Policy barriers to child sexual abuse secondary prevention programs in Australia

ABSTRACT

Child sexual abuse (CSA) secondary prevention is available in multiple international jurisdictions but despite government commitment, a similar service is yet to be established in Australia. This has been a significant policy gap in the Australian response to CSA. Drawing on interviews with six secondary prevention stakeholders in July 2021, this research aimed to identify barriers to secondary prevention policy. Data was analysed with a focus on perceptions of government agenda-setting and processes of issue prioritisation. This research produced new knowledge regarding policy barriers to secondary prevention, including the government’s prioritisation of policing over prevention, constraints on public and professional awareness of CSA due to a lack of adequate data, and the ambiguity and infancy of the field of secondary prevention. The research identified opportunities for establishing and sustaining secondary prevention policies, including national and international shifts towards a public health approach to CSA and increased policy appetite for prevention.

KEYWORDS:

• Child sexual abuse
• public health
• secondary prevention
• policy
• multiple streams approach

Practice impact statement

CSA secondary prevention services are an important but controversial component to public health efforts to reduce the prevalence of child sexual abuse. This paper outlines the major policy barriers to the establishment of these services and provides advice to service workers, managers and policymakers on how to pre-empt and address potential criticism and obstacles to secondary prevention.

Introduction

The Australian response to child sexual abuse (CSA) relies heavily on tertiary-level responses, including detection, apprehension and involvement in the criminal justice system (CJS) (Commonwealth of Australia, 2021). There has been significant government investment in providing services to young people with problematic, harmful sexualised behaviours (PHSBs) with or without a conviction (Australian Government, 2021; KPMG, 2014), but the government has not extended these services to adults. Availability of support for adults seeking to manage sexual feelings towards children is a significant policy gap in Australia’s response to CSA, recognised in the National Strategy to Prevent and Respond to CSA, which committed to establishing a secondary prevention programme for adults at risk of abusing children (Commonwealth of Australia, 2021). The Commonwealth government has recently committed $10.2 million to pilot a CSA secondary prevention programme. A pilot led by Jesuit Social Services (JSS) commenced in September 2022.

This paper explores policy obstacles and opportunities for CSA secondary prevention in Australia. After a brief overview of the prevalence of CSA and current responses, the paper presents a thematic analysis of stakeholder interviews identifying current challenges to CSA secondary prevention in Australia and significant shifts in government willingness to countenance early intervention services for undetected or potential CSA offenders. The paper draws on Kingdon’s (2014) “three streams” model as a policy heuristic and identifies ongoing obstacles to CSA secondary prevention. The article closes by discussing opportunities for advancing a comprehensive public health approach to child sexual abuse in Australia and beyond.

Background

CSA is the “involvement of a child in sexual activity that he or she does not fully comprehend, is unable to give informed consent to, or for which the child is not developmentally prepared and cannot give consent, or that violates the laws or social taboos of society” (World Health Organisation, 2003, p. 75). This definition includes contact and non-contact offences and highlights the differential power dynamics between the victim and the perpetrator, who may be adults, children, or adolescents. In Australia, child sexual abuse victimisation is reported by 37.3% of women and 18.8% of men (Mathews et al., 2023). Child sex offenders are not a homogenous group and include offenders with a pathological sexual preference for children (paedophilia) or teenagers (hebephilia), as well as those who commit offences due to other factors, such as disinhibition, impulsivity, general sexual deviancy, a desire for power and control, or convenience and opportunity (Sullivan & Sheehan, 2016). There is growing recognition of a cohort of individuals with sexual feelings towards children seeking support not to offend against children (Beier et al., 2009; Wilpert & Janssen, 2020).

A public health approach to CSA

There has been significant interest in public health approaches to CSA in Australia and internationally, acknowledging that a multi-faceted response is necessary to combat abuse, including primary, secondary and tertiary prevention. Public health frameworks coordinate interventions across multiple levels of society to promote behaviour change at a broader population level (Sallis et al., 2015). Primary prevention is directed toward the general population and focuses on early intervention or preventing abuse from occurring in the first place. In Australia, primary prevention efforts have been limited to school-based education programmes that aim to enhance knowledge of CSA and protective behaviours and policies for working in youth-orientated organisations such as working with children checks (Cale et al., 2016). Tertiary prevention approaches target perpetrators and victims after harm has occurred. While victims are provided counselling (which is often difficult and expensive to access, see Salter et al., 2020), convicted perpetrators may receive a custodial sentence or a community-based order and undergo involuntary treatment to address their offending behaviour. While tertiary-level preventions are necessary to deter, incapacitate and protect the community, they are enacted after the initial harm and may have a limited preventative impact. Additionally, many CSA perpetrators are not detected, investigated or prosecuted, meaning they may never receive treatment. Public health approaches to prevent CSA are in their infancy, and there has been limited investment by governments in Australia or internationally in so-called “upstream” interventions.

Secondary prevention programmes for people with a sexual interest in children

Secondary prevention initiatives targeted toward those concerned about their sexual impulses, feelings or thoughts about children have emerged since the mid-1990s (Lievesley et al., 2018). Key target groups for these initiatives include people with a sexual interest in children who are yet to offend and those who have committed offences in the past but are undetected (Beier et al., 2009). Secondary prevention services typically include an anonymous helpline in partnership with specialist services and forensic out-patient units. Helplines operated by professionals experienced in working with people with a sexual interest in children is the first point of contact providing support, advice and referrals to those at risk of committing CSA (Van Horn et al., 2015). Users are encouraged to implement protective actions to reduce any immediate risk they pose and may then be referred for a clinical appointment (Van Horn et al., 2015).

Stop it Now! is a secondary prevention initiative, including an anonymous helpline providing information and advice on intervening and protecting at-risk children. Between 1992–2019, the helpline responded to 23,682 enquiries (Stop it Now!, 2020). Only 12% of enquiries are from those at risk of committing abuse, and bystanders accounted for 69% of people contacting the service (Grant et al., 2019; Stop it Now!, 2020). 37% of respondents had no other contact with professional services before contacting Stop it Now!, and 84% of all helpline users felt better prepared to act on advice (Grant et al., 2019; Stop it Now!, 2020). Similar models have been adopted internationally in Ireland, the United Kingdom (UK) and the Netherlands through non-government organisations such as The Lucy Faithful Foundation. In Australia, the recently released National Plan in response to the Royal Commission into Institutional Responses to CSA commits the Australian government to CSA secondary prevention for the first time.

Van Horn et al. (2015) evaluated Stop it Now! in the UK and Netherlands. After engaging in the service, they found that users identified their behaviour as harmful, implemented strategies to reduce risk, and increased awareness of the triggers associated with abusive behaviour (Eisenberg et al., 2014; Van Horn et al., 2015). Additionally, in the Netherlands, the helpline successfully linked users with specialised services, with 57.5% of participants giving up anonymity to engage in treatment for child sexual abuse material (CSAM) and CSA behaviours (Eisenberg et al., 2014; Van Horn et al., 2015). Users of the helpline also indicated increased recognition and awareness that their problematic behaviours required intervention and the ability to identify support networks to assist with relapse prevention (Van Horn et al., 2015).

The appeal of secondary prevention initiatives is that they may intervene before the onset of offending; however, evidence suggests that many or most people seeking help from such services have often already offended. Between June 2005 and August 2008, 808 respondents contacted the German initiative Prevention Project Dunkelfeld (PPD), and 45% attended the outpatient clinic (Beier et al., 2009). Within the group assessed by the outpatient clinic, 74.5% of 247 participants had already committed or engaged in sexually exploitative behaviour towards a child (Beier et al., 2009). PPD is the only service that has published a quasi-experimental evaluation of behaviour change outcomes (Beier et al., 2015). Beier et al. (2015) evaluated changes in risk factors by comparing a small sample of self-identified paedophiles or hebephiles undergoing treatment via PPD with a waiting list control group. While a reduction was found in all risk dimensions of the treatment group indicative of increased sexual regulation, there was no statistically significant difference in CSA-related behaviours (Beier et al., 2015). Twenty percent of the treatment group self-reported CSA-related actions six months before the post-assessment, including voyeurism, discussing sex or showing children pornography and touching or fondling, while 91% reported they had viewed CSAM (Beier et al., 2015). Additionally, 24% of men in the treatment group who had no reported history disclosed first-time use of CSAM during treatment (Beier et al., 2015).

Despite a lack of evidence that secondary prevention initiatives can reduce offending, it can be an essential pathway to clinical treatment for people with sexual feelings and behaviours toward children who would otherwise go undetected. There is broad agreement regarding the need for a comprehensive public health approach to CSA incorporating secondary prevention initiatives for at-risk groups. However, these interventions are limited or unavailable in most jurisdictions, including Australia. Scholars have pointed to several potential reasons for this: a lack of consensus on the most appropriate policy response to CSA, a focus on punitive responses to sex offenders at the expense of prevention and rehabilitation, and the disorganisation of government responses to CSA, which are often fragmented across health, welfare and criminal justice agencies (Letourneau et al., 2014; McKibbin & Humphreys, 2020). There is a lack of systematic research into these policy barriers to date. This paper explores barriers to secondary prevention of CSA in Australia by asking: “What are the barriers identified by policy stakeholders to implementing CSA secondary prevention in Australia?” Drawing on Kingdon’s (2014) “three streams” model of policy analysis, this paper examines critical forces in the policy development process to identify obstacles and opportunities for CSA secondary prevention in Australia.

Methodology

Interviews with participants from an active working group of 10 policy stakeholders were conducted. The working group met regularly to advance the prospect of secondary prevention services in Australia, including service providers, academics, advocates, and philanthropists. An email invitation was circulated in June 2021 to this working group, and six participants contacted the researcher after the first invitation. This is an exploratory study. Although the sample size was small, Braun and Clarke (2013) emphasise that six to 10 interviews can generate enough data to make an original contribution to knowledge. In this study, key themes recurred throughout the interviews, indicative of thematic saturation (Guest et al., 2020). To be eligible to participate, the respondents must be involved professionally in advocating for CSA secondary prevention. Ethics approval was received from UNSW Human Research Ethics Coordinator (HC210228).

Interviews

Semi-structured virtual interviews were undertaken in July 2021 using Zoom’s video conferencing platform. As the study is concerned with stakeholders’ experiences of policy barriers, it was important that participants share their perspectives without predetermined constraints in structured interviews and were able to raise unanticipated issues that the researcher may not have been aware (Braun & Clarke, 2013). Participants were located in multiple Australian jurisdictions, and as they took place during a worldwide pandemic, online interviews were deemed suitable. In two cases, participants requested to undertake a joint interview. A total of four interviews were held with six participants.

Sample

The paper is based on a convenience sample of active policy stakeholders with an interest in the secondary prevention of CSA. The sample included academics (3), advocates (1) and persons in the not-for-profit sector (2). Five out of the six participants were female, and most were in their 40s. All participants had tertiary qualifications, and three had PhDs. Participants had been employed in the field of CSA for less than one to 27 years, with three participants operating in the area for over 20 years and the other three for 10 years or less. However, participants had experience working nationally and internationally in multiple capacities in the private sector and government. Five participants previously worked in tertiary prevention with children, victim-survivors, or offenders.

Theoretical framework

The analytical framework of this research drew from Kingdon’s (2014) multiple streams approach (MSA). Kingdon’s (2014) model addresses why certain issues gain government attention, and other equally feasible issues do not. The MSA examines how problems come to the government’s attention and enter the policymaking agenda and the forces at work during decision-making and implementation. Kingdon’s (2014) model describes three parallel streams or drivers in agenda-setting: problems, policies and politics. In the problem stream, actors in and around the government identify and define issues as policy problems (Kingdon, 2014). While some issues are identified through routine monitoring, an issue is more likely to gain policy actors’ attention through a “focusing event” such as a crisis, the personal experience of someone who is pushing the issue, feedback from constituents, or the media (Kingdon, 2014, pp. 94–103). In the policy stream, ideas or potential solutions are galvanised within policy networks by specialists through informal and formal channels. For example, discussions may be held between colleagues or stakeholders, published papers, or hearings to float ideas and persuade other actors of a given proposal’s viability (Kingdon, 2014). The political stream refers to events such as a change of government, national sentiment, or lobbyists’ interests that facilitate a shift in the government decision agenda (Kingdon, 2014). Perceived public sentiment is critical as governments balance the national mood and lobbyists’ interests with re-election and reputation concerns (Kingdon, 2014). Kingdon’s (2014) description of the strategic aspects of agenda-setting and policymaking provides an apt foundation for examining why secondary prevention has yet to be applied to the problem of CSA.

Data analysis

Interviews were digitally recorded and transcribed verbatim. Transcripts were anonymised, replacing proper nouns. With the participants’ consent, details were retained about their professional fields. Each case was imported into NVivo (QRS International Pty Ltd, 2020), and data relevant to the research questions were coded thematically (Braun & Clarke, 2013). Transcripts were read multiple times, and an initial coding framework was developed informed by the literature review and the conceptual categories offered by the MSA framework. Codes that were informed by the existing literature included themes such as “emotionally defensive responses”, “complexity of CSA”, “mandatory reporting” and “perpetrator/victim binaries”. Passages were also coded according to whether they conformed to the policy, political and problem streams of the MSA. Data-derived codes were also developed where participants’ responses did not necessarily reflect the theoretical framework or existing literature. Themes were discussed between authors, and codes were assigned to relevant passages. Text passages may have been assigned to multiple codes, and coding matrices were performed to confirm relationships between codes. MSA was then used as a critical overlay to position the findings.

Findings

The thematic analysis identified four major obstacles to CSA secondary prevention in Australia: 1. the policing versus prevention paradigm, 2. the complexity of the problem, 3. emotionally defensive responses and 4. the infancy of the secondary prevention field and research. These four themes predominantly but not exclusively fit within the “problem” and “policy” streams of the MSA, as participants identified barriers to secondary prevention in terms of the “capture” of the issue by law enforcement, the complexities and ambiguities of CSA and secondary prevention, and adverse psychological reactions to CSA.

1. The policing versus prevention paradigm

While participants agreed that the government viewed CSA as a serious social issue, they identified several reasons governments have focused on tertiary responses to the detriment of secondary prevention. First, they indicated that CSA is compartmentalised as a “policing issue” rather than a prevention issue. Five out of six participants discussed the government’s overreliance on the CJS to address CSA. Tertiary prevention is an essential aspect of a multi-faceted public health model; however, by focusing on CSA prevention at the back end, Advocate states that even “the police would be the first to say we are only catching the tip of the iceberg”. Advocate elaborates that, with the increase in online child sexual exploitation, if additional actions are not introduced to prevent CSA, we will continue to fight an uphill battle while children continue to be abused. Advocate asks how the CSA response in Australia would differ if it were grounded in health rather than policing.

We have set up a centre to counter child exploitation in Australia which is run by the police … established with a policing lens rather than a prevention lens … we have amazing organisations in our country dealing with mental health … If those centres … [were] set up by the Australian Federal Police instead of health clinicians and academics, what would they look like? They would look much different because the perspective is different (Advocate).

Prevention is a long-term strategy that does not have the appeal that tertiary prevention elicits. Academic1 noted that tertiary prevention has more populist appeal than primary prevention:

“Primary prevention is not sexy because primary prevention would be the smoke detector and tertiary prevention is the fireman”, and the firemen hosing down the flames is sexy and hardcore. That would be on a tv show, but you would not make a tv show about smoke detectors. However, that is where we need to go, focus further upstream, and prevent the fire from happening in the first place (Academic1).

The compartmentalisation of CSA as a policing issue impacts the distribution of resources for secondary prevention. At any one time, the government can only respond to a finite number of policy problems (Kingdon, 2014). The monopolisation of CSA has led to the CJS and prevention agendas competing over limited resources. Academic2 observed that prevention is overlooked because urgent concerns take precedence.

It challenges corrective services departments because if you [need] to decide what are we going to do today. We have a crisis in our prison or we can think about secondary prevention, then you will have to put the prison first because that is your core business, and that is what you have to deal with immediately (Academic2).

Budgetary constraints also prevent the government from considering viable alternatives and proposals (Kingdon, 2014). However, two participants, Advocate and Academic1, highlighted that the social and economic impact of CSA and the comparatively negligible amount of funding necessary to commit to secondary prevention in Australia seems like an economically rational approach.

The dominant policing perspective constrains funding for alternative solutions and focuses policy attention on the available evidence in narrow ways. Academic2 and Academic3 both emphasised that the focus on tertiary prevention has adversely impacted on the availability of funding for other interventions:

My biggest obstacle is the uptake of our research, publications and citations. There is still this sort of concentration on what works and tertiary prevention … I think that more and more, this public health approach is being taken on, and from that, the rhetoric changes, the focus will change, and suddenly, everyone will be involved in prevention (Academic3).

Ironically, policing and prevention are not opposed but two parts of a comprehensive resolution to a complex problem. Endorsing and resourcing primary and secondary prevention does not negate the need for law enforcement and tertiary prevention, which multiple participants in this study confirmed.

2. The complexity of CSA

Advocate suggested that the complexity of the CSA can potentially explain why the public has not called the government to account for the issue. Interestingly, Kingdon (2014) explains that problems come to the government’s attention in many ways. Indicators measure and monitor the extent of policy problems, and feedback from constituents raises legislators’ awareness about existing problems (Kingdon, 2014). Speaking from experience and attempts to locate information on CSA, Advocate highlights the lack of publicly available data, which obscures individuals’ awareness of the extent and magnitude of the problem.

… If we had numbers that we could track easily and regularly, we would all be onto it because we would be like, look at that number; this is getting out of control. Whereas you have to hunt around for it, which is just wrong. One of the biggest slights in our society, and we should have that measured, and we should have someone accountable for measuring it (Advocate).

Community complaints are one way that the government receives information about the progress of policies (Kingdon, 2014). Still, without publicly available data on CSA, they cannot monitor trends to apply political pressure. The lack of accessible data might explain why the public has failed to call the government to account for the failure of tertiary prevention initiatives that the government relies on to respond to the problem of CSA.

Participants also explained why CSA is so challenging, including heterogeneity of child sex offenders, lack of understanding of risk factors and behavioural indicators, and conceptual ambiguity between primary and secondary prevention, which are reinforced by discrete professional fields. Academic3, Non-profit1 and Non-profit2 suggested that the public may not have a nuanced understanding of the differences between those that sexually offend against children. Academic2 and Academic3 reported that teaching the public about risk factors associated with CSA is integral to demystifying the issue. Academic1 stated that old notions of stranger danger may have subsided over the past 20 years as people are increasingly acknowledging that CSA “happens at the hands of somebody who is in the children’s circle of trust” however, people still need to be better educated about the signs and symptoms of CSA to ensure prompt detection and minimise harm. The public’s limited understanding of the problem and its presentations are compounded by a poor understanding of secondary prevention, as suggested by Academic2.

… if you have an area where we know there is low employment, high crime rates, high rates of parental incarceration, people in out-of-home care … How do we [distinguish between] primary [and] secondary prevention because the community or the setting there is already known risk. I am not sure whether we have had those real clear discussions and thinking conceptually about the distinction between primary, secondary and tertiary and whilst some of that is still ambiguous and confusing, that can’t help the cause (Academic2).

Interviewees also felt it is harder to know whom to target intervention towards in the secondary prevention space, particularly compared to tertiary interventions (Academic1; Academic2; Academic3; Non-profit2). Concrete and simplistic notions of victims and perpetrators formulated within the criminal justice paradigm are less applicable in secondary prevention. As Academic1 states, this contributes to the difficulty in discerning which interventions should be targeted.

… it is not as clean, right, tertiary prevention, the guy is in an orange jumpsuit, and he is in handcuffs; there are a lot of visual cues that tell us that they are the people we focus on. In secondary prevention, they do not all wear orange jumpsuits; they are not as clearly identified, making it much more difficult (Academic1).

Participants in this study indicated that CSA and prevention initiatives are complex; a one-size-fits-all approach will not resolve the problem because the people who commit such crimes or do not but have a sexual preference for children is diverse. Although the public’s awareness of the problem and historical inaccuracies surrounding stranger danger is being contested, the nuances, risks and protective factors are not communicated. Additionally, secondary prevention is poorly understood, which challenges sex offender stereotypes and preconceived ideas about paedophiles.

3. Emotionally defensive responses

Kingdon (2014) states that policy problems that are emotionally and morally charged render more controversy, which was quite apparent in this study. For example, many participants suggested that secondary prevention often conflicted with community perceptions about appropriate penalties for child sex offenders. Academic1 and Non-profit1 surmised that support for CSA secondary prevention is tempered by society’s general lack of empathy for paedophiles. Academic2 and Non-profit2 felt that secondary prevention was likely seen as being “soft on crime”. Academic3 and Advocate indicated that spending money on potential perpetrators rather than victims is not supported by the broader public. Advocate states that community sentiment was such that paedophiles should fix themselves, and Academic1 points out that these views impact the policies that governments support.

When the community generally thinks about sex offending, it is easy to “other” them. It is easy for us to say he is a monster he has done a terrible thing- he is a stranger … and those are the cases that make the news. They are the ones we hear about, and they make the news because they happen very rarely. They happen so rarely that every time they happen, they make the news which then makes us think they happen more often than they do and encourages us to make legislation based upon the narrowest of circumstances which are not necessarily useful (Academic1).

There has been a shift in the types of proposals politicians and the public are willing to support in Australia. Academic2 suggests people are beginning to accept the value of intervening earlier, particularly for young people with PHSBs. Non-profit1 also stated, “there is an increased openness to engage in a discussion about young people”, but Academic1 stressed that the same tolerance level is not afforded to adults.

Participants believed that the government’s reluctance to implement secondary prevention for at-risk adults was due to the government’s aversion to risk. For instance, Advocate, Non-profit1 and Non-profit2 thought the government did not want to be seen spending public money on paedophiles. Concerns over re-election likely influence the reluctance of politicians, but as Non-profit1 highlights, elected officials often reflect the ideals of their constituents. Non-profit1 posits that the wider public may not be ready to accept initiatives targeted towards those who might commit such crimes.

… politicians are mirrors of where we are as a society … there is a need for an improved understanding of what the facts are about CSA, and it is in some respects … it is sometimes easier to shun and to shut down and turn the other way. Yet we have seen some progress with our approach to family violence, where you have the men’s referral service, men’s line, and so we know that mindsets can shift, but I just think we are not quite there so far as mindsets around the perpetration of CSA (Non-profit1).

The urge for political leadership was emphasised in this study by participants who felt that the government’s reluctance toward adult-targeted secondary prevention resulted from conservative ideologies of some key political stakeholders (Advocate, Non-profit1 and Non-profit2) and a lack of political ownership over the issue (Advocate, Academic2, Academic3 and Non-profit1). Participants also reflected on the drive and entrepreneurship of those outside government who have invested significant resources into championing the cause.

Before the Royal Commission, JSS convened an advisory group that includes Home Affairs, the National Office for Child Safety (NOCS), law enforcement, Google, Bravehearts, SNAICC and others. This has been made primarily possible because JSS has committed to furthering this work, and in more recent times, because of the grant from Westpac. I get the sense that those actors would not be coming together in the same way were it not for JSS’ efforts to push the work forward (Non-Profit1).

Participants acknowledged that political challenges are compounded by the national mood and the perception that the broader Australian population is not ready or willing to support intervention for adults at risk of committing CSA.

4. The infancy of the field and research

The infancy of secondary prevention and the lack of a rigorous evidence-base impacts the types of initiatives that are supported dampens the belief that secondary prevention will have the desired outcome, constrains advocacy efforts and government support. For instance, Academic2 explains that school-based education overshadows secondary prevention because it is more acceptable due to the infancy of secondary prevention research.

Secondary prevention is still in its infancy; education programs for children is where this has gained some traction, and so that [is] where it continues to flourish. The field has not advanced; potentially, we do not have endless resources, but I do not think we have done a good job of critically thinking about where this needs to be targeted. Often we target where it is easiest and the groups that it is easiest and if we already have these education programs, then it’s easier to continue to spread that out rather than think critically. Are there other groups we should be focused on? (Academic2).

CSA secondary prevention is a relatively new field. As discussed, available evaluation data is mixed at best. Regardless of whether secondary prevention works, Academic3 and Non-profit2 indicated that leveraging the outcomes from international programmes was essential to garnering support from the government and, or the public for secondary prevention, as suggested below.

[T]he effectiveness of these programs is still in its very early stages, so it’s not like Corrections where we know a particular program has an effect at reducing reoffending … there are a limited number of evaluations that have been done. For example of “Stop it Now!” there is only one significant one, and it was done quite a while ago, so I think the evidence base is still relatively small, and that is an obstacle because the more information we have about the effectiveness of the program the better armed we are to advocate for more programs (Non-profit2).

Academic1 suggested that the demand for services should underpin the decision-making standard around secondary prevention in Australia.

I am familiar with those programs, and I am also familiar with the fact that there is no hard and fast research that says this has been successful or this reduced this many cases … The fact that they built that system, and people called it, is evidence of a demand for that supply (Academic1).

Two other participants echoed the same sentiment, including Non-profit1, who indicated that people in Australia are reaching out to services overseas that are ultimately subsidising the Australian government. Similarly, Academic3 stated that although we are yet to measure the benefit of secondary prevention, people looking for services provided overseas is a good indicator that early intervention should be available in Australia.

Governments do want to know what they put their money into has a return … However, statistics would say there is a gap, a need and a demand in the Australian community for this work. So, having people from Australia look to early intervention in other places is a tell-tale sign that we need to do something here in our backyard (Academic3).

The apprehension that a proposal will have the expected outcome can also diminish support for a proposal (Kingdon, 2014). In the field of secondary prevention, what makes this more challenging is that measuring outcomes is neither straightforward nor politically tangible in terms of value for money, at least not in the short term. Academic2 and Academic3 made the point, how do you measure something that does not occur? For example, Non-profit2 stated that the effectiveness of tertiary prevention programmes can be measured, and Academic3 elaborated, explaining that when it comes to quantifying the effect of something not happening, it takes time and the ability to control a multitude of cooccurring and confounding variables. While three participants discussed the infancy of the secondary prevention field and research, it was not necessarily viewed discriminately as a factor impacting policy decisions.

Discussion

While the scholarly literature has long recognised policy barriers to implementing a public health approach to CSA, this study is the first to apply Kingdon’s (2014) model to CSA secondary prevention policy. This study supports the conclusions of existing scholarship on policy barriers to secondary prevention, with Australian stakeholders referring to divisions between professional fields involved in CSA, the complexity of the problem and a tendency towards emotionally defensive responses to CSA, which contribute to calls for harsher penalties (Letourneau et al., 2014: McKibbin & Humphreys, 2020). However, the paper has also generated new knowledge about barriers to secondary prevention, such as the government’s prioritisation of policing and the consequent resource deficiency for other viable prevention methods, a lack of publicly available data on CSA, which obscures the magnitude of the problem, and the infancy of the secondary prevention field which restricts the capacity of policy actors to leverage evidence from research when advocating for secondary prevention. The following sections discuss critical challenges identified by this study before outlining the facilitators and opportunities evident in the recent government commitment to secondary prevention.

Compartmentalising policy problems

This paper found that, in Australia, the problem of CSA has been narrowly defined as a policing problem. By defining CSA as the responsibility of a singular agency, policymakers have limited ways to approach the problem and resources are disproportionately invested at the tertiary end at the expense of long-term prevention strategies. The monopolisation of prevention by the CJS is not confined to the problem of CSA. For instance, Avery (2004) examined how the US response to bioterrorism prevention is siloed within policing, which is expensive and neglects other effective strategies, including improving public health surveillance, research and response, and developing infrastructure and training as a more viable prevention strategy. It appears that when it comes to CSA, the government’s “get tough on crime” ideology and rehabilitative disillusionment are apparent in the types of policies that are implemented. Further research is necessary to explore why the government favours tertiary CSA prevention over other viable alternatives. Some criminologists have also argued that penal or punitive populism can entrap governments in cycles of increasingly harsh criminal justice policies for electoral reasons (Jennings et al., 2017).

Popular punitivism

This paper emphasises the role of the public, emotions and politics in CSA prevention. Interviewees felt that the public either does not understand or want to know about CSA and is generally hostile towards people who commit these crimes. Participants believed these attitudes influence the interventions deemed appropriate for child sex offenders. In line with the existing literature on policy barriers, these responses were thought to be inflated by alarmist representations in the media and stereotypical portrayals of stranger-perpetrated sexual abuse (Grealy, 2014; Pickett et al., 2013). However, this study also suggests that the government’s fear of public backlash, alongside the ideological values of a conservative government, diminishes the willingness of key decision-makers to take a necessary risk on secondary prevention for fear of being seen to be providing services to paedophiles. There is limited empirical research into public perceptions of sex offenders in Australia. However, the research that does exist finds that stereotypical images of sex offenders have implications for public policy linked to misconceptions regarding “pathological sexual orientation (i.e. lack of control), sexual specialisation, fixed sexual proclivities (uncontrollable or untreatable) and a high level of future dangerousness” (Gelb, 2007, p. 11). In a qualitative social media study, Richards (2018) found that paedophilia was viewed as either biologically motivated, a mental illness, a choice or perpetuated by the cycle of abuse and the overwhelming perception that paedophiles are untreatable, uncontrollable, or unacceptable risk to children increased blameworthiness and calls for harsher criminal justice responses. However, Kewley et al. (2021) state that the political and social climate that has been hostile towards providing services to paedophiles is beginning to shift.

Complexity and ambiguity of the field

This paper suggests that the diverse offending profiles of child sex offenders, and the lack of clarity over risk and protective factors, contribute to the complexity of the problem of CSA from a policymaker’s perspective. Participants thought that the complexity of the problem had created a reliance on and investment in prevention strategies such as school-based education that are publicly acceptable and easy to implement. Interviewees felt that the lack of publicly available data to monitor trends and the magnitude of the problem could make it difficult for the public to hold the government accountable. Public CSA data in Australia is hindered by disparities in definitional and recording systems across jurisdictions; however, a sound surveillance system facilitates the development of effective interventions by enabling resources to be distributed to areas with the most significant risk (Broadley & Goddard, 2015). Public health surveillance systems and research improvements could increase public awareness and inform policy to find effective alternative solutions rather than rely on conventional prevention strategies. Data and research were seen as vital to educating the public and policymakers. McCartan et al. (2021) highlighted similar concerns in their international interview research with sexual violence prevention professionals. Their results also indicated that the complexity of sexual violence reinforced perceptions that criminal justice was the most appropriate response to the problem (McCartan et al., 2021).

Lack of strong evidence

Another finding of this paper is that the lack of evidence to support the efficacy of secondary prevention programmes suppresses government support by making it difficult to leverage the outcomes of other programmes’ successes. For instance, to date, there is minimal evidence to suggest that secondary prevention reduces offending or reoffending, and the existing research has methodological limitations or lacks rigour (Kewley et al., 2021). One evaluation found increased use of CSAM by those receiving intervention who had not previously reported use (Beier et al., 2015). However, evidence suggests a significant demand for these services (Beier et al., 2009), which participants in this study also emphasised. Nevertheless, to some extent, the government’s need to justify investment, particularly in policy areas that are controversial and emotionally charged, requires a greater level of accountability because of the risk and reputational damage that can ensue (Kingdon, 2014). Interventions that are experimental or do not produce immediate results are less politically favourable to those that map more easily onto public sentiment (Jennings et al., 2017). Any benefit from secondary prevention requires a commitment to long-term research and evaluation strategy unencumbered by the appetite of present-day government or the commensurate risk that either party is willing to take on.

Facilitators and opportunities

As previously mentioned, despite these obstacles, the Commonwealth government has committed to funding a pilot of Stop It Now! This shift can be conceptualised according to essential changes across the “three streams” identified by Kingdon (2014). First, in terms of the positioning of CSA as a social problem, the Royal Commission into Institutional Responses to Child Sexual Abuse can be understood as a key event that redefined CSA as “so widespread, and the nature of the abuse so heinous, that it is difficult to comprehend” (Commonwealth Government, 2017, p. 5). The Royal Commission also explicitly recommended the establishment of a secondary prevention initiative.

Regarding policy salience and advocacy, the persistence of JSS in bringing together government and non-government stakeholders, and galvanising support for a secondary prevention service, appears to have been a central success factor. Their efforts included releasing a scoping study emphasising the technical feasibility of implementing Stop it Now! in Australia (JSS, 2019). In 2020, JSS received corporate funding from Westpac (Westpac, 2020) for a pilot programme which further underscores the initiative’s viability. Despite the commitment to secondary prevention articulated in the National Strategy, the pilot only commenced in late 2022, which is perhaps suggestive of the sensitivity of the proposal.

The paper also suggests that some barriers to secondary prevention identified in other research (Kewley et al., 2021; McCartan et al., 2018) may not be as significant in Australia. For instance, Heasman and Foreman (2019) attribute the absence of mandatory reporting to PPD’s success. However, this study suggested that it was less of a concern and that implementing secondary prevention can be navigated without reforming legislation. Limits on confidentiality are said to deter people at risk of committing CSA from contacting services because of concerns over being outed or referred to authorities (Van Horn et al., 2015), but participants in this study did not raise this as an issue. An evaluation of a helpline in England by Hossack et al. (2004) found that 80% of a small sample of callers disclosed past or ongoing sexual abuse despite knowing that the helpline had a responsibility to inform authorities if victims or potential victims were identified, and 60% of callers gave their name and address so they could obtain information. Potentially more important than attempting to change mandatory reporting legislation is ensuring that people contacting services are informed about the limits of confidentiality.

Limitations

This is an exploratory study with a small sample, which necessarily limits the generalisability of the findings. Half of the participants were from the non-government sector, and the other half were from academia. Future research on this topic should seek to engage with government stakeholders, law enforcement, child protection and other agencies currently engaged in tertiary responses to CSA. Nonetheless, the project engaged a highly experienced group who have been engaged in advocacy for secondary prevention for a prolonged period and had considerable insights to share on the topic.

Notably, this study pointed to barriers and opportunities within the problem and policy streams of Kingdon's three streams model, but our available data did not extend to the “politics” stream. Future research would benefit from engaging government stakeholders directly to discuss the political appetite and balance of interests surrounding secondary prevention in Australia.

Conclusion

The National Plan commits the Australian government to CSA secondary prevention for the first time, and in a positive development, the Commonwealth government has pledged $10.2 million to pilot a CSA secondary prevention programme. However, the obstacles identified in this study remain. These obstacles include the prioritisation of policing over CSA prevention, the issue’s complexity, the intense emotions that CSA engenders and the infancy of the secondary prevention field. Interviewees envisaged secondary prevention as part of a multi-faceted public health approach that bridges the siloes that have beset CSA policy-making for a more holistic approach across the non-government and government sectors dispersal of funding across a range of initiatives rather than weighted towards law enforcement.

While the interviews were undertaken before the strategy's release, participants recognised Australia is on the “precipice” (Academic3) of a movement towards a public health model that includes secondary prevention programmes. The National Plan commits Australia to a public health model; however, it is not as well advanced as the field of violence against women, where the Australian public health model is internationally recognised (Dutton et al., 2015). Participants in this study considered the government’s hesitancy to stem from fear of public backlash over supplying services to people with sexual interest in children. Indeed, this study suggests that much of the momentum for secondary prevention has been driven by actors outside the government. This mirrors similar dynamics overseas, such as in the UK, where philanthropic organisations such as the Lucy Faithful Foundation have been crucial to establishing secondary prevention services. However, while corporate and private philanthropy have played a role in promoting secondary prevention in Australia, this investment has fallen short of establishing a full-blown service. As a result, secondary prevention advocacy has relied on receiving support and investment from governments who have been hesitant to be associated with such initiatives. A limitation of this research is that it could not engage policy actors from within the government sector to discuss their views on secondary prevention. However, stakeholders consistently pointed to a lack of momentum within the government.

Participants felt that, as a society, Australia is yet to recognise CSA as a public health issue, defining CSA as policing issuing and focusing interventions on perpetrators while avoiding confronting but essential public conversations. Participants felt that public sentiment around perpetrator programmes is based on the view that paedophiles are untreatable and CSA is inevitable but that this must be challenged. Australia can learn from the insights of public education campaigns undertaken elsewhere where the responsibility and accountability of CSA have been repositioned onto the wider community, which may increase the public’s willingness to support alternative policies and interventions (Kemshall & Moulden, 2017). In countries such as the US, public education campaigns aim to increase awareness of the issue and change public attitudes, whereas, in Germany, where PPD has been operating since 2005, marketing campaigns are also directed towards potential perpetrators encouraging those at risk to seek help early (Beier et al., 2009; Kemshall & Moulden, 2017). These discussions are beginning to emerge in Australia; for example, the “Stop the stigma” campaign released by Australian Centre to Counter Child Exploitation in September 2021. Notably, this was developed and released by a policing agency, reinforcing the narrow focus of Australian responses within law enforcement. Without an awareness of the services people can access for support or without services in place, people wanting to seek help are disempowered, and the trajectory of CSA will not change.

In the National Plan, NOCS has been appointed to launch a CSA prevention initiative for adults in Australia. This is a positive movement forward as the urge for political leadership was emphasised by participants who felt that the government’s reluctance towards adult-targeted secondary prevention resulted from conservative ideologies of some critical political stakeholders, a lack of ownership over the issue, and jurisdictional ambivalence. According to MSA, political leadership is crucial to prioritising policy problems. While researchers, academics and consultants are in important positions to advise governments, they have less influence when bringing about agenda change (Kingdon, 2014, p. 54). Zahariadis (2014) also states that people closest to the centre of power have the greatest chance of their proposal succeeding. However, survivor leadership, not just political leadership, is necessary for the movement forward. Australian of the year Grace Tame, a survivor of paedophilia, has publicly acknowledged that penalties for child sex offenders are only part of the solution and that there needs to be a greater focus on prevention to stop violence against women and children (ABC News, 2021). The Australian Federal Police Commissioner Reece Kershaw has supported Tame’s call for prevention, and Shadow Foreign Affairs Minister Penny Wong publicly reiterated this sentiment (ABC News, 2021). A genuine public health approach requires strong political leadership, collaboration with non-government and government actors and a coordinated and “unified” (Letourneau et al., 2014, p. 225) approach to the problem.

Despite the badging of the recent National Plan as a public health document, law enforcement received the largest amount of funds from any stakeholder named in the document. A comprehensive public health approach to CSA has yet to emerge in Australia, despite the commitment to a CSA secondary prevention programme. Based on this study’s findings, specific recommendations relevant to reducing barriers to secondary prevention or supporting the implementation of secondary prevention include the comprehensive development of an evidence-based public health model of CSA, informed by rigorous epidemiological data. Such a model would provide the basis to review the ongoing focus on law enforcement responses to CSA and develop a medium to long-term plan to rebalance investments across primary, secondary and tertiary prevention.

Disclosure statement

No potential conflict of interest was reported by the author(s).