Screening for Sexual Violence Against Children

What it is and how it works

The program, designed and implemented through the Population Council in collaboration with Kenyatta National Hospital (KNH) and two public primary schools, assessed the feasibility of screening children for sexual violence in school and health care settings and linking them with appropriate response services. Trained psychologists administered a screening tool to assess children's experiences of sexual violence from January to April 2017 at the two public schools and KNH, a public hospital in Nairobi. Participants included 456 children aged 10 to 17 in the two schools and 41 in the hospital setting [6]. 

Components of the school-based intervention included:

• Parent dialogues. To gain buy-in, parents of children in grades 6-8 participated in guided sessions with dynamic exercises to stimulate conversations about sexual violence against children, its impact, and barriers to disclosure and service receipt.
• Student sensitization. Psychologists provided information about what constitutes sexual violence and about efforts to make services more available to students during four routine weekly assemblies.
• Health-care provider training. School-based providers learned to administer the child-friendly screening tool and respond to child survivors.
• Sexual violence screening paired with sexual violence service provision. Psychologists administered private sexual violence screening among children who agreed and whose parents gave permission in grades 6-8. Children could disclose verbally, in writing (‘yes’ or ‘no’), or by using dolls to describe their experiences. Children who reported sexual violence received school-based counseling and/or an accompanied referral for comprehensive care, depending on the severity of the case. 

The hospital intervention included:

• Health-care provider training. Casualty (emergency) department providers learned to administer the child-friendly screening tool and respond to child survivors.
• Psychologist-administered sexual violen e screening in the casualty department.
• Immediate counseling by psychologists and accompanied referrals to the hospital-based one-stop center for comprehensive care, depending on the severity of the case.

Evaluation

The intervention was evaluated using a mixed-methods study design. Quantitative data were collected primarily via the screening tool, such as the number of children disclosing experiences of sexual violence, types of sexual violence disclosed, perpetrators, and the number of child survivors interested in receiving help, as well as parent permissions and child assent information. Qualitative data were recorded with field notes during interactions with child survivors and parents, group interviews with providers who supported the intervention, and semi-structured individual interviews with school administrators and teachers [6]. 

The evaluation indicates that the intervention was feasible based on the dimensions of ‘acceptability’ and ‘demand’ among participating adults and children in school and health facility settings [6].

School-based screening:

• There was a high satisfaction with the screening intervention among children, parents, and school personnel. Parents from non-participating schools attended the parent dialogues and requested screening for their schools, while parents in non-participating grades asked that it be offered for all children.
• Parents participating in the dialogues requested counseling because they suspected their children had experienced sexual violence.
• Parents and school personnel expressed interest or intention to use the screening intervention. School staff called to expand the tool to other locations and age groups.  School staff felt the intervention boosted students’ confidence in their academic work and improved their communication with teachers.

In addition:

Hospital-based screening:

• All parents gave permission, and all children agreed to participate in the screening.
• One in ten children indicated they had experienced sexual violence, and all of those received services.
• Hospital staff believed the screening should be expanded to other hospital departments and in the education sector.

Challenges: 

• The study did not gather information from the nearly 2 in 5 caregivers who did not consent for their children to participate. This represents an important group for whom the intervention may not have been acceptable [6].
• Time constraints on school personnel posed modest challenges for implementation [6].
• While most children who reported sexual violence in this study accessed health services, the intervention does not provide information regarding the legal follow-up or court proceedings related to relevant cases [7].

Lessons learned: 

• Teachers believed psychologists or counselors were better suited to conduct the screening intervention, as teachers faced time and capacity constraints [6].
• ‘Father’s Days’, which included a traditional ‘goat-eating’ convening, successfully encouraged men’s participation after the first sessions were attended primarily by women [6].
• Findings suggest that the tool could be adaptable to other contexts and different categories of children, such as unaccompanied children [7].
• More recent findings from the humanitarian context in Uganda demonstrate the model's adaptability to different settings and categories of children, coupled with even stronger indications of feasibility and insights into the intervention's effectiveness [8].