We shouldn’t wait for child sexual abuse to occur before we act to prevent it

Written and submitted by Elizabeth Letourneau.

Elizabeth is the inaugural director of the Moore Center for the Prevention of Child Sexual Abuse and Professor at the Department of Mental Health at Johns Hopkins Bloomberg School of Public Health, and is a past president for the Association for the Treatment of Sexual Abusers. Elizabeth spoke on the TEDMED stage in 2016, and you can watch her talk here.


Child sexual abuse is a preventable problem that causes needless suffering and harm. We can prevent it, yet we wait before we intervene, usually acting only after harm has occurred. Most cases of child sexual abuse – about 80% – occur in someone’s home while nearly 20% take place in institutions, including schools, camps, religious facilities, foster care and other youth-serving settings. In rare instances, abuse occurs in public spaces such as parks or shopping malls. Different settings offer different challenges and opportunities for prevention. Likewise, people who engage in harmful sexual behavior with children do so for a variety of reasons.

It’s not widely known that children and adolescents account for as many as half of all sexual offenses against young children. They may be acting impulsively, acting out their own abuse, or experimenting with age-inappropriate partners. Many simply may not know that engaging younger children in sexual behavior is harmful. Likewise adult offenders engage in these behaviors for many reasons. Different prevention programs and policies are needed to address the different factors that influence child sexual abuse.

To a large degree, our nation has ignored prevention in favor of after-the-fact interventions that focus on mandated reporting and criminal justice sanctions. When we have focused on prevention, it has been with school-based programs that attempt to train children to distinguish between good and bad touches. Yet no single approach can possibly be sufficient. What is needed – what is long overdue – is a comprehensive public health approach to the prevention of child sexual abuse.

We do not need to start from scratch to develop a national public health approach to child sexual abuse. Many youth-serving organizations already mandate child sexual abuse prevention training for staff and volunteers. We can look to them for good and promising practices. For example, Boy Scouts of America requires two adults to be present for all interactions with children. Likewise, training programs have been developed by organizations such as Stop It Now! and Darkness 2 Light to help parents, teachers, and child care workers detect and intervene in child sexual abuse. Essential to these and other efforts is empirical evaluation to determine their effectiveness. We would not release a vaccine without rigorous testing, and we should not broadly disseminate prevention practices unless and until we are certain they do the job of preventing sexual abuse against children.

A comprehensive public health approach will bring needed empirical rigor to this field and will help us expand prevention efforts to – for example – deter children, adolescents, and adults from engaging in abusive behaviors in the first place. As I discuss in my TEDMED Talk, we have begun to make exciting progress in this area.

A public health approach will also help us to move beyond focusing solely on the behavior of individuals to focusing on prevention at the community level, including design and messaging. For example, the Boys and Girls Clubs of America have invested deeply in identifying structural changes to their buildings that might reduce the risk of child sexual abuse. Some of their efforts, such as placing windows in all interior doors, increase the visibility of adult-child interactions. Does making such interactions more visible and “interruptible” discourage abusive behavior? Perhaps. But before we recommend that everyone remodel their buildings, it would be prudent to gather some data. The YMCA is looking into the use of creative signage to see if these can impact the behavior of adults towards children. Wouldn’t it be amazing if architects, structural engineers, and designers helped us solve the problem of child sexual abuse? The public health approach encourages such multidisciplinary collaborations.

There are no doubt myriad ways to effectively prevent child sexual abuse just waiting to be found. But we need the will to put significant resources into designing and testing these before-the-fact interventions. What we’ve been doing for the past 30 years – teaching our children how to protect themselves, mandating teachers and others to report abuse, and relying on law enforcement strategies – just isn’t enough. We can do much better. We can develop and fund a national public health prevention program to keep children safe from sexual abuse.