Parent-focused primary prevention of child sexual abuse: An Effectiveness-Implementation Hybrid Trial

ABSTRACT Child sexual abuse (CSA) is a global public health problem affecting 1 in 5 girls and 1 in 12 boys before age 18. Parents are uniquely positioned to protect children from CSA, yet parents have largely been ignored in CSA primary prevention efforts and the few that do exist have not demonstrated a significant effect on protective behaviors. Parent education (PE) programs provide parents with foundational skills related to child development, parent-child communication, and safety. These foundational skills can be logically extended into didactics relevant to CSA prevention: healthy sexual development, strategies for parents to communicate with their children and others about sexual topics and sexual behaviors, and creating physical and online environments safe from potential exploitation and recognizing grooming behaviors. Our team developed Smart Parents – Safe and Healthy Kids (Smart Parents) as a single session, skills-based, parent-focused CSA prevention module that adds these key CSA-specific prevention concepts to PE program curricula. Leveraging the PE foundational skills, Smart Parents provides parents with CSA-prevention knowledge to increase their CSA-related attitudes and perceived norms as well as the opportunity to practice protective behavioral skills. A recent cluster randomized clinical trial demonstrated preliminary to be effective in raising parents' awareness and increasing their intention to use of CSA protective behaviors when added to Parents as Teachers (PAT), an evidence-based PE program supported by most state child welfare systems. The proposed study seeks to expand the empirical evidence for the effectiveness of Smart Parents and to explore the implementation factors that might promote or hinder adoption, fidelity, and scalability, the proposed study uses a type 2 hybrid effectiveness-implementation design. We will conduct a stepped wedge-cluster randomized trial (N = 400) To determine effectiveness (Aim1) of Smart Parents when added to PAT (PAT+Smart Parents) on CSA-related awareness and intention to use CSA protective behaviors compared to parents receiving PAT treatment as usual (PAT-TAU. We will follow-up participating parents in both conditions at 12- and 24-months to determine retention of awareness (i.e., knowledge and attitudes) and actual use of protective behaviors (Aim 2). To describe factors that hold promise for future dissemination and implementation efforts (Aim 3), we will: assess parent, provider, and organizational-level moderators of Smart Parents effectiveness; conduct a cost analysis; and conduct structured interviews with Smart Parents providers (N = 100) and focus groups with key PE stakeholders (N = 25) to identify factors that may impact future dissemination and implementation. By leveraging the foundational skills taught in existing PE used by state-supported family service providers across the US—and supported through federal policy such as the Family First Prevention Services Act—the integration of Smart Parents into PE programs is not only efficient and cost-effective, but constitutes a sustainable model of system-wide, real-world, community-based implementation of primary CSA prevention.