Reflection #3

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Communicating about child sexual abuse with the public: learning the lessons from public awareness campaigns

Hazel Kemshall & Heather M. Moulden

To cite this article: Hazel Kemshall & Heather M. Moulden (2017) Communicating about child sexual abuse with the public: learning the lessons from public awareness campaigns, Journal of Sexual Aggression, 23:2, 124-138, DOI: 10.1080/13552600.2016.1222004

To link to this article: http://dx.doi.org/10.1080/13552600.2016.1222004

Published online: 06 Sep 2016.

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Communicating about child sexual abuse with the public: learning the lessons from public awareness campaigns Hazel Kemshalla and Heather M. Mouldenb

aDepartment of Community and Criminal Justice, De Montfort University, Leicester, UK; bDepartment of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada

ABSTRACT Despite numerous public awareness campaigns child sexual abuse (CSA) remains a significant global issue affecting millions of children. This suggests that such campaigns have had minimal impact, and the paucity of good quality empirical evaluation makes it difficult to establish what has worked and what has not. This article considers how different and evolving approaches to public awareness campaigning on CSA since the 1990s have influenced (or not) attitudinal and behavioural change. The article reviews a number of key initiatives from around the world and identifies common themes that can inform campaigning and prevention efforts. Recommendations for further research efforts, social problem framing, and targeting are offered. The article concludes by arguing that more recent multi-faceted campaigns which combine a range of messaging methods are more likely to turn public awareness campaigning into public action campaigning.

ARTICLE HISTORY Received 24 March 2016 Revised 28 July 2016 Accepted 4 August 2016

KEYWORDS Child sexual abuse (CSA); child sexual abuse prevention; public awareness campaigns

Introduction

Child sexual abuse (CSA) is a global problem with a UN estimate of over 2 million children per year affected by some form of abuse or sexual exploitation (UNICEF, 2014). In 2010 the Council of Europe initiated the One in Five Campaign to stop sexual violence against children in recognition of the wide- spread nature of the problem across the EU (Council of Europe, 2012). In the UK approximately 473,000 adults are victims of sexual offences, and 1 in 20 children in the UK have been sexually abused; 1 in 3 by an adult and did not tell, and 90% are abused by someone they know (National Society for the Prevention of Cruelty to Children [NSPCC], 2014a). More recently, the UK Office of the Children’s Commissioner has estimated that “up to 1.3 million children living in England will be a victim of sexual abuse by the time they turn 18” (2015, p. 26; see also Bellis, Hughes, Perkins, & Lowey, 2014; Horvath, Davidson, Grove-Hills, Gekoski, & Choak, 2014; Radford et al., 2011). Accord- ing to Statistics Canada, children under the age of 18 accounted for over half (55%) of all victims of sexual offences reported to police in 2012. In the majority of these cases, the accused was an acquain- tance (44%) or a family member (38%) of the child (Cotter & Perreault, 2014). Anglophone countries, along with some states in Western Europe (e.g. Germany and the Netherlands), have placed increas- ing priority on the prevention of CSA in recent years (Zeuthen & Hagelskjær, 2013). Interestingly, this is against a backdrop of research which indicates that prevalence rates of CSA have not diminished since the 1990s (Pereda, Guilera, Forns & Gomez-Benito, 2009, cited in Zeuthen & Hagelskjær, 2013). Notwithstanding current estimates, defining exactly the state and magnitude of the problem has

© 2016 National Organisation for the Treatment of Abusers

CONTACT Hazel Kemshall [email protected]

JOURNAL OF SEXUAL AGGRESSION, 2017 VOL. 23, NO. 2, 124–138 https://doi.org/10.1080/13552600.2016.1222004

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continued to be challenging (see Wurtele, 2009 for discussion about the issues in establishing the prevalence of CSA).

What is certain is that CSA is accepted as a major social problem, which is simultaneously poorly understood by the public and decision-makers alike. Despite the far reaching and lasting impacts of CSA, most people, including policy-makers, do not learn about CSA firsthand, but rely on media for information about the problem (Sample & Kadleck, 2008). Unfortunately, media portrayals have his- torically been inaccurate about offender, victim, and offence depictions, resulting in misperceptions of risk, and faulty public and personal risk management (e.g. stranger-danger). However, depending on the coverage or campaign the media can have a profound influence on shaping the message. In fact media reporting and public awareness campaigns can have greater influence on public knowl- edge and action than empirical evidence (Mejia, Cheyne, & Dorfman, 2012).

This article considers how different approaches to public awareness campaigns have influenced (or not) attitudinal and behaviour change in respect of CSA prevention. The article does not present an in-depth historical narrative, but rather presents key trends since the 1990s. Nor does it seek to offer a comprehensive meta-analysis of effectiveness. Rather the article presents a number of key campaigns which are illustrative of trends and changes in public awareness campaigning from the 1990s to the present day. Most notable during this period were changes in the audience targeting, ranging from targeted campaigns at victims, perpetrators, parents/carers; and more univer- sal campaigns aimed at the community or societal level. Campaigns also differ in terms of the locus of agency and responsibility for achieving change, notably personal, group, community, or society. These changes are illustrative of differing and at times contested framings of public awareness cam- paigning for CSA. Most notably victim/survivor groups seek to move responsibility for combating CSA onto wider society (Tabachnick & Klein, 2011); paralleled by attempts to foreground prevention through targeting specific groups such as parents/carers, (potential) perpetrators, and key pro- fessional groups working with children (Bolen, 2003). More recent campaigns have attempted to move to a more holistic and multi-faceted approach, combining universal societal messaging, with targeted events for specific audiences, such as parents, and utilising multi-media strategies including social media (Massachusetts Citizens for Children, 2001, 2010). Campaigns also differ with respect to their aims such that some programmes have sought to increase awareness of the problem, combat myths, or improve knowledge, whereas others attempt to modify attitudes, beliefs, and ultimately behaviours in the target audience.

Historically, developments in public awareness campaigns do not follow a simple linear trajectory towards ever increasing sophistication or efficacy. For example, it is possible to identify a varying range of public awareness campaigns at the present time, ranging from those targeting specific groups, educative campaigns for parents or carers, professionals working with children, perpetrators (including those who self-identify as “at risk” of sexually harming children), and universal campaigns at the community and societal level. Selection of approaches has been driven by a range of factors, for example, resources (Cosc, 2015), ideology and value framing (McCartan, Kemshall, & Tabachnick, 2015), as well as empirical evidence (Tabachnick & Newton-Ward, 2010). Evidence reviews have largely focused on specific campaigns or approaches (see Fenton, Mott, McCartan, & Rumney, 2016, on bystander campaigns), with little comparison of effectiveness between approaches (see also Horsfall, Bromfield, & McDonald, 2010). Good practice and effectiveness guides are largely derived from general social marketing research, adapted for campaigns on sexual violence, gender-based violence, and child sexual abuse (Cosc). In their review of sexual abuse prevention, Dickson and Willis (2015) surveyed 42 agencies in New Zealand and described themes consistent with other international surveys (see Townsend, 2015 for US data), such that the primary mode of prevention focused on sexual violence education, public policy advocacy, and increasing public awareness. However, the authors noted that the majority of initiatives were focused on information about services for victims and perpetrators, and raising awareness versus primary prevention. In this evaluation specific gaps were noted in resources for school-aged children and the evaluation of pre- vention programmes in general. Furthermore, despite the fact that an ecological model was the most

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frequent prevention model endorsed, the method, implementation, and evaluation of the pro- gramme reflected an individual focus aimed at influencing change within a victim, parent, or perpe- trator. In 2008, Russell prepared a literature review on the efficacy of sexual violence primary prevention in New Zealand. Although conclusive statements are avoided due to inadequacy in research evaluation of the programmes, successful components are summarised across programmes which (1) emphasise an ecological model with embedded networks and partnerships within the com- munity, (2) promote healthy behaviours and challenge cultural norms that support sexual abuse, (3) are tailored to the audience and include multiple targets, and (4) include research and evaluation. Conversely, many of the gaps identified in New Zealand prevention are related to these issues and include limited evaluation, lack of resources, no long-term or behavioural outcome measures, cultural factors and influence. Mass media campaigns can be effective in improving awareness and knowledge about a topic. However, many have observed that these types of programmes are less effective in conveying complex information, teaching skills, or changing attitudes and beliefs (see Saunders & Goddard, 2002). What changes are observed seem to be short-lived, and awareness and behavioural change are correlated with the active presence of media campaigns in a cyclical way (Olafsen, Corwin, & Summit, 1993 in Saunders & Goddard, 2002).

Based on a necessarily limited overview, this article will outline some of the lessons that can be learnt for future campaigns.

Defining “public awareness campaign”

Drawing on a range of literature as diverse as global climate change (Sampei & Aoyagi-Usui, 2009; UNEP, 2006), disaster management (IFRC, 2011), flood risk awareness (Joyce, 2011), HIV campaign evaluations (Kirby, Laris, & Rolleri, 2007), and CSA public awareness research (McCartan et al., 2015), public awareness can be defined as a campaign that uses: “ … media, messaging, and an organised set of communication activities to generate specific outcomes in a large number of indi- viduals and in a specific period of time” (Coffman, 2002, p. 2). Through the use of the media public awareness campaigns can contribute to policy and change by generating solutions to social pro- blems, putting pressure on policy-makers, activating community members, and eliciting new emotions or perspectives on a particular issue. However, understanding and designing effective public awareness campaigns is more challenging. In a presentation on public awareness campaigning on biosafety procedures Tamale (2013) unravels the complexity of public awareness campaigning and argues that awareness aims to inform, highlight, or draw attention to a specific issue and to inspire others to act in desired ways. It is often accompanied by education in order to impart knowl- edge and/or skills aimed at increasing the capacity and competence to act on those targeted by the message. Awareness, and particularly education, are often supported by delivery methods and communication strategies designed to deliver the message, information, knowledge, and skills. This can involve outreach to particular communities (e.g. migrant communities at risk of exploitation) or specific groups (e.g. young people at risk of HIV, new parents, and parents/carers of vulnerable children). Outreach can involve the use of “champions” or “grasstops” (Bouder, 2013), that is, commu- nity leaders who carry the desired message and reach or influence those who might otherwise remain inaccessible to the public awareness campaign. Sustaining the impact of the message may involve long-term work with key groups to transfer knowledge and skills or to sustain behaviour change over the longer term, such as sustained work with journalists to change reporting practices on CSA (see Mejia et al., 2012).

Coffman also distinguishes between campaigns that “ … try to change in individuals the beha- viours that lead to social problems or promote behaviours that lead to improved social well- being”, and campaigns that aim to mobilise “public will” or galvanise public action for policy change (2002, p. 2). CSA prevention has seen both types of campaigns, with some organisations oper- ating both types at the same time. Prevention Project Dunkelfeld (PPD) targets perpetrators and is a social marketing campaign aimed at engaging them in early treatment and prevention (Beier et al.,

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2009, 2015). The Stop It Now campaign, launched over 20 years ago by Fran Henry and currently operating in the USA, UK, and Ireland, and the Netherlands, has operated a number of campaigns, ranging from those that both redefine CSA as a public health issue, and attempt to mobilise public attitudes to change understandings of CSA, whilst also operating “prevention education, a help service, community outreach, and advocacy in the public policy arena” (Stop It Now!, 2010). These activities illustrate the sheer complexity of public awareness campaigns (as highlighted by Tamale, 2013), but also their development both in terms of formulation and implementation over time.

The early initiatives of the 1990s: Stop It Now! USA and Zero Tolerance Edinburgh

Public awareness campaigns have formed an important part of prevention strategies for CSA, particu- larly from the 1990s onwards. Arguably such campaigns stem from a number of key sources, most notably activism and victim/survivor groups (e.g. Fran Henry and the founding of Stop It Now! in the USA in 1992), as well as charities working with child victims (e.g. the NSPCC in the UK). For example, Kitzinger (2004) identifies the “discovery of the paedophile” in the UK in the mid-1980s as directly linked to the BBC Childwatch programme and the inception of Childline, used by children to self-report with 55,000 attempted calls on the first night (Harrison, 2000). Similarly, since it began in 1989, Canada’s Kid’s Help Phone, has provided free confidential counselling to children over 7 million times, and in their most recent service evaluation found the helpline to be related to reductions in distress, learning of new strategies, and increased confidence and clarity about what to do next (kid- shelpphone, Canada, 2013). Through such initiatives, the public, policy-makers and politicians became aware of the extent of the problem. However, public and policy-makers tended to frame CSA as “stranger-danger” with stereotypical notions of the “predatory paedophile” dominant, particu- larly in news coverage and public policy (Kitzinger, 2004).

The development and changes in CSA public awareness campaigns during the 1990s illustrate important shifts in the site of intervention and locus of responsibility for combating CSA. An early example of such a shift is the Zero Tolerance poster campaign (see Zero Tolerance website). Launched in 1992 by the Edinburgh District Council, the Zero Tolerance campaign was aimed at challenging attitudes toward violence against women and girls, and including CSA. Their posters and slogans attempted to highlight the social issues underlying CSA and dispel myths about CSA happening to “other people” by juxtaposing sexual abuse with affluence and as perpetrated within the home. These were novel notions compared to the popularised “stranger-danger” programme, which did little to facilitate discussion of CSA where perpetrators were known to victims. Zero Tolerance chal- lenged the prevailing view that the most effective strategies to prevent CSA were sole reliance on therapeutic work with abusers, or training children to “recognise and resist molestation” (Kitzinger, 1994, p. 246). Rather Zero Tolerance set out to challenge broader social attitudes towards sexuality and violence, and is the first UK example of a public awareness campaign aimed at galvanising public opinion against sexual violence.

Zero Tolerance had positive outcomes in that it effectively increased awareness and communi- cation about CSA, empowered (potential) victims, and increased disclosure. The campaign attracted attention, largely gained approval, and provoked considerable public debate. It has been much repli- cated both in the UK and abroad (see Council of Europe, 2012; Gillan & Samson, 2000). However, respondents interviewed expressed caution that the campaign did not necessarily lead to concrete changes in terms of policy or law, or indeed with respect to public action (Kitzinger, 1994, pp. 254– 255; see also Kitzinger & Hunt, 1993). The prevention focus remained on male perpetrators (albeit that traditional stereotypes were challenged), despite a wish from many promoters of the approach to place the prevention focus on societal attitudes (Kitzinger & Hunt, 1993). However, Zero Tolerance did serve to extend and shift the nature of responsibility for CSA, move the locus of intervention from stranger-danger to home, and challenge societal attitudes to sexual violence against girls and women.

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Arguably the most important campaign to address societal attitudes to CSA is Stop It Now! Informed by the “survivor voice” and linked to activism, Stop It Now! aims to educate both public

and policy-makers on the nature and extent of CSA. Early campaigns (e.g. Vermont) were character- ised by awareness raising, and challenging societal attitudes and understanding of CSA (Stop It Now!, 2000). During the 1990s Stop It Now! was instrumental in pioneering public awareness campaigns, surveying public attitudes to CSA (Fontes, Cruz, & Tabachnick, 2001; Stop It Now!, 2010), including survivors in formulating messages about CSA, and seeking to inform policy development via empiri- cal research (Schober, Fawcett, & Bernier, 2012; see Stop It Now! website for full range of research and evaluations). Whilst light on methodological detail, the four year evaluation of the early Vermont pro- gramme found that abusers would use a dedicated helpline. In addition, three random digit-dial phone surveys in 1995, 1997, 1999 of 200 Vermont residents found a “40% increase in the number of Vermonters who could explain or define child sexual abuse over the past 4 years” (Stop It Now!, 2000, p. 2). However, this awareness did not necessarily result in action, with adults not sure how to act on “suspicions” and unsure of what to look for (p. 3). The evaluation recognised two important future steps: “delivering skill-based programmes for adults” and “creatively collaborating with media” to reframe public understandings of CSA (pp. 4–5). This was confirmed by Tabachnick and Dawson (2000) who found that while awareness of CSA was high, most people, even after hearing the public messages, did not know what to do. This was still the case in a large attitudinal survey of adults in six American States in 2010 (Stop It Now!, 2010, p. 6).

These early efforts were clearly increasing awareness of CSA as a social problem, but with no demonstrable impact on attitudes or actions. Indeed evaluation has been slow in this arena due to limited financial investment beyond the campaign implementation itself, and with little research expertise to guide and carry out such an evaluation. Horsfall et al. (2010) reviewed twenty-one social marketing campaigns specific to child maltreatment. Of that list, only two CSA specific campaigns provided information for evaluation, Stop It Now! (USA) and Some Secrets You Have to Talk About (Netherlands). Stop It Now (USA) described attitudinal change, evidenced by a 10% increase in those who believe a perpetrator can live within one’s community. This same programme reported improved knowledge such that at post-campaign evaluation more respondents could define CSA. Both programmes reported increased calls associated with the social marketing campaign. However, as the authors note, there is no information about changes in the ultimate behaviour on behalf of the callers (Horsfall et al., 2010). Rheingold et al. (2007), in an independent evaluation of a CSA mass media campaign in the USA, also found that there was no significant impact on CSA atti- tudes or on several behavioural responses. Based on a sample of 200 parents recruited from 8 sites across the USA, they found that initially the campaign impacted knowledge of CSA compared to no intervention. However, knowledge and behavioural gains were not sustained at the one-month follow-up. Despite a small sample size at follow-up, they concluded that “media campaigns alone may not significantly affect primary prevention of CSA” (p. 352).

A further Stop It Now! evaluation after 15 years of community-based programmes found that “messaging, educational materials, Help Services, and training” needed to be “more accessible to more people”, and create “easier ways for people to talk about this issue” (Stop It Now!, 2012, pp. 4–5). Recommendations were made to “broaden the impact” through increased online engage- ment, whilst remaining “grounded in communities”. The complexities and challenges of both repli- cating and evaluating a complex model comprising a range of activities were also acknowledged.

These findings illustrate the challenges in translating awareness into action, such as perceptions of stigma, lack of perceived relevance to consumers of the message, lack of engagement with the message and the medium by which it is conveyed, and reluctance coupled with uncertainty about what to do (see Berlin, Malin, & Dean, 1991; Finkelhor, 2007; Tabachnick & Dawson, 2000). In an quasi-experimental study of sexual abuse prevention programming for adolescent girls in Nigeria, the authors concluded that although knowledge about sexual abuse increased over the course of the programme and was maintained at the post-intervention stage, there was no significant shift in attitudes about sexual abuse (Ogunfowokan & Feajemilehin, 2012). The authors attribute this

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lack of impact, to the tension between targeted efforts in attitudinal shift and the beliefs held and promoted within the larger society. This illustrates how the attitudes and behaviours targeted are not isolated from, nor independent of, other attitudes which exert their own influence. Kitzinger and Skidmore (1995) noted that many commonly held beliefs about CSA are maintained despite evi- dence and education to the contrary because the alternative is at odds with other beliefs. For example, the notion that parents can engage in incest is contradictory to the essential concept of parenthood. Similarly, Saunders and Goddard (2002) review how conceptualisations of youth in society may inadvertently dehumanise children and contribute to implicit justification for abuse. Negative, shaming, and explicit portrayals of child physical and sexual abuse in campaigns have been used to influence behavioural change. However, in Australia in particular, there has been a clear argument against such an approach given the potential to be distressing to survivors, reduce help-seeking behaviours, and create fear in young children (Horsfall et al., 2010).

Although some early public communications regarding sexual violence have been effective in changing many problematic attitudes or cognitive frames, some have also inadvertently reinforced existing stereotypes or have failed to achieve maximum impact because of prevailing public under- standings of CSA. The Frameworks Institute of Washington has been central to the investigation of public understanding or “framing” of sexual abuse including CSA, most notably in their examination of American Perceptions of Sexual Violence (O’Neil & Morgan, 2010). The study importantly maps the “gaps” between expert and lay understandings of sexual violence. Although experts conceptualise sexual violence as a sociocultural issue, the public relies on an individualistic perspective to under- stand motivations, character, and victimisation. Flowing from this individualistic frame, the public tends to characterise individuals involved in sexual violence as sick, predatory, weak, or vulnerable, rather than ordinary people universally at risk. Finally, whereas experts interviewed for the study tended to view sexual violence as a health issue, the public identified it as a criminal issue. Not sur- prisingly, these frameworks influenced the public’s response to prevention in that most respondents narrowly focused on deterrence and punishment for perpetrators and victim education. However, experts noted that targeting curriculum in schools and workplace policies would be more advan- tageous. Furthermore, experts suggested that media portrayals of women and children undermine efforts to challenge gender inequality, and support healthy sexuality, and should be targeted by cam- paigns aimed at changing the public perception of sexual violence. The Framework approach suggests that using a child developmental approach to situate sexual violence within a sociocultural context and imbed responsibility within the broader community may be more effective. In their work on child abuse and neglect they found that when people understood child development and how healthy development is thwarted or supported, this increased their appetite for intervention and policy support. Another important finding from this work is that health perspectives tend to foster individual responsibility rather than social accountability and in this way may run counter to the intended contextualisation of sexual violence from a public health perspective.

Despite limits in long-term impact, particularly in facilitating appropriate action from adults, these early campaigns began to reframe the understanding of CSA in the UK and USA, respectively. The locus of responsibility and accountability began to shift from victims and potential victims, and from children, to adults, communities and society. Whilst evaluations revealed limits to universal mes- saging, particularly in enabling action, and sustaining knowledge and attitudinal change over time (Stop It Now!, 2012; Tabachnick & Dawson, 2000), the long journey to reframing CSA as everyone’s concern and everyone’s business had begun.

Further developments: personal responsibility, normalising action, and skill building

The social and psychological barriers to intervening can be considerable, and this reluctance may be affective, behavioural, or cognitive, and range from fearfulness to victim blaming, and a lack of per- ception of responsibility for intervening. For example, the UK NSPCC “Full Stop” campaign raised

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some £250 million between the 1990s and 2009. However, by 2014 the CEO stated that: “We weren’t telling people what we were doing to solve the problem-just that the problem existed … This con- tributed to the view that child abuse is inevitable, rather than a problem that we can all prevent”. Thus the evolution of messaging had the unintended consequences of dampening public support, and thus fund raising income declined (NSPCC, 2014b).

By the early to mid-2000s these barriers to taking action were increasingly recognised (Bolen, 2003). Developments in public awareness campaigning began to tackle these issues. Three areas were critical: developing and enhancing personal responsibility and the ability to take appropriate action; a move to targeting of campaigns on specific groups and communities (sometimes through collaborative partnerships) in order to use resources more effectively; and the foregrounding of prevention rather than reactive criminal justice responses.

Campaigns to enhance personal responsibility and personal agency largely comprise Bystander programmes, parent education, and campaigns aimed at actual or potential perpetrators of CSA, which encourage them to self-disclose and seek treatment to manage and reduce their harmful behaviours. Bystander programmes are rooted in gender-based violence reduction in Universities (Banyard, 2011, 2015; Banyard, Moynihan, & Plante, 2007) with some transfer to the arena of CSA (Brown & Saied-Tessier, 2015; National Coalition to Prevent Sexual Abuse and Exploitation, 2012) and limited research into the role of bystanders in incest based sexual offending (Stop It Now! Min- nesota, 2009).

Bystander programmes deal with an unwillingness on the part of the public observer to accept responsibility and intervene. As Tabachnick (2009) suggests, Bystander programmes include inter- vening at all levels and instances before someone is harmed (i.e. harassing comments). The challenge for many bystanders is processing significant amounts of information, formulating a judgment and executing behaviour, often in the face of limited skills, support or confidence. Research indicates that when faced with a crisis situation bystanders fail to act because they expect others to intervene, defer to the cues of those around them, fear they will look foolish, or believe they do not possess the skills to act effectively (Australian Human Rights Commission, 2012; Chekroun & Brauer, 2002). Bystan- der programmes aim to challenge some of the social cognitive processes that contribute to tolerance of violence and victim blaming, and importantly provide bystanders with the skills and competencies to act (Banyard, Plante, & Moynihan, 2005; Berkowitz, 2002; Coker et al., 2011). Whilst Bystander pro- grammes have their origins in University campuses (e.g. Green Dot launched at the University of Ken- tucky in 2010), they have extended into school bullying, and CSA (Tabachnick, 2009). Evaluations of Green Dot have been positive, demonstrating increased knowledge and awareness, similar to media campaigns, and Green Dot boasts significant reductions in campus sexual assaults following their intensive multi-stage programme (Coker et al., 2011). Similar findings were reported by Banyard and colleagues in their evaluation, such that those who received the bystander training showed improvements on knowledge, attitudes and behaviour compared to a control group (2007). These gains were maintained at 4- and 12-month follow-ups.

More recently, a study compared the efficacy of a US college bystander programme with a tra- ditional psycho-education programme aimed at preventing sexual violence (Cornelius & Resseguie, 2007). Both programmes provided information on dating and sexual violence, but the bystander pro- gramme also included discussion of intervention skills and encouragement to use them. Although both programmes resulted in reductions on rape myth acceptance and improved knowledge about sexual violence, there was little evidence to support the bystander programme’s superiority. It is noteworthy that the bystander programme improved bystander efficacy which is defined as con- fidence in performing bystander behaviour, and this is likely directly linked to the bystander skills training. However, there was no evaluation of actual change on indicators of decreased sexual violence.

Fulu, Kerr-Wilson, and Lang (2014), in a review of bystander programmes, drew on a previous meta-analysis by Ricardo, Eads, and Baker (2011), and a mapping exercise by Powell for the Victorian Health Promotion Foundation in Australia (2011; Pennay & Powell, 2012). They identified 13

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evaluations of bystander programmes, all concentrated in the USA, including controlled trials with and without randomisation. Although no study evaluated a bystander programme for CSA specifi- cally, six studies measured effects for the perpetration of sexual or domestic violence, and the rest measured the impact of the programme on knowledge, awareness and attitudes, such as gender roles, violence, and rape myth acceptance. All studies were characterised by short-term follow-up periods with 7 studies having periods less than 7 months, and only 2 having 12-month follow-up periods. Only one RCT found positive outcomes on intimate partner violence (Miller, 2012; see Fulu et al., 2014); with reductions in negative attitudes and abusive behaviours. Four studies found positive change with respect to intentions to intervene, but studies were limited by short follow- up periods and consequent lack of data on long-term sustainability of change. The evidence is at present conflicting, with more refined studies and models of bystander programmes beginning to emerge suggesting the promise of increased effectiveness going forward (see Banyard, 2011, 2015; Tabachnick, 2009).

Importantly Bystander programmes have shifted responsibility to act from victims to members of the public, establishing not only the notion of personal responsibility, but providing the foundation for broader community and societal acceptance of responsibility. Banyard (2011) suggests that com- munity level variables may help explain bystander behaviour and provide additional sources for change. Specifically, she suggests attending to culture, community and peer dynamics, in addition to efforts focused on individual awareness, skills, and attitudes. There appear to be two important aspects to the success of bystander programmes: (1) the use of Peer Opinion Leaders (POLs) or cham- pions (e.g. student leaders, “grasstops”; see Bouder, 2013) and (2) the programmes are skill based, centred on activities that promote a sense of responsibility, confidence to act, and significantly promote norms about what is right to do, and what others are likely to expect one to do (Coker et al., 2011). Stop It Now! Minnesota (2009) found that understanding warning signs was critical in facilitating parents in acting on suspicions, and that targeting “clusters” such as parents, church leaders, religious counsellors, and counselling professionals was likely to be most effective (see also Tabachnick, 2009).

Prevention campaigns are facilitated by providing instruction to the target groups about not only what to watch for, but what to do in response. However, identifying the target is sometimes challen- ging – is it victims, carers, the entire community? Community education has been pursued as a public awareness strategy to combat CSA. Most often targeted at particular groups, for example, parents, and at times delivered in collaboration with key community groups. Two community education cam- paigns in England by Lucy Faithfully Foundation and Stop It Now! UK and Ireland in 2008 targeted parents, carers and others with a responsibility for the care of children. However, they found it difficult to recruit parents, the topic was seen as “taboo”, and leaflets were ineffective in promoting engage- ment and attendance. Those parents who did attend tended to be “already engaged” with the topic, and the initiative was characterised by “lack of interest” by the public (Lucy Faithfull Stop It Now, 2009, p. 36). Additional barriers were identified by Finkelhor (2007) who found an invisible barrier in educating parents and children, such that consumers of the message participated and benefited minimally from educational resources. The main issues tended to be that parents did not access the resources due to stigma, they did not perceive the message as relevant, or when they did engage with the material, they ultimately underestimate the applicability and risk. However, they found the advice of local community representatives valuable, and recommended the establishment of strong links with credible organisations and the key child protection partners and lead professionals from the outset. Such collaborative arrangements were seen as more likely to enhance engagement and attendance (Lucy Faithfull Stop It Now!, 2009).

By the early 2000s it was also recognised that CSA was not reducing significantly, and programmes targeting victims were largely ineffective (Bolen, 2003). Attention turned to perpetrators, with an initiative in the UK run by the Lucy Faithfull Foundation targeting perpetrators, their partners and families to use a Helpline and seek treatment; and in Germany, PPD which used social marketing to reach out to potential perpetrators and offer support and treatment.

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In the development of the PPD, known paedophiles were consulted about how best to target potential perpetrators in the media campaign (Beier et al., 2009). The feedback suggested that mes- saging to the audience should express empathy, distance them from discrimination for sexual pre- ference, reduce their fear of penalty, assure confidentiality, and reduce feelings of guilt and shame. From their 2009 study, it appears that these strategies effectively resulted in intermediate behaviour change (e.g. help-seeking behaviour). In their initial evaluation in 2009, the authors demonstrated that not only was the campaign effectively reaching the target audience of potential sexual abusers, but they also responded by seeking help, proving the programme was successful in affecting change on this intermediate behaviour (Beier et al., 2009). The subsequent non-randomised waitlist control evaluation of the treatment component of the PPD showed promise for target behav- iour change, such that the authors reported reduction in dynamic risk factors for CSA and relapse (Beier et al., 2015). However, the data was based on self-reported (re)offence rates, and there was ongoing offending behaviour (e.g. CSA, viewing of CSA images) in the treatment group, suggesting limitations in the effect on ultimate behaviour change.

During the late 1990s and into the 2000s important lessons were also learnt about social market- ing and media campaigns from other health risk behaviours (e.g. smoking, road safety, sex-related behaviours, HIV, and child survival). For example, in a large scale study of media campaigns aimed at a range of risky behaviours, Wakefield, Loken, and Hornik (2010) concluded that mass media cam- paigns can be effective at the population level. However, they argue that unlike the typical media campaign, which is largely passive, effective programmes are characterised by concurrent availability of services and products, community programmes, and policies which reflect the desired behaviour change. A similar pattern of results was observed in a meta-analysis of school-based child abuse pre- vention programmes (Davis & Gidycz, 2000). The prevention programmes were shown to be effective, but the moderators of the effect were equally informative, such that teaching healthy and appropri- ate behavioural skills contributed significantly to the effect.

The effectiveness evidence for the approaches discussed in this section is promising rather than decisive. Some approaches, such as Bystander, continue to refine and evolve, and techniques for achieving robust evaluations are improving. Arguably these approaches all saw a subtle shift towards personal responsibility, action and skill promotion, and a more nuanced understanding of public framings and perception of sexual violence and CSA as a backdrop to public awareness and social marketing campaigns. “Targeting” became important, although differences in who to target, how, and with what techniques, remains an area of continuing evaluation and development. This combined approach of information/education and direction about how to act or change is consist- ently noted to be critical to efficacious prevention programmes and campaigns. However developing such campaigns is challenging and at times costly.

Moving to multi-faceted public awareness campaigns and the development of multi-layered and systemic approaches

The Enough abuse campaign in Massachusetts attempted to take on the challenge of an effective campaign by implementing a comprehensive five-step programme to combat CSA. A prevention campaign as well as a public awareness one, the Enough Abuse campaign offers important lessons in the development of a multi-faced and multi-layered approach and is rooted in community crime prevention methods (Hawkins & Catalano, 1992). Such methods aim to identify community- based problems and solutions, with a focus on systematic evidence collection and the use of local collaborative partnerships.

The Enough Abuse campaign:

. Developed a state-level infrastructure for CSA prevention.

. Assessed CSA perceptions and public opinion.

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. Developed local infrastructures for implementing training programmes focused on the prevention of CSA perpetration.

. Facilitated change in local communities to child-related systems and services.

. Invited Massachusetts residents to “join an advocacy based movement to prevent child sexual abuse” (Schober, Fawcett, & Bernier, 2012, p. 456).

In essence, the Enough Abuse campaign was a “state-wide education and community mobilis- ation effort to prevent CSA in Massachusetts” (see http://www.enoughabuse.org) (Schober et al., 2012, p. 457; see also Massachusetts Citizens for Children, 2001). The campaign had five phases of collaborative community action: (a) assessing, prioritising, and planning; (b) implementing tar- geted action; (c) changing community conditions and systems; (d) achieving widespread change in behaviour and risk factors; and (e) improving the population’s health (Schober et al., 2012, p. 458). The campaign developed training materials for the prevention of CSA which focused on knowledge, skills and competence and were targeted at family and community use. They selected and trained 75 local community members, and provided ongoing support to these champions (or POLs). In this way, training was provided to over 2000 parents, professionals, and other resi- dents, and a further 3000 citizens via state-wide conferences, plus training for “-early education and child care staff” (Schober et al., 2012, p. 461). The message was supported by a CSA awareness campaign to residents via television, radio and print, a website with toolkit and materials, preven- tion tips, and a helpline. Child and youth services were also targeted for capacity and awareness building, including the improvement of policies, systems, and procedures aimed at discouraging sexually inappropriate behaviours, improvement of recruitment practices, improvement of super- vision and training to staff, strengthening of internal prevention policies and practices, and embed- ding of prevention of CSA into the culture of the organisation (Schober et al., 2012, p. 462). Evaluation results in 2003 and 2007 were indicative of success, with 69% of respondents reporting that adults should take responsibility in 2003, and by 2009 this had risen to 93%. Citizens were also urged to join Massachusetts Citizens for Children (2010). Whilst pledge data was not available at time of Schober’s article, the Enough Abuse campaign website recorded over 259,000 visits from December 2009 to August 2011. The final key indicator of success is the reduction in the incidence of CSA. Based on data from the Massachusetts Department of Children and Families (2010), the number of substantiated reports of CSA in Massachusetts declined 69% from 1990 to 2007 (the final year of the Enough Abuse Campaign’s CDC grant) (Schober et al., 2012, p. 464). While the findings cannot be attributed solely to the campaign, the authors conclude that “the Enough Abuse Campaign’s contribution to educating community residents and successful legal advocacy likely contributed to this increased public awareness and possibly to preventive action” (Massachusetts Citizens for Children, 2014; Schober et al., 2012, p. 464; see also Schober, Fawcett, Thigpen, Curtis, & Wright, 2012). Further independent evaluation would be valuable, but arguably Enough Abuse has highlighted the importance and likely effectiveness of multi- faceted and multi-layered public awareness campaigning in locating responsibility with adults and communities, and in contributing to behaviour change. However, such an approach requires considerable effort, funds and organisation to achieve, potentially only available at State or govern- ment level, or via extensive partnerships between NGO and government departments. Whether the approach can be replicated with sufficient integrity and effectiveness on a lesser and more loca- lised scale has yet to be established.

Concluding remarks

Despite decades of public awareness campaigns there is surprisingly limited empirical evidence to conclude what works or what does not. A number of questions remain unanswered. This paper has attempted to highlight significant trends in campaign methodology, and identify common themes with respect to effects, barriers, and future directions. Lessons can be discerned in the

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areas of research evaluations of public awareness initiatives; the framing of CSA within public aware- ness campaigning; and targeting of programmes.

In terms of research two specific areas require attention in order to strengthen evaluation meth- odologies. First, all campaigns should be required to have clearly delineated outcomes, including intermediate and ultimate behaviour change, with both short and long-term follow-up. Poorly designed evaluations, and in some cases significant methodological flaws, have reduced the useful- ness of results from an evaluation perspective. Campaigns and initiatives will also have to include appropriate budgets for independent programme evaluation.

Second, a number of relevant research questions remain unanswered pertaining to both the effi- cacy of campaigns/programmes themselves, but also about the mechanisms of change. Greater understanding of how and why individuals and communities choose to act would be beneficial in guiding future initiatives. To date, research appears to indicate that increased self-efficacy and “knowing what to do”; normalisation of expectations to act positively; cultural and organisational norms; skill enhancement; empathy; and positive framing of victims are significant in enabling appro- priate action. Further research to test the importance and role of these various mechanisms in pro- mulgating action could be achieved by running multiple trials of a programme (see Banyard, 2011 for a full discussion).

Framing of the social problem also emerged as an area relevant to the understanding of public campaigns and prevention. Although CSA is often framed as a public health issue, we are challenged to consider the implications of this on how members of the public interpret this framing. Much of the bystander literature suggests that ecological framing that positions CSA as a social problem broadens the scope of intervention and potentially the receptivity of the community to seeing itself as respon- sible for taking action.

Research has also indicated that appropriate targeting of audiences, points of intervention and outcomes are important. Targeting in some campaigns/programmes appeared narrow, ill-defined, or not logically linked to the outcome measures. Research to date clearly indicates that education and awareness is not sufficient, and that attitudinal change does not lead to behaviour change. Instead broad, multi-faced campaigns that provide targeted, specific instruction and train- ing to different groups (e.g. bystanders and parents) combined with some universal messaging have the greatest potential for success. However, such campaigns tend to be large scale and resource intensive, requiring significant government funding (e.g. Massachusetts Citizens for Children, 2001, 2010), and cannot necessarily be replicated in other situations or countries (see e.g. Cosc, 2015 on barriers to large scale, multi-faceted campaigns in Ireland due to resource constraints).

However, campaigns such as Massachusetts Citizens for Children have shown the importance of public action rather than mere public awareness. In this sense, the term “public awareness campaign” is becoming a misnomer in regard to CSA prevention. As prevention strategies continue to evolve, and public awareness campaigns promote and enable action, the future agenda for campaigning has subtly changed. The future for CSA prevention now lies not in public awareness campaigns, but rather in public action campaigns.

Disclosure statement

No potential conflict of interest was reported by the authors.

Funding

This work was supported by a Leverhulme Grant: “Community engagement and partnership working with sexual offen- ders network” 2014–2016. http://www1.uwe.ac.uk/hls/research/offenderengagement.aspx.

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