NC Coalition for the Prevention of Child Sexual Abuse

With support from PCANC, the NC Coalition for the Prevention of Child Sexual Abuse established comprehensive statewide efforts to engage allies in the prevention of child sexual abuse.

Building a Movement to End Child Sexual Abuse in North Carolina

In North Carolina, we take our role as stewards of the next generation seriously, and know that our ability to raise strong, competent children who will lead tomorrow’s communities requires smart and innovative thinking today. The good news is that developmental science provides us with a blueprint for how to do just that. 

We now know that the brain’s architecture is built over time and from the bottom up, much like a house. Sturdy architecture is built when children have stable, positive experiences and relationships with caring adults at home and in the community. And, while experiencing normal life stress - such as getting an immunization, or falling off a bike – is part of healthy development, some kinds of stress can be toxic to development. Toxic stress responses occur when children experience severe or repeated exposure to harmful experiences or environments, and without adequate adult support. This toxic stress can weaken the brain’s architecture, with damaging effects on health, learning and behavior across the lifespan. But research also suggests that a supportive, stable relationship with at least one key caregiver in a child’s life can buffer even toxic stress, preventing or reversing its effects. 

That is why it is so important for communities to put in place strategies that can help prevent such adverse experiences from happening, and when they do happen, to prevent them from becoming toxic. And for children confronting significant risk– those whose toxic stress responses are continual, or are triggered by multiple sources – early intervention can shore up fragile foundations, effectively changing the course of their development.  But when we fail to act, we do so with great cost not only to our children’s wellbeing, but to our collective future, as well. 

Child sexual abuse is a significant public health problem, one that causes toxic stress and results in multiple long-term health consequences, astronomical costs (both human and financial), and a host of systemic social problems. It is a problem, however, that is preventable. One key to effective prevention is a comprehensive approach that targets the systems and policies that influence the health and well-being of our families and communities.

The Lifetime Impact of Child Sexual Abuse

The Centers for Disease Control and Prevention has identified childhood sexual abuse as a significant public health problem, with an estimated prevalence of between 12-20% of the child population (Dube,, 2005; Finkelhor, 1997). The long term chronic physical and behavioral health implications of experiencing sexual abuse have been well-documented through multiple research studies (Dube, et al., 2005; Felitti, et al., 1998; Fergusson, Boden, & Horwood, 2008; Irish, Kobayashi, & Delahanty, 2010; Lalor & McElvaney, 2010; Neumann, Houskamp, Pollock, & Briere, 1996; Spataro, Mullen, Burgess, Wells, & Moss, 2004).

Survivors of child sexual abuse are at much higher risk of poor physical, mental, behavioral, and experiential outcomes. Specific outcomes include higher rates of disease, including gastrointestinal, cardiopulmonary, and obesity; as well as higher rates of mental illness, including personality disorders, depression, substance abuse disorder, anxiety, post-traumatic stress, and suicidality. Survivors of child sexual abuse are also at exponentially increased risk of future victimization.

The Effective Prevention of Child Sexual Abuse

To understand how to best prevent a problem from occurring and re-occurring, it is important to understand concepts of prevention. Prevention approaches have the most impact if they include strategies to prevent problems before, during, and after they occur.

When researching systems and policy strategies to prevent child sexual abuse, the NC Coalition for the Prevention of Child Sexual Abuse asked the key questions illustrated in the table below. In order to answer these questions, the Coalition surveyed community members and professionals, convened a Survivor Advisory Group, held Coalition and committee meetings focused on different types of prevention approaches, held a series of community listening sessions and community dialogues, and conducted a scan of research and prevention policies.

Primary Prevention

Prevention of Re-victimization

Prevention of Recidivism

What will prevent child sexual abuse from ever happening in the first place?

What do victims need to recover from child sexual abuse? As children? As adults?

What do sex offender management laws need to look like to be evidence-based and effective?

What will prevent first time perpetration?

What do victims need to prevent re-victimization? As children? As adults? As caregivers responsible for protecting children?

What treatment do sex offenders need to prevent recidivism? As adults? As juveniles?

Research indicates shared risk and protective factors across multiple forms of violence. When one poor outcome is prevented, multiple other poor outcomes can be prevented, as well. In other words, “prevention is prevention is prevention.” There are multiple benefits to an approach that targets these shared risk and protective factors, some of which include:

  • Greater impact on more individuals, communities, and the population at large
  • Greater impact on more symptoms and consequences of disparate types of violence
  • Opportunities for multi-disciplinary collaboration and collective impact
  • More opportunity to prevent violence from happening in the first place

In North Carolina, multiple state prevention plans have been developed to target social problems, injury, and violence, including: suicide, child maltreatment, intimate partner violence, chronic disease, adolescent pregnancy, juvenile delinquency, adult sexual violence, and others. There may be an opportunity to examine shared risk and protective factors, common strategies, and shared outcomes across prevention plans.

Several years of study culminated in the identification of key strategies in the following areas:



Prevention of first time perpetration, including the prevention and reduction of adverse childhood experiences as well as increased protective factors.

  • Because risk and protective factors are shared across multiple forms of violence, injury, disease, and social problems, this approach can prevent a range of adverse experiences.
  • Children’s outcomes are better when adverse experiences are prevented from happening in the first place.
  • This approach has the greatest impact with the least investment of resources.

Prevention of re-victimization and trauma, and the provision of evidence-based treatment for maltreated children.

  • Evidence-based trauma treatment mitigates the risk of poor health and behavioral outcomes for maltreated children, including chronic disease, mental illness, juvenile delinquency, and others.
  • Many children and youth who are sexually reactive or have problem sexual behaviors have been maltreated themselves. Trauma treatment can lead to reduced problem behaviors.
  • Effective treatment better prepares survivors to care for the next generation of children.

Prevention of recidivism among known offenders, including the provision of comprehensive assessments, evidence-based and evidence-informed treatment, and monitoring.

  • Assessments can determine risk of recidivism and potential responsiveness to various treatment modalities.
  • Standards and guidelines are critical to ensuring evidence-based and evidence-informed treatment is available, increasing the likelihood of successful treatment and reduced recidivism.
  • Strategic monitoring through a risk-based system can improve accountability and prevent subsequent offenses.

Raised awareness and increased capacity among adults to understand, respond, and work towards the prevention of child sexual abuse.

  • Increased awareness among adults can increase the likelihood of earlier intervention, appropriate responses, and referrals to treatment when abuse does occur.
  • Awareness is necessary to build capacity and support for more comprehensive prevention approaches.

Improved data collection and analysis

  • Improvements in data collection and analysis will allow a more accurate understanding of prevalence and incidence, as well as data to demonstrate whether prevention approaches are successfully impacting the problem.

It is clear that the most promise lies in a comprehensive approach including the implementation of a full range of strategies in all of these areas, as well as the avoidance of ineffective or isolated approaches.

The Link between Human Trafficking and Child Sexual Abuse

There is an intersection of human trafficking and child sexual abuse. Research indicates that the majority of sexually exploited children and adult sex workers have a prior history of child sexual abuse (Lalor & McElvaney, 2010). The National Institute of Justice found that people who were sexually abused as children were 28 times more likely than their non-abused peers to be arrested for prostitution (Widom, 1995). Some studies indicate that individuals engaged in survival sex work, a significant risk factor for trafficking, have an almost universal likelihood of having been sexually abused as children (Lalor & McElvaney, 2010). Traffickers have a history of abuse, as well. Interviews with a sample of ex-traffickers indicate extremely high rates of childhood physical abuse (88%) and sexual abuse (76%). A full 24% had been placed in foster care, while 48% report having run away due to physical and sexual abuse (Raphael, 2010).

Human Trafficking Commission Recommendations for the Prevention of Child Sexual Abuse in North Carolina

Recognizing the significance and preventability of the problem, the 2014 NC General Assembly charged the Human Trafficking Commission with making recommendations for the prevention of child sexual abuse (S.L. 2014-199, Section 4). The Commission partnered with a study committee of the NC Coalition for the Prevention of Child Sexual Abuse. In determing their recommendations, the Commission utilized data from the NC Coalition for the Prevention of Child Sexual Abuse, conducted additional study of the issue, and widely disseminated a survey to ensure a broad representative voice of professionals, parents, survivors, and community members. Read the report here.

National Resources

State Resources

For more information, Please contact Melea Rose-Waters at This email address is being protected from spambots. You need JavaScript enabled to view it. or call 919-829-8009.

Prevent Child Abuse North Carolina

A chapter of Prevent Child Abuse America

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