LAUSR

In recent decades, there has been a growing recognition of the depth, extent and impact of sexual violence globally (National Sexual Harm Resource Center, 2015; UNICEF, 2014). In the last decade, in particular, we have seen a rise in the reporting of sexual abuse, current and historical, linked to institutions, clubs, charities, colleges, and the church, as well as an increased media profile of sexual violence. The financial, social, and health implications of sexual abuse provide a strong argument to reframe our understanding of, approaches to, and responses to it (Laws, 2000; McCartan, Kemshall, & Tabachnick, 2015; Wortley & Smallbone, 2006); arguing that we should move from a criminal justice only approach to a health, and more broadly a public health, approach (McCartan, Merdian, Perkins, & Kettlebrough, 2018). In recent years the research and practitioner communities have started to advocate for a public health approach to stopping sexual abuse based upon the fact that sexual abuse is a life course andmulti-disciplinary issue impacting not only individuals, but communities and society as a whole (see Brown & Saied-Tessier, 2015; Laws, 2000; Wortley & Smallbone, 2006 and for a broader discussion of a public health approach in responding to sexual abuse). A public health approach offers a unique insight into preventing and responding to sexual abuse by focusing on the safety and benefits for the largest group of people possible and providing a comprehensive response to the problem. A public health approach allows a reframing of sexual abuse that advocates proactivity and prevention in the place of reactivity. A public health approach focuses on four levels Primary (broad based population level interventions – media campaigns, etc), secondary (working with atrisk populations – the Stop it Now inform programme, STOPSO, Safer Living Foundation), tertiary (working to stop relapse – treatment programmes like Kaizen and Horizon) and quaternary (working to reduce the negative outcomes, and collateral consequences, of tertiary interventions – Circles of Support and Accountability). Therefore, a public health approach emphasises the opportunities to intervene at the primary or secondary stage, before sexual abuse or violence has occurred, as well as at the tertiary and quaternary stages, after the abuse has occurred, to help victims and perpetrators (Kemshall & Moulden, 2016; Laws, 2000; Smallbone, Marshall, & Wortley, 2008; Tabachnick, 2013; Wortley & Smallbone, 2006). In regard to sexual violence prevention, the core aim of these four levels is to stop offending, protect the public, reduce the impact of sexual violence and manage risk (McCartan et al., 2015; Smallbone et al., 2008). These preventative stages work within a socio-ecological framework that targets the individual, the relationship, the community and the societal level (Brown, 2018; Krug, Dahlberg, Mercy, Zwi, & Lozano, 2002; Shields & Feder, 2016) by drawing on multi-disciplinary knowledge and perspectives; which enables both macro (societal, community and institution based) and micro level (individual, family and relational) solutions. This means that we are able to think about the reality of poverty, social conditions, education, community management, individual risk and protective factors (including, Adverse Childhood Experiences (ACE’s), mental health issues) in respect to actually, as well as potential, victims and perpetrators. However, research in sexual abuse prevention, internationally, indicates that the majority of interventions happen at the tertiary level, with a smaller number at the primary level with a growing, but limited, body of interventions at the secondary level (Eradicating Child Sexual Abuse (ECSA), 2018; Troubled Desire, 2018). Initiatives such as Together for Childhood (NSPCC, 2018) which is taking a place-based approach to learn what works in the prevention of child sexual abuse spanning across the public health prevention continuum are important in helping to build the evidence base on effective approaches in a field that has relatively little empirical evidence of efficacy or impact.