Outcome measurement for a school-based child sexual abuse prevention intervention amidst national reading-level...

Child sexual abuse (CSA) is a public health concern. In recent years, community-based facilitators in Pennsylvania have raised concerns regarding students' abilities to read the post-workshop assessment for Safe Touches, an evidence-based child-focused CSA primary prevention workshop designed to equip children with body safety knowledge and skills. Indeed, reading levels in Pennsylvania were over half a year behind in 2024 compared to 2019 pre-COVID-19 pandemic. The current study sought to evaluate observable differences in post-workshop assessment scores between students who received Safe Touches pre-pandemic (2018-2020) compared to post-pandemic (2022-2024).

The current study was a secondary analysis of post-workshop assessment data from 4 years of Safe Touches implementation in second-grade Pennsylvania classrooms (N = 31,901). Flesch-Kincaid Grade Level tests were used to determine the reading level of the six-item assessment, adapted from the Child Knowledge of Abuse Questionnaire. Bivariate analyses evaluated item-level scores pre- and post-pandemic. Logistic regression models were fit to obtain odds ratios (ORs) for scoring correctly on items post- vs pre-pandemic with covariates sex, semester, and facilitating site. A phenomenological analysis of post-pandemic facilitator implementation forms was conducted to contextualize quantitative results.

Five of the six items exceeded a second-grade reading level (range: 2.4-8.5). The odds of scoring correctly significantly increased post-pandemic for 4 items (Adjusted ORs 1.16-1.76) and decreased for 1 item (0.86). Students who received Safe Touches in the spring had significantly greater odds of scoring correctly for every item (1.20-1.40), compared to those who received it in the fall. A meaningful variation in odds was found depending on the community-based site. Qualitative data demonstrated student challenges with reading level and test-taking, and highlighted supportive strategies leveraged by facilitators.

With the measure as is, we cannot understand whether performance is due to students' abilities to comprehend questions above their reading level or their true knowledge of CSA preventive strategies. While facilitators may be able to use strategies to compensate for the assessment items' high reading levels, this is neither sustainable nor consistent. The need for an updated measure validated at a lower reading level to evaluate children's knowledge and awareness of CSA is evident.