Zollner et al.

Child and Adolescent Psychiatry and Mental Health 2014, 8:5

http://www.capmh.com/content/8/1/5

COMMENTARY Open Access

Prevention of sexual abuse: improved information

is crucial
Hans Zollner SJ1*, Katharina A Fuchs1 and Jörg M Fegert2

Abstract
Sexual abuse can lead to long-lasting, even life-long, consequences and is a serious problem on an individual,
familial and societal level. Therefore, prevention measures on different levels are a public health issue. Minors as well
as adults should be involved in prevention work in order to prevent sexual abuse of minors in a sustainable way.
Besides norms, structures and values in society, the respective laws as well as attitudes and structures should be
changed and amended in such a way that abusers and the abuse are clearly confronted everywhere. In the last
decades, numerous prevention programs for victims have been developed for various target groups (e.g. parenting
education classes, home-visiting programs, public education, training sessions for teachers, E-Learning Programs of
the German Federal Ministry for Education and Research and the Centre for Child Protection). Many of these
programs have proven partially effective. Nevertheless, until now there is no consensus in the scientific community
on what constitutes effectiveness in this context. Reasons for this are the discrepancies in definitions or the scarcity
of attention which the evaluation of prevention measures has received.
Keywords: Prevention, Sexual abuse, Effectiveness, Evaluation

Background church or sports. The need for continued education

During the Round Table on “Childhood Sexual Abuse” seems to be particularly high in institutions which are
organized between 2010 and 2012 by three German Fed- taking care of a population that is already more endan-
eral Ministries (the Ministry for Research and Education, gered, such as children’s homes and boarding schools.
the Ministry for Families, Senior Citizens, Women and The study ordered by the Independent Commissioner
Youth and the Ministry of Justice) one of the key ques- showed that particularly in this latter area, directors of
tions revolved around ways in which the renewed large- such homes and schools saw a clearly increased risk in
scale victimization of children and youth in institutions, being confronted with such scenarios [2]. The German
but also in families could be avoided in the future. Fur- Federal Ministry for Families, Seniors, Women and
thermore, Dr. Christine Bergmann, a former Federal Youth charged the German Association for the Preven-
Minister was appointed Independent Commissioner to tion and Intervention (DGfPI) into Childhood Abuse
investigate the sexual abuse of children. Many of those and Neglect with the development of a continued educa-
affected who had turned to the Independent Commis- tion program for institutions providing youth services.
sioner for Childhood Sexual Abuse [1], had requested Currently, these programs are being established nation-
generally better prevention and earlier intervention to wide with experts from youth counselling services. To
avoid potential harmful consequences for the abused. improve the information available to health and educa-
Several areas were identified as central to the dissemin- tion professionals, the Federal Ministry for Research and
ation of improved information and prevention strategies, Education has financed the development of an e-learning
including specific psychotherapy, school and leisure edu- program [3]. The Pontifical Gregorian University in Rome
cation as well as volunteer activities associated with the in 2012 founded the Centre for Child Protection (CCP)
and tasked it with developing an internationally-oriented
e-learning program for use by the Church [4]. To do so, a
* Correspondence: [email protected]
1
Istituto di Psicologia – Centre for Child Protection, Pontificia Università consortium was established in Munich, Germany, with the
Gregoriana, Rome, Italy support of the Arch Diocese of Munich-Freising and other
Full list of author information is available at the end of the article

© 2014 Zollner et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative
Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and
reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain
Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article,
unless otherwise stated.
Zollner et al. Child and Adolescent Psychiatry and Mental Health 2014, 8:5 Page 2 of 9
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sponsors. During the initial phase, the consortium will be

able to draw on the expertise of the Medical Faculty in Assure
Ulm, Germany, in the areas of child protection and e- widespread
Develop adoption
learning. During the Round Table discussions, there was Identify
and test
prevention
agreement that the rapidly implemented activities to im- risk and strategies
Define the protective
prove victim-focused prevention measures needed to be problem factors
evaluated. However, there was not much discussion about
the criteria that would be used to measure success, beyond Figure 1 Public Health Model (according to Center for Disease
simply indicating satisfaction. This is largely due to the fact Control and Prevention (CDC) [9]).
that there are differing ways to conceptualize and imple-
ment prevention. This article is an attempt to integrate spe- through political or legal measures) and/or behavior-
cific prevention activities for childhood sexual abuse into based prevention (support for developing active and self-
the broader public health debate on prevention. The focus protective modes of behavior and strategies) [10].
in a public health debate on prevention should lay on sensi- With regard to behavior-based prevention, the follow-
tive and carrying environments and the responsibility of ing differentiations can be made:
adults instead of putting too much responsibility on the
child to learn to protect himself/herself from sexual abuse.  Primary prevention
In about 80% of the abuse cases the perpetrators are per-  Secondary prevention
sons known to the child and his/her family [5,6]. Therefore,  Tertiary prevention
the adult environment of a child should be a main focus of
prevention approaches. The article will point out corre- This concept [11] was adopted by the WHO in 1994
sponding challenges in prevention strategies and highlight and is often used in curricular prevention programs. In
potential approaches to evaluation. this context, primary prevention refers to each and every
measure that is taken to reduce sexual violence from the
How to define prevention? outset, for instance through workshops with minors.
There is no uniform, generally applicable definition of Secondary prevention includes measures used in high-
prevention. However, one can point to a few commonal- risk situations, for example in order to put a stop to
ities among the various definitions. For Bloom [7], for abuse that is emerging or in progress. The reaction to
instance, prevention is usually interdisciplinary and sexual crimes already committed is the domain of ter-
has as its goal a long-term change on several levels. tiary prevention which aims at mitigating the immediate
Conceived more broadly, prevention can be understood consequences of abuse and at minimizing secondary
as a path to reducing potential injuries to body and soul consequences. Additionally, this level comprises relevant
and, simultaneously, to encouraging positive interactions therapies and measures to prevent a relapse in order to
and contexts. With regard to sexual violence, prevention strengthen the psychological and physical health of those
means creating healthy and safe circumstances and be- affected, cf. among others [12]. So far, a majority of
haviors so as to prevent sexual crimes before they can current political measures for the prevention of sexual
even take place [8]. Prevention of sexual violence is not abuse rests on secondary and tertiary prevention. Pri-
easy to measure which makes a critical discussion as mary prevention strategies have received scant attention
well as regular evaluation of prevention work and pre- in prevention programs as well as in internationally-
vention approaches all the more indispensable [8]. The oriented prevention policies.
Public Health Model for the prevention of violence, Besides the distinctions in Caplan’s [11] “classical”
adapted from the US Center for Disease Control and concept described above, Gordon’s [13] more person-
Prevention, understands prevention mainly as a reduc- oriented concept of prevention, introduced by the Insti-
tion of risk factors and an increase in protective factors tute of Medicine (IOM), has been increasingly been
with the goal to prevent sexual violence from happening employed. Gordon’s model differentiates between uni-
in the first place [9]. The Model (see Figure 1) spells out versal, selective and indicated prevention, cf. [12,14,15].
four levels: [1] defining the problem, [2] identifying risk Unlike the previous model, Gordon [13] does not make
factors and protective factors, [3] development and test- a distinction with regard to the time-line of measures
ing of prevention strategies, and [4] assuring widespread but rather with regard to the target groups which are to
adoption of these strategies. be reached by the measures. Universal prevention is di-
Preventive approaches to sexual violence can take rected at the overall population of a country, a region, a
many forms. Victim-focused prevention, for instance, city or a company’s employees or a school’s students.
can include relationship-based prevention (changes to Selective prevention is geared towards a group or individ-
and/or control over potentially dangerous relationships uals who are at higher risk for abuse based on specific,
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generally well-known conditions. Indicated prevention

takes place when individuals find themselves in risk-
Societal
prone situations or when they exhibit unusual behavior
(such as a sudden drop in school grades to which par-
Community
ents and teachers react quickly and attentively).
Figure 2 illustrates the fact that these two concepts
Relationship
[11,16] cannot only be used separately but also in com-
bination and through integrated approaches.
As named above, secondary prevention includes mea-
Individual
sures used in high-risk situations, therefore it is, as Meili
[17] suggests, not only important for individuals at a
high risk for abuse but for example also for the overall
Figure 3 The Social-Ecological Model (according to Dahlberg &
population of a certain region, city or school, where the Krug, [19]).
individuals are at a high risk. Furthermore tertiary pre-
vention can not only be seen as indicated prevention;
tertiary prevention can, according to Meili [17], be for worldwide sexual violence are: the unequal treatment
understood as selective prevention by trying to minimize of the sexes, economic disparities as well as social and cul-
the immediate and the secondary consequences for a tural norms which sanction particular images of masculin-
group or individuals at a high risk for abuse. ity predicated on the control of women, and which value
In their Spectrum of Prevention Model, Cohen and male strength and toughness [20]. In public debates and
Swift [18] point to the importance of an organizational political discussions, however, this analysis is only rarely
approach. According to their model, the prevention of linked to the sexual abuse of minors. The marked increase
sexual abuse occurs on several levels: from the individual in the national [2] and international [21] public’s and me-
to the organizational level. They argue that in order to dia’s interest in issues of sexual abuse have nevertheless
work towards prevention of sexual abuse, political goals led to increased efforts by more and more nations (such
and legal frameworks also have to undergo a change on as Germany, England, South Africa, Australia or the
the organizational level. This concept corresponds to the Philippines) which are attempting to actively pursue pol-
approach of the Social-Ecological Model by Dahlberg & icies against sexual abuse [22-24]. Examples include train-
Krug [19] which identifies four levels of a person’s social ing measures in schools to recognize the signs of sexual
environment as necessary for abuse prevention (cf. Fig- abuse in minors, or, with regard to employment, checking
ure 3): the individual level, the relationship level, the official records for indications of previous relevant arrest
community level and the societal level. records. As Finkelhor [16] has been able to show, preven-
In order to prevent sexualized violence against minors tion work against childhood sexual abuse has become
and sexual abuse sustainably and over the long term, pre- widespread in schools internationally and is frequently
vention has to address several levels. Often-cited reasons supported politically.
Before we address prevention and prevention pro-
grams in detail, a brief terminological clarification may
be necessary, namely the distinction between efficacy
and effectiveness.
A treatment proves effective, if it works under non-
ideal conditions in everyday practice [25]. Scientists,
clinicians and politicians often are called upon to differ-
entiate between the effectiveness and the efficacy of a
prevention or intervention. Efficacy trials (explanatory
studies) state whether prevention or intervention measures
produce the expected result under quasi experimental con-
ditions. Effectiveness trials (pragmatic studies), on the other
hand, measure the extent of the positive effectiveness under
“real-world” conditions in everyday settings. For this reason,
researchers formulate hypotheses and study designs of
effectiveness trials based on certain conditions, such as rou-
tine clinical practices and the importance of the trial’s re-
Figure 2 Overlap between the types of prevention (according
sults for clinical decisions. Effectiveness cannot be measured
to Meili, [17]).
through the use of controlled, experimental studies, as the
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simple fact of inclusion in a study leads to distortion of cus- factors which determine the success of a given measure,
tomary practice. Effectiveness can be assessed via observa- include materials used and their mode of integration
tional studies in the actual field and allows for both into the program; the didactic implementation and
qualitative as well as quantitative assessments. length of the measure; the professional qualifications of
Efficacy and effectiveness exist on a continuum [25,26]. those implementing the measure and those in positions
Generalization depends on the perspective of the re- of responsibility; implementation that takes into account
searcher or observer as well as on the conditions prevail- gender and culture-specific aspects. Moreover, studies
ing during the study. The patients’ basic data (e.g., indicate the effectiveness of close interdisciplinary net-
gender, age, severity of illness, racial groups) are vital works and cooperation with counselling and therapeutic
factors for the generalisability; this means that the services, trauma ambulances, emergency hotlines, abuse
generalization of one and the same study can, depending commissioners, ombuds posts and/or the police and re-
on the population, vary from low to high [25]. spective courts [27].
The following aspects are – as shown in existing stud-
Effectiveness of prevention in general ies for an overview see [27,28] – the hallmarks of a
Effective prevention strategies operate on various levels: successful prevention program:
on the level of minors; on the level of adults who live or
work with children and youth; but also on the level of – Prevention measures are directed primarily at adults
societal norms and values, on the legislative level, and and only secondarily at children and youth; this puts
on the level of attitudes and structures which – more or the responsibility for the protection of minors from
less intentionally and more or less “consciously” – pro- sexual abuse squarely in the hands of adults.
tect perpetrators or downplay their behavior (cf. E- – Prevention measures are implemented in frequent,
Learning Program of the German Federal Ministry for short, and regular intervals.
Education and Research and the Centre for Child – Prevention measures employ appropriate language; it
Protection [3,4]). is important to provide compact information that is
Two aspects deserve particular attention for successful easily understandable, specific and comprehensive
prevention work with regard to childhood sexual abuse: and which does not ask too much of the target
content areas (What does one have to know?) and struc- group.
tures (Which methods are being used? What kind of in- – In the case of children, relevant questions include if
stitutional and personal assistance is being offered?). and to what extent they have had sex education.
The content areas of prevention measures and programs – Both girls and boys are equally and equivalently seen
determine to a large degree how effective the changes in as potential victims.
the behavior of minors and adults are [27]. The structure – Prevention programs are implemented by a team
decisively influences whether the program or measure is representing both genders.
effective in the long term [27]. Victim-focused preven- – Prevention measures confront the day-to-day
tion of sexual abuse of minors is based on competent complexities of a specific target group; this means
and comprehensive information and has as its goal that besides gender and language, culture, religion,
the effective protection of children. The focus is on politics, status as well as the legal system of the
conveying factual and comprehensive information which respective state is taken into account.
takes into account the specific circumstances, needs and – Many prevention programs (e.g., including the
resources of the person and his/her environment. In E-Learning-Program of the German Federal Ministry
addition, victim-focused prevention highlights various for Education and Research as well as the Centre for
prevention options and integrates co-operating partners Child Protection at the Pontifical Gregorian
on various levels [12,27]. Besides conveying content, University in Rome) offer basic information on
changes in structural components are decisive for suc- potential intervention measures.
cessful prevention work. As several survey studies by
Knorth, Knot-Dickscheit & Strijker [28] have shown, For ethical reasons, it is often difficult to study
there exist identifiable structural factors which are highly evidenced-based prevention in the field, particularly
promising. These include: providing solid basic informa- with regard to sexual abuse [29]. This is probably one
tion; using a variety of prevention methods; involving of the reasons why there are few existing comprehen-
parents, family members, teachers, peers or other con- sive studies which would allow to make statements
tacts; providing a precise and competent introduction to about the empirical basis for the efficacy of prevention.
a prevention program or a specific prevention measure Additionally, there are hardly any studies which make
and its consistent implementation in the respective con- valid statements about the efficacy and the long-term
text (e.g., school, sports club, parish) [28]. Additional effectiveness of prevention measures [27].
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Types of prevention programs and their effectiveness confirmed in the case of women with mental retardation
Over the course of time, numerous prevention programs who received training in prevention strategies against
for the protection of minors from sexual abuse have sexual abuse, e.g., [32]. According to Knorth et al. [28],
been developed. These programs show that in most meta-analyses and review studies show positive effects of
cases it is not sufficient to educate minors in order to school-based prevention programs merely with regard to
prevent sexual abuse. Truly effective primary prevention general protection factors, but not with regard to pre-
not only means that everything is being done to vention of sexual abuse. In assessing the effectiveness
minimize the number of sexual criminal offenses; it also of prevention programs, researchers need to critically
includes broadly disseminating information to the gen- evaluate what minors themselves say about a particular
eral public and corresponding actions. While public measure and/or their increased sense of personal safety.
awareness of childhood sexual abuse in the society at Important questions in this context include: To what ex-
large and also in Church contexts has increased signifi- tent are minors able to implement the skills and strat-
cantly over the past few years in North America and in egies practiced in the event of an emergency? How high
Western and Central Europe, many societal groups, is the risk of traumatization through role-playing of
countries, and cultures are still lacking information on attempted advances? Obviously, children who defend
the issue, especially with regard to prevention. The task themselves are merely able to delay the perpetration but
then consists in not only providing information but also not to avoid it, cf. [31]. Part of the reason for this seems
in developing prevention strategies and programs, in to stem from the fact that prevention programs geared
implementing them and in evaluating their effectiveness at children and youth often neglect those aspects which
within the respective cultures and contexts. Prevention allow for sexual abuse to occur. Areas and circumstances
programs are directed either primarily to minors or to over which minors have no or only slight control and
adults. which fall under the complete or primary control of
adults, are neglected [31]. This includes intercultural
Prevention measures primarily addressed to minors and interreligious contexts to which the majority of
In order to be able to protect themselves from unwanted existing programs do not pay attention, because they
advances by adults, minors need to be able to recognize orient themselves on Western cultures and their norms
inappropriate behavior as such and to respond to it ac- and regulations [27]. Moreover, it needs to be critically
cordingly. Therefore, a policy mix of behavioral preven- remarked that many primary prevention measures which
tion and structural prevention is necessary. Prevention focus on the acquisition of self-protection skills delegate
programs which are specifically geared towards minors the responsibility for the protection from abuse to po-
most often take the empowerment approach. Of central tential victims, i.e., to minors. These minors, then, carry
concern in this approach is acquiring skills for self pro- the burden of a responsibility which they are generally
tection which are conveyed via concepts and practical unable to shoulder. The responsibility for the protection
exercises, such as saying no, avoidance, running off and of minors lies with adults. It is indispensable for effective
reporting. These four skills are at the center of training and successful prevention that minors not only acquire
programs for the prevention of sexual abuse and have the skills but that they learn to apply them in a danger-
proven effective [30]. Minors themselves have perceived ous and high-risk situation by avoiding or escaping from
and evaluated them as positive, cf. [31]. Through these it [27].
training programs, they learn to recognize situations
which endanger their personal safety, to avoid similar Prevention measures additionally or exclusively
situations, to escape the danger and afterwards to imme- addressed to adults
diately tell a trusted adult (behavioral prevention), but Some prevention programs are addressed exclusively to
on the base of a long-term effectiveness it is also import- minors, others involve adults as well [33], still others are
ant to know which adults are trustworthy and to have geared exclusively to adults. Recent studies show that
such adults available (structural prevention). These the involvement of adults in the prevention of child sex-
adults might be for example school-psychologists or li- ual abuse is important. Through their involvement,
aison teachers in schools. adults not only learn how to talk with minors about
In the past, researchers have primarily used three types sexuality and their sexual and emotional development
of assessment to evaluate the effectiveness of safety but also how to recognize problematic behavior, how
training for children and youth: verbal reports and/or other adults can be held accountable for their wrong be-
self-reporting; role plays and construction of realistic havior, and what to do when signs of sexual abuse exist
cases (in situ). Research has proven that an evaluation in [34]. As the US-based National Sexual Violence Re-
situ is the only valid assessment criterion with regard to source Center (NSVRC) was able to show in 2005, the
skills that increase personal safety. These results were inclusion of adults in prevention work brings with it
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many advantages [35]. For instance, minors are better specific groups of society but also the general public as a
able to grasp risk-reducing messages, when these are whole are encouraged and strengthened to work against
conveyed by adults at home or in school. In addition, sexual and other forms of violence [22]. Such an ap-
care providers, teachers, coaches, or educators should proach includes the questioning of prevailing social
receive advice and information about where to ask for norms such as the private sphere, power, gender roles,
assistance and support in emergencies. etc. [40]. As Cohen, Lyles & Brown [41], for instance,
Table 1 provides an overview of various types of pre- were able to show, bystander education has a positive
vention programs addressed to various groups of adults effect. Some prevention approaches in this context at-
as well as the programs’ goals and effectiveness. tempt to react to clearly identifiable shortcomings (for
A further central aspect in prevention work with instance, when teachers do not know how to report a
adults is bystander education, which aims at sensitizing suspicion, they receive training on this particular aspect).
the largest number of people possible to the topic. The Other approaches are oriented on common sense (“We
principle of bystander education focuses on expanding have to keep children away from sex crime offenders.”);
the prevention of abuse from the individual and familial still others result in laws, which, for example, proscribe
level to the societal level. This means that members of where such offenders are allowed to live.

Table 1 Overview of various types of prevention programs addressed to various groups of adults
Parents/Guardians People working with children General public
(e.g., teachers, coaches)
Goals To educate parents and guardians on....., To educate people working with
children on....,
1. How to inform their children about 1. How to inform children about the 1. To inform the public about
sexual abuse prevention of sexual abuse sexual abuse (e.g., prevalence,
opportunities for intervention, etc.)
2. How to protect their children from 2. How to recognize and report sexual 2. To change societal behavior
sexual abuse abuse
3. How to recognize signs of (potential)
sexual abuse und how to stop it
4. How to strengthen a healthy family
dynamic
Challenges for the Important factors for the success of a Important factors for the success of a
conceptualization and program addressed to parents/guardians program addressed to those working
implementation of are: with children are:
effective measures
• Interest in the topic • Interest in the topic • Media-based campaigns are com-
plex in content and costly to
• Qualification of the prevention educator • Qualification of the prevention
finance
educator
• Program time-frame (length of training • Program time-frame (length of training • Their effectiveness can indirectly
measures and/or independent work) measures and/or independent work) depend on the availability of
monetary donations
• Source of referral (Parents put more • Source of referral (similar to those of • Social-marketing campaigns
trust into recommendations by physicians parents/guardians) need to be based on solid re-
or teachers than those by the media) search with a view towards the
target group
Studies to evaluate • Parents who have participated in a • Programs addressed to teachers have a • Up to now, only very few public
prevention programs program led by qualified educators and positive influence on the teachers’ campaigns on this topic have
have discussed the topic, are in a stronger knowledge about the topic [37] been assessed [34]
position to protect a child from sexual
• Campaigns that focus on specific
abuse [36]
target groups and topics receive
• Programs which include both parents • People who received training feel in a more attention and are therefore
have consistently proven to be effective much stronger position to make a more effective [34]
[37]. “Home visitations “in high-risk families decision not solely based on physical
result in a decrease in the risk of abuse signs; in addition, frequency, duration,
[38] intensity, and the professional standards
of training measures play an important
role [39]
Legend: Overview of goals, of challenges for the conception and implementation of effective measures as well as of studies on the evaluation of prevention
programs for adults.
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Discussion prevention of sexual abuse. Rassenhofer et al. [23] reported

For a number of years now, research has been undertaken about a critical incident reporting system established by the
into the evaluation of prevention programs for sexual German Federal Government with a government commis-
abuse, e.g., [30,42]. Numerous studies point to the fact that sioner, functioning as an ombuds person. This example
the relevant knowledge about sexual abuse and the neces- shows that a trustworthy adult person is essential for effect-
sity for increased prevention has been on the increase, e.g., ive prevention and early intervention. If the child does not
[43]. This finding could be confirmed for safety training know who to tell about and how to find an adult that will
programs with children, especially when these training pro- listen, believe and help, behavioral trainings for children will
grams included an active approach to learning, e.g., [44,45]. not beware them from sexual abuse for a long time. So it is
The significance of these studies is limited as there is usu- necessary to sensitize adults and to aside a qualified, trust-
ally no behavioral assessment but only self-assessment on worthy person to the child.
the part of the children. This means that researchers and
program educators have to rely on these self-assessment The political contribution
without being able to observe the behavior of minors in situ Adequate evaluation of prevention programs has to face
[46]. Studies, e.g., [44], which have instituted in-situ assess- numerous hurdles: scarcity of finances; lack of professional
ments as basis for evaluation, have shown that minors be- expertise; additional time requirements; society’s critical at-
have differently in situations which could lead to potential titude toward research findings. In some cases, politicians,
abuse than they stated previously. Willich [47] and Damrow lawyers and scientists felt under pressure to “have to” con-
[27] comment further that the evaluation of the effective- firm the effectiveness of a particular program. Such pres-
ness of prevention programs for minors often contains sure can lead to distorted data analysis and interpretation
qualitative flaws which, in turn, limits their significance. Ex- of research results [48]. For this reason, researchers [49,50]
amples for such flaws are: the use of divergent assessment plead for a broader understanding of effectiveness as well
criteria for the evaluation of preventive measures, a scarcity as for a more integrative evaluation strategy which com-
of studies with regard to cost effectiveness of measures bines various approaches. According to Tseng [50], such an
taken as well as a lack of longitudinal studies, e.g., [27]. It is approach could prevent the neglect of promising strategies
only through cooperation, regular evaluation and the con- and promote new approaches to find solutions for urgent
tinuous work of many that prevention programs can be fur- societal questions. In the medium and long-term, an inte-
ther developed in the future to educate and encourage grative approach to knowledge generation will be helpful in
adults to protect minors from sexual abuse [34]. better protecting minors and families in danger. In addition,
In the meantime, many programs addressed to adults the use of multiple evaluation methods allows for a more
have been evaluated according to strict empirical criteria. comprehensive assessment of the effectiveness of preven-
Table 1 provides a detailed survey. A considerable number tion programs [49]. Proceeding from these findings, further
of diverse prevention measures with strong financial sup- steps for prevention work in organizations and institutions
port focus on adults as the target group. These programs can be deduced [2,51]. Partnerships and cooperative pro-
were evaluated and implemented in specific societal con- jects between politicians and researchers could give rise to
texts. These local efforts work towards a culturally compe- political prevention measures whose societal effect and
tent approach which focuses on the specific needs of preventive effectiveness will continuously have to be re-
divergent societal groups which are often neglected or over- assessed [2,23,50]. Groups, institutions, and organizations
looked in broader campaigns [34]. Increased cooperation as a whole as well as those who hold positions of responsi-
among institutions can benefit the development of ideas bility within them are called upon to regularly evaluate the
and resources along these lines. effectiveness of their political work.
Let there exist different definitions of level of behavioral
prevention which have to be considered and structural pre- Conclusions
ventive measures. E.g., in substance abuse prevention struc- The present article provides a survey of prevention con-
tural measures like nationwide taxation policies prove to be cepts in general and of prevention programs and political
very effective and at the same time easy to evaluate. Still it measures against sexual abuse of minors in particular. Fur-
seems difficult to describe pure structural measures of pre- thermore, it highlights the difficulties in the evaluation of
vention in the context of child sexual abuse because the the effectiveness of preventive measures to protect minors
structures surrounding a child in the sense of a sensitive from sexual abuse. A central point is the development of
environment are created by behaviors and emotional avail- targeted evaluation methods and/or the review and critical
ability of teachers and other caregivers or peers. As a struc- assessment of existing strategies. Programs to avoid sexual
tural measures creation of networks, the installation of an abuse have to be regularly and validly reviewed for their ef-
ombudsman could be mentioned but there is not much fectiveness and, if necessary, be modified within a particular
empirical literature about structural measures in the context or, if they result to be in-effective, discarded.
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So far, there exists a multitude of different prevention 2. Unabhängige Beauftragte zur Aufarbeitung des sexuellen
programs which address a different clientele (minors and/ Kindesmissbrauchs (UBSKM): Abschlussbericht der Unabhängigen
Beauftragten zur Aufarbeitung des sexuellen Kindesmissbrauchs.
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