Findings from a recent literature review to synthesise international evidence regarding risk and protective factors related to child sexual abuse in institutional contexts

Background

In 2015 we (Keith Kaufman and Marcus Erooga) were commissioned by the Australian Royal Commission into Institutional Responses to Child Sexual Abuse a literature review to synthesise international evidence regarding risk and protective factors related to child sexual abuse in institutional contexts.

Literature review methodology

The methodology for the review was built on the Royal Commission�s broad definition of institutional child sexual abuse. Working with the project team of graduate students Kelly Stewart, Judith Zatkin, Erin McConnell, Hayley Tews and Australian consultant Associate Professor Daryl Higgins the first step was to identify a wide range of relevant search terms that we then circulated among experts in the United States (US), the United Kingdom (UK) and Australia to solicit additional terms. A similar process was conducted to identify databases that would yield the most relevant articles for this review. We then developed final lists of search terms and databases for the review based on feedback.

Simultaneous, independent literature reviews of each of five identified areas were then conducted using the final search terms. These were conducted by the authorial team, the Australian Institute of Family Studies (Australia), the National Child Advocacy Center (US), the National Sexual Violence Resource Center (US) and the National Society for the Prevention of Cruelty to Children (UK) and focused on scientific research literature as well as �grey literature� such as reports, inquiries, evaluations and dissertations.  

The nature of the reviewed literature

The review yielded more than 400 relevant documents, primarily comprising research studies from professional journals. The literature was distributed across the three key review areas of victim, perpetrator and institution and further divided across six specific types of institutional setting including faith-based settings; early childhood education, care and schools; healthcare; out-of-home care; sport; and public inquiries and case reviews. The result was a series of related literature with limited integration - in particular the documents specific to victim, perpetrator and institution are quite distinct, with little overlap and minimal cross-referencing. Articles describing child sexual abuse in various types of institutional setting are also highly �siloed�. The separate nature of these research sub-areas is an important dimension for understanding the strengths and weaknesses of the available literature on child sexual abuse in institutions.

Findings

For the purposes of this blog we highlight the �big-picture findings� regarding risk and protective factors pertinent to victims, perpetrators and institutions, as well as the role of prevention of institutional child sexual abuse.

 

Risk and protective factors regarding victims

 

Many children spend a significant amount of time in institutional settings and whilst all children are inherently vulnerable to sexual abuse in institutional settings where is a motivated perpetrator, some children are more vulnerable than others.

A majority of child sexual abuse victims overall are female (Finkelhor and Baron, 1986). In institutional settings specifically, Faller (1988) reported that 62 per cent of sexually abused children in a day care setting were female; while Leahy, Pretty and Tenenbaum (2002) found that females in organised competitive sports were at twice the risk of being sexually abused as males (for both elite and youth sports). However, there is concern that the rates of disclosure, while minimal for both genders, may be disproportionately low for boys. This may be due to male socialisation processes, males may possibly not recognising some sexual activity as abusive, a propensity to downplay the impact of abuse, and outright denial that abuse has occurred to avoid social stigma, particularly when the perpetrator is also male (Alaggia & Millington, 2008; Fondacaro, Holt & Powell, 1999; Holmes, Offen & Waller, 1997; Holmes & Slap, 1998; Love, 2016; Parent & Barron, 2012).

Age has been identified as a risk factor for sexual abuse victimisation generally, with younger children particularly at risk (Bohm, Zollner, Fegert & Liebhardt, 2014). In institutional child sexual abuse, the age at which abuse begins seems to vary according to the type of setting. This may be related to the fact that children use different types of institutions at different developmental stages � for example, childcare centres during their pre-school years, and residential camps during their teenage years.

Higgins (2010) suggested that the presence of any disability leads to a higher risk of sexual victimisation, with multiple disabilities further increasing the probability of abuse. Higher rates of sexual victimisation were associated with intellectual disabilities, behavioural disorders and communication disorders.

A number of family characteristics have been identified as risk factors for child sexual abuse. Peter (2009) suggests that children from families with a low socio-economic status are at greater risk of sexual victimisation. This may be because these families have access to fewer resources and often include parents who work multiple jobs, leaving children to spend more time in the care of others. In a sample of children who were abused in a hospital setting, Feldman, Mason and Shugerman (2001) identified risk factors including parental mental illness, parental substance abuse, legal problems and vindictiveness against medical service providers.

Research on child sexual abuse risk and protective factors has several methodological limitations. Perhaps the most significant of these relates to the limited generalisability of study findings. Another significant barrier is the overall lack of empirical research in this area due to the difficulty of studying a phenomenon such as child sexual abuse, which relies on retrospective data and involves significant ethical limitations (Hartill, 2005; Love, 2016).

 

Risk and protective factors regarding perpetrators

Institutional sexual abuse perpetrators are a sub-category of extrafamilial offenders who abuse children that they have access to by virtue of working, volunteering or otherwise being associated with a particular institution.

There is no �type� or �profile� relating to perpetrators in institutional settings, or elsewhere. However, in general, risk factors for sexual offending include deviant sexual interest, distorted attitudes about sex, poor socio-affective functioning and poor self-management (Sullivan et al., 2010).

Criminal justice staff who work with perpetrators have identified eight broad conceptual categories of perpetration motivation, some possibly causal and others contributory:

�                     developmental issues

�                     poor social competence

�                     sexual motivation

�                     need for power and control

�                     psychopathology

�                     perceived victim characteristics

�                     values and beliefs that enable child sexual abuse

�                     personality deficits (Purvis, Ward & Devilly, 2003).

Longstanding sexual interest in children is not the sole factor for choosing to perpetrate child sexual abuse. There is a useful distinction between those described as preferential offenders, who have a long-term sexual preference for children, and those described as situational offenders, who take advantage of opportunities to offend against minors. These opportunities especially arise in situations where they have access to, privacy with, and authority over children, such as when they are serving in positions of trust in institutions.

Overall, the literature presents a solid basis for identifying the background characteristics of offenders and other risk factors that may lead to institutional child sexual abuse. However, a great deal of work must still be done to further investigate risk factors that facilitate institutional child sexual abuse.

 

Risk and protective factors regarding institutional settings

Child sexual abuse can occur within any institution where there are children and a motivated perpetrator. Some perpetrators will actively try to manipulate institutional conditions to create an opportunity to sexually abuse. Institutions can act to reduce risk factors and enhance protective factors. This involves considering the role of an institution�s policies, climate, culture and norms.

A major risk factor is that screening processes, used to exclude unsuitable people from joining organisations, are not as effective as widely believed (Erooga et al., 2012a). This is because many perpetrators either have no criminal history or their history does not include sexual offences, meaning they would pass a criminal background screening process (LeClerc & Cale, 2015).

A lack of clearly defined policies, or variability in the comprehensiveness and appropriateness of child-safe policies, also facilitates child sexual abuse in institutions. In the US, for example, each state has a different definition of �coercion involving the misuse of authority�, and therefore handles sexual abuse cases differently (Weiss, 2002). This is particularly problematic as there is a gap between research and policy regarding child sexual abuse prevention (Quadara et al., 2015).

Rather than focusing solely on individuals, risk management needs to address environmental factors (Beyer et al., 2005), in what is generally referred to as a situational prevention approach. Research shows that certain characteristics of an institution can increase the risk of staff members committing sexual crimes against children. These characteristics may include the physical condition of the facility, child safety policies and procedures, the training and supervision of staff, and also the less tangible risk factors of institutional culture and environment. It is also important to consider the impact of the power differential between institutional staff or volunteers and the children in contact with the institution.

Organisational culture was cited as a key contributory factor in a significant number of recent inquiries into institutional child sexual abuse in the UK. A proportion of perpetrators surveyed stated that the culture of the organisation in which they offended did not proactively promote child welfare (Erooga et al., 2012a).

Implications for policy and practice

Overall, the literature reflects the promising nature of prevention strategies and policy initiatives for enhancing child safety. Prevention strategies span the continuum from awareness training directed at individual parents or staff members to more systematic, institution-wide efforts to identify and ameliorate environmental or situational conditions that allow child sexual abuse to occur.

In a complementary fashion, the design and implementation of key safety policies foster child safety by helping to establish clear professional boundaries, acceptable practices, and mechanisms for identifying and reporting inappropriate behaviour that places children at risk.

Prevention and policy initiatives should target the types of abuse inhibitors that Finkelhor (1984) refers to in his Four Preconditions model for understanding the conditions under which child sexual abuse can occur. The literature also highlights a compelling need to increase investment in prevention and policy initiatives as well as to better tailor such efforts to the needs and characteristics of particular institutional settings to maximise their effectiveness.

A striking feature of this review is that many of the actions described in the literature aim to implement protective systems and processes more rigorously, thoroughly and consistently.

Another major conclusion that can be drawn is the need for greater attention to be paid to the quantity and quality of research related to child sexual abuse in institutions. Systematic research programs should be tailored to various types of institutions and address key areas of concern, such as identifying risk and protective factors, promoting early disclosures and improving prevention program outcomes.

At the same time, it is important to advocate for more methodologically sound investigations of child sexual abuse in institutions. This includes a greater diversity of study approaches, more quantitative as well as qualitative studies, and approaches with greater generalisability.

The most important action that institutions and those who work in them can take is to become familiar with the key literature contained in this review. They should consider their practices in light of the information contained in this literature, and act accordingly to maximise children�s safety. It is incumbent upon institutions to not only subscribe to these strategies as a matter of policy, but to ensure that their staff adheres to these principles as a matter of routine practice on a daily basis.

In summary, the literature shows the best way to reduce the risk of institutional child sexual abuse is to avoid dangerous practice rather than attempt to screen out allegedly dangerous people. Effective prevention is predicated on creating a positive, open and inclusive organisational culture in which the safety of children is paramount. This culture should be led by senior management and wholeheartedly endorsed and owned by staff at all levels.

The full report can be downloaded from: http://www.childabuseroyalcommission.gov.au/policy-and-research/our-research/published-research/risk-profiles-for-institutional-child-sexual-abuse

Marcus Erooga (me7664@gmail.com) and Keith Kaufman (cbkk@pdx.edu)

October 2016