CRFR Associate Researcher Dr Sarah Nelson reflects on the problematic issues around prevalence studies of childhood sexual abuse.
The wealth of prevalence studies of childhood sexual abuse (CSA) continue to display wildly differing results. Yet the impetus to carry out more studies continues, nationally and internationally. These studies are driven by the demands of commissioners and funders to ‘prove’ need before services are provided or expanded, but also by professional ambition among researchers to be the ones producing a definitive study.
Neither of these is a child-centred approach, especially when basic services – as for instance an NSPCC Scotland report recently demonstrated – remain inadequate for the minority of sexually abused children we do know about. I suggest that conventional prevalence studies are largely fruitless, and that greater accuracy about prevalence will come about as a by-product of ethical, child-centred practice against sexual abuse.
First of all, while factors like safety and confidentiality, follow-up, inclusion of stigmatised subgroups, and description of acts rather than terms like ‘abuse’ or ‘rape’ will produce more accurate survey findings, we will never approach anything like total accuracy about a secretive, often organised crime overlaid with coercion, shame and silencing.
Crucially, recent revelations, such as professional footballers in their 40s reporting abuse for the first time, support research findings that a majority of children do not tell, and sometimes never will. Officially recorded cases always understate: Stoltenborgh’s examination of hundreds of prevalence studies, for instance, found self-report rates 30 times higher than authorities’ reports. Another problem is that CSA and child sexual exploitation (CSE) overlap in their characteristics, and increasingly now in their official definitions. Do we count them together, or separately?
Even more to the point, there has never been any evidence that studies suggesting higher prevalence rates have led to any increase in services, nor to greater action against abuse. Unpalatable as this may be, public scandals exposing shameful practice have been far more likely to do so, just as they have been in other public services. For example, action against child sexual exploitation in Rotherham, Rochdale or Greater Manchester did not belatedly take place because someone conducted a prevalence study of CSE, but through exposure of disgraceful practice towards young victims.
Commissioners and funders are better directed to the results of good practice in investigation as a demonstration of significant prevalence figures. Many ‘searchlight’ or ‘snapshot’ investigations have uncovered that over decades. Back in 1984 for instance a single, active police investigation unit uncovered ten sex rings and 175 victims in one area of Leeds alone. Peter McKelvie’s proactive social work/police investigations between 1988 and 1995 closed several abusive schools and convicted dozens of perpetrators while Professor Alexis Jay’s Rotherham investigation, reported in 2014, found at least 1400 girls had been sexually exploited over 16 years.
However, ethical good practice in enabling abused children and young people to speak out may in future have the single greatest impact in uncovering a greater accuracy of prevalence. Again, it will do so as a by-product of that good practice.
For example, the Barnahus Children’s Houses, now spreading across Europe from Scandinavia, provide a reassuring child-centred ‘one stop shop’ for enabling children to tell, for interviewing, for preparing court cases and for therapeutic work. They are being actively considered by the Scottish Government for adoption here. The Confidential Space model being piloted in several Scottish local authorities at present aims to slow the investigation process to an abused child’s pace, increase their support, and build knowledge and confidence among staff who work with young people.
There is another alternative way to persuade commissioners and funders to increase CSA/ CSE services and prevention work – to show them that while results of prevalence studies vary greatly and will continue doing so, a substantial, more consistent body of research on negative effects of abuse has demonstrated over decades that survivors are at higher risks than others of mental and physical ill health, addictions, homelessness, very young pregnancy, suicide, self-harm, offending, and distressed acting-out behaviour by young people.
As a result of this, current costs and ‘revolving door’ usage continue to be high in many hard-pressed services – including mental and physical health, prisons, social work, addiction services and homelessness projects. Future resource savings, through investment in support and prevention projects, can thus be emphasised to funders and commissioners.
…And of course these negative effects, most of all the suffering survivors face, in themselves suggest the importance of a major investment in prevention.