1. There are few academic articles that can shape the policy around child protection policies (Davison et al., 2021).
2. Despite the long history of CSA, society still does not have a final solution and proper prevention mechanism integrated into the policy actions and reforms that could solve the problem (The Economist Intelligence Unit Limited, 2020).
3. Existing prevention mechanisms are not delivered to every child (Tutty et al., 2020).
4. The data of CSA is not coherent and does not provide information below the age of 19, sometimes excludes several target groups and depends mainly on self-reports (Moynihan et al., 2018).
5. Most sexual abuse cases go unreported. Certain types of taboos and shame around the topic impact the chances of reporting (Tyson, 2019; Downing et al., 2021).
6. Reporting is identified as retraumatizing by the victims. The justice system is not trauma-informed (Haskell, & Randall, 2019).

There is an urgent need to explore each topic as mentioned above. Sexual abuse is a widely uninvestigated issue that needs to be addressed, and government should implement the action-based policies that will:

• Collect relevant data by increasing the reporting through (1) supporting campaigns that tackle the social shame (2) support/conduct research targeting specifically CSA, including different states of Canada and demographics of the citizenry (3) implement the preventive programs in schools for increasing the immediate reporting (4) making the reporting and CSA cases transparent in all states.
• Protect children from abuse by introducing forceful preventive strategies into the care system.
• Provide relevant care to victims that will be free of judgment, implementing trauma-informed care in the action plans coordinated by the Ministry of Children and Family Development, Justice Canada and Health Canada and relevant organizations.

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Understanding Child Sexual Abuse in Canadian Context

Child sexual abuse (CSA) is a widely under-recognized crime affecting millions of children worldwide (World Health Organization, 2020). Approximately 120 million girls worldwide under the age of 20 are experiencing forced sexual contact (World Health Organization 2020),

Sexual abuse is defined as an action of using a child or youth for sexual gratification (Government of British Columbia, 2017). Abuse has destructive and long-lasting effects on the victims, causing mental and physical harm, problematic behaviour, chronic diseases, and social-economic problems (Government of British Columbia, 2017). Children are seeking defence and protection, enabling them to reach their full potential as they grow. However, children are brought up in a sexually restrained social context during their lifetime, surrounded by stigmas and tabooed contextual mindsets that affect their perception of sexual behaviour, making them more vulnerable to sexual predators. Often stigmatizing sex and empathizing shame around it results in prolonged hiding, suppression of feelings, and disclosure problems for children who have experienced CSA (Conroy & Cotter, 2017).

This issue has remained unsolved for decades, and the making the heading of the news featuring abuse even in athletic, spiritual, educational and care institutions. In Canada, parents are considered primarily responsible for the child's upbringing and safety (Government of British Columbia, 2017). Nevertheless, family members or close friends/relatives who have the child's trust are often identified as sexual offenders (Statistics Canada, 2017). It is only logical that government and society should implement successful and forceful strategies for creating safe environments, preventing sexual abuse instead of looking aside and tabooing the topic that causes damage to future generations. It is not only a matter of family but a social concern that needs to be addressed. This study will explore CSA in the Canadian context, examine how CSA has been studied, and identify gaps in the system and society, underlining the importance of paying more attention to the issue.

• What is CSA, and what are the long-term effects on an individual and social level?
• What are the successful mechanisms that prevent CSA? 

_{Key Words: Child Sexual Abuse; Child Sexual Victimization; Child Maltreatment. Grooming; Long-term Effect; PTSD; Trauma; Prevention programs; Protecting factors. Child Safety; Government Policy; Protective Services; Lows; Legislations; Child Abuse reporting shame.} 

_{Databases: EBSCOhost (identified journals from APA PsycInfo; Socindex; Academic Search complete; Criminal Justice Database; ERIC), Google Scholar,} 

_{Limitation: 2017-2021; English; British Columbia; Canada; Scholarly (Peer Reviewed) Journals; Relevancy ranked; Search “With” and “And”.}

_{Search Engine: Google Scholar for citation chasing; Google Advance Search for grey literature.}

In total, I have selected 18 papers (see figure 1): twelve Scholarly articles, seven Grey literature. Grey literature consists of statistical analyses from official governmental Institutions, the report from relevant organizations, guidebook, book, and web articles. Out of peer-reviewed scholarly articles, the majority used Meta-Analyses and surveys to understand the attitude towards examining the issue; two used case studies as a primary research tool.

Figure 1

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Long-Term Effects of Child Sexual Abuse 

Early traumas that occur during childhood shape the life of the person. The experience is transmitted from personal to interpersonal level, affecting families, societies, the justice system and social norms (Bodkin et al., 2019). It is critically important to ensure that every child gets an opportunity to be brought up in a healthy, violence-free environment where they can reach their full potential. 

CSA is an unsolved worldwide injustice towards children with long-lasting harmful consequences such as mental health issues, high-risk behaviour, chronic diseases, and social-economic obstacles (world Health Organization 2020; Cotter, 2021). Adverse Childhood Experiences (ECA) are strongly associated with adverse outcomes and increase the risk for future victimization (Cotter, 2021; Downing et al., 2021). The toxic abuse cycle is an obvious pattern in almost every reported case, which increases the chances of repeated assault in a more extended period, chances of imprisonment and relived trauma (Conroy & Cotter 2017; Cotter, 2021; Bodkin, at., al 2019). 

Around 2.4 million Canadians were sexually victimized as children (Conroy & Cotter 2017), and one in five Canadians had experienced physical or sexual abuse before the age of 15 (Cotter, 2021) due to the self-reported surveys. There is an apparent correlation between ACAs such as physical and sexual abuse with Poor Health-Related Quality of Life (HRQoL) (Downing et al., 2021) and mental health issues (Downing et al., 2021; Conroy & Cotter 2017; Cotter, 2021). Victims often suffer from Post-Traumatic Stress Disorder (PTSD), depression, anxiety and have various suicide attempts (Tyson, 2019). Besides the mental harm and harmful narrative (Cotter, 2021), individuals with ECAs are less likely to obtain postsecondary education or education below a bachelor's degree and have an annual household income of less than $20 000 (Joshi et al., in 2021).

Ensuring child safety during covid-19 became especially concerning. Kids Help Phone Canada (2020) has reported an increased number of calls stating abuse, anxiety, and high-stress level in children below 19. The number of children left outside of school during the pandemic reaches approximately 1.5 billion worldwide, leaving them at home unprotected, where government and different institutions do not have access to protect child's rights (World Health Organization, 2020). United Nations' 2020-2030 program guideline underlined the need for immediate action to protect children from abuse and suggested the governments to scale up their efforts and increase the involvement in the buttle against child violence. However, since the beginning of the pandemic, coordinated responses to address child safety and protection in Canada by the government have been limited, and child maltreatment cases have increased (Davison et al., 2021), many abuse cases happen behind closed doors (Lamberik, 2020). In 2020, B.C. police reported over 10,300 sexual violations against children (Canadian Centre for Child Protection Inc, 2014), though approximately 93% of sexual or physical abuse cases during childhood have not been reported to the authorities (Cotter, 2021).

Some of the studies indicate the decline in CSA in Canada since 1990. Nevertheless, the data used during the research is not complete since the data sampling does not include the indigenous communities’ full-time members of the Canadian armed forces and people living in institutions (Ligier et al., 2019), as well as unreported cases.

Victim Characteristics

Few variables can affect the likeliness of sexual assault: female, young, indigenous, single, and LGBTQ+, and those with poor mental health are at higher risk of sexual assault (Conroy & Cotter, 2017). Women are exposed to sexual assault significantly more, whereas men report being exposed more to physical abuse (Joshi et al., 2021; Ligier et al., 2019; Canadian Centre for Child Protection, Inc., 2019). Both women and men with ACEs are more vulnerable and are four times (for women) and two times (for men) more likely to become victims of abuse in adulthood (Cotter, 2021). Problematically for the field, studies regarding CSA uses different age groups providing very little information about children below 18 (Moynihan et al., 2018).

Assault being the most under-reported crime is due to the stigma of sexual victimization (Conroy & Cotter, 2017). There is certain apathy and stigma around the sexual victims. Additionally, street-connected children and youth are often misjudged as criminals, especially when involved in prostitution (Government of B.C. 2017). 

CSA survivors' children are at higher risk of being abused and neglected (Tyson, 2019). Bodkin et., al (2019) indicated a pattern discovering that half of the prisoners were exposed to abuse in childhood, empathizing commonness of sexual abuse with more than 50.4% in women and 21.9% in men (Bodkin, at., al 2019). Both studies (Tyson, 2019 & Bodkin et al., 2019) provide crucial evidence of the cyclical nature of childhood abuse, putting future generations in danger by transiting the traumatic experience.

Disclosure 

Child sexual abuse mainly goes unreported due to widespread prejudice and the abusive culture (Tyson, 2019; Downing et al., 2021). Children find it very difficult to start the healing process, "they have been raised in a culture that accepts and seemingly embraces both rape myths that blame victims and just world ideologies that suggest bad things only happen to bad people" (Tyson, 2019, p. 7). Fear of not being believed or understood can be interpreted as a sign of prolonged disclosures. Additionally, racial differences and age factors affect willingness to disclose (Downing et al., 2021). Social campaigns have an essential role in raising awareness regarding the stigma and shame around sexual abuse; for example, the #MeToo social movement affected many personal cases and reflected juridical conceptions (Tyson, 2019). The movement enabled victims to speak out and improved the quality of data generated through increased reporting (The Economist Intelligence Unit Limited, 2020).

Trauma-informed practices and common prejudices in sexual assault cases influence the reporting and trust. "Dominant rape myth is that women and children are prone to 'lie' about experiences of sexual assault and sexual abuse. These kinds of harmful beliefs and rape myths create a context of suspicion and doubt, making it particularly difficult for victims to report experiences of sexual assault" (Haskell & Randall, 2019, P. 24).   The importance of understanding the general mistreatment and lack of information on the sexual abuse topic takes a critical role in the justice system. Even if the victim decides to go through, the reporting authority's response is not immediate, and the victim might disclose several times before the action is taken (Government of B.C., 2017). 

In the research papers, sexual exploitation is not well defined, often using judgmental languages when describing CSA, even labelling S.A. survivors. (Moynihan et al., 2018). Not many people can identify abuse and provide relevant help (Government of B.C. 2017). Frontline practitioners play a critical role in the CSA survivors healing, and it is critically important to receive nonjudgmental care for all sexual abuse survivors (Moynihan et al., 2018). 

The Justice system lucks the trauma-informed practices that can ease the reporting for children without harming them more.  Even adult victims who choose to report the abuse have identified the process as harmful and retraumatizing, how the government expects children to go through the Justice system without harming them more (Haskell, & Randall, 2019). 

Prevention

In the hope of prevention or early intervention, sexual abuse educational programs were first developed in 1970 (Tutty et al., 2020; Plummer, 1999) and were introduced in the Canadian public health sector in 1980 (Ligier et al., 2019). The program was widely successful and positively affected overall abuse reports (Plummer, 1999). Preventive programs included educational campaigns regarding sexual abuse for parents and introductory courses that improved life skills and informed children regarding sexual abuse in primary schools. Many of the programs are specifically focused on girls (Moynihan et al., 2018). School-based programs are the central strategy to educate children about child sexual abuse, yet many schools do not offer CSA preventive programs due to other programs' time commitment and busy schedules (Tutty et al., 2020). Nonetheless, there is not much information regarding preventive programs that work best and reflect the actual needs of the children (Moynihan et al., 2018).

In General, programs show a positive outcome in decreasing risky behaviours and reporting fewer depression cases in high school (Moynihan et al., 2018).

Conceptual and Methodological Frameworks

If people create it, people can change it.

Canada prides on human right protection, however, lacks evidence-based framework that protects children from abuse and enables them to report trough trauma-informed platforms. The lacked attention to the issue of Child Maltreatment is apparent due to the limited academic resource on CSA (Davison et al., 2021). Only 20 relevant research articles were identified out of a possible 11,824 papers relevant to child sexual abuse, child maltreatment and child protection (Davison et al., 2021). 

Davison et al. (2021) identify the necessity of the peer-reviewed academic evidence-based materials that could potentially be used as a response tool during the COVID-19 pandemic influencing policymaking (Davison et al., 2021). Though the research did not examine the content of the identified articles, it identified the shortage of academic light, indicating child sexual abuse and protection is not properly prioritized. 

CSA is a socially constructed complex problem; avoidance and ignorance of the problem lead to long-term damage on a personal and social scale. Many red flags indicate urgent action needs, though not enough actions-plans. My proposal aims to begin to understand how an issue is being researched and explore trauma-informed services to identify gaps that the different players could fill. From the annotation of the literature review, my approach will follow a similar research design examining how the CSA is studied in Canada and analyzing trauma-informed judicial practices using a qualitative approach studying the case of abuse in the shelters combining it with the theoretical background of socially constructed concepts around sexual victimization. 

Child sexual abuse is an issue on a vast international level, all the way down to municipal level, touching different demographics and creating a toxic cycle. Currently, available data does not represent reality considering the unreported cases. From a psychoanalytical setpoint, sex is taboo; Canadian culture is quite reluctant to talk openly about it, let alone talk about sexual abuse. My proposal aims to clearly define the need for a potential investigation on social norms identifying normative educational campaigns and policy influencing results.  

Research Needs for Policy/ Program Development

The government of Canada lacks an investment in resources to equip institutions and adequately respond to the need, collect necessary data to understand the scope of the problem regarding child sexual abuse (The Economist Intelligence Unit Limited, 2020). Compared to the countries such as the U.K. (86.2), Sweden (74.8), and Australia (72.9), Canada's commitment index is significantly low (64.9) (figure 2). Canada needs to increase the capacity, "including designated national plans, policies and institutions to combat sexual violence against children, efforts to collect data and resources available to support legal professionals" (The Economist Intelligence Unit Limited, 2020, p 19).

Most conducted research examining the CSA is vastly observational or quasi-experimental, which is not focused on legal or policy-level interventions to prevent sexual exploitation and promote healing of the Sexual Exploitation survivors (Moynihan et al., 2018). In Canada, the misconduct disciplinary decisions are publicly available by only two provinces (B.C. Ontario), raising the remaining provinces' transparency issue regarding the CSA reporting system (Canadian Centre for Child Protection Inc., 2019). B.C has one of the highest rates of CSA (Canadian Centre for Child Protection Inc., 2019), keeping in mind that most provinces do not report the result is not surprising.  

There is an obvious need for collaboration between the policymakers and researchers modifying criminal justice system involvement in exposing childhood abuse, structuring an issue, and minimizing the likeliness of imprisonment by introducing trauma-informed services by authorities (Bodkin, at., al 2019). 

Ministry of Children and Family Development, Justice Canada and Health Canada are the three central governmental institutions that should create a care structure in coordination with service-providing NGOs working on a multi-disciplinary level. It is highly advisable to create a coalition that will directly target improving the quality-life of children and youth in Canada by providing prevention mechanisms on several levels. My research proposal will shed light on the issue in the Canadian context and provide recommendations towards the necessary policy reforms and research discourses that will uncover previously hidden instances of sexual violence against children, facilitate the implementation of preventive strategies and trauma-informed care. 

Next Steps

CSA cases have been troubling society for centuries. Despite the fact, society is constantly aware of CSA cases, not many things have changed, and surely the problem remains the same endangering future generations and healthy community development. 

I have worked with street-connected children and youth for almost four years. I have seen the drastic effect of adverse life experiences on the bright, intelligent children and youth victims of violence. One of the best ways to protect children from adverse experiences is by providing life skills necessary for independent living, incorporated in the preventive programs. I am a trainer of one of the preventive programs - Protective Behaviours, which is mostly implemented in south Africa SOS kindergarteners and know from the experience that the results are excellent. Throughout the TOT trainings, I have seen many cases when caregivers are not aware of what they need to teach children; they themselves do not know the difference between safe and unsafe risks. I am also part of the working group in Georgia, where the government adopts the Protective Behaviour syllabus and inputs it into the national agenda, which from my perspective should be the case for all countries. Empowering children and youth and making timely interventions must be a priority for the government worldwide, especially when it does not require much effort and the outcome is the safety of our future generation.

The immediate action plan is necessary for the evidence-informed policy processes. The government is advised to:

• Collect relevant data by increasing the reporting through (1) supporting campaigns that tackle the social shame (2) support/conduct research targeting specifically CSA, including different states of Canada and demographics of the citizenry (3) implement the preventive programs in schools for increasing the immediate reporting (4) making the reporting and CSA cases transparent in all states.
• Protect children from abuse by introducing forceful preventive strategies into the care system.
• Provide relevant care to victims that will be free of judgment, implementing trauma-informed care in the action plans coordinated by the Ministry of Children and Family Development, Justice Canada and Health Canada and relevant organizations.

Citizenry needs to demand an adequate response from the government, providing a safe environment for children free from sexual violence through policy reforms and new social paradigms. Until then, the issue will continue to make headlines and build a constant need for reform, reminding us that it is happening even when we do not see it.

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References 

• Akinlotan, R., & Thornhill, C. W. (2021). The impact of childhood sexual abuse and adverse childhood experiences on adult health related quality of life. Child Abuse & Neglect, 120, N.PAG. 10.1016/j.chiabu.2021.105181
• Bodkin, C., Pivnick, L., Bondy, S. J., Ziegler, C., Martin, R. E., Jernigan, C., et al. (2019). History of childhood abuse in populations incarcerated in Canada: A systematic review and meta-analysis. American Journal of Public Health, 109(3), e1–e11.
• Canadian Centre for Child Protection Inc. (2019). The Prevalence of Sexual Abuse by K-12 School Personnel in Canada, 1997-2017. Journal of Child Sexual Abuse, 28(1), 46-66. 10.1080/10538712.2018.1477218
• Conroy, S., & Cotter, A. (2017). Self-reported sexual assault in Canada, 2014 [Juristat]. Canadian Centre for Justice Statistics. https://www150.statcan.gc.ca/n1/pub/85-002-x/2017001/ article/14842-eng.pdf 
• Cotter A. (2021). Criminal Victimization in Canada, 2019. Juristat. Statistics Canada Catalogue no. 85‑002‑X.
• Davison C. M., Thanabalasingam S. J., Purkey E. M., & Bayoumi I. (2021). Child maltreatment and Public Health: Do Gaps in Response during the COVID-19 Pandemic Highlight Jurisdictional Complexities? International Journal of Environmental Research and Public Health. 18(13):6851. https://doi.org/10.3390/ijerph18136851
• Government of British Columbia. (2017). The B.C. Handbook for Action on Child Abuse and Neglect. Province of British Columbia. https://www2.gov.bc.ca/assets/gov/public-safety-and-emergency-services/public-safety/protecting-children/childabusepreventionhandbook_serviceprovider.pdf
• Haskell, L., & Randall, M. (2019). The impact of trauma on adult sexual assault victims. Justice Canada.
• Joshi, D. Raina, P., Tonmyr, P., MacMillan, HL., Gonzalez, A. (2021). Prevalence of adverse childhood experiences among individuals aged 45 to 85 years: a cross-sectional analysis of the Canadian Longitudinal Study on Aging. CMAJ Open, 9 p. e158-e166
• Kids Help Phone. (2021). Get insights. https://kidshelpphone.ca/get-insights/home/#tour.
• Lamberink, L. (2020). Child abuse reporting has 'gone quiet' and that's troubling for this Ontario pediatrician. CBC News. https://www.cbc.ca/news/canada/london/child-abuse-reporting-ward-1.5537747
• Ligier F., Giguère CÉ., Seguin M., Lesage A. (2019) Survey evidence of the decline in child abuse in younger Canadian cohorts. European Journal of Pediatrics. 178,1423–32.
• Moynihan, M., Pitcher, C., & Saewyc, E. (2018). Interventions that foster healing among sexually exploited children and adolescents: A systematic review. Journal of Child Sexual Abuse, 27(4), 403–423. https://doi.org/10.1080/10538712.2018.1477220.
• 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
• The Economist Intelligence Unit Limited (2020). Out of the shadows: Shining light on the response to child sexual abuse and exploitation. 
• Tutty, M. L., Aubry D., Velasquez, L. (2019) The “who do you tell?” child sexual abuse education program: Eight years of monitoring.  Journal of Child Sexual Abuse, 29 (1) p. 2-21
• Tyson, V. (2019). Understanding the personal impact of sexual violence and assault. Journal of Women, Politics & Policy, 40(1), 174-183.
• Wallis, R. D. C., Woodworth D. M., (2020). Child sexual abuse: An examination of individual and abuse characteristics that may impact delays of disclosure. Child Abuse and Neglect, 107, 104604, doi: 10.1016/j.chiabu.2020.104604
• World Health Organization. (2020). Global status report on preventing violence against children 2020. https://www.unicef.org/media/70731/file/Global-statusreport-on-preventing-violence-against-children-2020.pdf