Scoping Review: Evaluations of out-of-home care practice elements that aim to prevent child sexual abuse

Dr Sandra South PhD, Professor Aron Shlonsky PhD, Dr Robyn Mildon PhD, Ms Anastasia Pourliakas, Ms Jessica Falkiner and Mr Adrian Laughlin

Parenting Research Centre and the University of Melbourne

November 2015

ISBN 978-1-925118-89-6

Please note this is a revised report. Please disregard any previous version and note the correction on the inside cover of the revised report.

Executive summary

Overview

The aim of this scoping review was to map evaluations of out-of-home care (OOHC) practice elements that aim to prevent child sexual abuse (CSA) in OOHC. It was conducted by the Parenting Research Centre (PRC) and the University of Melbourne for the Royal Commission into Institutional Responses to Child Sexual Abuse. This report describes the methods used to conduct the scoping review and the findings of the scoping review.

Methods

Systematic searches for existing evaluations of OOHC practice elements were conducted using an extensive list of electronic databases and websites, hand searching of website publication lists (when no search engine was available), contact with experts in the field and searches of the reference lists of the potentially relevant studies. Results were then synthesised across study content, methods, findings and recommendations, and this was followed by a narrative interpretation of these findings.

Number and types of studies found

Using all sources searched, we identified a total of 1,484 papers: 1,455 through bibliographic databases, 15 through website searches, two through a concurrent PRC review on pre-employment screening, three through reference lists of potentially relevant papers and nine through contact with experts. After removing duplicates from the results of the database searches (n=360), 1,095 abstracts were screened for inclusion and a total of 222 potentially relevant papers were then screened for inclusion. In total, 16 evaluations were identified that aim to prevent CSA.

Overall, the level of rigour of the evaluations was quite low and tended to fall into two broad categories:

  • Evaluations of training, support and/or treatment for sexually abusive and/or sexually ‘acting-out’ children in OOHC and their caregivers (n=7).

  • Retrospective case studies and surveys attempting to identify practices that either contributed to, or prevented, CSA in OOHC (n=9).

No studies were identified that specifically tested the effectiveness of practice elements or programs that aimed to prevent CSA by caregivers or staff at OOHC institutions.

Findings and recommendations from training, support and/or treatment for sexually abusive and/or sexually ‘acting-out’ children in OOHC and their caregivers

  • Sexually abusive and/or sexually ‘acting-out’ children in OOHC and their caregivers have unique needs that must be addressed if placements are to be successful.

  • Caregivers tended to endorse the provision of programs and/or services to support the placement of sexually abusive and/or sexually ‘acting-out’ children.

  • Support programs for caregivers and youth should be delivered in ways that support caregivers to do their job well, including practical elements such as the scheduling and location of services.

  • Unplanned emergency placements of sexually abusive and/or sexually ‘acting-out’ children can result in the placement of children in unsuitable homes.

Findings and recommendations from retrospective case studies and surveys attempting to identify practices that either contributed to, or prevented, child–child sexual abuse in OOHC

  • Provide adequate information to caregivers at the time of placement regarding the relevant history and needs of sexually abused and/or sexually abusive children.

  • Strongly consider the appropriateness of specific placements prior to placement.

  • Plan for maintaining the safety of other children at the OOHC institution.

  • Develop specifically articulated and well-executed procedures for the supervision of sexually abusive and/or sexually ‘acting-out’ children (e.g. tight house rules, supervision when playing with other children, and fitting devices such as intercom systems and alarms so staff know, for example, if the child leaves their bedroom at night).

  • Provide formal, effective therapeutic treatment for children that addresses their sexually abusive and/or sexually ‘acting-out’ behaviour (e.g. working with trauma).

Findings and recommendations from retrospective case studies and surveys attempting to identify practices that either contributed to, or prevented, caregiver–child sexual abuse in OOHC

  • Conduct rigorous pre-employment screening and selection of staff.

  • Include screening practices that extend beyond criminal background checks.

  • Anticipate and check for the use of pseudonyms.

  • Remove organisational characteristics that provide opportunities for, or otherwise encourage, CSA (e.g. power differentials, unsupervised access to children, ensuring that children do not share bedrooms with foster parents).

  • Develop an environment where children/youth feel safe enough to disclose.

Interpretation and implications of findings

First and foremost, while there is a great deal of practice wisdom guiding current practices in OOHC, there are very few existing studies that test which types of practices or programs are actually effective for preventing CSA in OOHC by caregivers, non-related adults, or other children. Indeed, we identified no effectiveness studies of practice elements or programs that aim to prevent CSA by caregivers or staff at OOHC institutions, and only four effectiveness studies were identified that aimed to prevent child–child sexual abuse through training, support and/or treatment programs for sexually abusive and/or sexually ‘acting-out’ youth and their caregivers. Even the studies that do exist are of a fairly low methodological quality and cannot be relied upon with any reasonable degree of certainty. The findings and recommendations from these studies amount to suggestions rather than reliable and robust evidence. This does not mean that the findings and recommendations from the studies we found are incorrect, but that they should be interpreted with great caution. Changing practices and policies, even when doing so makes sense both politically and in terms of best practice, can have unintended consequences that can cause harm to the very people the changes are designed to protect. In this context, policy and practice changes should be carefully considered and rolled out slowly using high-quality implementation strategies and evaluation methods.

From a more general perspective, the research found in this review and in the extant literature indicates that:

  • At least in the US, public health messaging may be an effective, long-term, population-level strategy for decreasing CSA.

  • Past and current efforts to curb caregiver to child CSA, including public health messaging and other broad preventive efforts such as employment screening and sentencing of offenders, have probably made it more difficult for this type of maltreatment to occur without discovery. This does not eliminate the need for continuing prevention efforts to avoid future generations of children experiencing abuse at the hands of caregivers.

  • A major focus of preventing CSA in OOHC should be on efforts to prevent child–child sexual abuse.. While the prevalence of CSA in OOHC is yet to be consistently and rigorously measured, a substantial proportion of CSA in OOHC appears to be child-child sexual abuse. The different nature of this type of maltreatment (peer rather than caregiver perpetration) means that additional, and likely different, efforts to prevent CSA should be undertaken to prevent all types of CSA in OOHC.

  • Insufficient attention may be paid to the individual needs of children when they are initially placed in OOHC and, later, when other children are placed in the home. Safety planning, education and an environment that is conducive to disclosure should CSA occur are essentials for placement in OOHC.

That said, new rules and strategies, even those suggested here, must be undertaken very carefully lest OOHC becomes safer in terms of preventing CSA, but then becomes more cold and impersonal as a result. The retrospective case studies and surveys identified in this scoping review provide some potentially important practice elements whose causal relationship with subsequent child–child and caregiver–child sexual abuse should be explored, but they should also be tested for the types of unintended consequences that make OOHC a less liveable and developmentally stimulating and nourishing place for vulnerable children.