What is this?

• Child sexual abuse (CSA) can affect all socioeconomic groups and ethnicities, with an estimated 10-20% of girls and 5-10% of boys having experienced child sexual abuse before the age of 18, ranging from unwanted touching to penetrative assault. CSA is associated with a range of adverse psychological outcomes.
• This summary presents evidence on the effectiveness of school-based education programmes for the prevention of child sexual abuse (CSA) for children aged 5-12 years.
• School-based education programmes for the prevention of CSA were first developed in the US in the 1970s, and have since been widely adopted across many schools in the US and other countries.
• The content of the interventions included safety rules, body ownership, private parts, distinguishing appropriate and in-appropriate touches, distinguishing types of secrets and whom to tell and four studies included abduction prevention.
• Programmes used a range of strategies including discussion, practice and role-play.

How is it meant to work?

• School-based education programmes aim to equip children with the knowledge, skills and strategies to avoid potentially risky situations or advances as well as appropriate help-seeking behaviours.
• Children are equipped with strategies to verbally and physically repel sexual approaches and minimise harm by understanding appropriate help-seeking in the event of abuse or attempted abuse. This is based on the notion that children will transfer classroom-based learning to real-life situations.
• The underlying mechanisms draw upon classroom pedagogical principles such as social cognitive learning theories which highlight the social context of learning using techniques such as modelling, rehearsal and reinforcement of the desired behaviours.

What are the evaluated outcomes?

• Child self-protective skills
• Factual knowledge of sexual abuse and its prevention
• Application of knowledge of sexual abuse and its prevention
• Child anxiety or fear (due to participation)
• Sexual abuse disclosures

How effective is it?

Outcome 1: Child self-protective skills
Overall, the intervention showed a positive effect on child self-protective skills. This is based on low strength evidence from two studies with a sample of 152 children. The interventions in these studies were Children Need to Know Personal Safety Training Programme and the Videotape Intervention.

Outcome 2: Factual knowledge of sexual abuse and its prevention 
Overall, the intervention shows a consistently positive effect on factual knowledge of sexual abuse and its prevention. This is based on moderate strength evidence from eighteen studies comprising 4657 participants. Results also showed that knowledge retention remained six months after the intervention.

Outcome 3: Application of knowledge of sexual abuse and its prevention
Overall, the intervention shows a consistently positive effect on factual knowledge of sexual abuse and its prevention. This is based on moderate strength evidence from eleven studies comprising 1688 participants.

Outcome 4: Child anxiety or fear (due to participation)
Overall, the intervention shows that participating in a preventative CSA education programme had no effect on a child’s self-reported anxiety or fear. This is based on moderate strength evidence from three studies, comprising 795 participants.

Outcome 5: Sexual abuse disclosures
Overall, the intervention shows a mixed effect on sexual abuse disclosures. It is not possible to conclude whether school-based education programmes affect the number of disclosures of sexual abuse. This is based on moderate strength evidence from three studies comprising 1788 participants.

How strong is the evidence?

The review included seven randomised controlled trials based on randomisation of individuals, eleven cluster-randomised trials and six quasi-randomised trials.

Quality of evidence was rated as moderate for most outcomes because most studies had an unclear risk of bias. Where schools randomly allocated classes there was a risk of contamination between the intervention and control group. There was also a risk of spillover of intervention effects through child interactions on the playground, and difficulty concealing group allocation.

The extent to which knowledge and skill acquisition in the classroom extends to practical knowledge in real-life situations is unknown. Further, is it unknown whether the skills demonstrated in simulated scenarios of repelling strangers are the same skills children require to protect themselves from threats from familiar adults. Finally, the review does not provide evidence as to how much knowledge children need to produce clinically important protective effects.

Where has it been studied?

• Sixteen of the studies carried out in the United States, three in Canada and one each in China, Germany, Spain, Taiwan and Turkey.
• Practitioners should consider the different national contexts when applying these interventions to the UK context.

Who does it work for?

• All interventions were delivered to school-aged children with 23 of the studies conducted in primary schools and one in a special school.
• Of the studies that reported ethnicity, school-based education programmes were delivered to a diverse range of children.
• When findings were considered according to child age, results suggested that older children of ten years or more may be better suited to questionnaire-based knowledge compared to younger children of below nine years.
• There was no difference found for applied knowledge between the two age groups.

When, where and how does it work?

• All intervention programmes were delivered on school premises and during school hours. Only one intervention was delivered in the morning before the school class began.
• The interventions tend to be delivered to whole classes and tailored to age and cognitive ability.

What are the costs and benefits?

• School-based education programmes lend themselves to a public health approach as they can be implemented in schools at comparatively little cost without stigmatising those at greater risk.
• However, no economic analysis and cost-effectiveness was included in the review.

In summary...

• Children’s self-protective knowledge and skills can be increased by school-based education programmes for the prevention of child sexual abuse.
• There was no evidence that the school-based education programmes included in this study increased or decreased children’s anxiety or fear.
• The evidence is unclear as to whether participation on a school-based education programme for the prevention of child sexual abuse increases the number of sexual abuse disclosures during or after participation.
• More research is needed regarding the long-term effects of programmes, their effectiveness for specific groups of children, which components are most effective and their associated costs.
• Finally, while school-based education programmes can help children to protect themselves from sexual abuse, this does not replace the need for interventions focused on adolescents, perpetrators of child sexual abuse, situations where it is likely to occur and the wider community.