CE25-026 - Evaluating Comprehensive Child Sexual Abuse Prevention Initiatives: A Cluster Randomized Trial of Rural Elementary Schools

Project Summary/Abstract Child sexual abuse (CSA) is a significant, preventable major public health issue associated with considerable adverse physical and mental health outcomes. Notably, CSA is typically committed by someone the child knows and trusts (CDC, 2024; Finkelhor & Shattuck, 2012), and a significant portion of sexual harm involves problematic sexual behavior (PSB) of youth (Gewirtz-Meydan & Finkelhor, 2020). Schools are on the frontline for preventing CSA and PSB of youth. Rural schools are particularly vulnerable to the impact of CSA due to health disparities, low-resourced areas, and stigma (Morales et al., 2020). Consistent with recommendations of prevention leaders, Praesidium is a widely disseminated CSA and PSB prevention program designed to comprehensively address policies and procedures that shift the organizational culture to one of protection and child well-being. Program evaluations are promising, but rigorous evaluation has not yet been implemented. Directly teaching rules about boundaries and sexual behavior is critical to prevention of PSB. Both the ROAR and Stop-Go-Tell prevention programs have been successfully implemented in numerous schools; report positive feedback from caregivers, students, and school personnel; and have considerable demand for the program in the state. The present study is a cluster randomized trial designed to rigorously examine a comprehensive multi-layered approach to address prevention at the organization, professional, caregiver, and student levels (Praesidium with ROAR and Stop-Go-Tell integrated as consumer participation tools). Forty rural elementary schools that meet inclusion criteria will be randomized to the intervention or waitlist control condition. Integration of consumer (caregiver, youth, school personnel, and partner agencies) authentic voices comprehensively during the planning year and throughout the implementation and dissemination of the project is designed to enhance program and research quality, engagement, and reduce attrition. Further, strategies to enhance impact and sustainability through repetition, self-analysis, and train-the- trainer implementation will be tested. Qualitative methods will be utilized to examine contextual factors impacting school culture, implementation fidelity, facilitators, barriers, costs, and unintended consequences. Oklahoma is prime to conduct this research as it builds on our longstanding collaborative partnership among key leaders, investment of the state and community in CSA and PSB prevention, and commitment to our rural communities. Results will have important implications for prevention services to youth in underserved, diverse rural communities that is currently a critical gap in the CSA and PSB prevention literature.