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Moore Center for the Prevention of Child Sexual Abuse

The following is an excerpt of Dr. Elizabeth Letourneau’s speech at the 30th Anniversary of the Convention on the Rights of the Child at the United Nations in Geneva, Switzerland on November 14, 2019. The content was edited for length. 

Elizabeth Letourneau at the United NationsFor more than 30 years I’ve focused my career on developing, evaluating, and disseminating effective child sexual abuse prevention efforts.

You may be surprised to learn that about half of sexual offenses committed against children are by children under the age of 18, usually under the age of 15. Indeed, in the United States, the peak age for committing a sexual offense against a prepubescent child is 14. This may seem surprising, but it makes sense if you consider that children who are just beginning to engage in sexual behaviors are vulnerable to making mistakes and bad decisions.  

  • They don’t understand consent

  • They don’t realize that their younger friends and family members are off-limits

  • They don’t know that sexual images of children are illegal

  • And we don’t teach them. 

Eventually, children do figure these things out.  We see a steep drop in the number of sex crimes committed by older youth starting at age 15. A meta-analysis based on more than 33,000 juvenile sex crime cases found a 5-year sexual recidivism rate of less than 3%.  

Rather than waiting for children to figure out the complicated rules of sexual behavior on their own, we believe it makes more sense to give children – and their parents and educators -  the knowledge, skills and tools to successfully navigate early sexuality. That is why we developed a school-based perpetration prevention program that we call Responsible Behavior with Younger Children.  The premise is simple: teach kids what they need to know to avoid making mistakes and bad decisions in the first place.  

In an initial randomized controlled trial, we implemented the program across four public middle schools and collected pre- and post-treatment data from 150 students ages 11 to 13, and our early findings are very promising. 

Of course, developing, evaluating and disseminating effective programming requires sustained resources. The initial evaluation of Responsible Behavior with Younger Children was supported by a $275,000 grant from the National Institutes of Health, the United States’ primary funder of health research. To my knowledge, this is the first perpetration prevention study that NIH has ever funded. The same year that NIH funded my study, the federal government spent about 7 billion dollars to incarcerate sex offenders.  

Let me repeat that:  Every year, the United States spends about 7 billion dollars to lock up people who already committed sex crimes and almost no money to prevent people from engaging in sexually abusive behavior in the first place. I realize that no other country spends as much money on incarceration as the United States. But like the United States, every other country spends more on punishment than on prevention.  

Only about 5% of sex crimes are perpetrated by people with prior sex crime convictions.  Thus, after-the-fact interventions such as incarceration fail to address 95% of the problem. Spending enormous resources on punishment and almost none on prevention is a choice. Children are harmed by this choice. We are all harmed by this choice.

So why do we do this?  Why do we put nearly all our time, money, and resources into after-the-fact responses and almost none into prevention? I believe it’s because most people - and perhaps some of you - don’t really believe that child sexual abuse perpetration can be prevented. This is simply not true. 

What is needed is a concerted effort to shift this paradigm and to promote a more accurate and compelling understanding of child sexual abuse as a preventable public health problem.  

I am happy to say that we are having some success in shifting this paradigm in the United States. My [Moore] Center led a coalition of 25 other youth serving organizations in urging Congress to allocate new funding in support of child sexual abuse prevention research. As a result, the House Committee on Labor, Health, and Human Services included two million dollars in their budget for fiscal year 2020. The Senate Committee did not include any such funds, but did add a statement acknowledging the importance of child sexual abuse prevention research.

What can the United Nations do? 

  • I believe the United Nations can use its extraordinary power to convene and persuade to help shift this paradigm. To encourage states [member countries] to address child sexual abuse as the preventable public health problem that it is.

  • I believe the United Nations can collaborate with states to identify feasible ways to invest in prevention efforts for child sexual abuse, as they already do for other forms of childhood adversity. 

  • Holding people accountable for harmful behavior and addressing the needs of survivors are necessary but insufficient responses to child sexual abuse.  

  • The time has come to enact a truly comprehensive approach that includes investing in the development, evaluation, and dissemination of effective perpetration prevention efforts.

For 18 months the Moore Center, in collaboration with Tiffany Kaszuba, Vice President at the lobbying firm CRD Associates in Washington D.C., has advocated for Congress to include $10,000,000 in its budget to support child sexual abuse prevention research. This work included visits with members and staffers, a congressional briefing and a community sign-on letter with more than 25 organizations supporting this “ask”. 

Last year we were successful in getting language added to the Fiscal Year 2019 Appropriations Report noting the need for more information on child sexual abuse prevention research.

Recently, the House Appropriations Committee released its Fiscal Year 2020 report, which includes $2,000,000 in the budget for child sexual abuse prevention research. 

The specific report language reads:

Child Sexual Abuse Prevention.—While the incidence of child sexual abuse is believed to be far greater than reported, it is estimated to affect nearly 10 percent of all U.S. children, according to CDC. In light of the harmful physical, cognitive and emotional effects on a child’s development, a far more proactive approach is needed to prevent child sexual abuse. Therefore, the Committee includes $2,000,000 for a new research effort supporting the development, evaluation, and dissemination of effective child sexual abuse prevention practice and policy. 

The Senate Appropriations Committee has not yet released its Fiscal Year 2020 report. We know that at least eight senators included our $10,000,000 request in their budgets. Our hope is that the Senate’s final number is higher than the House’s and that the process of reconciliation results in a final amount closer to our ask. Of course, we would be remiss not to recognize that the Senate’s number could be the same or lower than the House’s. Still this is an early “win” that we believe presages greater U.S. investment in prevention research.  

The report is available here: There is a chart on page 72 and the language pertaining to CSA prevention research is on page 73.

Catholic ChurchThis excerpt is from our latest column, Prevention Now, in Psychology Today.

On Tuesday, August 14, 2018, a grand jury in Pennsylvania issued a report alleging that more than 300 priests in six dioceses abused 1,000 children over seven decades. Further, this report alleges that the bishops leading those dioceses perpetrated additional harm by concealing the abuse, rather than disclosing it. The report is the largest of any government agency in the United States on child sexual abuse within in the Catholic Church.

Over the last week, many people have asked me what we ought to do about child sexual abuse in the Church and I tell them this: We have taken an after-the-fact approach to child sexual abuse for 30 years. In this time, we made major inroads in the prevention of child physical abuse, child neglect, bullying and adolescent suicide. Consequently, we now have evidence-based effective prevention interventions for these types of childhood victimizations.

Child sexual abuse is also a preventable public health problem. And until our nation puts serious resources into the development, evaluation and dissemination of prevention efforts, we are going stay trapped in a cycle of abuse, outrage and disbelief.


90.5 WESAThe latest child sexual abuse allegations in Pennsylvania have gained international attention. In Pittsburgh, citizens are grappling to understand why over 1,000 victims were abused and what the Catholic Church should do to protect children and communities.

Dr. Elizabeth Letourneau, director of the Moore Center for the Prevention of Child Sexual Abuse at the Johns Hopkins Bloomberg School of Public Health, was interviewed for this story by Sarah Boden for 90.5 WESA, Pittsburgh's local NPR station.

A few weeks ago, I was approached by the TED team to weigh in on a recent TEDx talk titled “Why our perception of pedophilia has to change.” After giving the talk, the speaker received death threats and asked TEDx to remove it from their YouTube channel.

In explaining their decision to do so, TEDx noted the threats and also that they felt that the talk did not cite current research about pedophilia. TEDx further noted that the talk left many to believe that the speaker was promoting the abuse of children.

I concur that the speaker makes some statements not fully supported by the research. We do not yet know what causes some people to have a sexual attraction to children. There is as yet no intervention that has been shown to keep “98%” of patients from offending. Yet she does not in any way promote the abuse of children. What she promotes is a more thoughtful, objective understanding of people who may pose a risk to children and how to effectively address that risk and prevent the sexual abuse of children.   

Child sexual abuse is a topic that can evoke strong emotions. When professionals (or, in this case, students) speak objectively about individuals with sexual interest in children, it can sound like we are taking an “offender defender” stance. We are not. When we talk as if people with sexual interest in children are, in fact, people and not predators or monsters, some listeners react with anger. This is unfortunate because, as the speaker rightly notes, open and honest conversations about child sexual abuse are necessary if we are to move the field toward the development of truly effective prevention interventions. 

In my opinion, the speaker took some liberties with the available research. She is a student and students make this type of mistake. But the real issue is that she is promoting a very different view of people with sexual interest in children – a view that those with an unwanted attraction to children are people who need and want help to not offend. She should be applauded for making this stance public.

Elizabeth J. Letourneau, PhD
Director, Moore Center for the Prevention of Child Sexual Abuse