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Preventing Child Sexual Abuse

Illustration of a person standing in front of a pathway

Providing people with pedophilia safe avenues to seek therapy and thrive as non-offenders

In dealing with child sexual abuse as a society, we tend to focus on the aftermath. We arrest and convict the offenders and engage the survivors in a process of healing. If preventative efforts do exist, they typically focus on teaching children to protect themselves from incurring sexual harm.

But new programs around the world — including one housed at the Centre for Addiction and Mental Health (CAMH) in Toronto — offer a new avenue in preventing child sexual abuse by aiming efforts at would-be offenders before they cross the line.

Talking for Change,” which launched in mid-August 2021, is the first national, federally-funded program to provide support and treatment to individuals concerned about their sexual interest in children, their interest in child sexual exploitation material (often called child pornography), or their risk to sexually offend (online or offline).

Dr. Ainslie Heasman (PhD), a Clinical Forensic Psychologist at the Sexual Behaviours Clinic at CAMH, says this initiative is woefully overdue. “This really is the missing piece in addressing the public health issue of child sexual abuse,” she said. “It just seems so logical to offer help and support to someone who is struggling with their thoughts at a time before any lines are crossed.”

Prevalence

It is estimated that one out of every 12 boys and one out of every five girls experience some form of child sexual exploitation or abuse. Recent research indicates only one in three child sexual abuse incidents are reported to a parent or trusted adult, and only one in five are reported to police.

Considering the prevalence of child sex abuse and the high cost its sequelae exact from society, it’s been discouraging that most programs addressing it have been reactive, not proactive, says Dr. Michael Seto, one of the foremost authorities on people who suffer from pedophilia. (Some people prefer the term “minor-attracted persons”). Dr. Seto is Director of the Forensic Mental Health Research Unit at The Royal’s Institute of Mental Health Research.

“Over the last few years, we have just really begun to recognize, as a profession, that while providing treatment after people have offended could be part of a solution, it certainly wasn’t a sufficient solution because by definition it meant that something bad had already happened,” he said.

For most people who suffer behavioural addictions or mental health issues, multiple avenues for help and support do exist. It’s a much different story for people struggling with their sexual interest in children, said Dr. Seto.

The fear of judgment and the negative consequences of disclosure are so intense that people will almost always choose to live in torment with their secret. “I just can’t think of anything more stigmatized than pedophilia,” he said. The shame and secrecy of living with their problematic attraction sees higher rates of substance misuse and suicide among this population, he said.

“These are people who feel extraordinary shame,” agrees Dr. Heasman. “With the internalized and external stigma that comes with [pedophilia], there is just no easy way to reach out for help or even to know where to go… We need to create spaces for individuals who are experiencing such distress, shame and secrecy to be able to get help.”

Many people with pedophilia will never offend, don’t want to offend, and very much understand the harms that would come from the use of child sexual exploitation material or the sexual abuse of a child, said Dr. Heasman.

“My hope,” said Dr. Seto, “is that we can develop methods to identify those who will develop pedophilia early and support them in developing effective ways of managing their sexual thoughts, fantasies and urges.”

Because initiatives seeking to stop people with pedophilia before they act on their impulses are so new, it’s not clear yet what forms of support work best. A large-scale research endeavour, with Dr. Seto as one of its leads, is aiming to find out.

The new initiative is called “Global Perpetration Prevention: Translating Knowledge to Action” and its goal is to identify, evaluate, and share information about new and existing perpetration prevention programs worldwide. 

The support for this five-year endeavour, which rolled out in January 2020, came from The Oak Foundation, a private foundation based in Geneva, Switzerland.

One of the first steps in the Global Perpetration Prevention project is to conduct a systematic review of the most promising perpetration prevention programs. Dr. Seto is leading this aspect of the initiative and co-leading the evaluations.

“We need to create spaces for individuals who are experiencing such distress, shame and secrecy to be able to get help.”

The grant also supports the creation of an online capacity-building hub that will highlight effective perpetration prevention programs, and the empirical evidence needed by governments, policymakers, practitioners, and other stakeholders and decision-makers.

The selected programs will take into consideration the different ways they are designed to reach their intended audience. For example, the curated collection may include a school-based prevention program, a confidential helpline or a clinician-guided online therapy platform.

Dr. Seto sees the capacity-building hub becoming a trusted resource, and a foundation of scientific evidence that will drive policymaking and funding decisions around the world.

“I just really think there has been a real sea change in terms of how we view non-offending people with pedophilia. My hope is that we can, as a society, work towards the prevention of child sexual exploitation and abuse, while still recognizing the humanity of those who are sexually attracted to children,” he said.

Dr. Heasman says she would like to see more family physicians’ offices become safe spaces for people to discuss their sexuality. “We recognize that sex and sexuality, regardless of how it’s felt or experienced, can really be a significant part of a person’s identity and lived experience. So, it deserves some exploration and attention as well in the physician’s office.”

She said that a patient struggling with the nature of their sexual interests may not wish to disclose the first time their physician queries it. But if made clear that the door is open to the conversation, a patient may choose to disclose their interests at a later visit. Having a poster in one’s office advertising the Talking for Change program is another way of signalling openness to such a conversation.

But Dr. Heasman acknowledges that such conversations can cause uncertainty and anxiety for physicians not accustomed to speaking to patients about problematic sexual attractions. She urges physicians who want help navigating such conversations with their patients to contact the Talking for Change program, or CAMH’s Sexual Behaviours Clinic for advice and guidance.

Talking for Change

Talking for Change has a bilingual website, which provides resources to youth and adults concerned or distressed about their sexual interest in children, and/or concerned about their risk to offend involving children (either online or offline). It serves as the hub for a national, anonymous helpline (chat or phone) that provides support to these individuals through a trained clinician. CAMH is also able to offer chat in more than 20 languages using an advanced translation program.

The in-person/virtual (non-anonymous) therapy program offers free assessment and psychotherapy to individuals 18+ in Ontario and Atlantic Canada. This program is for individuals with no current legal involvement for a sexual offence.