Journal of Child Sexual Abuse

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Children’s Knowledge of Abuse Questionnaires

(CKAQ)-Short: Two Brief Ten-Item Measures of
Knowledge about Child Sexual Abuse Concepts

Leslie M. Tutty

To cite this article: Leslie M. Tutty (2019): Children’s Knowledge of Abuse Questionnaires
(CKAQ)-Short: Two Brief Ten-Item Measures of Knowledge about Child Sexual Abuse Concepts,
Journal of Child Sexual Abuse, DOI: 10.1080/10538712.2019.1688443

To link to this article: https://doi.org/10.1080/10538712.2019.1688443

Published online: 21 Nov 2019.

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JOURNAL OF CHILD SEXUAL ABUSE
https://doi.org/10.1080/10538712.2019.1688443

Children’s Knowledge of Abuse Questionnaires (CKAQ)-Short:

Two Brief Ten-Item Measures of Knowledge about Child
Sexual Abuse Concepts
Leslie M. Tutty
Faculty of Social Work, University of Calgary, Calgary, Alberta, Canada

ABSTRACT ARTICLE HISTORY

Child-focused sexual abuse prevention programs were developed Received 8 August 2019
in the 1970s in response to significant concerns across North Revised 17 October 2019
America with respect to children being sexually abused. While Accepted 23 October 2019
program evaluations are common, measures to evaluate these KEYWORDS
programs, most of which are offered to children in elementary Child sexual abuse;
schools, are not widely available. This article reviews the key con- prevention programs;
cepts covered in CSA prevention education programs that com- outcome measures;
prise the constructs used to measure knowledge/attitude gains psychometric assessment
post-program. Available measures are reviewed and the psycho-
metrics of two new 10-item versions (one for students in grades
1–2; the other for grades 3–6) of the CKAQ-33, a commonly used
tool, are presented and psychometrically assessed with a sample of
7646 elementary school students.

Child sexual abuse (CSA) is a significant problem across the globe (Barth,
Bermetz, Heim, Trelle, & Tonia, 2013; Stoltenborgh, van IJzendoorn, Euser,
& Bakermans-Kranenburg, 2011). Its consequences include significant indi-
vidual psychological issues including depression, anxiety and post-traumatic
stress (Daigneault, Vézina-Gagnona, Bourgeois, Esposito, & Hébert, 2017;
Gray & Rarick, 2018), which often extend into adulthood as continuing
mental health problems and interpersonal difficulties with intimate partners
(Hillberg, Hamilton-Giachritsis, & Dixon, 2011; Lalor & McElvaney, 2010).
Further, childhood sexual abuse exacts a high economic price from society
(Letourneau, Brown, Fang, Hassan, & Mercy, 2018).
Given these widespread and significant consequences, preventing child sexual
abuse is clearly the best option. However, authors have long debated how best to
do this (Rudolph & Zimmer-Gembeck, 2018; Zeuthen & Hagelskaer, 2012). Key
prevention strategies including media and public awareness campaigns (Kemshall
& Moulden, 2017; Rheingold et al., 2007), parent education (Guastaferro, Zadzora,
Reader, Shanley, & Noll, 2019; Nickerson, Livingston, & Kamper-DeMarco, 2018)
especially with the parents of preschoolers (Mendelson & Letourneau, 2015;

CONTACT Leslie M. Tutty tutty@ucalgary.ca Faculty of Social Work, University of Calgary, MT 301, 2500
University Dr., Calgary, Alberta, Canada T2N 1N4
© 2019 Taylor & Francis
2 L. M. TUTTY

Wurtele, Moreno, & Kenny, 2008) and school-based child-directed programs

(Walsh, Zwi, Woolfenden, & Shlonsky, 2015).
Arguably, each prevention strategy should be offered concurrently as every
effort to prevent CSA is warranted. However, ever since the conception of
school-based CSA programs, critics have been concerned about children
being taught the core CSA prevention concepts, worrying that they might
be negatively affected, become anxious or traumatized or that they might
generalize this to fear about benign or loving touches from trusted adults.
These concerns remain, despite considerable research concluding that most
children have no negative or unintended consequences after participating in
a child-focused CSA prevention education program (Dale et al., 2016).
This article briefly reviews the history and the key concepts taught in child
sexual abuse prevention programs, leading to a discussion about what measures
are available for evaluating these efforts. One of the most often-used measures, the
CKAQ-33, is described, with a rationale for shortening the scale for use in
program outcome monitoring. Program monitoring occurs after having deter-
mined program efficacy to address long-term effectiveness and fidelity and, as
such, the methodology is not as stringent as the original research (Bond &
Carmola Hauf, 2004). The psychometric properties of the two 10-item scales,
one for children in grades 1–2; the other for grades 3–6, are analyzed.

Prevention education programs about child sexual abuse

Child sexual abuse is an ancient problem (Rush, 1981), but widespread concern
about this only surfaced in North America in the 1970s, when prevention efforts
began (Plummer, 1999). Finkelhor’s (1984) four preconditions for sexual offenses
to occur (an offender’s motivation; offender’s inhibitions, external impediments
and child resistance) provide a useful framework for identifying prevention
options. Each precondition can be the target of primary (universal factors),
secondary (early interventions) and tertiary (treatment) prevention programs
(Tutty, 1991).
Adult-focused prevention (addressing external impediments) is arguably
important, since it is parents’ responsibility to safeguard their children. Some
excellent public health initiatives that address CSA have been developed such as
the US “Stop It Now!” and the Massachusetts’s “Enough Abuse” campaign.
However, these are not widespread, and their efficacy is difficult to assess
(Kemshall & Moulden, 2017). Parent-focused CSA programs are often specific
to parents of young preschool-aged children where parents are taught to provide
the education materials to their own children with generally favorable results
(Wurtele & Kenny, 2010; Wurtele, Saslawsky, Miller, Marrs, & Britcher, 1986).
Parent-directed orientations/workshops are often a component of child-focused
programs, especially in the 1990–2000s, albeit one that attracted few parents: Tutty
(2000) reported that only one-fifth of parents invited to the information session of
 JOURNAL OF CHILD SEXUAL ABUSE 3

the “Who Do You Tell?”™ program actually attended, which is similar to other
studies of parent workshops/orientations (25% in Hébert, Lavoie, & Parent, 2002;
24% in Tutty, 1993).
By and large though, the earliest and most common prevention efforts are
primary (universal) programs targeting children in elementary schools or pre-
school programs (Tutty et al., 2005). While school-based prevention education
programs are generally portrayed as primarily educating potential victims of
CSA (child resistance), they can also be conceptualized as teaching children who
are current or potential sexual offenders that these behaviors are inappropriate
(addressing offender’s inhibitions) (McGibbin, Humphreys, & Hamilton, 2017).
While relatively common in the 1970s to 1990s, school-based programs became
more difficult to market with the advent of two issues in the 2000s: Backlash
against sexual abuse disclosures with the premise of false allegations (Friend &
Snyder, 2017) and the proliferation of school-based programs to address other
interpersonal violence issues such as bullying, dating violence and substance abuse
(Tutty et al., 2005; Wurtele, 2009), which, among other issues such as crowded
curricula, has created difficulties in accessing students. A study by Finkelhor,
Asdigian, and Dziuba-Leatherman (1995) found that, while 67% of youth aged
10–16 had been exposed to a school-based victimization or abuse program in
schools, only 19% had received a comprehensive program. A recent study
(Finkelhor, Vanderminden, Turner, Shattuc, & Hamby, 2014) supports the low
availability. In this US national study of youth (ages 5–17) who participated in
violence prevention programs, only 21% had had “sexual assault” prevention, but
the subset of children aged 5 to 9 were much less likely to have had such
programming.
Nevertheless, with new media attention to children as victims of sexual abuse by
Catholic priests (Faisal & Barron, 2018) and celebrities (Doyle, 2019), reinvigo-
rated interest in educating children in the hope of preventing or intervening early
has arisen. Also notably, school-based CSA programs are being developed and
evaluated worldwide in countries such as China and Taiwan (Jin, Chen, & Yu,
2016; Zhang et al., 2014), Ecuador (Bustamante et al., 2019), Korea (Kim & Kang,
2017), South Africa (Dunn, 2011) and Turkey (Tunc et al., 2018) to name a few.
The rationale for child-focused programs is to educate children about the core
dynamics that abusers use to groom or lure children into sexual activities so that
children might recognize these, avoid them, if possible, and seek assistance.
According to Walsh et al. (2015):

They seek to prevent CSA by providing students with knowledge and skills to recognize
and avoid potentially sexually abusive situations and with strategies to physically and
verbally repel sexual approaches by offenders. They endeavor to minimize harm by
disseminating messages about appropriate help seeking in the event of abuse or
attempted abuse and equip adults with strategies for responding quickly and effectively
to disclosures to protect children from further abuse (p. 34).
4 L. M. TUTTY

These skills and concepts form the core items in knowledge measures used to
evaluate CSA prevention education programs.

Evaluating child sexual abuse prevention education programs

CSA prevention education programs have been extensively evaluated (for
reviews see Topping & Barron, 2009; Walsh et al., 2015), the bulk of which
support the conclusion that children learn many of the core CSA prevention
concepts. These evaluations typically use two complementary types of standar-
dized measures: Knowledge/attitude scales such as the CKAQ-33 (Tutty, 1995)
or the Personal Safety Questionnaire (Wurtele et al., 1986) and vignettes tests
such as the “What If” Situations Test (Wurtele, Hughes, & Owens, 1998).
Knowledge scales often include shorter vignette-like items such as “If you fell
off your bike and hurt your private parts, it would be OK for a doctor or nurse
to look under your clothes;” or “If you’re walking down the street with your
mother and she starts talking to a neighbour you have not met before, it’s OK to
talk with them too.” – both from the CKAQ-33 (Tutty, 1995).
A comparison of knowledge/attitude measures for elementary school chil-
dren is presented in Table 1. In three instances, the scale items were not
published (Binder & McNeil, 1987; Fryer, Kerns Kraiser, & Miyoshi, 1987;
Hazzard, Webb, Kleemeier, Angert, & Pohl, 1991) so, while these are men-
tioned, it is not possible to comment about them extensively. Excluded from
Table 1 were publications in which the measure is so specific to a particular
program (i.e. Wood and Archbold (2015) regarding Red Flag Green Flag
People) that it would not be easily applicable for evaluations of other
prevention education efforts. Notably, relatively few measures specific to
elementary school-aged children have been published. Most are short
(10–13 items), with only the Kraizer’s (1986) 18-item Knowledge Scale,
Dake, Price, and Murnan (2003) 16-item, Hazzard et al.’s (1991) unpublished
25-item scale and the CKAQ-33 (Tutty, 1995) being longer.

The Children’s Knowledge of Abuse Questionnaire (CKAQ)

The original 40-item Children’s Knowledge of Abuse Questionnaire (CKAQ-
40) was developed to assess the knowledge levels of abuse prevention con-
cepts for elementary school-aged children in grades one through six (Tutty,
1995). It was designed as a non-program specific measure, so that it could be
used by programs other than “Touching,” the program evaluated in the
original study (Tutty, 1992). The measure starts with a brief introduction
to the concepts of good, bad and confusing touches so that children who may
not have had any information about child sexual abuse prevention concepts
can understand the premise of the CKAQ items. Generally, while children
are provided with a paper copy of the measure that they answer themselves,
Table 1. Measures of child sexual abuse knowledge for elementary school-aged children in published studies.
Citation of
Measure Measure Information & Psychometrics Evaluations Using the Measure Comments
Children’s Knowledge of Tutty (1995) Grades K-6: 33 items: T-F responses; CKAQ-33: Casper, 1999; Dunn, 2011; Gangos et al., Good psychometrics for
Abuse Questionnaire 24-item Inappropriate Touch 2018; Hayward & Pehrsson, 2000; Holloway & Polido, Inappropriate Touch subscale.
Revised (CKAQ-33) subscale: alpha = .84; 1 month test- 2018; Oldfield et al., 1996; Pulido et al., 2015; Tutty, Not as strong for Appropriate
retest = .89; 1997. Touch subscale.
9-item Appropriate Touch subscale 24 item Inappropriate Touch subscale: Daigneault
alpha = .50; 1 month test-retest = .59. et al., 2012
Protective Behaviors Dale et al., 2016 Grade 1. 12 items; alpha = .55; test- White et al., 2018; Dale et al., 2016 Relatively low alpha
Questionnaire (ProB) retest .77 (no time specified).
Personal Safety Saslawsky & Grades: K-6. 13 items; KR-20 = .78; Wurtele, Kast, & Melzer, 1992; Wurtele et al., 1986; Used for preschool-aged
Questionnaire (PSQ) Wurtele, 1986 1 week test-retest = .64. Preschool to Hébert et al., 2001; (Lee & Tang, 1998) through Gr. 6. Later articles
4 item version: Kenny et al., 2012; Tunc et al., 2018; using 4-item version.
Zhang et al., 2014
Knowledge About Abuse Ko & Cosden, Highschool: 10 items; T-F responses Ko & Cosden, 2001 No psychometrics
and Abuse Prevention 2001
Children’s Safety Kraizer, 1986. Ages 7–10. 18 items; various Likert MacIntyre & Carr, 1999 Most items specific to private
Knowledge and Skills Items cited in scales; alpha = .79; parts and sexual abuse by
Questionnaire MacIntyre & strangers.
Carr, 1999
Knowledge of Sexual Abuse Jin et al., 2016 Grades 1–5. 10 items; T-NT; Jin et al., 2016 Chinese originally. Not used in
Prevention alpha = .66: N.A. studies
Knowledge Questionnaire (Dake et al., Grade 3: 26 items – 16 about CSA
2003) knowledge. alpha = .64
Knowledge Questionnaire (Wolfe, Grade 3: 7 items. No psychometrics. 5 of 7 items
MacPherson, discriminated between
Blount, & Wolfe, treatment & control conditions
1986)
Measures with No Published Items
Children’s Knowledge Binder & McNeil, K to Gr. 6; 13 items; 5 point Likert Binder & McNeil, 1987 Items not included
Questionnaire 1987 scale; alpha = .70
What I Know About Hazzard et al., Grades 3–4: 25 items; Y-N-DK, Hazzard et al., 1991 Items not included
JOURNAL OF CHILD SEXUAL ABUSE

Touching Scale 1991 alpha = .75; 2-wk. test-retest = .77

Children Need to Know (Fryer et al., K to Gr. 2; N = 44: 21-items. No Items not included. Used in
Knowledge/Attitude Test 1987) psychometrics conjuncton with a simulated
5

(CNTKKAT) abduction attempt

6 L. M. TUTTY

the items are read aloud so that younger children or those with any reading
problems are provided verbal versions of the items.
The CKAQ-40 uses a true-false format and has strong psychometric properties:
Kuder-Richardson-20 (a measure of internal consistency version for dichotomous
scales) = .90 with a one-month test-retest r of .76 (Tutty, 1995), both tests
providing strong support for the measure’s reliability. Its construct validity was
assessed by correlating the items with the Personal Safety Questionnaire (PSQ)
(Saslawsky & Wurtele, 1986) with the resulting r of .92, providing strong evidence.
Based on a factor analysis, the original CKAQ-40 was shortened to a 33-item
measure (CKAQ-33) (Tutty, 1995). It was re-conceptualized as two subscales: one
to identify knowledge about “inappropriate touch” and situations that could lead
to sexual abuse and the other labeled as “appropriate touch” to identify miscon-
ceptions or unintended negative consequences from being in a CSA prevention
program. The 24-item Inappropriate Touch Subscale includes items regarding
important beliefs and facts about child sexual abuse, such as “Even someone you
know might try to touch you in ways you don’t like;” and “If someone touches you
in a way you don’t like, you should tell a grown-up you trust.” The nine-item
subscale on Appropriate Touch includes items about the fact that sometimes
doctors may need to see a child’s private parts and that, if lost, it is appropriate to
ask a security guard for help, even if he is a stranger. Notably, while similar to
items in the CKAQ-40, items on the Appropriate Touch subscale were re-written
or expanded to better reflect this variable.
The CKAQ-33 has been used in a number of CSA prevention programs
evaluations or will be in future (e.g. McElearney, Brennan-Wilson, Murphy,
Stephenson, & Bunting, 2018). While most researchers used the 33-item scale
(Casper, 1999; Dunn, 2011; Hayward & Pehrsson, 2000; Holloway & Polido,
2018; Oldfield, Hays, & Megel, 1996; Pulido et al., 2015), some used only the
24-item Inappropriate Touch subscale (Daigneault, Hébert, McDuff, &
Frappier, 2012); others shortened the measure (Czerwinski, Finne, Kolip, &
Alfes, 2018; Müller, Rödera, & Fingerle, 2014), or adapted it with items from
other measures (Baker, Gleason, Naai, Mitchell, & Trecker, 2013; Hébert,
Lavoie, Piché, & Poitras, 2001; Lee, McGee, & Ungar, 2001).
The measure has been translated into different languages including French
(Daigneault et al., 2012; Hébert et al., 2001), German (Czerwinski et al., 2018),
Greek (Gangos, Nega, & Apergi, 2018), Africaans & IsiXhosa from South Africa
(Dunn, 2011), Spanish (De Luna & Hernandez Sampieri, 2005) and Indonesian
(Fitriana, Suryawati, & Zubaidah, 2018). Finally, although not originally
designed for this purpose, the CKAQ-33 has also been used as an outcome
measure for CSA treatment (Liotta, Springer, Misurell, Block-Lerner, &
Brandwein, 2015; Misurell, Springer, & Tryon, 2011; Reeker & Ensing, 1998;
Springer & Misurell, 2010; Springer, Misurell, & Hiller, 2012).
The 24-item Inappropriate Touch subscale of the CKAQ-33, has strong
reliability: Cronbach alpha = .84 (N = 238); 1 month test-retest of .89
 JOURNAL OF CHILD SEXUAL ABUSE 7

(N = 114) but the psychometrics on the 9-item Appropriate Touch subscale

are not as strong: Cronbach alpha = .50 (N = 238); 1 month test-retest of .59
(N = 114) (Tutty, 1997). The length of the CKAQ-33 has been problematic
for some evaluators, especially those wishing to assess multiple outcomes
besides knowledge such as behavioral intentions, anxiety or self-esteem, as
only a few examples. Further, long measures are less desirable for monitoring
program outcomes. The purpose of this paper is to highlight the develop-
ment and psychometric properties of two 10-item measures from the longer
CKAQ-33, one for students in grades one and two and the other for students
from grade three to six.

Method
The “Who Do You Tell?”™ CSA prevention education program (“WDYT?”™)
The “Who Do You Tell?”™ program was first developed 35 years ago in 1983,
and was updated in the early 1990’s by the Calgary Communities Against
Sexual Abuse (CCASA). The program is offered at the request of elementary
school principals. Two trainers offer the program in small groups (15 to 30)
of children from kindergarten to Grade 6. The program is delivered to
children in two sessions of 45 to 60 minutes apiece, on consecutive days.
The program includes teacher training and parents are invited to an intro-
ductory presentation and receive informational handouts. Parental permis-
sion to attend is required, with participation in the program monitoring
included in the school board approved consent forms. The “WDYT?”™
program was evaluated previously (Tutty, 1997, 2000) using the CKAQ-33,
concluding that children who received the programs significantly increased
their knowledge of CSA concepts after having received the program in
comparison with students in the control condition.

Developing the CKAQ-Short measures

The Calgary Communities Against Abuse agency was interested in monitor-
ing the program effectiveness of “WDYT?”™, however, the CKAQ-33 is too
lengthy for outcome monitoring. As such, the author worked with then
“WDYT?”™ program director, Anne-Marie Tocher, to shorten and revise
the CKAQ-33. First, Ms. Tocher identified items that were directly addressed
in the curriculum. Using data from the Tutty (1997) “WDYT?”™ evaluation,
items from the short-list that were deemed the most difficult (i.e. lowest
scores at pretest) were identified. Notably, all items were from the CKAQ-33
Inappropriate Touch subscale.
Damon (1988) suggested subdividing age groups of 6 to 12 into 6 to 7 years
and 8 to 12 years based on differences in moral developmental. For example,
8 L. M. TUTTY

a child’s ability to ignore or to oppose the wishes of an adult, a key CSA

prevention concept, is better developed in the older age-group. Further, as the
response pattern to the CKAQ-33 differed between younger and older children,
two separate 10-item scales were developed with eight common items and two
different final items for the separate grade groups (Grades 1–2 and Grades 3–6).
The results of the monitoring study are presented elsewhere (Tutty, Aubry, &
Vasquez, 2019) concluding that students from all grades made statistically
significant improvements on knowledge after participating in “WDYT?”™,
with increased scores on every item of the two CKAQ-10 short scales.

Research setting
This study took place in the city of Calgary, Alberta, Canada over an 8-year
period (2010–2017). The “WDYT?”™ program was presented in 50 elemen-
tary schools. Program staff administered the CKAQ-10 measures immedi-
ately before the program and shortly after the second session, but only the
pretest scores were used in the current study.

Data analysis
Psychometric tests were conducted on the pretest scores of the two scales as
suggested by DeVellis (1991). Internal consistency is measured by the coeffi-
cient alpha (Cronbach alpha) for the total scores. Corrected item-total scale
correlations (correlating each item with the total score when that particular
item is removed) provide information about the extent to which the scale
items are related; high correlations are important in measures assessing
a single construct (DeVellis, 1991. Finally, principle component factor ana-
lyses were conducted on the pretest scores of the two scales. In test con-
struction or validation, a factor analysis is used to identify whether the items
represent one or several underlying variables (Field, 2009). A principal com-
ponents analysis extracts factors by rank, ordering the items in terms of
highest association with the construct being measured (called factor load-
ings). Field (2009) suggests that items with factor loadings of .40 indicate
a significant fit with the construct.

Results
As can be seen in Table 2, a total of 7646 elementary school students
completed pretests using the new measures.
In the CKAQ-10-Gr 1-2, notably, the number of Grade 1 students was small,
with the majority of the CKAQ-10-Gr 1-2 measure answered by Grade 2 students.
The internal consistency (Cronbach alpha) for the CKAQ-10-Gr 1-2 (N = 1241) is
.57. As can be seen in Table 3, all items significantly correlated with the corrected
total score (range of .12 to .33). The Cronbach alphas if the item was removed were
lower but relatively close to the alpha for the total score (.57). Since the resulting
 JOURNAL OF CHILD SEXUAL ABUSE 9

Table 2. CKAQ-10 responses by grade level.

CKAQ-10-short N per grade Percentage of Total Subgroup
CKAQ-10-Gr. 1-2 Grade 1 (n = 16) 1.2%
Grade 2 (n = 1311) 98.8%
Combined Grades 1 & 2 N = 1327 100%
CKAQ-10-Gr. 3-6 Grade 3 (n = 1699) 26.9%
Grade 4 (n = 1617) 25.6%
Grade 5 (n = 1514) 24.9%
Grade 6 (n = 1489) 23.6%
Combined Grades 3–6 N = 6319 100%
Total 7646

scale would be 9 items instead of ten, this makes sense as coefficient alpha is
sensitive to scale length (DeVellis, 1991).
With respect to the CKAQ-10-Gr 3-6, 6319 students completed the CKAQ-
10-Gr 3-6. The Cronbach alpha for the CKAQ-10-Gr 3-6 (N = 5765) is .70.
In the principle components factor analyses, the first two factors, as
identified by the eigenvalue 1.00 rule and the SCREE test (Field, 2009),
were then rotated using a varimax procedure. On both scales, two major
factors were identified accounting for 21% and 13% of the variance in
CKAQ-10-Gr 1-2 and 28% and 15% for CKAQ-10-Gr 3-6, respectively. All
items loaded on both factors, but Factor 1 had the stronger factor loadings in
both measures. In both scales, one item had a factor loading lower than .40
on Factor 1. In the CKAQ-10-Gr 1-2, item 7 had a factor loading of only
.212, and in the CKAQ-10-Gr 3-6, item 1 had a factor loading of .398, which
is very close to the generally proposed cutoff of .40 (Field, 2009).

Discussion
Although child-focused sexual abuse prevention education programs are less
commonly offered in schools, the need to teach children these concepts is arguably
more important than ever. Children, themselves, have voiced their right to be
taught these ideas (Bustamante et al., 2019; Tutty, 2014). New school-based
programs are being developed and evaluated in North America (e.g. Pulido
et al., 2015) as well as internationally (e.g. Bustamante et al., 2019; White et al.,
2018).
Researchers interested in assessing the knowledge of children receiving such
programs currently have few options with respect to outcome measures.
Evaluators are always looking for short but psychometrically-sound versions of
measures. A case in point is Saslawsky and Wurtele’s Personal Safety
Questionnaire (PSQ) (1986). The most current citations use a 4-item verion rather
than the original 13-items (Kenny, Wurtele, & Alonso, 2012; Tunc et al., 2018;
Zhang et al., 2014) allowing for additional measures such as vignettes to assess
recognizing potentially abusive situtations, and body safety. Nevertheless, one
must be careful to include sufficient numbers of knowledge items to assess the
10 L. M. TUTTY

Table 3. CKAQ-10 item means, corrected item-scale correlations, alpha if item deleted and factor
loadings.
Grades 1–2 (N = 1327) Grades 3–6 (N = 6319)
Corrected α if Corrected α if
Item Item- Item Factor Item Item- Item Factor
Item Mean* Scale r deleted Loading Mean* Scale r deleted Loading
1. You always have to .49 .23 .548 .427 .62 .26 .696 .398
keep secrets.
2. Sometimes it’s OK to .50 .26 .540 .457 .76 .34 .682 .495
say “no” to a grown-up.
3. Even hugs and kisses .39 .28 .535 .461 .63 .40 .672 .563
can turn into not OK
touches if they go on
too long.
4. If a grown-up tells you .28 .33 .523 .565 .63 .42 .668 .583
to do something you
always have to do it.
5. Even someone you like .48 .27 .536 .471 .54 .37 .678 .536
could touch you in
a way that feels bad.
6. You have to let grown- .47 .28 .534 .519 .76 .33 .684 .479
ups touch you whether
you like it or not.
7. If someone touches you .52 .12 .578 .212 .65 .28 .693 .415
in a way that does not
feel good, you should
keep on telling until
someone believes you.
8. Someone you know, .25 .24 .544 .422 .36 .46 .661 .632
even a relative, might
want to touch your
private parts in a way
that feels confusing.
9a. If someone touches .71 .24 .544 .460 N/A NA NA NA
you in a way you don’t
like, it’s your own fault.
10a. If someone touches .60 .28 .534 .496 N/A NA NA NA
you in a way you don’t
like, you should just
keep quiet about it.
9b. Some touches start N/A NA NA NA .51 .37 .676 .542
out feeling good then
turn confusing.
10b. Sometimes someone N/A NA NA NA .51 .38 .676 .550
in your family might
want to touch you in
a way you don’t like.
*Item scores range from 0 (incorrect) to 1 (correct)

developmentally sensitive and complex issues conveyed in CSA prevention edu-

cation programs (Tutty, 2000; Wurtele, 2009).
While the original CKAQ-33 has been used extensively and may be particu-
larly appropriate when assessing the in-depth knowledge of core prevention
concepts included in CSA prevention education programs, a briefer but reliable
and valid version may be preferable for some, especially when knowledge is only
 JOURNAL OF CHILD SEXUAL ABUSE 11

one aspect of a more comprehensive evaluation of a CSA prevention education

program or when monitoring program outcomes. The two short CKAQ-10
measures were created systematically, focused on core concepts taught in the
“WDYT?”™ program, especially those that had previously been shown to be
difficult to learn. Other researchers have used shortened versions of the CKAQ-
33 (Czerwinski et al., 2018; Müller et al., 2014) but this necessitates reanalyzing
the psychometrics of the new scales, as was done in the current article, because
shortened versions may have different reliability or validity (DeVellis, 1991).
The current psychometric assessment of the CKAQ-10-Gr 3-6 provides
general support for its use, with an acceptable internal consistency (Cronbach
alpha of .70) and strong factor loadings for all ten items on one factor. However,
as currently constructed, the CKAQ-10-Gr 1-2 is not as strong psychometrically.
The Cronbach alpha of .57 is lower than desired, although similar to the alpha of
.55 described for the Protective Behaviors Questionnaire (ProB) (Dale et al.,
2016), which was used with Grade 1 students, similar to the current analysis.
Item 7 (If someone touches you in a way that does not feel good, you should
keep on telling until someone believes you.) has a low factor loading (.212) and the
Cronbach alpha of the total scale would improve very slightly from .57 to .578 if
the item were deleted. Notably though, children in grades 1 and 2 significantly
improved their score on this item (from 52% to 82% correct post-program;
N = 1116) in a recent monitoring study using this measure (Tutty et al., 2019).
Nevertheless, although this item conveys one of the key messages of most pre-
vention education programs, it may be too complex for young children in grades 1
and 2 as written. This item was not a problem for the older children in the CKAQ-
10-Gr.3-6 (factor loading of .415 and relatively little impact on the total scale
Cronbach alpha if deleted. The item could be deleted or at the very least, simplified
for use with the younger children. It could be rewritten as “If a touch does not feel
good, keep on telling until someone believes you.”
Another factor that influences the psychometric properties is scale adminis-
tration. As originally constructed and acknowledging their developmental
abilities such as newly developing reading skills (Tutty, 1997), children in the
lowest grades (kindergarten to Grade 2) were administered the CKAQ-33 items
individually. This meant that reading skills were not a factor and the one-on-
one nature of the administration led to good concentration and attention. The
shift to using the CKAQ-10 measures for monitoring purposes precluded
individual administration. However, there may be a way to simplify the
responses on the CKAQ-10-Gr 1-2 so that the children do not respond to
a true-false format, which is conceptually abstract, but responded to symbols (e.
g. thumbs up/thumbs down) representing true/false equivalents.
Additional psychometric assessment of the two short measures is recom-
mended; in particular, test-retest reliability and concurrent validity by correlating
the scores with a similar CSA knowledge measure such as the Personal Safety
Questionnaire (PSQ) (Saslawsky & Wurtele, 1986). With a dearth of available
12 L. M. TUTTY

measures to evaluate child-focused CSA prevention education programs, new

options will likely be of interest, especially as such programs proliferate world-
wide. Nevertheless, researchers must ensure that measure’s content is consistent
within each program so as to be valid. Continued psychometric assessment of
available measures is needed to ensure that they remain relevant as well as valid and
reliable.
A limitation of the current study is that the measures were tested in
a program outcome monitoring study. As mentioned previously, monitoring
occurs after a program has been rigorously evaluated (Bond & Carmola Hauf,
2004), as was the case with “WDYT? ™” (Tutty, 1997). When monitoring, one
typically collects little or no demographic information such as race/ethnicity or
socio-economic background, as two examples that might impact a measure’s
psychometric properties. For example, in Holloway and Pulido’s (2018) study,
children from low-income families had lower CKAQ-33 scores at both baseline
and posttest. Continued research with the two short CKAQ-10 measures is
needed in studies with a broader range of background information.
In conclusion, child-directed CSA prevention education programs remain
necessary, even after almost 50 years of implementation. This unfortunate
fact reminds us of the importance of both evaluating the available programs
and searching for additional venues to alert everyone that child sexual abused
remains prevalent and we need all prevention options, preferably well-
evaluated, to be more widely available for all audiences.

Acknowledgments
Thanks to Danielle Aubry, CEO of Calgary Communities Against Sexual Abuse, for stead-
fastly supporting the “WDYT?”™ program and this research. Thanks also to the “WDYT?”™
educators for engaging young children in learning child sexual abuse education concepts and
collecting the data for this project.

Disclosure of Interest
No conflicts to report

Ethical standards and informed consent

All procedures followed were in accordance with the ethical standards of the responsible
committee on human experimentation [institutional and national] and with the Helsinki
Declaration of 1975, as revised in 2000. Informed consent was obtained from all parents of
students included in the study.”
 JOURNAL OF CHILD SEXUAL ABUSE 13

Notes on contributor
Leslie M. Tutty, Ph.D., is a Professor Emerita with the Faculty of Social Work, University of
Calgary, Calgary, Alberta, Canada.

ORCID
Leslie M. Tutty http://orcid.org/0000-0003-3000-7601

References
Baker, C. K., Gleason, K., Naai, R., Mitchell, J., & Trecker, C. (2013). Increasing knowledge of
sexual abuse: A study with elementary school children in Hawai’i. Research on Social Work
Practice, 23(2), 167–178. doi:10.1177/1049731512468796
Barth, J., Bermetz, L., Heim, E., Trelle, S., & Tonia, T. (2013). The current prevalence of child
sexual abuse worldwide: A systematic review and meta-analysis. International Journal of
Public Health, 58, 469–483. doi:10.1007/s00038-012-0426-1
Binder, R. L., & McNeil, D. E. (1987). Evaluation of a school based sexual abuse prevention
program: Cognitive and emotional effects. Child Abuse & Neglect, 11(497-506. doi:10.1016/
0145-2134(87)90075-5
Bond, L. A., & Carmola Hauf, A. M. (2004). Taking stock and putting stock in primary
prevention: Characteristics of effective programs. The Journal of Primary Prevention, 24(3).
doi:10.1023/%2FB%3AJOPP.0000018051.90165.65
Bustamante, G., Andrade, M. S., Mikesell, C., Cullen, C., Endara, P., Burneo, V., …
Grunauer, M. (2019). “I have the right to feel safe”: Evaluation of a school-based child
sexual abuse prevention program in Ecuador. Child Abuse & Neglect, 91, 31–40.
doi:10.1016/j.chiabu.2019.02.009
Casper, R. (1999). Characteristics of children who experience positive or negative reactions to
a sexual abuse prevention program. Journal of Child Sexual Abuse, 7(4), 97–112.
doi:10.1300/J070v07n04_07
Czerwinski, F., Finne, E., Kolip, P., & Alfes, J. (2018). Effectiveness of a school-based
intervention to prevent child sexual abuse: Evaluation of the German IGEL program.
Child Abuse & Neglect, 86, 109–182. doi:10.1016/j.chiabu.2018.08.023
Daigneault, I., Hébert, M., McDuff, P., & Frappier, J. (2012). Evaluation of a sexual abuse
prevention workshop in a multicultural, impoverished urban area. Journal of Child Sexual
Abuse, 21(5), 521–542. doi:10.1080/10538712.2012.703291
Daigneault, I., Vézina-Gagnona, P., Bourgeois, C., Esposito, T., & Hébert, M. (2017). Physical
and mental health of children with substantiated sexual abuse: Gender comparisons from a
matched-control cohort study. Child Abuse & Neglect, 66, 155–165. doi:10.1016/j.
chiabu.2017.02.038
Dake, J. A., Price, J. H., & Murnan, J. (2003). Evaluation of a child abuse prevention
curriculum for third-grade students: Assessment of knowledge and efficacy expectations.
Journal of School Health, 73(2), 76–82. doi:10.1111/(ISSN)1746-1561
Dale, R., Shanley, D. C., Zimmer-Gembeck, M. J., Lines, K., Pickering, K., & White, C. (2016).
Empowering and protecting children by enhancing knowledge, skills and well-being:
A randomized trial of learn to BE SAFE with Emmy™. Child Abuse & Neglect, 51,
368–378. doi:10.1016/j.chiabu.2015.07.016
14 L. M. TUTTY

Damon, W. (1988). The moral child: Nurturing children’s natural growth. New York, NY: Free
Press.
De Luna, M., & Hernandez Sampieri, R. (2005). Comparativo de instrumentos de evaluacion
para programas de prevencion del abuso sexual infantil en preescolares. Archivos
Hispanoamericanos De Sexologia, 11(1), 73–90.
DeVellis, R. F. (1991). Scale development: Theory and applications. Newbury Park, CA: Sage.
Doyle, J. (2019, Feb. 26). The grimmest of tales: In new HBO Michael Jackson documentary,
leaving neverland, testimony that the star was an abuser. The Globe and Mail. Retrieved
from https://www.theglobeandmail.com/arts/television/article-the-grimmest-of-tales-
testimony-that-michael-jackson-was-an-abuser/
Dunn, M. (2011). The learning of sexual abuse prevention concepts and the reliability of the
CKAQ-RIII in the South African context. Social Work, 47(2), 155–175. doi:10.15270/47-2-133
Faisal, R., & Barron, I. G. (2018). The Roman Catholic church: A centuries old history of
awareness of clerical child sexual abuse (From the first to the 19th century). Journal of
Child Sexual Abuse, 27(7), 778–792. doi:10.1080/10538712.2018.1491916
Field, A. (2009). Discovering statistics using SPSS (3rd ed.). Los Angeles, CA: Sage.
Finkelhor, D. (1984). Child sexual abuse: New research and theory. New York, NY: Free Press.
Finkelhor, D., Asdigian, N., & Dziuba-Leatherman, J. (1995). The effectiveness of victimiza-
tion prevention instruction: An evaluation of children’s responses to actual threats and
assaults. Child Abuse & Neglect, 19(2), 141–153. doi:10.1016/0145-2134(94)00112-8
Finkelhor, D., Vanderminden, J., Turner, H., Shattuc, A., & Hamby, S. (2014). Youth
exposure to violence prevention programs in a national sample. Child Abuse & Neglect,
38, 677–686. doi:10.1016/j.chiabu.2014.01.010
Fitriana, R. N., Suryawati, C., & Zubaidah, Z. (2018). Effect of peer education model on
knowledge and self-efficacy in the prevention of physical sexual violence. Belitung Nursing
Journal, 4(1), 51–57. Retrieved from http://belitungraya.org/BRP/index.php/bnj/
Friend, C. S., & Snyder, S. M. (2017). A response to “The legacy of the witch-hunt narrative”.
Journal of Interpersonal Violence, 32(6), 979–1001. doi:10.1177/0886260516681818
Fryer, G., Kerns Kraiser, S., & Miyoshi, T. (1987). Measuring actual reduction of risk to child abuse:
A new approach. Child Abuse & Neglect, 11, 173–179. doi:10.1016/0145-2134(87)90055-X
Gangos, C. J., Nega, C., & Apergi, F. (2018). Adaptation and psychometric evaluation of the
Children’s Knowledge of Abuse Questionnaire (CKAQ-RIII) in Greek elementary school
children. Journal of Child Sexual Abuse. doi:10.1080/10538712.2018.1538175
Gray, S., & Rarick, S. (2018). Exploring gender and racial/ethnic differences in the effects of
child sexual abuse. Journal of Child Sexual Abuse, 27(5), 570–587. doi:10.1080/
10538712.2018.1484403
Guastaferro, K., Zadzora, K. M., Reader, J. M., Shanley, J., & Noll, J. G. (2019). A
parent-focused child sexual abuse prevention program: Development, acceptability, and
feasibility. Journal of Child and Family Studies, 28, 1862–1877. doi:10.1007/s10826-019-
01410-y
Hayward, K. S., & Pehrsson, D. E. (2000). Interdisciplinary action supporting sexual assault
prevention efforts in rural elementary schools. Journal of Community Health Nursing, 17
(3), 141–150. doi:10.1207/S15327655JCHN1703_02
Hazzard, A., Webb, C., Kleemeier, C., Angert, L., & Pohl, J. (1991). Child sexual abuse
prevention: Evaluation and one-year follow-up. Child Abuse & Neglect, 15, 123–138.
doi:10.1016/0145-2134(91)90097-W
Hébert, M., Lavoie, F., & Parent, N. (2002). An assessment of outcomes following parents’
participation in a child abuse prevention program. Violence and Victims, 17(3), 355–372.
doi:10.1891/vivi.17.3.355.33664
 JOURNAL OF CHILD SEXUAL ABUSE 15

Hébert, M., Lavoie, F., Piché, C., & Poitras, M. (2001). Proximate effects of a child sexual
abuse prevention program in elementary school children. Child Abuse & Neglect, 25,
505–522. doi:10.1016/S0145-2134(01)00223-X
Hillberg, T., Hamilton-Giachritsis, C., & Dixon, L. (2011). Review of meta-analyses on the
association between child sexual abuse and adult mental health difficulties: A systematic
approach. Trauma Violence & Abuse, 12(1), 38–45. doi:10.1177/1524838010386812
Holloway, J. L., & Polido, M. L. (2018). Sexual abuse prevention concept knowledge: Low
income children are learning but still lagging. Journal of Child Sexual Abuse, 27(6),
642–662. doi:10.1080/10538712.2018.1496506
Jin, Y., Chen, J. Q., & Yu, B. (2016). Knowledge and skills of sexual abuse prevention: A study
on school-aged children in Beijing, China. Journal of Child Sexual Abuse, 25(6), 686–696.
doi:10.1080/10538712.2016.1199079
Kemshall, H., & Moulden, H. M. (2017). Communicating about child sexual abuse with the
public: Learning the lessons from public awareness campaigns. Journal of Sexual
Aggression, 23(2), 124–138. doi:10.1080/13552600.2016.1222004
Kenny, M. C., Wurtele, S. K., & Alonso, L. (2012). Evaluation of a personal safety program
with Latino preschoolers. Journal of Child Sexual Abuse, 21(4), 368–385. doi:10.1080/
10538712.2012.675426
Kim, S., & Kang, K. (2017). Effects of the Child sexual abuse prevention education (C-SAPE)
program on South Korean fifth-grade students’ competence in terms of knowledge and
self-protective behaviors. The Journal of School Nursing, 33(2), 123–132. doi:10.1177/
1059840516664182
Ko, S. F., & Cosden, M. A. (2001). Do elementary school-based child abuse prevention
programs work? A highschool follow-up. Psychology in the Schools, 38(1), 57–66.
doi:10.1002/(ISSN)1520-6807
Kraizer, S. K. (1986). Children need to know personal safety program. In M. Nelson & K.
Clark (Eds.), The educator’s guide to preventing child sexual abuse. Santa Cruz, CA:
Network Publications.
Lalor, K., & McElvaney, R. (2010). Child sexual abuse, links to later sexual exploitation/
high-risk sexual behavior, and prevention/treatment programs. Trauma Violence & Abuse,
11(4), 159–177. doi:10.1177/1524838010378299
Lee, D., McGee, A., & Ungar, S. (2001). The effectiveness of a computer-based safety
programme for children with severe learning difficulties. Child Abuse Review, 10(3),
198–209. doi:10.1002/car.692
Lee, Y. K., & Tang, C. S. (1998). Evaluation of a sexual abuse prevention program for female
Chinese adolescents with mild mental retardation. American Journal of Mental
Retardation, 103(2), 105–116. doi:10.1352/0895-8017(1998)103<0105:EOASAP>2.0.CO;2
Letourneau, E. J., Brown, D. S., Fang, X., Hassan, A., & Mercy, J. A. (2018). The economic
burden of child sexual abuse in the United States. Child Abuse & Neglect, 79, 413–432.
doi:10.1016/j.chiabu.2018.02.020
Liotta, L., Springer, C., Misurell, J. R., Block-Lerner, J., & Brandwein, D. (2015). Group
treatment for child sexual abuse: Treatment referral and therapeutic outcomes. Journal of
Child Sexual Abuse, 24(3), 217–237. doi:10.1080/10538712.2015.1006747
MacIntyre, D., & Carr, A. (1999). Evaluation of the effectiveness of the stay safe prevention
programme for child sexual abuse. Child Abuse & Neglect, 23(12), 1307–1325. doi:10.1016/
S0145-2134(99)00092-7
McElearney, A., Brennan-Wilson, A., Murphy, C., Stephenson, P., & Bunting, B. (2018).
Cluster randomised controlled trial of ‘whole school’ child maltreatment prevention
programme in primary schools in Northern Ireland: Study protocol for keeping safe.
BMC Public Health, 18. doi:10.1186/s12889-018-5492-8
16 L. M. TUTTY

McGibbin, G., Humphreys, C., & Hamilton, B. (2017). “Talking about child sexual abuse
would have helped me”: Young people who sexually abused reflect on preventing harmful
sexual behavior. Child Abuse & Neglect, 70, 210–221. doi:10.1016/j.chiabu.2017.06.017
Mendelson, T., & Letourneau, E. J. (2015). Parent-focused prevention of child sexual abuse.
Prevention Science, 16(6), 844–852. doi:10.1007/s11121-015-0553-z
Misurell, J. R., Springer, C., & Tryon, W. W. (2011). Game-based cognitive-behavioral
therapy (GB-CBT) group program for children who have experienced sexual abuse:
A preliminary investigation. Journal of Child Sexual Abuse, 20(1), 14–36. doi:10.1080/
10538712.2011.540000
Müller, A. R., Rödera, M., & Fingerle, M. (2014). Child sexual abuse prevention goes online:
Introducing “cool and safe” and its effects. Computers & Education, 78, 60–65. doi:10.1016/
j.compedu.2014.04.023
Nickerson, A. B., Livingston, J. A., & Kamper-DeMarco, K. (2018). Evaluation of second step
child protection videos: A randomized controlled trial. Child Abuse & Neglect, 76, 10–22.
doi:10.1016/j.chiabu.2017.10.001
Oldfield, D., Hays, B., & Megel, M. E. (1996). Evaluation of the effectiveness of project trust:
An elementary school-based victimization prevention strategy. Child Abuse & Neglect, 20
(9), 821–832. doi:10.1016/0145-2134(96)00070-1
Plummer, C. A. (1999). The history of child sexual abuse prevention: A practitioner’s
perspective. Journal of Child Sexual Abuse, 7(4), 77–95. doi:10.1300/J070v07n04_06
Pulido, M. L. P., Dauber, S., Tully, B. A., Hamilton, P., Smith, M. J., & Freeman, K. (2015).
Knowledge gains following a child sexual abuse prevention program among urban stu-
dents: A cluster-randomized evaluation. American Journal of Public Health, 106(7),
1344–1350. doi:10.2105/AJPH.2015.302594
Reeker, J. A., & Ensing, D. (1998). An evaluation of a group treatment for sexually abused
young children. Journal of Child Sexual Abuse, 7(2), 65–85. doi:10.1300/J070v07n02_04
Rheingold, A. A., Campbell, C., Self-Brown, S., de Arellano, M., Resnick, H., & Kilpatrick, D.
(2007). Prevention of child sexual abuse: Evaluation of a community media campaign.
Child Maltreatment, 12(4), 352–363. doi:10.1177/1077559507305994
Rudolph, J., & Zimmer-Gembeck, M. J. (2018). Reviewing the focus: A summary and critique
of child-focused sexual abuse prevention. Trauma Violence & Abuse, 19, 543–554.
doi:10.1177/1524838016675478
Rush, F. (1981). The best kept secret: Sexual abuse of children. NewYork, NY: McGraw Hill.
Saslawsky, D., & Wurtele, S. (1986). Educating children about sexual abuse: Implications for
paediatric intervention and possible prevention. Journal of Paediatric Psychology, 11(2),
235–245. doi:10.1093/jpepsy/11.2.235
Springer, C., & Misurell, J. R. (2010). Game-based cognitive-behavioral therapy (GB-CBT):
An innovative group treatment program for children who have been sexually abused.
Journal of Child & Adolescent Trauma, 3, 163–180. doi:10.1080/19361521.2010.491506
Springer, C., Misurell, J. R., & Hiller, A. (2012). Game-based cognitive-behavioral therapy
(GB-CBT) group program for children who have experienced sexual abuse: A three-month
follow-up investigation. Journal of Child Sexual Abuse, 21(6), 646–664. doi:10.1080/
10538712.2012.722592
Stoltenborgh, M., van IJzendoorn, M. H., Euser, E. M., & Bakermans-Kranenburg, M. J.
(2011). A global perspective on child sexual abuse: Meta-analysis of prevalence around the
world. Child Maltreatment, 16(2), 79–101. doi:10.1177/1077559511403920
Topping, K. J., & Barron, I. G. (2009). School-based child sexual abuse prevention programs:
A review of effectiveness. Review of Educational Research, 79(1), 431–463. doi:10.3102/
0034654308325582
 JOURNAL OF CHILD SEXUAL ABUSE 17

Tunc, G. C., Gorak, G., Ozyazicioglu, N., Ak, B., Isil, O., & Vural, P. (2018). Preventing child
sexual abuse: Body safety training for young children in Turkey. Journal of Child Sexual
Abuse, 27(4), 347–364. doi:10.1080/10538712.2018.1477001
Tutty, L. M. (1991). Child sexual abuse: A range of prevention options. Journal of Child and
Youth Care. Child Sexual Abuse: Expanding the Research Base on Program and Treatment
Outcomes, 1, 23–41. [Special issue]. B. Thomlison & C. Bagley (Eds.).
Tutty, L. M. (1992). The ability of elementary school children to learn child sexual abuse
prevention concepts. Child Abuse & Neglect, 16(2), 369–384. doi:10.1016/0145-2134(92)
90046-T
Tutty, L. M. (1993). Parent’s perceptions of their child’s knowledge of sexual abuse
prevention concepts. Journal of Child Sexual Abuse, 2(1), 83–104. doi:10.1300/
J070v02n01_06
Tutty, L. M. (1995). The revised Children’s Knowledge of Abuse Questionnaire: Development
of a measure of children’s understanding of sexual abuse prevention concepts. Social Work
Research, 19(2), 112–120. doi:10.1093/swr/19.2.112
Tutty, L. M. (1997). Child sexual abuse prevention programs: Evaluating “Who Do You Tell”.
Child Abuse & Neglect, 21(9), 869–881. doi:10.1016/S0145-2134(97)00048-3
Tutty, L. M. (2000). What children learn from sexual abuse prevention programs: Difficult
concepts and developmental issues. Research on Social Work Practice, 10(3), 275–300.
doi:10.1177/104973150001000301
Tutty, L. M. (2014). Listen to the children: Kids’ impressions of Who Do You TellTM. Journal
of Child Sexual Abuse, 23(1), 17–37. doi:10.1080/10538712.2013.841790
Tutty, L. M., Aubry, D., & Vasquez, L. (2019). The “Who Do You Tell?”™ child sexual abuse
education program: Eight years of monitoring. Journal of Child Sexual Abuse. doi:10.1080/
10538712.2019.1663969
Tutty, L. M., Bradshaw, C., Thurston, W. E., Barlow, A., Marshall, P., Tunstall, L., &
Nixon, K. L. (2005). School based violence prevention programs: Preventing violence against
children and youth (Revised ed.). Retrieved from https://www.academia.edu/1597984/
School_based_violence_prevention_programs_Preventing_violence_against_children_
and_Youth_Revised_Ed._
Walsh, K., Zwi, K., Woolfenden, S., & Shlonsky, A. (2015). School-based education programs
for the prevention of child sexual abuse: A Cochrane systematic review and meta-analysis.
Research on Social Work Practice, 28(1), 1–23. doi:10.1177/1049731515619705
White, C., Shanley, D. C., Zimmer-Gembeck, M. J., Walsh, K., Hawkins, R., Lines, K., &
Webb, H. (2018). Promoting young children’s interpersonal safety knowledge, intentions,
confidence, and protective behavior skills: Outcomes of a randomized controlled trial.
Child Abuse & Neglect, 82, 144–155. doi:10.1016/j.chiabu.2018.05.024
Wolfe, D., MacPherson, T., Blount, R., & Wolfe, V. (1986). Evaluation of a brief intervention
for educating school children in awareness of physical and sexual abuse. Child Abuse &
Neglect, 10, 85–92. doi:10.1016/S0145-2134(97)00095-
Wood, M., & Archbold, C. (2015). Bad touches, getting away, and never keeping secrets:
Assessing student knowledge retention of the “Red Flag Green Flag People” program.
Journal of Interpersonal Violence, 30(17), 2999–3021. doi:10.1177/0886260514554426
Wurtele, S. K. (2009). Preventing sexual abuse of children in the twenty-first century:
Preparing for challenges and opportunities. Journal of Child Sexual Abuse, 18(1), 1–18.
doi:10.1080/10538710802584650
Wurtele, S. K., Hughes, J., & Owens, J. S. (1998). An examination of the reliability of the
“What If” Situations Test: A brief report. Journal of Child Sexual Abuse, 7(1), 41–52.
doi:10.1300/J070v07n01_03
18 L. M. TUTTY

Wurtele, S. K., Kast, L. C., & Melzer, A. M. (1992). Sexual abuse prevention education for
young children: A comparison of teachers and parents as instructors. Child Abuse &
Neglect, 16, 865–876. doi:10.1016/0145-2134(92)90088-9
Wurtele, S. K., & Kenny, M. C. (2010). Partnering with parents to prevent childhood sexual
abuse. Child Abuse Review, 19(2), 130–152. doi:10.1002/car.1112
Wurtele, S. K., Moreno, T., & Kenny, M. C. (2008). Evaluation of a sexual abuse prevention
workshop for parents of young children. Journal of Child & Adolescent Trauma, 1(4),
331–340. doi:10.1080/19361520802505768
Wurtele, S. K., Saslawsky, D. A., Miller, C. L., Marrs, S. R., & Britcher, J. C. (1986). Teaching
personal safety skills for potential prevention of sexual abuse: A comparison of treatments.
Journal of Consulting and Clinical Psychology, 54(2), 688–692. doi:10.1037/0022-
006X.54.5.688
Zeuthen, K., & Hagelskaer, M. (2012). Prevention of child sexual abuse: Analysis and
discussion of the field. Journal of Child Sexual Abuse, 22, 742–760. doi:10.1080/
10538712.2013.811136
Zhang, W., Chen, J., Feng, Y., Li, J., Liu, C., & Zhao, X. (2014). Evaluation of a sexual abuse
prevention education for Chinese preschoolers. Research on Social Work Practice, 24,
428–436. doi:10.1177/1049731513510409