This presentation was prepared as part of a group consultation assignment in the psychiatric mental-health nurse practitioner program at University of Tennessee Health Sciences Center.

1. PMH802
ELEMENTARY SCHOOL
CONSULTATION
Sexual Abuse Prevention

2. Scenario
• The Principal of PS 2009 reports that last week, a third grade
student was molested on her way home from school.
• The teachers, parents and students are in a state of panic.
• There are accusations that an older student in the school is the
perpetrator and this has led to anger and divisiveness within the
school community.
• The Principal is requesting a consultation to discuss ways to best
cope with the fallout from this situation for staff, students, and
community and to address the safety and boundary issues this
situation presents so hopefully it will not reoccur.

3. Guidelines and Legal Aspects
• The law requires professionals who work with children to report
suspected neglect or abuse.
• Guidelines for reporting sexual abuse and neglect are state-specific but
they all show commonalities in the reporting process. Failure to report
child abuse or neglect is a violation of the law (Department of
Children’s Services, 2011).
• Victims can sue their abusers in civil court
• Many states have extended their criminal and civil statutes of
limitation for child sexual abuse cases.
• Any suspicion of child sexual abuse must be reported to child
protective services agency or law enforcement agency immediately.
• Local child protection agencies investigate intra-familial abuse and the
police investigate extra-familial abuse.

4. Tennessee Law
If a school official, or any other school personnel has knowledge of
sexual abuse on school premises then they must notify the parent or
legal guardian within 24 hours that a report has been made and shall
provide other information relevant to the future well- being of the child
while under the supervision or care of the school. The notice must also
be coordinated with the DCS.
https://www.sworps.tennessee.edu/child_abuse_reporting/start.html

5. Needs Assessment
• Staff
• Internal procedures to report, track, and follow-up on disclosure/suspicion
• Who is trained/interested in teaching SA prevention
• Preferred formats for education
• Students
• Effectiveness of SA teaching
• Preferred methods of instruction and available teaching tools
• Parents and Community (and staff)
• Role in educating children about body safety and boundaries
• Available secondary and tertiary care for SA
• Level of SA knowledge in school-aged peers and mandatory reporting laws

6. Cost-Effective Primary Prevention
• Nine Principles of Prevention
• Comprehensive Varied Teaching Methods
• Sufficient Dosage Theory Driven
• Positive Relationship Appropriately Timed
• Socio-Culturally Relevant Outcome Evaluation
• Well-Trained Staff
• Free Programs
• Stop It Now!
• Speak Up Be Safe
• Vermont Sexual Violence Prevention Taskforce
• Community education resources

7. Agency Resources
• Service Providers
• Educators
• Counselors
• School/District Nurse
• Training
• Relationship with community resources
• Facilitator training: Child Help, Darkness to Light
• Outsourcing
• In-Agency
• Collaborative
• Third-Party

8. Outcomes
Students
• Increased perception of appropriate vs. inappropriate touching.
• Increased understanding of how to report abuse.
• Increased self-esteem.
• Increased perception of personal boundaries.
• Appropriate assessment of risk.
Parents and Staff
• Increased confidence among teachers and staff in reporting protocols
• Increased confidence among teachers and staff in responding to students
concerns.
• Increased understanding of how to discuss issues of risk, abuse,
boundaries and reporting according to developmental stages.
• Local child protective services to be prepared for possible disclosures
following presentation/consultation by notifying administration prior to
program (Barron and Topping,

9. Troubleshooting
• Secondary trauma, re-experiencing a primary trauma, revealing
staff or parental molestation are potential scenarios that may be
addressed through primary, secondary, and tertiary sexual abuse
prevention strategies.
• Post consultation questionnaires to be evaluated to assess
understanding of presented material and unmet needs and or
questions.
• Concerns not met by plan and plan items with poor learning
outcomes to be addressed or readdressed as necessary within an
agreed upon time frame.
• Booster sessions may be necessary to reinforce previous learning as
well as address new concerns.

10. TEACHING PLAN:
STAFF
Jaclyn Engelsher

11. Objectives
• 1. Identify 3 sexual violence prevention resources that can be used
for classroom learning
• 2. Describe 3 concerning behaviors that could indicate a child has
been exposed to sexual abuse
• 3. List 5 appropriate responses for handling student disclosure of
sexual abuse
• 4. Name a community resource for each level of prevention
(primary, seconder, tertiary)

12. The
Jerry
Sandusky/P
enn State
Teaching
Moment

13. Common Sexual Behavior in School Age
Children
• Questions on physical development, babies, puberty, sexuality
• Experiments with same age and gender peers through games and role
play in spontaneous, mutually enjoyable fashion (pre-puberty)
• Increasing interest in sexual discussion and experimentation with peers
(puberty)
• Private self-stimulation
• Follows limits set by adults and community

14. Concerning Sexual Behavior in School Age
Children
• Interprets social gestures as sexual
• Explicit sexual knowledge; provokes sexual discussion
• Mimics adult sexual behaviors
• Exhibits sexual behaviors in public, on the phone, or online
• Prefers to play with younger/smaller children including secret or
special games involving physical contact, exhibition, or voyeurism
• Uses physical or verbal sexual threats/harassment
• Regressive behaviors, fearful or explosive around particular peer(s)

15. Warning Signs of Possible Sexual Abuse
(or divorce, death, trauma, conflict, life-change illness . . .
)
• Low self-esteem
• Misses or skips a lot of school
• Shows unusual signs of anxiety
• Shows signs of guilt
• Exhibits signs of depression
• Becomes more angry and hostile
• Runs away from home
• Using drugs or alcohol
• Assuming perpetrator role

16. Reporting & Disclosure
• Avoid denial, interrogation, implication of blame
• Do not make assumptions, judgments, promises
• Provide a safe environment
• Reassure and support
• Active listening
• Document with exact quotes
• Seek advice
• Report suspicions

17. Sexual Violence Prevention
• Primary
• Promote resilience: caring relationships, high expectations and academic
standards, provide opportunities for participation and contribution
• Implement education guidelines using 9 principles of prevention
• Build alliances with CPS and law enforcement to define roles, values,
objectives, and language; reporting and debriefing protocol; and outcome
evaluation measures
• Secondary
• Schools are primary reporting of source suspected SA
• Crisis counselor, ER/SANE/MD, CPS, legal
• Re-victimization, vicarious trauma
• Tertiary
• Long-term MH services for victim/survivor: individual, group, family
• Offender treatment and rehabilitation

18. References
• Barron, I. G. & Topping, K. J. (2009). School-based child sexual abuse prevention programs:
The evidence on effectiveness. Journal of Children’s Services 3(3), 31-53.
• Center for Women and Families, (2011). Community education and training. Retrieved from
http://www.thecenteronline.org/learn-more/community-education-and-professional-training
• ChildHelp (2011). Speak up be safe: The evolution of good touch bad touch. Retrieved from
http://www.speakupbesafe.org/index.html
• Department of Children’s Services (2011). Child safety. Retrieved from
http://www.tn.gov/youth/childsafety.htm
• Smith, M. C. (2008). Pre-professional mandated reporters' understanding of young
children's eyewitness testimony: Implications for training. Children and Youth Services
Review, 30(12), 1355-1365.
• StopItNow! (2007). Do children sexually abuse other children? Preventing sexual abuse among
children and youth. Brandon, VT: The Safer Society Press.
• StopItNow! (2010). Training for prevention. Retrieved from
http://www.stopitnow.org/training
• U.S. Department of Health & Human Services, (2011). State statutes search. Retrieved from
http://www.childwelfare.gov/systemwide/laws_policies/state/index.cfm?event=stateStatute
s.showSearchForm
• Vermont Sexual Violence Prevention Taskforce, (2010). Technical assistance resource guide.
Burlington, VT

19. TEACHING PLAN:
PARENTS
Tawney Burgess

20. How can I keep my child safe?
1. Teach healthy boundaries – it is
acceptable to have privacy to
dress, bathe, use the bathroom and
sleep.
2. Teach the difference between O.K.
touch and inappropriate touch
3. Make sure your child knows it is o.k. to
tell
4. NO! Teach your children it is alright to
say no about their body and respect
when they do
5. Teach the proper names for body parts
6. Make sure they know the difference
between a secret and a surprise.
Secrets leave our children vulnerable.
7. Teach internet safety
• http://www.stopitnow.org/dont_wait_
everyday_prevention

21. What do I do if my child discloses?
1. Believe them
2. Stay calm
3. Assure them they are not to blame
4. Let them know “telling” was the right
thing to do – don’t promise not to tell
5. Report the abuse
6. Make sure to tell them it is o.k. to be
mad or sad
7. Seek medical attention –
documentation of injury, preservation
of evidence and treatment if necessary
8. If the incident was recent (within 5
days) wait until after seeking medical
attention to take a bath/shower, use
the bathroom (if possible), change
clothes, eat or drink. Preserve as much
evidence as possible
http://www.shelterhousemidland.org/index.php/is-this-abuse/signs-of-child-a-teen-abuse/what-do-i-do-now
http://www.rainn.org/get-information/aftermath-of-sexual-assault

22. Don’t Add
1. While it is important to let the child talk as much as they
want about the incident, do not ask a lot of questions
about it or quiz them. Information gathering is best
accomplished by forensic interviewers, SANEs and law
enforcement. This protects the integrity of the
statement.
2. Do not discuss the incident with those who do not need
to know. Protect your child’s privacy.
3. If there are other victims, do not discuss the incident
with them either….this protects all cases involved.
4. Do not promise the child they will not have to tell their
story more than once.
5. Do not share your anguish with your child, they need to
see you calm. Find someone to talk to such as a
therapist.
http://www.shelterhousemidland.org/index.php/is-this-abuse/signs-of-child-a-teen-abuse/what-do-i-do-now

23. Self Care
• Although it will be natural that your
thoughts will be centered on your
child, it is important to remember that
you can provide a better environment
for your child by taking care of
yourself.
• Journaling, meditation and seeking
counseling are all recommended by
RAINN.org for family members of
abuse victims.
• http://www.rainn.org/get-
information/sexual-assault-
recovery/tips-for-friends-and-family

24. Where do I go for
help?
Your child's
pediatrician or your
local emergency
department are good
starting places. They
can help link you to
law enforcement,
child protective
services, and health
care providers that
specialize in the care
of the abused child.

25. Questions to consider when choosing a school or
afterschool program
• What is their policy of abuse prevention?
• What is the staff screening process?
• Are background checks and references checked?
• Are child/adult interactions monitored and do they have a policy
regarding interactions between staff and children?
• Do staff receive training about the prevention of child sexual
assault?
• How do they handle allegations of abuse?
http://www.stopitnow.org/9questions

26. References
• Aftermath of Sexual Assault | RAINN | Rape, Abuse and Incest National Network. (n.d.).
RAINN | Rape, Abuse and Incest National Network | RAINN: The nation's largest anti -sexual
assault organization.One of “America’s 100 Best Charities" —Worth magazine.
Retrieved November 28, 2011, from http://www.rainn.org/get-information/aftermath-of-
sexual-assault
• Child Sexual Abuse: What do I do now?. (n.d.). Shelterhouse of Midland and Gladwin Counties:
Eliminate Domestic Violence and Sexual Assault. Retrieved November 28, 2011, from
http://www.shelterhousemidland.org/index.php/is-this-abuse/signs-of-child-a-teen-
abuse/what-do-i-do-now
• Don’t Wait: Everyday Actions to Keep Kids Safe | Stop It Now. (n.d.). Stop It Now |
Together We Can Prevent the Sexual Abuse of Children. Retrieved November 28, 2011, from
http://www.stopitnow.org/dont_wait_everyday_prevention
• Nine Questions Parents Need to Ask When Selecting a Program for their Child | Stop It Now.
(n.d.). Stop It Now | Together We Can Prevent the Sexual Abuse of Children. Retrieved
November 28, 2011, from http://www.stopitnow.org/9questions
• Self-Care for Friends and Family Members | RAINN | Rape, Abuse and Incest National
Network. (n.d.). RAINN | Rape, Abuse and Incest National Network | RAINN: The nation's
largest anti-sexual assault organization.One of “America’s 100 Best Charities" —Worth
magazine. Retrieved November 28, 2011, from http://www.rainn.org/get-information/sexual-
assault-recovery/tips-for-friends-and-family

27. CONSULTATION
TEACHING PLAN:
CHILDREN
Sharon D. Ward,
PMHNP-Student

28. I Am Somebody
Pearls for Boys and Girls

29. Goals and Objectives
• The goal is to teach children how to prevent or reduce the risk of sexual abuse.
• The students will be able to define child sexual abuse.
• The student will be able to verbalize appropriate names of their body parts.
• The students will be informed that they have the to make decisions about their
bodies.
• The students will be able to name safe places to go and safe people to tell if they
are being sexually abused.

30. What Is Child Sexual Abuse?
• Child sexual abuse is any type of sexual activity with a child where permission is
not or cannot be given.

31. KNOW YOUR BODY
• Know the appropriate names of your body
parts. Body parts does not have
nicknames. Ask parent to teach you the
appropriate names.
• Your body belongs only to you and it is not
ok for anyone to ask to touch or look at
your body especially your
breast, buttock, and genitals.
• It is not ok for you to look or touch another
person’s body parts especially the
breast, buttock, or genitals even if he/she
tells you it is ok to touch them.
• No one should touch your body in exchange
for money, candy, toys, or other gifts.

32. Know Your Voice
• You have a right to tell a person that you trust if someone
touches or looks at your private body parts. Sometimes it
is necessary for your parent(s) or doctor to touch your
private area.
• Tell someone as soon as possible if someone touches your
private area. DO NOT wait because the longer you
wait, the longer it will take for someone to help you.
• There are no secrets when someone hurts you.
• You have the right to say "NO" if someone wants to touch
you in any way that makes you feel uncomfortable, afraid
or confused.
• Safety rules about touching apply all the time, not just with
strangers.

33. Know Your Safe Places
• Your Parent
• Your Doctor
• Your Church
• Police Department/Police Officer in your
neighborhood
• School’s Guidance Counselor/Principal/Favorite
Teacher

34. “What If” Game
• What If... something was bothering you and you did not know what to do about it?
Who might be able to help you?
• What If... someone touched you in a way you did not like and offered you a candy
bar, a brand new doll or something else you really wanted to keep a secret?
• What If... a stranger offered you a ride in a shiny new car?
• What If... you did not want to be hugged by a particular adult?
• What If... someone is tickling you and it starts to hurt?
• What If... Mommy, daddy or a doctor touched the private parts of your body?
• What If... the baby sitter wanted to touch you under your night clothes?
• What If... your uncle (aunt) wanted you to sit on his (her) lap and you did not want
to?

35. Answers to “What If” Game
• People you trust, such as a parent, another relative, neighbor, teacher, school nurse, police
officer, clergy.
• Say "NO!" and tell someone.
• Never accept rides from a stranger.
• Say "NO!" to that adult. You may like the person, but you may not want to be hugged at that time.
• Tell them to stop. If they will not stop, call for help. If I am not home at the time, tell me about it
later.
• There are times when others may need to touch your private parts. For example, mommy or
daddy may touch your private parts if you complain of pain in your private area; or a doctor may
need to touch you during an examination. But, if the touching hurts or bothers you, tell them.
Alternate... Grown-ups do not usually need to touch children in private areas unless it is for health
reasons.
• No one has the right to put their hand under your clothes; force you to touch them; touch your
body; or touch your private body parts.
• You can say "NO!" to your uncle/aunt if, for some reason, you do not want to do it.

36. References
Office of Children & Family Services (n.d.). Say no! Protecting children against
sexual
abuse pub. 1154. Retrieved November 24, 2011, from
http://www.ocfs.state.ny.us/main/publications/pub1154text.asp.
Tennessee Department of Human Services. Keeping kids safe. Retrieved November
24, 2011 from www.tn.gov/humanserv/adfam/kkswv.pdf.
The National Child Traumatic Stress Network. Child sexual abuse fact sheet.
Retrieved
November 24, 2011 from http://www.nctsn.org/products/child-sexual-abuse-fact-
sheet-parents-teachers-and-other-caregivers%20.