SECTION II

Meeting Community Needs

The Prevention Initiative:  Helping The Community To Heal And Prevent Futher Abuse

Represented on the committee were public health nurses, social workers, early childhood educators and members of the Treatment Team. Three committee members were seconded to the prevention effort for the duration of the two-year project: a half-time public health nurse and a half-time sexual health counsellor from the local health unit, Bonnie Erwin and Cecile Loiselle, and a part-time community mental health worker from Family Focus, Louise Ward. The latter was funded by special project money made available from the Ministry of Community and Social Services.

The health unit staff and Louise Ward of Family Focus began planning the prevention initiative in the summer of 1990. Other members joined the Prevention Committee in the latter part of 1990 and the beginning of 1991. Before the committee could carry out its plan, they came face to face with the fact that Prescott was a traumatized community which urgently needed healing. From the first workshops for professionals on healthy sexuality given in the fall of 1990 it was clear that people couldn't understand concepts of prevention until they had come to terms with their own feelings about the sexual abuse crisis that had devastated their community.

On one occasion, the prevention committee was called in to work with Prescott municipal employees at the request of the mayor, Sandra Lawn. "It used to be a source of pride to work for the town and that had been taken away - these people were angry," says Cecile Loiselle. "It was then that Cecile realized that we had missed the grieving process," says Marjorie Gunn. "So we had to back up a bit and change things." The community was experiencing the same feelings as an individual who had suffered a significant loss.2  In this case, what was lost was innocence, normality and a sense of security.

The first reaction was shock. Then came denial, the unwillingness to believe an unwanted reality, as well as distancing - the attempt to avoid pain by convincing oneself that the problem only affects other people.

"Outsiders distanced Prescott off as this weird little place where everybody gets abused," explains psychologist Susan Meyers. Within Prescott, towns people did the same thing. "It wasn't happening where they lived, but over there, in another part of town. Then you'd go to that part of town and people would say, no, it's not happening on this street, it's that street. And it certainly wasn't happening just on one street. When you looked at the pattern of people who were in fact charged, it was across the area."

"Once the story broke, every week there were more perpetrators and more victims," recalls Louise Ward. "There was a feeling of being out of control. People were having panic attacks about what was going on in their community. At the mental health centre where I worked, referrals were way UP, even among families where there were no known victims or offenders."

For healing to take place on a collective level, there must be an acceptance of the truth - that sexual abuse does happen - and a belief that people working together have the power to stop it. "We know that when there's a disaster," says Erwin, "whether it's a tornado or hurricane, if people can get out and start clearing the rubble away, if they can be part of the process of cleaning up, they feel more in control and less victimized."

It took about six to eight months for this to happen, says Erwin, and for people to stop feeling helpless and start contributing toward making Prescott a safer place. Recognition of the need for community healing led to the development of workshops to help professionals and community members acknowledge and share their pain.

"Emotions create a content," says Cecile Loiselle. "If I'm angry, I might start saying that this group should do this or this group should do that." When people understand the grieving process, she says, "you still get the anger but it tends not to be as destructive." Taking the time to work through the feelings can help speed the process of reaching acceptance and taking positive action.

"As a professional, you need to really listen and not get defensive," she counsels. "People need to vent about the system. You have to validate how they feel. State what you are doing about it now and make it clear that we're all responsible for the inaction of the past. The longer we stay in that place of blaming the longer we delay the process of healing." As a result of their experience, the Prevention Committee strongly advises that when a sexual abuse crisis hits, enough time be allowed for community healing efforts before any new sexual abuse prevention programs are introduced.

It wasn't always easy to reach the people most in need of assistance, especially at the beginning. Efforts to take care of people's social and emotional needs had to be made carefully so as not to threaten the criminal investigation. The police had to be concerned that nothing be done to jeopardize their evidence. "They might have preferred if this attention to community healing was all kept aside, because they had to do their work," says Cecile Loiselle. "Sometimes the systems don't work too well together."

Morrell was one of the founders of Community Action for Recovery (CAR), the citizens group set up to help rebuild the profile of Prescott. It sprang from initiatives undertaken by Family Focus after the Prevention Committee had formally ended. CAR got off the ground in February 1993. One of the catalysts for its creation was the release of the public surveys showing that Prescott residents held older children partly responsible for their abuse. "A lot of us said VMOA!" recalls Morrell. "This problem is going to be with us as it is with the whole Canadian society. It is not just going to be mopped up and people put in jail, the children treated and that is the end of it. Now it is time for us to take action, to take ownership of this problem."

The committee has sponsored meetings to discuss the reintegration of perpetrators and to provide information about how townspeople should handle suspected abuse. According to Wendie Morrell, the group feels that residents need more regular contact with the police and assurances that if they do report abuse, something will be done. "We know if there is a fire, we call the fire department and they will come. We need that instilled in us when it comes to sexual abuse," she says.

Care for Kids:   Educating Children and Parents About Healthy Sexuality

Child-focused prevention programs are based on the premise that the secretive nature of child sexual abuse makes it difficult for children to reveal their victimization and to receive help. Therefore, it is vital to reach children before abuse happens. Also, because perpetrators often misrepresent abusive activity as normal, there is a need to educate children about what kind of body contact is appropriate and inappropriate. And, if abuse does occur, children need to be encouraged to ask for help.

Early on, health unit staff started going into the schools with sexual abuse prevention programs. They began by using standard personal safety programs such as Max the Safety Cat but grew dissatisfied with them as their limitations became evident. These packages have to be tailored to the developmental levels of children from different age groups. If oversimplified, messages about 'bad" and "good" touch can confuse young children. The can also lead to incidents that may distress parents and caregivers. Marjorie Gunn recalls the story of how one child who had been taught to say no if he didn't want to be touched, upset his mother terribly by refusing her kisses at bedtime.

Most programs attempt to teach children about sexual abuse without discussing sexuality or even recognizing that children are sexual beings. Even though the implicit goal of these programs is to prevent sexual exploitation, the explicit goal is to teach personal safety, not sex education. This is often done to avoid conflicts with schools and parents.

There is also a serious concern that some prevention programs, by stressing the child's role in saying no to unwanted touch, place too much responsibility on children to stop abuse, when they don't have the power to do so. 'This can stigmatize kids who have been victimized," says social worker Henry De Souza. 'They convey the message that if you are abused, it's obviously your fault, because you didn't say no."

In an effort to address all these concerns, and bring adults into the picture, the public health unit staff, with advice from Prevention Committee members, developed Care for Kids, a program for children and adults that aims to prevent sexual abuse by promoting healthy sexual behaviour. It provides children and adolescents with information about age-appropriate and normal sexual behaviour, thoughts and feelings, presented at times when they are ready to absorb it.

"Health promotion is one of the most effective methods of prevention," says Marjorie Gunn. "If you focus on what is healthy then you can more easily recognize what isn't. When you are comfortable with healthy sexuality, you are able to speak more openly about any concerns you might have."

Care for Kids extends from preschool to high school. While the elements of the entire program have been conceptualized and piloted, so far only the first section for preschool to Grade Three has been formally documented. The program consists of seven sessions, each with specific messages taught through activities, books, songs and anatomically-detailed dolls. (See Part 5 for more information on the key messages conveyed by the Care for Kids program.)

Before the program is offered in a school or child care facility, much adult preparation must be done. The success of prevention lessons taught at school depends on the support of parents at home, and the other important adults in children's lives, both to clarify concepts and to help children apply their new knowledge in daily life. (See Components of a Care for Kids Initiative further in this section)

Carefor Kids assumes that open communication between parents and children about healthy sexuality is a key factor in protecting children. The program helps adults overcome their anxiety about discussing sexual topics with their children. Additional advantages are that children might find it easier to disclose abuse and that adults will become better able to identify child victims and respond helpfully to their disclosures.

Recognizing that you can't always protect children from sexual abuse, the Care for Kids program also aims, says Louise Ward, "to give the community and the children the skills to know what to do when something confusing or abusive happens and also to create an environment where people will be comfortable listening to children talking about sexual abuse."

Most children in Prescott have been through one phase of the Care for Kids program. Because it is designed as a developmental program, children who are exposed at a young age will continue to receive more advanced versions until they are young adults. "It's very flexible," says Marjorie Gunn. "We can do it with kids and parents, or with parents alone, with teachers alone, or with parents and teachers." The health unit is working with a "train-the-trainer" model so that teachers can learn how to deliver the program. Instructors offering the program receive two days of training.

"I think the school systems locally have gone miles in terms of what they are allowing in sexuality education," says Denise Gaulin. "The crisis put enough fear into parents for them to tolerate information and education for children." The public school board was also inspired to review and revise its kindergarten and primary personal safety programs based on what was being learned about their effectiveness through the Prescott case.

But Loiselle continues to be amazed and frustrated by the denial she sees in communities that haven't experienced a crisis. "In some areas, there is no way you can make progress without the shock factor," she says. For example, in trying to introduce prevention programs in another small town, she faced opposition from educators and professionals who insisted the programs weren't necessary because sexual abuse was not a problem in their community.

It is clear that classroom-based programs must operate in the context of multilevel preventive efforts involving parents, the community and professionals.

Working it out Together:   Deciding What to Do and How to Do it

The success of the Prescott project can be attributed in large measure to the effectiveness of the many interdisciplinary teams that evolved to perform critical tasks. Each one - from the main Advisory Committee to the investigative and treatment teams, to the prevention committee, as well as all the subcommittees that were created - confronted similar challenges in trying to blend a diverse set of professionals from a variety of disciplines, agencies and backgrounds into a smoothly-functioning team. Ultimately, through trial and error, each found its own unique recipe for successful collaboration.

Fortunately, committee members were able to get beyond the need to cling rigidly to their own points of view. By honouring everybody's area of expertise, they were open to learning from one another and devising an approach that reflected the best of everybody's knowledge." When different disciplines work with each other," says Erwin, "there has to be a commitment to respect and listening and not thinking you have the only solution."

Being highly motivated by the desire to serve a community in crisis provided a strong impetus for cooperation. Committee members found ways to work together harmoniously in order to get on with the urgent work at hand. The high visibility of the project created added incentive to settle disputes quickly. The front-line people were given a directive at the beginning to work together by their respective agencies.

Another thing that made working in the Prevention Committee a challenge, was that "some people had a lot of time allocated to the work, while others did not," recalls Denise Gaulin. "People had to put aside their competitiveness," says Louise Ward, "and the need to view their work as more important."

Juggling the sometimes conflicting demands of the committee and their agencies was often difficult for the members who were seconded. The committee might decide on a particular approach and then leave the staff to justify it to their agencies. Sometimes there were conflicts about what the committee felt should be a priority and what different agencies felt. Workers were caught in the middle, unsure which hat they should be wearing and where their loyalties lay. "A team tends to get its boundaries blurred when it works really well together," says Cecile Loiselle. This can provoke clashes with agencies that narrowly define their territory and try to ensure that the activities of their staff are confined within it. There is often more trust between individuals than between agencies.

.'The Prevention Committee decided to follow a community development model which sees change as a long-term process, builds on the strengths of a community, and involves people in decision-making about their lives. "At the beginning we didn't know exactly what we were going to do or when we were going to do it," says Bonnie Erwin. "We had to be sensitive to community needs and what the community was saying to us."

"One strength of the committee was that we were all located in Prescott," says Louise Ward. "We were all front-fine workers who knew the population we were dealing with and really had a good feel for the community." That was key to developing a sense of trust between townspeople and professionals, which is harder to achieve during times of crisis when people are feeling insecure. That's one reason it's important for professionals who may be coming in new to the community to align themselves with others who are known and trusted.

Prescott resident Wendie Morrell also sees ending sexual abuse as an issue requiring professionals and residents to blend their efforts. 'This is our town's problem, the people's problem," she says. "The service providers have to be sympathetic to what the townspeople are saying and the townspeople have to understand that the service people are mandated to do certain things. In that way you work together."

This model, which required a great deal of flexibility and consultation, did not lend itself well to traditional project planning. "You have to plan the big picture, not the details, so that there's room for development," says Denise Gaulin. "If you are tied tightly to a plan, it makes it very difficult to follow where you feel the thing is taking you."

There had to be a capacity to respond to community feedback. "Whenever we were going to do anything, we consulted," recalls Louise Ward. "We would go out and see what people needed, not just assume we knew." Still, it was critical to have a plan on paper in order to keep on track. "For those of us who are doers," says Louise Ward, "this sometimes felt like a waste of time. But in the long run it was very necessary to define our goals and objectives very clearly, including what we meant by prevention." The committee developed a clear mission statement as well as precise goals, objectives and time-frames.

Management support from the agencies involved was also vital to the success of the community development approach. "It's not easy work," says Ward. 'There's no manual. You're fumbling and groping a lot even if you're going in the right direction. You have to trust in the process and management has to trust you enough not to interfere in the small details."

An excellent example of the community development approach in action was a project called "Flowers, Flowers, Flowers" held in May 1991. It was designed to reach the group hardest hit by the crisis, those living in the stigmatized area where the first cases were identified.

Bonnie Erwin and Louise Ward went door-to-door with flyers to take orders for flowers and were invited into kitchens and backyards to chat. "We knew we were building relationships, that's why we were doing it," recalls Louise Ward. "We didn't talk about sexual abuse. We didn't talk about anything except planting flowers." The seeds that were sown then bloomed as time went on, in more ways than one. The residents went on to form a tenant association and some individuals sought out individual counselling.

Five months later, recalls Erwin, she and Denise Gaulin were preparing the event in which Jan Hindman was being brought in to speak to the community. Hindman is a noted therapist, researcher and author on child sexual abuse. They were just finalizing details with the principal at the hosting school when a distraught mother stormed in threatening to boycott the evening. "She said this was just another attempt to pinpoint this particular school as the place where the 'perverts' ' kids go," recalls Bonnie Erwin.

Erwin recognized her as one of the women she had worked with in the flower planting project. That familiarity allowed her to calm the woman long enough to explain the purpose of the evening and reassure her that parents had been invited from schools all over the county. The woman finally decided that she would recruit other neighbours and they would all come together to the evening.

"This was a group that had been marginalized and disenfranchised and it was very frightening for them to come into a school system where they had often experienced failure and rejection," says Erwin. "But they did come, twenty of them. We felt it was a great response."

The event that featured Jan Hindman was a highlight for the committee and a turning point in the community healing process. Held in September 1991, it accomplished many things: it provided solid information on preventing sexual abuse and promoting healthy sexual behaviour; it boosted the community's morale; and it provided an opportunity to bring service providers and school boards together to share tools and resources. It was also a chance to obtain press coverage and involve the business community through donations. The turnout of 130 people, mostly parents and community people, was considered excellent and the audience responded positively to Hindman's uplifting and healing talk. She delivered important messages in a very humorous and entertaining manner.

Arranging with a free local newspaper to run book reviews every two weeks for two years was another way to involve people and get information out to the general public in a non-threatening way. The reviews were written by teachers, clergy, community leaders, parents, grandparents and children.

There were many other educational sessions offered to the general public during the life of the project. The committee found attentive audiences in senior citizens and parenting drop-in groups. One of the resources the Prevention Committee found useful in working with volunteers and recreation leaders was the Put the Child First package published by the Canadian Council on Children and Youth. They offered the workshop first to summer camp counsellors and continued to do it with other voluntary community groups.

The evaluation forms collected after educational sessions indicated that they were highly successful in helping participants become more comfortable discussing sexuality. Fully 99% of participants stated that they had learned something new.

The cost of special activities was covered by project funds supplied by the Ministry of Community and Social Services. However, as Marjorie Gunn points out, most prevention activities can be done without obtaining additional funds, by making better use of local people and existing resources.

Training for Professionals

With their skills, knowledge, and unique contacts with children, professionals such as teachers, day care workers, medical staff, counsellors, therapists, social workers, child protection workers and police are uniquely placed to play a role in the prevention of child sexual abuse. In the course of their work many have opportunities to educate children and parents about healthy sexuality and sexual abuse. They can also assist in uncovering abusive situations. Indeed, they have the legal obligation to report suspected cases. It has been shown that an appropriate and supportive reaction to a disclosure of sexual abuse can lessen the long-term effects suffered by the child.

Teachers and day care staff are in a position to readily notice unusual behaviour or changes in behaviour that might indicate a child has been abused. They are likely recipients of disclosures given their consistent relationships with children. They are also in a pivotal position to implement classroom based prevention programs and to reinforce children's application of prevention concepts.

However, professionals may lack information and skills, may feel emotional discomfort with the issue of sexuality and sexual abuse, may have fears associated with reporting suspected abuse, and may lack support from superiors and experience confusion as to roles and responsibilities.

The workshops organized by the Prevention Committee for this segment of the community tried to address all these issues and succeeded in reaching a wide range of professionals. One of the committee's key target groups was doctors. In trying to reach the medical community, the committee worked through the local medical association.

The medical professionals indicated that they wanted information on the identification of child sexual abuse, as well as when and how to report it. A workshop was arranged at Brockville General Hospital featuring a presentation by Dr. Robert Bates, a physician specializing in the assessment of sexual abuse. He discussed signs, symptoms and examination as well as how to furnish a child-friendly environment. One-third of all doctors in Prescott and surrounding area attended as well as other health staff and service providers.

A second workshop involved discussion between the medical community and child protection workers.

All doctors serving Brockville and Prescott received a comprehensive package of material from the committee containing information for themselves and their waiting rooms on how to detect and handle cases of child sexual abuse.

Strengthening Families and Transforming Social Values

As Reaching for Solutions puts it: "A commitment to creating a socially healthy culture has to underpin any serious long-term effort to reduce the incidence of sexual abuse of children and other forms of abuse in our society."3  T'herefore, prevention must extend beyond educational programs to initiatives that enhance the capacity of families to care for their children. Examples include family support programs such as drop-in centres, self-help support groups, youth leadership training and parenting education.

These activities help empower individuals and families and encourage healthy family functioning. Family Focus and the Health Unit ran many of these programs before the crisis and continued to do so afterward. Says social worker Alice Koekkoek, who replaced Louise Ward at Family Focus: "We realize now more than ever that we have to be doing these things if we ever want the number of incidents to decrease."

Finally, if we are to change the values that allow the sexual misuse of children to continue, we must work diligently to challenge the institutions and practices that uphold male domination, the powerlessness of children, the turning of sexuality into a commodity and the glorification of violence and exploitation of fellow human beings.

SUMMARY:

· Define target groups and anticipate needs

· Define goals and priorities

· Devise strategies for achieving goals

Community Healing

1. The need to facilitate community healing following the principles of psychosocial responses to disasters should be viewed as an urgent priority in an MVMO child sexual abuse crisis. An immediate response must be formulated.

2. Effective work with a community in crisis requires that service providers be responsive to its needs and provide opportunities for the participation of community members and groups. Professionals with this task are encouraged to learn about the community, build trust, consult and involve community members, promote communication between community members and professionals and provide information openly.

Education and Prevention Initiatives During a Crisis

1. Prevention of child sexual abuse must be seen as a multifaceted, multitargeted and long-term effort integrated into all community systems and institutions. In determining the most effective and appropriate strategies and target groups for prevention and community education, it is wise to consider a variety of approaches from community-based work aimed at supporting families to promoting healthy sexuality with children to training teachers, social workers and the medical profession to recognize signs of sexual abuse. All prevention efforts undertaken in a crisis must be seen within this broader context.

2. Suggestions for membership on a prevention / education team: community development workers, community mental health professionals, child protection workers, public health nurses, child sexual abuse treatment professionals, sexuality educators, clergy, teachers, parents, adult survivors, etc.

4. Decide which information is most effectively delivered in small group settings, workshops and public meetmgs and which is best conveyed through the mass media. The general public is often best reached through mass media in terms of knowledge and awareness. The process required for the development of skills needed in healthy sexuality must however be done in small groups. Subgroups may need to be targeted for specific intense education or re-education in certain areas.

a. adult survivors and their families

While people may be meeting around treatment and support issues, there is a need to consider healthy sexuality education. This is of particular importance for those who are parents. While their own personal work continues at an individual pace, parents need immediate strategies to keep up with their (children's "ongoing" developmental issues, so that sexuality has a healthy / normal side and not just a "problem / self protection" side.

b. parenting groups (including foster parents)

The overwhelming fear and negativism that accompanies highly publicized sexual abuse cases often overshadow the need for a healthy sexuality outlook and discussions. Parenting groups often request guests to speak on issues of "child abuse." They must, however, be convinced to also be educated about healthy sexuality and parenting issues. (For example, the language of sex, nudity, blended families, bedtime and bathroom privacy rules, affection and touch.) Because these group members are a natural support to each other, it is important that they be well informed and skilled so they do not agitate and generate panic and hopelessness for young parents.

While the mass media educate some, they merely result in slogan repetition for others. Some subgroups do not make inferences and need to be targeted for in-depth discussions and skills development on health sexuality issues. (For example, legal aspects, touch boundaries, negotiating skills, remedial adult "sex education.")

d. high schools

Sometimes programs in high schools revolve around dealing with dating violence, abuse, harassment, to the exclusion of the healthy / pleasurable aspects of sexuality, touching / privacy limits. Adolescents often have a lot of confusion regarding homosexuality / paedophilia /abuse and this can negatively affect their behaviour in ways that may contribute to the problems we are attempting to prevent. The need for balance in this education is imperative.

e. professional/union groups (eg. doctors, nurses, teachers, youth workers, day care providers)

Self protection against false allegations is an important issue, but there is often an over-reaction that can be tempered with education sessions that indicate the positive aspects of human touch, along with skills for "reading" and negotiating touch and privacy boundaries specifically related to situations requiring intimate contact.

5. Encourage the educational system and child care community to make a commitment to giving children access to information about healthy and inappropriate expressions of sexuality and training teachers in how to detect and deal with suspected cases of child sexual abuse.

6. Review the prevention programs already in use and consider their appropriateness in light of previously identified concerns about traditional approaches.

7. For work in schools, it is essential to present any material about child sexual abuse in advance to parents and teachers, to allay any anxieties and give them skills to cope with more open sexuality communication. This also helps to educate the adults and to overcome any potential community resistance to the programs. If using outside people in prevention programs, it is important to train local teachers who will continue to convey prevention concepts once the outsiders leave.

8. Ensure that services are available to handle increased disclosures of child sexual abuse that may be provoked by effective prevention programs. Alert all social services that the prevention programs are being undertaken.

9. Education on sexual abuse should be dealt with as an ongoing part of a community-based healthy sexuality program for adults and children.

Strategies For Community Healing

* the types of physical, emotional and behavioural stress reactions that individuals and families can expect to feel after a crisis

* that these reactions are normal, temporary responses to an abnormal situation or event

* that these emotions are best dealt with by acknowledging and accepting them and by discussing them with others

* that the expression of grief over loss and the retelling of upsetting experiences should be anticipated

* that these grief reactions do not necessarily lead to mental illness or breakdown

* where additional information or assistance with emotional reactions or memories of abuse can be obtained

* that it's quite common for people experiencing stress to use such services.

This type of educational material on emotional reactions to a crisis can be communicated through newspapers, leaflets, handouts, radio or TV spots, church bulletins, newsletters placed in grocery bags at local stores, or placed in mailboxes. A radio talk show on emotional reactions and the grieving process can also be beneficial. People who may shy away from workshops or information sessions might be more willing to share their personal concerns or ask questions over the phone.

Another method to convey such information is through mental health information workshops. This model was developed to assist communities ravaged by natural disasters, but could prove useful in cases of MVMO crisis. Public meetings specifically to address community healing can help:

* to educate participants about normal reactions to the crisis

* to provide a forum for people to obtain emotional support from other community members

* to teach some specific stress management skills, if appropriate

* to assist parents in helping their children cope with their emotional reactions (fear of abuse, shame, confusion)

* to provide information on where people can go for help if they are struggling with abuse memories of their own.

Approaches To Sexual Abuse Prevention

The goal of sexual health promotion is to foster healthy relationships and comfort with sexuality. It is based on the premise that adults who are cornfortable with their sexuality and at ease with openly discussing sexual issues will create a family environment that supports healthy sexual behaviour and responsible sexual choices.

The emphasis of tertiary prevention is on treatment and rehabilitation after abuse has occurred. Efforts to prevent victims from becoming victimizers and offender treatment programs fall into this category.4
 

1. Attend a train-the-trainer workshop.

2. Establish contact with a child care or kindergarten and primary school facility (preferably one where you already have rapport).

3. Arrange a meeting that includes a child care staff member, parent, administrator and board member to present the background information and philosophy of Care for Kids.

4. Assess readiness to consider a Care for Kids initiative. A tool for this purpose has been developed and is discussed in the training session.

5. Adult preparation

b. dealing with disclosures
Here we use "Put the Child First".

c. answering questions
Developmentally appropriate answers to common questions that children ask about sexuality.

6. Administrative preparation. Discussion of policies about sexuality education, sexual abuse prevention, reporting and staff education.

7. Creating supportive environments

a. "Tupperware" - style resource parties. Makes books and toys available for children in their informal learning environment.

b. Agency liaison. Makes sure that organizations and professionals who interact with young children and their families are aware of the Care for Kids Program.

8. Children's program. In seven parts or integrated into existing curriculum.

Produced by the Lanark, Leeds and Grenville Health Unit.

Individuals interested in the area of adult survivors of sexual abuse came together to form CASSA. It was agreed that this was needed as part of the project if the whole picture of sexual abuse was to be clearly seen. It was also becoming obvious that a lack of coordination between existing agencies was hampering effective service delivery to survivors of Sexual abuse. In some service areas there was duplication while in others there were significant gaps. Survivors did not always know where to go for assistance or know how to access services.

Over the last few years, in order to obtain a more complete picture of areas where services were lacking, the committee initiated a survey of service providers and a survey of consumers. Agencies planning new services were encouraged to use the committee as a sounding board to share information and seek input.

Also, in an effort to promote greater public and professional understanding of sexual abuse and its impact, CASSA maintains two libraries one for the general public at the Brockville office of the Canadian Mental Health Association and one for professionals at the Brockville Psychiatric Hospital.

The Treatment Of Perpetrators:   A Key Aspect Of Prevention

A subcommittee was set up to address these concerns but few members were interested in serving on it. "It was probably the last place people wanted to invest their time," says Director of Developmental Services, Geoff McMullen, who sat on both the Advisory Committee and the subcommittee. It was only when the first of those convicted had finished their sentences and were coming back to the community that reality set in. Community members began to realize that it wasn't enough to put perpetrators behind bars.

Obtaining Treatment for Offenders

While incarcerating offenders reduces the danger to children for the period offenders are out of the community, it does little to change their behaviour over the long term. The correctional system has not been designed to treat perpetrators, says Phil Ogden, director of Beechgrove Children's Centre, and subcommittee member. "It's a warehousing and gett-them-out-of-circulation system."

Over the last ten years of pioneering work, a wide range of approaches to treatment have been developed. These include the use of medication, psychodynamic therapy, cognitive restructuring, family therapy, group therapy, anger management, non-aversive arousal conditioning, sex education and social skills training. However, there is still no proven "cure" for child abusers and much disagreement about the most effective approaches. Many programs are currently being evaluated. It is much too early to tell definitively which ones work best on which populations of offenders.

One of the things the subcommittee did was to educate the larger Advisory Committee about what would likely happen to the Project Jericho offenders after conviction. "We brought in people to talk about sentencing and treatment from the federal system - corrections, parole and probation - as well as from provincial probation," says subcommittee member Geoff McMullen. The OPP and representatives from the Crown also attended the session and exchanged information about the sentencing process and the services available inside and outside correctional institutions.

This was the first time that most of the participants had ever come together to discuss the topic, says McMullen, and many were quite unaware of the barriers to the treatment and safe integration of offenders within the system. The meeting did, however, provide a good foundation for sharing expertise and limited resources.

Two frustrating realities became evident. The first was the scarcity of available and appropriate treatment resources - both within the community of Leeds-Grenville and within federal and provincial correctional facilities.5 Despite the need, there were no community treatment programs for sexual offenders in Leeds-Grenville at the time the Prescott case was uncovered. Brockville is the home of a major psychiatric hospital which housed, but could not treat, 56 sexual offenders between 1976 and 1992. Statistics collected in June 1992 showed that 35% of the population of the Forensic Unit at Brockville Psychiatric Hospital were individuals who had been charged with a sexually-related offence. These patients had to be referred out of the area for treatment. 6

The second frustration stemmed from the realization that it was not possible to mandate treatment for perpetrators. At present, a judge's order cannot guarantee that treatment be given to incarcerated offenders as part of their sentence. Even if treatment is recommended, there is no certainty that an offender will receive it if he goes to an institution that does not provide it. And even if treatment is available, it may be limited. An offender may be put on a waiting list and finish his sentence long before his name reaches the top of the list.

Consultation and Collaboration

The subcommittee also facilitated training and consultation with experts such as Jan Hindman, Drs. Tony Eccles and Bill Marshall of the Kingston Sexual Behaviour Clinic and Dr. John Yuille from the University of British Columbia. Dr. Yuille and Dr. Marshall participated in a colloquium on the treatment of perpetrators co-sponsored by the committee and Brockville Psychiatric Hospital's Clinical Services.

The Prescott case experimented with the use of the sentencing process to obtain treatment for offenders. 'Treatment issues have to be addressed in sentencing," says McMullen, "and if they aren't, you've lost it." McMullen's agency, Developmental Services, offers a treatment program for offenders with developmental delays.

'There is a window to treatment," he explains. 'We know that it is going to be needed over a long period of time, not just six months or a year. If we don't have a five- to seven-year involvement, we are lowering our chance of changing long-term behaviour." In some cases, work was done with the Crown prosecutor and judges to recommend treatment as part of the sentence. "If we're to have a chance at preventing further abuse, we've got to get in early in the game."

McMullen offers the following example from the Prescott case. Two teen-age offenders from similar abusive backgrounds, who had abused six to eight children between them, received two different sentences. One was sentenced to a three-year restrictive probation period and treatment; the other to two years less a day in a correctional facility. They are both in treatment with
Developmental Services. If the first youth doesn't follow through, he can be taken back to court as part of breaching probation.

"The other has now completed his time," says McMullen. "With two years less a day, you are out quickly. During that short time he received an assessment, but no treatment. The system just doesn't have that type of service, plus what can you do in six months?" He now attends treatment on a purely voluntary basis. He can refuse treatment at any time and it can't be imposed on him.

During its lifespan, the committee lobbied for the establishment of community-based treatment programs for sexual offenders without success. It supported a proposal for a sexual disorders clinic at the Brockville Psychiatric Hospital which would have provided both in-patient and out-patient services. The proposal was not approved.

There are many problems associated with starting treatment programs for sexual offenders. "It's probably the single biggest failure in all sexual abuse treatment," says Phil Ogden. "There's less information about what's effective with perpetrators than with sexual abuse victims. We've tried things in the correctional system. We know things that don't work. We don't know too
many things that do work."

Another obstacle is that in an era of shrinking social expenditures, there is some opposition to devoting limited funds to untried and potentially ineffective offender treatment programs instead of desperately needed services for abuse victims. In general, few mental health professionals have the skills, expertise or desire to work with sex offenders. Many are severely damaged
individuals and require extensive and long-term therapy. It's a difficult and challenging task.

Unfortunately, the Prescott case had minimal impact on developing actual treatment resources for perpetrators of sexual abuse, although today there is a much greater understanding in Leeds-Grenville about the dire need for them. There is also a growing informal network of professionals with interest and expertise in the area and a sharing of limited resources across fields. As well, Developmental Services of Leeds-Grenville has established an assessment and treatment service for perpetrators with developmental handicaps.

A small sum was allocated from project funds for this purpose, and a subcommiftee was struck to plan and coordinate the evaluation. Advisory Committee member Henry De Souza recalls: "We all agreed to take the little bit of money we had and do the best we could, recognizing the obvious limitations."

The Evaluation Plan

The subcommittee's job was to determine the terms of reference for the evaluation and to hire a professional to conduct it. Once the evaluator was selected, the subcommittee disbanded and the task of managing the evaluation was given back to the Advisory Committee. After the preliminary report of findings was prepared, another subcommittee was formed to oversee the preparation of the final report.

The Advisory Committee's original aim was to evaluate the work of the committee as a whole as well as the project's key components - the Treatment  Team, the Prevention Committee and the Committee for Adult Survivors of Sexual Abuse (CASSA). Therefore, each of the committees to be evaluated was represented on the original evaluation committee. 8

In planning the evaluation, the committee adopted a wide-ranging approach. The idea was to see whether the goals and objectives of each of the above components had in fact been met, and to generate information which could be used to determine future needs and directions.

The committee was interested in answering the following questions. Did the therapy have an impact on the children? Did the prevention activities in the community change public and professional attitudes about child sexual abuse? Were the prevention programs in the schools reaching the children? The evaluation made no attempt to examine the investigative, legal or child welfare components of the Prescott case.

The Challenges of Clinical Evaluation

Even though they recognized the challenges and complexities of clinical evaluation, the Treatment Team still hoped the evaluation could make a small contribution to the meagre knowledge base on the impact of therapy on sexually abused children. 'The idea," says therapist Bridget Revell, "was that a client profile and psychological tests would be filled out on our kids and on a comparable group of sexually abused kids who weren't part of Project Jericho."

Psychologist Susan Meyers adds that this kind of study might have shown if the children benefited from the treatment interventions over the long term and what kind had been most effective. "Our general notion was that working with the kids was helpful, but we don't really know that for sure. Only treatment outcome studies would give us that actual information."

As well, since the evaluation was completed while the children were still receiving treatment it was impossible to take the post-tests necessary for a reliable assessment of treatment outcome. As a result, the information on the treatment initiative contained in the final evaluation report does not draw any conclusions about its impact. However, it does provide a great deal of useful descriptive information about the characteristics of the children and the strategies of the treatment team.

Assessing Attitudinal Change

As outlined in an earlier section, the Prevention Committee undertook an program of activities that focused on several target populations, mcluding parents, the general public and professionals working with children. In an effort to find out the impact these activities had on the Prescott community, the first evaluator 9 designed two surveys: one of professionals in Prescott and a random community survey in Prescott and the control community of Gananoque. These were conducted first in 1991 and again in 1992. The bulk of the final evaluation report discusses the results of these surveys.

The aims of the professional survey were three-fold. First, to measure the response of professionals to the disclosures of sexual abuse in Prescott. Second, to systematically explore the information needs and attitudes of professionals. Third, to uncover any changes in attitudes or behaviour that may have occurred over the period 1991-1992. A questionnaire containing 20 questions was mailed to 300 individuals. The response rate was 47%.

A survey was also designed to be carried out for use in schools, to look at children's knowledge about child sexual abuse. However, the school boards raised concerns about the wording of some questions and the survey was never done.

Some members of the Prevention Committee felt it worthwhile to try to capture the impact of educational activities in a more informal, anecdotal manner, even though many of these activities had begun before certain key variables could be measured scientifically. There are creative methods that can be devised to provide useful information about program effectiveness. For example, to find out whether it had been worthwhile to place books on child sexual abuse and healthy sexuality in the Prescott library, public health unit staff member Denise Gaulin manually pulled a hundred or so books and tabulated how many times each had been taken out by Prescott residents. She found that all had been borrowed at least once and some had been taken out as many as 14 or 15 times, more often than the average library book.

The final evaluation report discusses the limitations of the survey design chosen and the indicators selected to measure the impact of prevention activities. Julian Roberts, the criminologist and program evaluation specialist who authored the final report, writes: "Many of the issues explored in the empirical research conducted in Prescott are not amenable to short-term change. For example, it would be naive to assume that public attitudes toward an issue like child sexual abuse are going to change within a few months, no matter how much attention was paid to the public education initiative." 10

He elaborates: 'The trouble is, if you do a pre-post design and there's only about 11 months in between, you won't see much change. You may be tempted to conclude that the Prescott initiative really didn't do anything. I think it did a fair amount. The limitations were not as a result of the individuals involved, they were limitations of the indicators used. For example, the public educational initiative was well received, as was the professional educational initiative. Everyone who participated thought those talks were beneficial. The problem was that only a small proportion of the entire community participated. You can't really expect that the attitudes of the whole community will change when such a small proportion is involved."

Solid research on the effectiveness of treatment and prevention programs takes time, money and a well-constructed research design. Phil Ogden, director of Beechgrove Children's Centre, believes that "evaluating the effectiveness of any kind of treatment is much more art than science at this point in time. It takes big numbers, which we didn't have in this project. There are thousands of variables. On top of that you lay over all the ideologies and unknowns about how to approach sexual abuse." He advises cornmunity groups to leave empirical research to the academics who have much longer time frames to work with and to concentrate limited evaluation resources on documenting their organizational processes in a way that will be useful to others.

Professional Survey

* Half the sample had reported a case of sexual abuse at some point in their careers.

* The majority of professionals were satisfied with the response to the report that they had made.

* The most frequently-cited reason for not reporting a case was that the evidence was not strong enough to sustain the allegation.
* When asked where they would now report a case, most said to Family and Children's Services.

* Almost half had attended one of the Committee's presentations dealing with child sexual abuse.

* An overwhelming percentage of professionals reported finding these sessions helpful in their professional lives.

* Most professionals stated that there was a continuing need for further professional training on the issue of sexual abuse.

* Fully 85% regarded parents as being the individuals with most responsibility for educating children about sexuality.

* Almost 90% felt there was little difference between Prescott and other communities in terms of the incidence of child sexual abuse.

Survey of the Public

* Only a small percentage of residents in either community reported having attended an information session on child sexual abuse.
* A higher percentage of the Prescott sample had attended such an information session.

* Of those who had, reaction was overwhelmingly positive.

* Almost half the respondents in Prescott said they would be interested in leaming more about sexual abuse.

* The news media were the primary source of information about sexual abuse in both communities.

* Only 19% reported that family discussions about child sexual abuse had had an influence on them'

* When asked to identify the most appropriate response to the problem of child sexual abuse, the most popular option was treatment for victims.
* Only one resident in ten thought that the community was doing enough to respond to the issue of child sexual abuse.

* One-quarter believed that people who sexually abuse children are mentally ill.

* Over 90% of respondents felt that abusers as well as victims needed help. Over 80% thought that child abusers have frequently been abused as children.

* When asked who was responsible for sexual abuse involving children, there was a tendency to attribute more responsibility to the victim when the victim was an older child. Thus 11% of respondents thought that children between seven and ten had some responsibility if sex occurred with an adult. This figure rose to 60% for cases involving and adult and a 16-year-old.

* Approximately one-third of respondents in both communities reported knowing a victim of sexual abuse.

* When asked what they would do if they became aware that a child was being sexually abused, the most likely response in both communities was to call the police.

* The majority of Prescott respondents felt that the problem of sexual abuse was no worse in Prescott than any other community.11

SUMMARY:

* Plan an evaluation process

* Manage the evaluation process

* Communicate the results of the evaluation

ACTION

1. Build in an ongoing procedure for evaluation and debriefing to assist with the ongoing planning process. At appropriate points in time, you will want to step back and analyze what you're leaming from the crisis.

2. Evaluation research must be carefully planned. It is important to clearly define the purpose of the evaluation and set realistic goals in line with available resources. Start by deciding what you want to know and why Who will use it? For example, are you doing the evaluation to meet the requirements of a funder, to give information to service providers or to inform the community? Are you trying to assess the long-term effectiveness of treatment, examine the effectiveness of the criminal justice response, measure changes in public opinion or learn from the strengths and weaknesses of the collaborative organizational response? Try to avoid letting turf wars and professional competitiveness interfere with the setting of evaluation goals.

3. The crisis context makes planning an evaluation especially difficult. If you're going to evaluate at all, it is vital to develop your plan early in the game. Most evaluations require that measures be built in from day one.

4. It is important to consult with trained evaluation methodologists in designing and planning your evaluation and select an evaluator skilled in the type of evaluation you're planning. You may want to contact a nearby university or college for assistance in finding such a person.

6. Establish a committee to oversee the evaluation process and guide the evaluator. Look for people with training in evaluation methodology to sit on this committee and define roles and responsibilities clearly.

 Page 103 - Reaching for Solutions. The Report of the Special Advisor to the Minister of National Health and Welfare
on Child Sexual Abuse in Canada (Ottawa: Department of Supply and Services Canada, 1990), p. 46.

Page 112 - Reaching for Solutions, P. 89.

Page 113 - Reachingf or Solutions, p. 54.

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