Bridging Theory and Practice: A Systems Approach to Childhood Sexual Abuse Prevention

1. Introduction

Childhood sexual abuse (CSA) is the harmful and criminal sexual acts that victimize and exploit children [1]. From the 1980s to the present day, prevention approaches have increasingly become a priority throughout the US [2]. With this honed-in effort, several programs and campaigns exist, including the Enough Abuse Campaign, the Children’s Justice Campaign, and the Pledge to Prevent Campaign [2,3]. Still, with the abundance of research and aims to decrease and prevent CSA, research suggests that as of 2019, “... approximately 1 in 10 children or 1 in 7 girls and 1 in 25 boys ...” in the US were CSA survivors [4].

The insights outlined articulate the foundation for this paper’s objective of conceptualizing an innovative approach to prevention. The discussion will primarily summarize CSA prevention and its background. Subsequently, the dialogue will rationalize research on the importance of CSA prevention through a theoretical lens and highlight the significance of CSA macro policy reform. Following a literature review focusing on CSA prevention and the associated barriers, the paper will delineate the interconnectedness between theoretical frameworks and introduce a framework aimed at enhancing the efficacy of CSA prevention.

2. Background

2.1. Scope of the Social Problem

CSA comprises a population of males and females under 18 worldwide [1,5,6,7,8]. Statistical variances in populations and sub-populations fluctuate based on age, gender, physical or cognitive disabilities, socioeconomic status, regional variations, and barriers to disclosure [5,8,9,10]. From a scoping perspective, the general findings indicate that approximately 10% of boys and 24% of girls in the US are CSA victims or survivors each year [8]. Furthermore, research suggests that 1 in 5 children do not disclose their sexual abuse [8].

The connections of CSA between the prevalence of the abuse and the setting in which it occurs are crucial to contemplate [9,11]. Research indicates that victims and perpetrators commonly have an established and trusting relationship, often resulting in the abuse happening in homes, educational, and religious settings [6,9,11]. Locales comprising disproportioned ratios of children per adult, such as sports and recreational venues, foster care group homes, after-school programs, and camps, are another environmental contributor to the prevalence factors [5,12,13]. Additionally, unsafe circumstances, including unmonitored internet access and neighborhoods characterized by exorbitant crime rates, represent environments inviting high-statistical CSA incidences [14,15].

2.2. CSA Disclosure

A prominent consideration of CSA prevalence is the several cultural considerations that either promote or hinder victim disclosure. As outlined previously, the vast definitions of CSA likely derive from diverse understandings of the abuse [15]. Moreover, the diverse society encompassing the American culture invites the potential for language barriers to prevent disclosure [5]. As diversity gains more substantial reception, cultural norms, including gender roles and power dynamics, impact a victim's willingness to report sexual abuse while concurrently worsening the stigma that survivors already meet. Ultimately, the outlined diversity and cultural considerations of CSA have produced many prevention tactics.

2.3. Prevention

Over time, experts have implemented various prevention and intervention practices [2]. An essential distinction to highlight is primary and secondary prevention [11]. Primary prevention includes educational approaches targeting children and families and community awareness campaigns [5,7,9,12,13,14,15]. Secondary prevention is designed to surround a CSA survivor once an indication of the abuse has been recognized [11].

2.4. Theoretical Frameworks

Common frameworks typically associated with CSA prevention and interventions are distinguished by their related purposes. The Ecological Framework (EF) supports prevention efforts and considers interpersonal, socioeconomic status, community, and relational factors. EF also umbrellas the enforcements grounded in the cultural and developmental frameworks, emphasizing the importance of considering different developmental stages and cultural norms [7,10,14,15]. The social learning theory (SLT) is another commonly highlighted theoretical supporter of prevention implementation, as it suggests that connections between modeling and teaching positive behaviors will adversely enhance healthy relationships [16]. Finally, the public health approach (PHA) and the systems theory (ST) are two approaches that improve community trust and dedicate prevention efforts to a multi-faceted layer of expertise distributed to multiple stakeholders [6,13].

3. Rationalization for Focus

Several researchers and experts on CSA prevention evidence the importance underpinning the topic of this conceptualization. Though the topic of CSA prevention has been an ongoing priority for decades, the data ultimately unveils the harsh truth – our population of youth remains plagued by volatile and impairing sexual abuse experiences [5,8,9,11,13]. Supported by the National Association of Social Workers (NASW), advocacy efforts through responsible research must continue to enforce social justice initiatives to reduce harm toward our children [17]. Developing an evidence-based policy reform approach to CSA prevention is demanded by ethics and essential to the safety of youths worldwide which are supported in theory [6,11,12,13,14].

4. Literature Review

4.1. Policy Prevention Approaches

Gross-Manos and Cohen [18] emphasize the crucial need for policy to implement programs that comprise a multidisciplinary approach to community prevention efforts, including professionals from health care, education, and mental health. Likewise, Mehta and Kelly [19] suggest policy reform that calls for prevention by raising awareness in community settings that provide ongoing health care and public academic education to eliminate the root causes of CSA. On the other hand, McPherson and Gatwiri [20] call for policy to enforce training to community leaders to implement a supportive environment in various settings, making disclosure a more determined action for children. Finally, Willmott and Mathew [21] recommend a policy implementing peer support prevention and recovery models.

4.2. Parental Education

Although legislation is critical in pursuing CSA prevention, studies also reflect the essential part of education for caregivers [19,20,21,22]. One need identified in pursuing parental education is the emphasis on identifying symptoms of the outlined abuse and the critical substantiation of open communication between the caregiver and child [20]. Recognizing symptoms of CSA in youths offers the ability to instill resilience in children, enforcing protective factors and fighting against revictimizing [22]. Extending outside of ecological approaches, a more informed community of parents on signs and risks of CSA suggests a more protective community for all children, mitigating risks of maltreatment concerning the ecology of children community-wide [19,21].

4.3. Environmental and Systems Considerations

A municipality guided by policy and endowed by informed parents enhances the ability to outline the significance of bridging ecological and systems theories in CSA prevention approaches [19,23,24,25,26,27]. It is critical to examine the abuse through an environmental lens to assess the needs while implementing a systems framework [25,26]. Identifying the ecology of childhood illustrates how family dynamics and community resources work together to increase or decrease vulnerabilities while also showcasing how community protective factors work together to mitigate CSA potential [23,24]. A final important consideration regarding the interconnectedness of ecological and systems theories is incorporating the biopsychosocial model as a guide for informing the prevention of CSA and exploitation on a mezzo and macro scale [19,27].

4.4. Legal Framework Considerations

Legal frameworks underscore the critical role prevention plays in protecting children [18,19,27,28]. It is essential to illustrate protective factors against commercial sexual exploitation, even on a mezzo level, which can be enforced through the interconnections of legal frameworks and health sectors in communities [19,27]. Additionally, studies underscore the essential need to address trauma through legal frameworks as part of a comprehensive approach to determining risk factors and prevention of CSA and sex trafficking [28]. Addressing the outlined risks to assess accounted for and necessary protective factors through legal frameworks invites the ability to introduce community change programs, empowering the efficacy of CSA prevention approaches [18].

5. Childhood Development and Preventative Intervention

This conceptualization model postulates the groundwork already paved for school readiness through the interconnectedness of childhood development in communities throughout the US. Employing evidence collected across research that identifies ecological and interpersonal risk influences of CSA aims to illustrate the interconnectedness between scientific research, evidencing the efficacy of early childhood development and preventative care strategies. Critical considerations of this framework underscore the importance of equity distribution, interdisciplinary collaboration, and tailored preventative care based on the child’s ecology [29]. In partnership with caregivers and highlighting the importance of ongoing evaluation, adaptation, and prevention education, this system’s approach to prevention will start with macro mandates offering specified interpretations for jurisdictional implementation [29].

5.1. Addressing the Gap

Given the number of CSA prevention efforts in the U.S. and the identified gaps in these strategies, centralized areas must be addressed. Each area represents components of systems throughout communities. Policy and legislation can help distribute responsibility equally. A defined distribution of responsibility enhances the purpose and scope of cross-professional collaboration, resulting in objective and tailored prevention approaches based on the child’s ecology [5,29,30].

5.2. Policy and Legislation

5.2.1. Macro Standards

A primary gap in CSA prevention starts at the national level – a lack of uniformed policies and legislation [6,12]. The outlined policy deficit has created cross-jurisdictional pitfalls due to state and local interpretations of the law [12]. With varying interpretations there are varying definitions of sexual abuse, which ultimately presents a multitude of reporting mandates and differing beliefs of what sexual abuse symptoms may present in a child [12,31]. The several interpretations of CSA prevention invite just the same for the CSA consequences [6].

5.2.2. National to Jurisdictional

Another considerable gap addressed with the introduced framework concerns the many children currently at risk due to the varying definitions and interpretations. A more substantial and streamlined policy must identify professional roles, responsibilities, criminal standards, and guidance for victims’ help. Refining the inconsistencies will reduce delayed reporting [6]. Moreover, our policies surrounding CSA can invite heavier and more consistent investigation and prosecution standards [6].

5.2.3. CSA Prevention Funding and Incentives

The identified spending actions and budgets for each state underscore the benefits of this model [6]. The allocated funding will encourage implementing more effective training programs for professionals in various fields [29], including healthcare, mental health, child welfare, legal, and education [30]. Incentivizing calls to action for identified symptoms of CSA within a child enhances the continuum of care through a trauma-informed lens.

5.2.4. Trauma-Informed Approaches

A critical step in closing the gap through policy is the need for more understanding of trauma-informed approaches across disciplines in the professional context. Integrating trauma-informed knowledge in healthcare, mental health, child welfare, and education systems strengthens the ability of various professionals to recognize signs of sexual abuse. In turn, this will likely set the stage for eliminating barriers to disclosure for those who are unable or have difficulties articulating their abuse. The twofold benefit of widespread knowledge of trauma-informed lenses is the quicker ability to intervene and support victims [29,30].

5.3. Equitable Distribution of Responsibility

5.3.1. Existing Pediatric Involvement

The consideration of equitable distribution for CSA prevention aims to eliminate the parent's sole responsibility while still honoring their proximity to the child’s ecology. CSA education and assessing ecological and relational CSA risk factors align with a multidisciplinary approach in our childhood development medical model [30]. This is similar to pediatricians' practices for various other child development reasons [32]. By engaging in CSA prevention education with the child, parent, and primary care physician, communities could leverage enhanced learning outcomes for both children and parents.

5.3.2. Families, Federal, State, and Prevention

Compared to other countries, the U.S. relies heavily on families to maintain awareness and prevent potential social problems, including CSA [33]. Meanwhile, the U.S. funds child welfare agencies at the state and federal levels to investigate the need for intervention when families face social disparities, such as intergenerational trauma and systemic inequalities [34]. This creates a twofold dilemma: It is crucial to uphold constitutional freedoms, yet social welfare and preventative partnerships through community agencies do not seem to impede American liberties [34].

5.3.3. Parental-Professional Collaborative Partnership

Research indicates that children experience enhanced “... learning gains ..." when a collaborative partnership involves a parent and a professional [7,30]. However, as is familiar with most types of child abuse, CSA is often perceived as being solely the responsibility of parents to protect their children against [7,30,34]. Furthermore, studies show that mothers are the most protective from CSA [30]. While it is troubling that fathers do not exhibit equal levels of protective behavior, it also highlights that males are the primary perpetrators in CSA cases [30].

5.3.4. Systemic Support

In many instances, mothers are predominantly responsible for CSA prevention and protection [7,30]. Conversely, around 27% of American children grow up in single-parent households [35]. Given the prevalence of childhood ecological factors that can complicate protective measures, it is essential to consider all aspects of the child’s system in safety planning, education, and prevention [29,32]. Public education institutions are added partnerships commonly identified within the child and family system [36].

5.4. Interconnectedness Across Professions

5.4.1. Multidisciplined Collaboration

A unique recommendation under this new framework is that multidisciplined professions impart interconnectedness by leveraging a systems approach to prevention that fosters collaboration and shared responsibility. As discussed previously, the immediate professions identified under this umbrella would be child welfare, healthcare, legal, and mental health professionals. Utilizing the various professional expertise angles postulates a coordinated response to CSA prevention. This notion bases the systems approach on the child’s ecological considerations, including family dynamics and relational risk factors, pushing for more efficacy than previously discussed, isolated prevention interventions [29,37].

5.4.2. Trauma-Informed Prevention and Disclosure

A critical element in this intervention process must include a trauma-informed approach across professions to educate children and families at each stopping point throughout the child’s development and preparation for school readiness. This purpose is based on the position that disclosure barriers will be eliminated with a trauma-informed approach [5]. Additionally, using a multi-angle professional approach in partnership with parents and children will assist in destigmatizing CSA survivors, along with normalizing the conversation surrounding risk factors [5].

5.4.3. Cross-Profession Prevention and Reporting

Furthermore, the plethora of ecological and relational risk factors that can present an increased risk of CSA victimization can become too complex for one profession or professional to address individually and effectively [28,38]. Adopting this cross-sector professional framework enhances practical resources and information sharing on prevention approaches and reported signs of sexual abuse exhibited by children within communities. The incorporation of legal frameworks across different community agencies is another crucial element, as this will foster adequate and timely protocols for reporting sexual offenses against a child or suspicion of sexual abuse [39].

5.4.4. CSA Survivor’s Dignity

The dignity and worth of CSA survivors is crucial for future prevention and intervention needs. The implementation of mandated training and multidisciplinary approaches to CSA prevention and intervention posits that knowledge of sexual abuse warning signs and lingering CSA impacts is a mitigating factor in stopping ongoing abuse and preventing future abuse [6]. Using the knowledge of warning signs sets the foundation for preventing re-traumatizing victims with a refined approach to the topic of sexual abuse, as all the different professionals would not fail to recognize the child’s need, enhancing levels of trust, safety, and victim empowerment. With this angle, closing the gap in community systems enhances interconnectivity and effective and compassionate responses to CSA prevention and intervention through educational approaches [6].

5.5. Objective and Tailored Approaches

5.5.1. Ecological Assessment and Prevention

Factors such as family dynamics, community and peer influences, and socioeconomic status play critical roles in a child's vulnerability to victimization [19,24]. An ecological framework guiding prevention efforts can help tailor education and assessment strategies based on unique environmental and relational considerations [29]. Doing so can empower professionals to understand how to identify potential risk factors the child is facing in their ecology – eliminating the one-size-fits-all approach to prevention education. The client’s neighborhood, familial, peer, and educational interactions must be closely assessed in partnership with parents.

For example, families who engage in frequent and damaging conflicts within their households or have family members who face substance abuse or addiction may face increased risks of CSA [40]. In the context of a multidisciplined approach, when assessing for these risk factors, a medical professional might be able to detect physical symptoms of abuse. At the same time, a mental healthcare provider might be more inclined to identify trauma symptoms. Referring to the discussion on better professional training material, the child and their family will receive CSA wellness assessments from each angle within their community [28,38].

5.5.2. Family, Relational, and Protective Factors

Primary relationships in a child’s life influence their emotional development, which can considerably impact CSA vulnerabilities [6,23,38]. Tailored prevention education determined by the outlined relationships enhances protective factors within the child’s system [27,37]. This notion must not discount the fact that many families comprise several appropriate protective factors within their dynamics [14]. However, relational risks are not only found within the child’s family dynamics.

A systems approach to prevention based on ecology must consider all relationships. Children engage in school, sports, churches, and various other extracurricular activities, and these relational dynamics also require the influence of protective factors [6,14,24,25]. As the child and their family make these pit stops in their ‘school readiness’ journey, tailored prevention and assessment methods must aim to normalize the discussion of CSA. The risks in relationships include peers or trusted adults outside the family [6,21,30,41]. An assessment based on the child’s ecology encompassing the child’s entire system is crucial, but cultural considerations must also apply.

5.5.3. Cultural Context

Cultural contexts have a considerable influence on risks and protective factors regarding CSA [10,27,33,42]. As we assess ecological elements through a systems approach, professionals and families must address beliefs about sexuality, gender-specific roles surrounding the child’s life, and ways child-rearing can influence CSA risks and outcomes [6,7,10,19,23,25,26,27,33]. Tailoring prevention and assessment approaches while addressing these outlined cultural contexts is an essential step in the systems process that cannot be overlooked [21,26]. Employing cultural humility invites an individualized experience when combatting CSA risks in collaboration with families [31].

6. Discussion

6.1. Key Theoretical Concepts

Multiple guiding frameworks are necessary for CSA prevention and intervention [27]. Each framework used throughout this text strengthens our perspective and understanding of CSA as a social issue [6]. When compiled, these frameworks invite a more comprehensive approach to combating sexual abuse in childhood [11]. The key is to integrate each framework effectively [18].

6.2. Ecological Framework

Ecological Systems theory (EST) is the foundational framework supporting this conceptualization. EST posits that childhood development is primarily influenced by various layers of the child’s environment [26]. These include primary settings such as their household and educational institutions (microsystem), and secondary layers such as neighborhoods, peer relationships, cultural norms, and community safety (macrosystem) [26,29]. As evidenced throughout the text, acknowledging micro and macro environmental risks is vital to CSA prevention and intervention.

6.3. Systems Theory

The systems theory (ST) emphasizes the interconnected approach to CSA prevention and intervention among various professionals and entities throughout a community, outlined in this conceptualization [27]. Certain aspects of a child’s development are measured through a systems approach, including state assessment tests, height and weight percentiles, and age comparisons of developmental milestones, such as walking and talking [24]. ST enables the measurement of reduced CSA. ST enforces the necessary protective factors outlined in the text by instilling professional role models in various community settings. Lastly, the notion that no single profession can single-handedly prevent and reduce CSA victimization is reinforced through ST [5,28].

6.4. Social Learning Theory

The Social Learning Theory (SLT) framework is relevant to CSA prevention and intervention in the context of preventative education for children and families at each step on their journey to school readiness [11]. At each stage of a child’s development in their school readiness journey, SLT posits the need introduced in this text to educate on presenting risk factors based on ecological assessments [5]. Furthermore, this same notion applies when assessing prevention for re-victimization. Promoting positive collaborative partnerships within a child’s social circle is grounded in the SLT [27].

6.5. Trauma-Informed Care

Approaching CSA prevention and intervention with a trauma-informed lens is also a critical framework. Respecting the dignity of CSA survivors is crucial regardless, but mainly to eliminate the possibility of re-traumatizing them [22,27]. Additionally, the need to dissolve the discomfort of preventative education with children and families is enhanced with a trauma-informed (TIC) approach [22]. TIC outlines the understanding of emotional and psychological considerations for children who have been sexually abused and children who are being empowered with education to prevent CSA [26].

6.6. Epistemological Assumptions

The belief underlying this paper suggests that CSA knowledge for prevention and intervention is derived from multiple sources [5,14]. A constructivist epistemological assumption highlights the proposition of interconnectedness among community stakeholders [25,29]. To support this, qualitative and quantitative data are crucial for informing and shaping our understanding of the abuse while considering lived experiences and cultural and relational factors [38,43]. A multidisciplinary collaboration between children, families, and professionals centralizes diverse areas of expertise and enhances knowledge.

Integrating empirical research, multiple frameworks, and differing areas of expertise prompts a multifaceted approach to understanding CSA [6,11,27]. Addressing the complex issue of CSA prevention invites an appreciation for the fact that we have discovered a wide range of pertinent information regarding CSA. We must construct this information across sectors within our systems, fostering our children’s development. Ultimately, the necessary collaboration when approaching CSA prevention strengthens the development of this comprehensive solution.

6.7. Ontological Assumptions

The ontological assumption adopted throughout this text is that CSA is not an isolated type of abuse and must not be combated with an isolated type of prevention [11,12,31]. CSA is recognized as an intricate phenomenon influenced by various aspects of a child’s micro and macro systems [24,27,41]. The perspective outlined focuses beyond ecological risks and implements systemic protective factors. Likewise, prevention and intervention strategies must be tailored to the child and family based on ecological assessments that include cultural contexts and honor each interaction as a unique circumstance.

The ontology underlying this systems approach establishes the interconnectedness of prevention. Addressing CSA with the outlined approach also recognizes how all ecological layers can contribute to sexual abuse. This text highlights the importance of advocating for targeted and tailored systemic changes from a national level that flow down to a micro level without alterations in interpretations. These innovations must aim to empower children, support families without isolating the responsibility of CSA prevention to the parents, and ensure a holistic response to this widespread social issue.

6.8. Strengths

The introduction of integrating multiple frameworks creates a universal approach evolving from many of the isolated CSA prevention and intervention efforts already in existence [6,11,27]. With an emphasis on multidisciplined collaborative approaches, this model unites professional missions into one united effort confronting CSA. This outlined effort ensures that the interconnected primary and secondary preventions are as robust and comprehensive as the abuse. Additionally, principles are included in each integrated framework, including TIC demands for a tailored response based on the child’s ecology, maximizing prevention, and minimizing re-traumatization while promoting dignity in the healing process of secondary preventions [22,43,44].

6.9. Limitations

While this model is ideal in theory, the implementation process is likely more comprehensive than the model itself [5,6]. Potential barriers to this model include limited resources and subjective interpretations of any policy reform if the language needs to be more concise and explicit enough to be universally interpreted [14]. Without these standardized laws that create a clear definition of CSA and a comprehensive approach to victim care and criminal proceedings, the success of this model could be significantly disrupted [6]. Finally, a notable foundation is presented in this model for primary prevention tactics, but there needs to be more discussion on secondary prevention tactics.

6.10. Implications

This comprehensive and multifaceted systems-based approach to CSA prevention and intervention has many implications for children and families whose ecological context includes CSA risk factors [19,38]. The proposed focus on the child’s micro and macro systems offers an avenue to address the root causes of CSA victimization [23,24]. The conceptual model implements individualized interventions based on the uniqueness of the ecological assessment. Most importantly, the implications offer better outcomes for children and their families.

Under this model, childhood development could mitigate CSA risks, enhance protective factors throughout a child’s school readiness journey, and deliver a widespread understanding of TIC among various professions. The child’s family could engage in healthier partnerships with community agencies. Additionally, Parents would not be forced into an isolated responsibility to prevent CSA. Lastly, a collective effort of CSA prevention among the broader community would encourage reducing the stigma of CSA victimization and the discussion surrounding CSA prevention [5,9].

7. Conclusions

This conceptualization showcases innovative CSA prevention by underlining the demand for prevention based on ecological assessments. The model incorporates input and collaboration from various professionals and acknowledges children and families as experts in the assessment. Integrating EST, ST, SLT, and TIC, this paper underscores the efficacy that interdisciplinary collaboration could invite when a systems-based approach to CSA prevention is an essential consideration. Recognizing CSA as a multi-layered, robust, and complex societal issue that tunnel vision will never solve, this conceptualization advocates for community support, incentivizing efforts by funding quality training across professions, a trauma-informed lens, and overdue and significant policy reform.

The outlined method stresses the importance of implementing a tailored, context-specific, culturally humble, and collaborative approach to assessing risks and implanting protective factors. Effectively measuring the child’s ecology through ongoing collaborative assessments is critical in addressing the prevalence of CSA. Without an equitable distribution of responsibility among children, families, professions, and stakeholders, the risk and prevalence of CSA remain. Prioritizing equity in combatting CSA will inadvertently prioritize the reduction of children who are victimized each year throughout the U.S.