Most of us would say that you can‘t put a price tag on keeping kids safe from sexual violence. Yet we do. And the amount is either generous or entirely inadequate, depending on which metric we are looking at.
Incarceration is one area in which we invest serious resources. A research paper we published with our colleagues at the Johns Hopkins Bloomberg School of Public Health tallies, for the first time, the amount that U.S. taxpayers spend incarcerating people for sex crimes against children each year—an impressive $5.4 billion. There are currently around 145,000 adults incarcerated for sex crimes involving kids, and the majority of these inmates will remain incarcerated for about eight years, some much longer. We will invest approximately $49 billion on the current cohort of inmates, with new prisoners arriving all the time. This sounds like progress, and to some extent it is. We need laws and consequences that send the unmistakable message that the sexual abuse of children is immoral, illegal, and intolerable, and that adult perpetrators will be held criminally accountable. But there is a wrinkle in all of this. By the time these men—and it is typically males—engage with the criminal justice system, a child, and in some cases several children, have already been victimized. This raises a couple of questions: Is this the best we can do when it comes to serving victims of sexual abuse? And is there a way to stop people from offending against a child in the first place? The answers are no and yes.
Up until a couple of years ago, we allocated almost no federal dollars to the primary prevention of child sexual abuse. That is, we failed to invest in developing, testing, or disseminating programs designed to prevent the sexual victimization of kids before the criminal justice system even needs to get involved. But Congress recently began adding funding to the federal budget for this very purpose. In the 2022 fiscal year, $2 million was allocated toward child sexual abuse prevention research. This is a great start, but strikingly different to what we spend on punishment—for every dollar that we spend on prevention research we allocate $2,700 toward incarceration. The latter figure doesn’t include costs related to the detection and prosecution of crimes or the post-release costs associated with parole, sex offense registration, and public notification.
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We need to address this imbalance. There are over 37 million adult survivors of child sexual abuse living in the U.S. today. 1 in 5 girls and 1 in 13 boys will go on to experience sexual abuse before the age of 18, and while many will live healthy happy lives, survivors are at increased risk for debilitating psychological, physical, and financial harms. These statistics are so overwhelming, the ramifications so pervasive and complex, that we can feel powerless to do anything more than we’ve always done, which is lock up offenders. This myth about the inevitability of child sexual abuse leads us to overlook, and underfund, the development and dissemination of prevention strategies.
One of us directs the country’s leading center for child sexual abuse prevention research, the other has a decade of experience reporting on sexual abuse perpetration and harm. For the past couple of years, we have been working on a book about about how to better prevent child sexual abuse, which includes taking a close look at the history and impact of U.S. sex crime legislation. During this time, we have met many people who have experienced the devastating consequences of victimization. One of whom is a young man named Connor.
Connor (his name has been changed to protect his identity and that of his victim) was 10 when he began sexually abusing a six-year-old relative. He abused this boy at least five times over the next three years. When it was finally detected, Connor, then 13, was adjudicated in juvenile court of first-degree criminal sexual conduct with a minor. He spent the next four years in juvenile prison and, at 17, became the youngest person committed to his state’s sex offense civil commitment program. Sex offense civil commitment is the involuntary and indefinite confinement of people convicted of sexual offenses in secure facilities following their prison sentence. It is ostensibly for treatment, though Connor’s program at the time was not housed in a hospital with rolling green grounds, but in a prison block originally built for death row inmates. The program director did not want Connor there, reasoning that he presented a low risk of reoffending and that his young age and slight build would make him vulnerable to the adult offenders at the facility.
The director was right. Within hours of Connor’s arrival an older resident tried to rape him. Sexual victimization became the norm during Connor’s four years in the facility. Adult men—all of whom had been locked up for years or decades—would expose themselves or masturbate in front of him. They’d come up behind him when he was alone in his room and tell him how much they wanted to rape him.
“I didn’t know how to navigate it,” Connor said. “It was completely different from juvenile [prison]. It’s a whole other level… knowing the consequences are going to be worse than just a fist fight.”
Connor was not innocent. He caused real harm to his young relative and action was needed to end the abuse, provide services to his victim, and guard against future harm. Yet there were opportunities to intervene before Connor began sexually offending, interventions that could have avoided these harms and the additional and unnecessary sexual victimization that Connor would go on to experience while incarcerated.
Connor was himself the victim of severe physical and sexual abuse in early childhood. While most victims of child sexual abuse do not go on to engage in abusive behavior, it’s also true that victimization is a significant risk factor for future perpetration, especially for boys.
Trauma-focused cognitive behavioral therapy, or TF-CBT, was developed to address trauma-related symptoms and disorders that are common among children and teens who experience sexual abuse or other adverse childhood experiences. At least 21 randomized controlled trials (the gold standard for evaluating such interventions) support the effectiveness of TF-CBT, and the federal government recognizes it as a Model Program; that is, a program with strong evidence of effectiveness. Connor and his family should have been offered this type of treatment but were not. Had they been, it might have prevented Connor from sexually abusing his younger relative, or prevented the escalation of that abuse to rape.
Even once Connor’s abusive behavior was uncovered there were options—more effective, more humane, and less costly ways to address it. Multi-systemic therapy is a family-focused and community-based treatment that has been shown to work with the hardest juvenile delinquency cases—including those involving youth who have sexually offended—to reduce subsequent offending, improve family-child relationships, and to keep children out of prison and in school. Yet, like TF-CBT, multisystemic therapy was never offered to Connor or his family. It’s symptomatic of a system that is firmly oriented towards punishment instead of prevention. Had Connor and his family received prevention and early intervention programs like these, the total cost would have been about $25,000. Instead, the state spent at least $750,000 locking Connor up after he had already caused harm.
Connor may seem like an isolated case, but as much as 70% of child sexual abuse is perpetrated by other kids under the age of 18; and many of them are subjected to the same criminal consequences as adults. There are now primary prevention interventions that specifically target these kids, and that try to divert them from harming others and getting caught up in the criminal justice system. These include Shifting Boundaries, a middle-school violence prevention program that teaches students about the consequences of perpetrating physical or sexual violence against peers, the state laws and penalties governing sexual and physical violence, and the construction of gender roles. The program has been shown—in randomized controlled trials—to prevent sexual violence perpetration of kids by kids. Stop It Now! is an organization focused on preventing child sexual abuse across all ages. It provides direct support with a confidential helpline, email, and chat services for youth and adults worried about their own thoughts or behaviors, as well as resources for people who are worried about the thoughts or behaviors of others. Neither Shifting Boundaries nor Stop It Now! receives federal support for dissemination.
In May 2020, the Moore Center for the Prevention of Child Sexual Abuse at the Johns Hopkins Bloomberg School of Public Health launched Help Wanted, an online resource for people concerned about their sexual attraction to children—a U.S. first. Though there are no age limits, Help Wanted is geared mainly toward adolescents and young adults. The website has been accessed more than 220,000 times since the program was made available, and the CDC recently awarded the center $1.6 million to evaluate its efficacy. Last year, the Geneva-based Oak Foundation awarded the Moore Center—along with Michael Seto at the University of Ottawa—a $10.3 million, five-year grant to identify and evaluate existing child sexual abuse perpetration prevention programs across the globe, with the goal of disseminating the most promising and scalable strategies. The Oak money is by far the largest private or federal grant ever awarded to child sexual abuse prevention research, and dwarfs the U.S. government’s current commitment.
The U.S. government’s recent support of child sexual abuse prevention research is an important step and a remarkable improvement from even just a few years ago. But $2 million is not enough to truly put a dent in a problem that affects one in nine children. We spend billions on incarceration each year; we should be spending much more to prevent harm from occurring in the first place. Prevention is possible—if we are willing to fund it.
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