This Desk Guide provides senior leaders of national, regional, and local YSOs with new guidance and actionable options for preventing and addressing CSA.
This guidance is based on the principal that is well established with many, perhaps most YSOs— specifically, that YSOs, regardless of their specific missions, are accountable for two fundamental goals: (1) to keep children safe and (2) to place children on a path to a successful and satisfying life, with better outcomes for education, employment, mental health, physical health, and social formation.
The Case for Transforming Current Prevention Practice
Extensive efforts to prevent and address CSA contributed to substantial declines in the rates of such abuse. For example, in the U.S., lifetime rates of CSA among children ages 14–17 (that is, children with the most exposure to childhood violence by virtue of their age) declined 22% across three national surveys, from 27.8% in 2009 to 21.7% in 2015.19,20,21 Even steeper declines were identified between 1992 and 2009. Declines were steepest in the 1990s, continued at a greatly reduced rate through the 2000s, flattened out in the 2010s, and appear to be increasing as we enter the 2020s.22 However, even at historically low rates, approximately 12% of the world’s children remain at risk for sexual abuse victimization.23,24,25
We believe it will take significant changes to existing prevention and intervention efforts to drive rates down towards zero. Such changes are both warranted and timely.
As is well known, CSA increases the risk for a host of mental health, behavioral health, and physical health disorders and is associated with substantial fiscal costs to individuals, families, and society. The immediate and long-term trauma and fiscal costs associated with CSA support addressing CSA from a public health perspective that focuses significant attention on prevention.
As YSO leaders appreciate, there is also a clear business case for introducing effective change, in addition to a public health case. YSOs require support from a variety of stakeholders to survive and prosper. Politicians, governance boards, insurers, communities, and families want children to be safe while in the care of YSOs. YSOs that do not implement best practices and provide an environment that decreases the likelihood of abuse, increases the likelihood of early detection, and enhances the likelihood of appropriate action risk the withdrawal of stakeholder support. Moreover, most YSOs are not for profit, a status predicated on providing a public good. Tolerance of abuse is contrary to the public good.
There are several existing guidelines for best practices to prevent and address CSA, and many YSOs already implement recommended practices. However, existing recommendations are not governed by an overarching framework and fail to take into consideration organizational theory, particularly the impact of organizational culture on the development, execution, and effects of prevention and intervention efforts.26 Many organizations have worked for years to implement these guidelines, and some may have successfully integrated these within their own organizational culture; however, the guidelines themselves do not provide guidance on how to do so, and we believe this is a significant oversight that may limit the effectiveness of best practice guidelines.
Absent a unifying framework, current guidelines tend to offer an increasing number of discrete recommendations that get layered on top of an organization’s existing rules and activities; they often prove difficult to implement in a way that is compatible with a YSO’s purpose and thus are not woven into the fabric of an organization’s mission, policies, and procedures.
Guidelines may suffer from two significant limitations. First, some rules may be vulnerable to being broken. For example, some organizations implement a rule requiring two adults in the presence of a child. There are many predictable situations in which such a rule will be broken, such as when the second adult is unexpectedly absent or late, when multiple children have competing needs (e.g., one needs to go to the bathroom, another needs close supervision), or when a child has an unexpected need and there is only one adult available to meet that need (e.g., for a ride home if a parent is detained or for a phone call to talk things over when a parent is unsupportive). When rules are occasionally or often broken, this contributes to an organizational culture in which rule- breaking is tolerated. Second, some discrete recommendations are fundamentally incompatible with the practice of many YSOs. For example, mentor-based organizations (e.g., Big Brothers and Big Sisters of America), organizations that provide individual training (e.g., piano lessons), and providers of confidential services (e.g., physical, mental, and behavioral health care) are all oriented around a one-on-one adult-child model.
This Desk Guide seeks to shift the focus on preventing and addressing CSA away from a seemingly endless series of discrete rules towards the achievement of overarching goals. We present a core set of rational principals that flow from a unified framework and that can help guide the development of individualized protocols to best meet local needs by addressing local risks with strategies that are feasible in a local context.
We recognize that much of what we propose is already reflected in many organizations’ policies and practices. Indeed, this work was informed by several organizations’ CSA-focused efforts. Our hope is that this Desk Guide increases the coherence and reduces the complexity of organizations’ CSA prevention efforts. While our focus is on CSA, we recognize there is substantial overlap in risk factors for CSA and other types of child abuse, neglect, and unintentional injury. We believe that efforts to prevent and address CSA will enhance the prevention of other form of child maltreatment and injury as well. Adverse childhood events, including different types of child abuse and neglect, are causally related to one another, and any effort that successfully reduces one form of harm, such as child sexual abuse, will likely be associated with reductions in other forms of harm.
A Systemic Overarching Framework for Youth Serving Organizations
As noted above, we believe that all YSOs should be accountable for the fundamental goals of keeping children safe and placing children on a path to a successful and satisfying life. Further, we believe that the primary way in which YSOs can achieve this fundamental result is through the development of caring and professional relationships between adults and children. Indeed, the development of positive relationships between children and adult staff and volunteers may be the only other unifying theme across all YSOs, whether they seek to enhance children’s arts, athletics, civic duty, education, religion, or more general success and wellbeing.
We situate this adult-child relationship at the heart of our framework to prevent and address CSA in the context of YSOs. Many leaders will be familiar with the ecological systems framework27 for understanding how a child’s qualities and the qualities of the ecologies within which a child lives (and the interaction of those qualities) influence growth and development. These ecologies occur at the level of the individual, the micro-system (relationships), the macro-system (e.g., neighborhoods, schools, communities), and society.
In our adapted framework, we depict these ecologies as they occur in organizations, starting (as before) with the level of the individual (which may be the child participant or the adult organizational member), then the relationship (e.g., between the child and the organizational member, between two organizational members, or between two children), then the macro-system of the local organization, then the “society” of the full organization for those organizations with regional or national governance bodies (Figure 1). At each level, there are factors that influence whether a given child will benefit from participating in a given organization and, more specifically, that influence the likelihood that a given relationship will result in CSA (or other types of harm).
Likewise, at each level there are prevention and response strategies that reduce the likelihood of abuse, increase the likelihood of early detection, and enhance appropriate action.
The Systemic Overarching Framework integrates organizational theory, ecological theory, and a public health model as described in this section of the guide. Adopting a public health approach to CSA is essential28,29 and means that communities and organizations seek the optimal ways to design, implement, and evaluate programs to prevent risk to children.30 This approach requires a multidisciplinary approach to the four dimensions of any public health response: (1) defining and measuring the problem; (2) identifying risk factors; (3) developing and testing interventions; and (4) implementing interventions.31,32 Importantly, this systematic public health approach depends on agencies and communities serving children to be genuinely committed to prevention of and early intervention for CSA, to monitor and refine prevention initiatives, and to coordinate implementation of responses.33 Communities and organizations play a central role, and their full participation is essential to create ownership of the problem and its solutions, to promote social justice, and to champion children’s health.34,35 At its best, a public health approach will involve the creation of networks of private and public organizational capacity, including community-based organizations, to respond proactively to CSA.36,37
Individual: Risk factors for adult perpetration of CSA have been identified within five risk domains, including sexual problems (e.g., sexual interest in children, hyper-sexual behavior); internalizing problems (e.g., depression), social deficits (e.g., loneliness); offense-supportive attitudes and cognitions; and externalizing behaviors (e.g., aggression, substance abuse). For children under the age of 18, common risk factors also include (but are not limited to) lack of sexual knowledge, inadequate adult supervision, impulsivity, curiosity, and a prior history of sexual or physical abuse victimization. Effective responses to CSA victimization include trauma-informed care and support such as Trauma-focused Cognitive Behavior Therapy.
Effective responses to youth problem sexual behaviors include Multisystemic Therapy for Problem Sexual Behavior and Cognitive-Behavior Therapy for Problem Sexual Behavior. Effective prevention strategies include school-based universal prevention interventions such as Shifting Boundaries.
Interpersonal: Less is known about risk factors that operate at the interpersonal level. However, adults in adult-child relationships that are characterized by a lack of shared biology (e.g., between a mother’s new husband or boyfriend and her children) and a high level of control (e.g., in the context of a locked out-of-home setting) are at increased risk of engaging in abusive behavior. Likewise, adults in relationships with children who are characterized by a disability or other characteristic that may be construed in negative terms (e.g., children found delinquent of crimes, children who identify as LGBTQ, children in poverty, children who are homeless) are at risk of engaging in abusive behavior. Other risk factors operating at the level of dyadic social interaction would include leadership rooted in charismatic authority and problematic social norms governing adult-child and child-child interaction. Examples of such problematic social norms include acceptance of adult-child interaction outside the context of regular YSO activities (e.g., individualized coaching of youth athletes outside the context of team practices), the use of sexualized banter to engage youth, and beliefs that youth and children have reached the same level of emotional, sexual, and moral development as adults. Prevention and response strategies include family-based therapy to strengthen family ties, development of pro-social behavior, assuring that leader authority rests on professional competence, and change of problematic social norms by, for example, limiting adult-child interactions to sanctioned YSO activities and by relating to children and adolescents in developmentally appropriate ways.
Local YSO: Still less is known about risk and protective factors that operate at the macro-system of the local organization. Potential risk factors likely include inadequate administrative controls, unitary chains of command, and resource constraints that may limit the resources available to address child sexual abuse (e.g., a small stand-alone childcare center). Prevention responses and strategies include encouraging organizational norms that support subordinates questioning superiors’ authority and enacting robust child safety guidelines, rules, and protocols.
YSO National Office: Perhaps the least information exists at the level of the “society” of the full organization, for organizations with regional or national governance bodies. Potential risk factors may include weak federation governance of satellite entities, competing goals (e.g., when the goal of keeping children safe is at odds with achieving competitive, reputational, or economic success), and inadequate training of leaders (training that might not impart knowledge, skills, and attitudes that facilitate child safety). Prevention responses and strategies include strengthening federation governance of satellite entities, appointing leaders with strong training or track records in child safety, and including a strong focus on child safety in leadership training.
Organizational Theory and Culture
Early in human history, the vast majority of adult-child relationships were formed either in the family or the community. Beginning with the Industrial Revolution, an increasing proportion of adult-child relationships have been incorporated within the boundaries of formal organizations.38 Today, while many adult-child relationships are formed inside the family or the community at large, an increasing number are formed in child-care centers, schools, after- school programs, religious organizations (churches, synagogues, temples, mosques), sports clubs, knowledge academies, and a plethora of other specialized types of YSOs (e.g., Boy Scouts, Big Brothers and Big Sisters, 4-H, etc). As such, YSOs are located at the relationship level in the figure above.
Formal organizations (hereafter, simply “organizations”) are sometimes referred to as “strong situations,” in that they are defined by a number of structures and processes that constrain human behavior so as to accomplish one or more purposes.39 Organizations consist of incentive systems, which attach rewards and punishments to different types of behaviors. They also consist of administrative systems, which divide members into subunits and articulate rules, protocols, and standard operating procedures that prescribe or proscribe different behaviors. Further, organizations are almost always characterized by chains of command, in which some members are given authority over others. They also are composed of small informal groups, which evolve norms that guide behavior and apply peer pressure to enforce them. Finally, organizations exhibit cultures, which consist of assumptions, values, and beliefs that guide behavior at the most general level. The manner in which these structures are constituted varies across YSOs and influences the likelihood that abuse will occur, the speed with which abuse that occurs will be detected, and the effectiveness with which detected abuse will be addressed. Each of the recommendations outlined in this Desk Guide can be traced back to these structures and processes.
Prevention and response strategies. In developing prevention and response strategies within the overarching framework, we first ask, “what is the overarching goal of the strategy?” Obviously, each strategy will be oriented toward preventing, identifying, or addressing abuse. However, if that is our only consideration, then we end up where we started—with a growing list of “dos” and “don’ts” including many that are impractical for and/or incompatible with too many organizational models to make them de facto recommendations. We recommend that organizations work to identify the larger principle that a specific rule seeks to address. That process will then position YSO leaders and their staff to identify and employ a broader range of effective solutions.
For example, one question might be, “what are we trying to achieve by eliminating one-on-one adult-child interactions?” By requiring the presence of a second adult at all times (and/or the presence of multiple children), we are trying to increase the visibility of adult-child interactions. And what does that achieve? We might assume that more visible interactions will be more professional and more caring because:
