, 30(3), 1014–1024. 10.6018/analesps.30.3.154231
    1. *Morris, M. C., Kouros, C. D., Janecek, K., Freeman, R., Mielock, A., & Garber, J. (2017). Community-level moderators of a school-based childhood sexual assault prevention program. Child Abuse & Neglect, 63, 295–306. 10.1016/j.chiabu.2016.10.005
    1. Nakagawa S, Santos ESA. Methodological issues and advances in biological meta-analysis. Evolutionary Ecology. 2012;26:1253–1274. doi: 10.1007/s10682-012-9555-5.
    1. Nickerson AB, Heath MA, Graves LA. School-based interventions for children impacted by sexual abuse. In: Paludi M, DenMark FL, editors. Victims of sexual assault and abuse: Resources and responses for individuals and families vol. 2: Cultural, community, educational and advocacy responses. Praeger; 2010. pp. 77–99.
    1. *Nickerson, A. B., Tulledge, J., Manges, M., Kesselring, S., Parks, T., Livingston, J. A., & Dudley, M. (2019). Randomized controlled trial of the Child Protection Unit: Grade and gender as moderators of CSA prevention concepts in elementary students. Child Abuse & Neglect, 96, 104101. 10.1016/j.chiabu.2019.104101
    1. *Ogunfowokan, A. A., & Fajemilehin, R. B. (2012). Impact of a school-based sexual abuse prevention education program on the knowledge and attitude of high school girls. The Journal of School Nursing, 28(6), 459–468. 10.1177/1059840512446949
    1. *Oldfield, D., Hays, B. J., & Megel, M. E. (1996). Evaluation of the effectiveness of Project Trust: An elementary school-based victimization prevention strategy. Child Abuse & Neglect, 20(9), 821–832. 10.1016/0145-2134(96)00070-1
    1. Pieper, I., & De Haan, N. (2017). Adviezen van jongeren en ouders voor het voorkómen van kindermishandeling [Advice from young people and parents for the prevention of child abuse].
    1. *Pulido, M. L., Dauber, S., Tully, B. A., Hamilton, P., Smith, M. J., & Freeman, K. (2015). Knowledge gains following a child sexual abuse prevention program among urban students: A cluster-randomized evaluation. American Journal of Public Health, 105(7), 1344–1350. 10.2105/ajph.2015.302594
    1. Rispens J, Aleman A, Goudena PP. Prevention of child sexual abuse victimization: A meta-analysis of school programs. Child Abuse & Neglect. 1997;21(10):975–987. doi: 10.1016/s0145-2134(97)00058-6.
    1. Rosenthal R. Parametric measures of effect size. In: Cooper H, Hedges LV, editors. The handbook of research synthesis. Sage; 1994. p. 239.
    1. Rosenthal R. Writing meta-analytic reviews. Psychological Bulletin. 1995;118(2):183–192. doi: 10.1037/0033-2909.118.2.183.
    1. Sanderson J. Child-focused sexual abuse prevention programs. How effective are they in preventing child abuse? Crime and Misconduct Commission: Research and Issues Paper. 2004;5:1–8.
    1. *Saslawsky, D. A., & Wurtele, S. K. (1986). Educating children about sexual abuse: Implications for pediatric intervention and possible prevention. Journal of Pediatric Psychology, 11(2), 235–245. 10.1093/jpepsy/11.2.235
    1. Scholes L, Jones C, Nagel M. Boys and CSA prevention: Issues surrounding gender and approaches for prevention. Australian Journal of Teacher Education. 2014 doi: 10.14221/ajte.2014v39n11.1.
    1. Scholes L, Jones CM, Stieler-Hunt C, Rolfe B. Serious games for learning: Games- based child sexual abuse prevention in schools. International Journal of Inclusive Education. 2014;18(9):934–956. doi: 10.1080/13603116.2013.860195.
    1. Stoltenborgh M, Bakermans-Kranenburg MJ, Alink LRA, Van IJzendoorn MH. The prevalence of child maltreatment across the globe: Review of a series of meta-analyses. Child Abuse Review. 2015;24:37–50. doi: 10.1002/car.2353.
    1. Sutherland A, Ariel B, Farrar W, De Anda R. Post-experimental follow-ups—fade-out versus persistence effects: The rialto police body-worn camera experiment four years on. Journal of Criminal Justice. 2017;53:110–116. doi: 10.1016/j.jcrimjus.2017.09.008.
    1. *Taal, M., & Edelaar, M. (1997). Positive and negative effects of a child sexual abuse prevention program. Child Abuse & Neglect, 21(4), 399–410. 10.1016/s0145-2134(96)00179-2
    1. *Telljohann, S. K., Everett, S. A., & Price, J. H. (1997). Evaluation of a third grade sexual abuse curriculum. The Journal of School Health, 67(4), 149–153. 10.1111/j.1746-1561.1997.tb03436.x
    1. Terrin N, Schmid CH, Lau J, Olkin I. Adjusting for publication bias in the presence of heterogeneity. Statistics in Medicine. 2003;22(13):2113–2126. doi: 10.1002/sim.1461.
    1. Topping KJ, Barron IG. School-based child sexual abuse prevention programs: A review of effectiveness. Review of Educational Research. 2009;79(1):431–463. doi: 10.3102/0034654308325582.
    1. Tutty LM. The revised Children’s Knowledge of Abuse Questionnaire: Development of a measure of children’s understanding of sexual abuse prevention concepts. Social Work Research. 1995;19(2):112–120. doi: 10.1093/swr/19.2.112.
    1. *Tutty L. M. (1992). The ability of elementary school children to learn child sexual abuse prevention concepts. Child Abuse & Neglect, 16(3), 369–384. 10.1016/0145-2134(92)90046-t
    1. *Tutty, L. M. (1997). Child sexual abuse prevention programs: Evaluating Who Do You Tell. Child Abuse & Neglect, 21(9), 869–881. 10.1016/S0145-2134(97)00048-3
    1. Van den Noortgate W, Lòpez-Lòpez JA, Marìn-Martìnez F, Sànchez-Meca J. Three-level meta-analysis of dependent effect sizes. Behavior Research Methods. 2013;45:576–594. doi: 10.3758/s13428-012-0261-6.
    1. Van den Noortgate W, Lòpez-Lòpez JA, Marìn-Martìnez F, Sànchez-Meca J. Meta-analysis of multiple outcomes: A multilevel approach. Behavior Research Methods. 2014;47(4):1–21. doi: 10.3758/s13428-014-0527-2.
    1. Viechtbauer W. Conducting meta-analyses in R with the metafor package. Journal of Statistical Software. 2010;36(3):1–48. doi: 10.18637/jss.v036.i03.
    1. Walsh K, Zwi K, Woolfenden S, Shlonsky A. School-based education programs for the prevention of child sexual abuse: A cochrane systematic review and meta-analysis. Research on Social Work Practice. 2018;28(1):33–55. doi: 10.1177/1049731515619705.
    1. *Weatherley, R., Siti Hajar, A. B., Noralina, O., John, M., Preusser, N., & Yong, M. (2012). Evaluation of a school-based sexual abuse prevention curriculum in Malaysia. Children and Youth Services Review, 34(1), 119–125. 10.1016/j.childyouth.2011.09.009
    1. Widom CS. Longterm consequences of child maltreatment. In: Korbin J, Krugman R, editors. Handbook of child maltreatment. Springer; 2014. pp. 225–247.
    1. World Health Organization . Report of the consultation on child abuse prevention, 29-31 March 1999, WHO, Geneva (No. WHO/HSC/PVI/99.1) World Health Organization; 1999.
    1. World Health Organization . European status report on preventing child maltreatment. World Health Organization; 2018.
    1. *White, C., Shanley, D. C., Zimmer-Gembeck, M. J., Walsh, K., Hawkins, R., & Lines, K. et al. (2018). Promoting young children’s interpersonal safety knowledge, intentions, confidence, and protective behavior skills: Outcomes of a randomized controlled trial. Child Abuse & Neglect, 82, 144–155. 10.1016/j.chiabu.2018.05.024
    1. *Wolfe, D. A., MacPherson, T., Blount, R., & Wolfe, V. V. (1986). Evaluation of a brief intervention for educating school children in awareness of physical and sexual abuse. Child Abuse & Neglect, 10(1), 85–92. 10.1016/0145-2134(86)90036-0
    1. Wurtele SK. Teaching young children personal body safety: The behavioral skills training program. Colorado Springs, CO: Author; 1986.
    1. *Wurtele, S. K., Gillispie, E. I., Currier, L. L., & Franklin, C. F. (1992). A comparison of teachers vs. parents as instructors of a personal safety program for preschoolers. Child Abuse and Neglect, 16(1), 127–137. 10.1016/0145-2134(92)90013-H
    1. Wurtele SK, Hughes JW, Owens JS. An examination of the reliability of the “What If” Situations Test: A brief report. Journal of Child Sexual Abuse. 1998;7(1):41–52. doi: 10.1300/J070v07n01_03.
    1. *Wurtele, S. K., Kast, L. C., & Melzer, A. M. (1992). Sexual abuse prevention education for young children: A comparison of teachers and parents as instructors. Child Abuse and Neglect, 16(6), 865–876. 10.1016/0145-2134(92)90088-9
    1. Wurtele SK, Owens JS. Teaching personal safety skills to young children: An investigation of age and gender across five studies. Child Abuse & Neglect. 1997;21(8):805–814. doi: 10.1016/S0145-2134(97)00040-9.
    1. *Yom, Y-H., & Eun, L. K. (2005). Effects of a CD-ROM educational program on sexual knowledge and attitude. Computers, Informatics, Nursing, 23(4), 214–219. 10.1097/00024665-200507000-00009
    1. *Zhang, W., Chen, J., Feng, Y., Li, J., Liu, C., & Zhao, X. (2014). Evaluation of a sexual abuse prevention education for Chinese preschoolers. Research on Social Work Practice, 24(4), 428–436. 10.1177/1049731513510409

Source: PubMed

3
구독하다