Maximizing the reach of universal child sexual abuse prevention: An equivalence trial

Child sexual abuse (CSA) is a public health problem affecting 1 in 5 girls and 1 in 12 boys before age 18. National estimates indicate children ages 7 to 13 are at highest risk for CSA and CSA is associated with lifelong negative sequelae. School-based prevention programs offer cost-effective universal programming teaching students personal safety skills, knowledge to identify boundary violations and unwanted forms of touch or contact, how to refuse approaches or invitations effectively, increase agency and access to resources. Several programs have demonstrated effectiveness in increasing children’s knowledge of self-protection and some have been linked with facilitating disclosures, including Safe Touches. Effectiveness notwithstanding, the programmatic reach of universal school-based programs is limited by the inherent reliance on school infrastructure and a dearth of available alternative delivery modalities, such as virtual delivery. This was most recently highlighted by the unprecedented school closures to mitigate the spread of COVID-19 wherein the infrastructure for prevention programming, and therefore the potential for school staff to identify potential abuse and disclosures, was eliminated. These circumstances, though unusual, highlighted the need for flexibility in the mode of delivery for effective school based preventive education programs even outside of pandemic times. Though some evidence-based school-based programs may have transitioned to virtual delivery, none have been empirically evaluated nor were they empirically compared against in-person versions. The proposed R21 is designed to address this gap in the CSA prevention research field, uniquely leveraging an existing partnership between university-based researchers (NYU), the Safe Touches model developer (NYSPCC), and community-based organizations with active implementations of Safe Touches in two states representing urban/rural, low/high income, and racially diverse settings. The study will use a rigorous cluster randomized design to determine the equivalence of effectiveness between two delivery modalities of Safe Touches: in- person vs. virtual. We will determine the equivalence of concept learning acquisition (Aim 1) and retention (Aim 2) among students in classrooms (N=180) that receive the in-person (n = 90) or virtual (n=90) Safe Touches workshop. To conclude equivalence, it is important to examine factors that may impact future dissemination and implementation, specifically program adoption among school personnel and implementation fidelity (Aim 3). Study findings will inform the ongoing development of effective CSA prevention programs and policy decisions regarding the sustainable integration of such programs within school systems. Given the scope and burden of CSA, especially among elementary aged students, it is a public health priority to efficiently disseminate effective school-based prevention programs on a wide scale.