SUPPORTED BY
OUT OF THE SHADOWS:
INTO THE SPOTLIGHT
FINDINGS FROM THE SECOND
ITERATION OF THE UNITED STATES
OUT OF THE SHADOWS INDEX
Contents
3 About the report
5 Executive summary
11 Enhancing the Out of the Shadows Index
14 A nation without a holistic approach
21 A spotlight on prevention
33 Building stronger response systems
49 Forming a more perfect union
51 References
© The Economist Group 2024
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About the report
This report is based on the findings of the second
iteration of the United States Out of the Shadows
Index, developed by Economist Impact and
supported by World Childhood Foundation USA.
This research and analysis stem from the
principle that all children
should have the
fundamental right to live a life free of violence.
Yet, the abuse of children, including sexual
exploitation and abuse, persists on a daily basis
across the United States (US). In alone,
child protective services agencies reported
an alarming , cases—or a new case
every nine minutes—of child sexual abuse.
The United States Out of the Shadows Index
was developed to evaluate state-level eorts to
prevent, respond to, and ultimately eradicate
sexual violence against children. The pilot index
was published in and examined states.
The second iteration of the index incorporates
an additional states into this assessment.
This report highlights findings from the
-state edition of the index. It considers
both state-level action and national trends,
highlighting where progress has been achieved
and where reforms are needed to safeguard
our most vulnerable members of society.
While the Out of the Shadows Index was
developed and produced by Economist Impact,
we would like to extend our thanks to the experts,
advocates and practitioners consulted for their
insights and advice throughout the project.
Special thanks to Janet O’Connell, Mary Pulido,
and Carla Davis (World Childhood Foundation
USA) for their support throughout the project.
The index was constructed by an
Economist Impact project team
including: Katherine Stewart, project
director; Laura Avery, project manager;
Roshni Saleem Chagan, analyst;
and Eve Labalme, consultant.
Research for the index was conducted
by Anjum Zahoor, Azania Patel, Eamon
Kircher-Allen, Edward Dehnert, Ian
Walshe, Michael Paterra, Arunima
Shrestha, Stefano Spalveieri and
Valerie Zabriski. The index model was
constructed by William Shallcross.
For any inquiries please contact:
Katherine Stewart
katherinestewart@economist.com
Laura Avery
lauraavery@economist.com
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Expert interviews (in alphabetical
order by name):
• Christine Soyong Harley, President
& Chief Executive Ocer, SIECUS:
Sex Ed for Social Change
• Daniela Ligiero, Executive Director & Chief
Executive Ocer, Together for Girls
• Denise Edwards, Director of Government
Aairs, National Children’s Alliance
• Elizabeth Letourneau, Director,
Moore Center for the Prevention
of Child Sexual Abuse
• Melissa Stroebel, Vice President of
Research & Insights, THORN
• Nina Agrawal, Child Abuse Pediatrician
• Teresa Huizar, Chief Executive Ocer,
National Children’s Alliance
• Victor Vieth, Chief Program Ocer,
Education and Research, Zero Abuse Project
• Zach Hiner, Executive Director, Survivors
Network of those Abused by Priests (SNAP)
Children’s Advocacy Center interviews
(in alphabetical order by state):
• Mari Mukai, Chapter Director,
Alaska Children’s Alliance
• Holly Fleming, Program Director, Children’s
Advocacy Centers of California
• Ashley Jellison, Executive Director,
Colorado Children’s Alliance
• Krystal Rich, Executive Director,
Connecticut Children’s Alliance
• Luzed L. Cruz, Executive Director, Florida
Network of Children’s Advocacy Centers
• Jim Jolley, Statewide Programs &
Training Coordinator, Florida Network
of Children’s Advocacy Centers
• Kim Mangiaracino, Executive Director,
Children’s Advocacy Centers of Illinois
• Tamra Jurgemeyer, Executive Director, Iowa
Chapter of Children’s Advocacy Centers
• Winn Stephens, Executive Director,
Children’s Advocacy Center of
the Bluegrass (Kentucky)
• Alexandria Taylor, Executive Director, New
Mexico Coalition of Sexual Assault Programs
• Jess Clark, Director of Sexual Violence
Prevention, New Mexico Coalition
of Sexual Assault Programs
• Deana Joy, Executive Director, Children’s
Advocacy Centers of North Carolina
• Greg Kasowski, Executive Director,
Children’s Advocacy Centers of North Dakota
• Danielle Vandergri, Chief Executive
Ocer & Executive Director, Ohio
Network of Children’s Advocacy Centers
• Celeste Prince, Director of Statewide
Programming, Ohio Network of
Children’s Advocacy Centers
• Carrie Little, Executive Director, Children’s
Advocacy Centers of Oklahoma
• Abbie Newman, RN, JD, Chief Executive
Ocer, External and Global Aairs, Mission
Kids Child Advocacy Center (Pennsylvania)
• Chris Kirchner, MSW, Executive Director,
Children’s Advocacy Centers of Pennsylvania
• Kimberly Marcantonio, Manager of
Commercial Sexual Exploitation of
Children Programming, Children’s
Advocacy Centers of Pennsylvania
• Tracey L. Tabet, Director, Utah
Children’s Justice Center Program
• Paula Reed, Executive Director, Children’s
Advocacy Centers of Washington
Economist Impact bears sole responsibility
for the content of this report. The findings and
views expressed do not necessarily reflect
those of the sponsors, the experts, or others
who kindly gave their time to advise us.
© The Economist Group 2024
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Executive summary
Over the past decade, a series of high-profile
cases have increasingly brought child sexual
exploitation and abuse (CSEA) out of the shadows.
These include the arrest of Jerey Epstein, and
the subsequent conviction of Ghislaine Maxwell
for sex tracking of minors in ,
as well as
a report from the Illinois attorney general
revealing that almost , children were
subjected to sexual abuse by over members
of the Catholic clergy over seven decades.
Despite the public outcry from such cases,
this insidious form of violence persists in great
numbers. The Centers for Disease Control and
Prevention (CDC) reports that approximately
one in four girls and one in boys in the
US will experience sexual abuse during
childhood,
while the National Association
of Adult Survivors of Child abuse estimates
that there are over million survivors
of
child sexual abuse across the country.
John F. Kennedy, the th president of the US,
remarked, “Children are the world’s most valuable
resource and its best hope for the future.”
Yet,
these figures indicate that the route to adulthood
is marked by violence for far too many children—
the impacts and trauma of which can extend
long into mid- or later-life.
,
The advent of
new technologies and heightened connectivity
also pose novel threats for young people
engaging with online spaces and digital tools.
The individual consequences of CSEA are not
the only cause for alarm: the average lifetime
cost per victim of nonfatal child sexual abuse
was estimated to be $, million in .
In short, child sexual abuse may be costing the
US upward of $. billion dollars a year.
Such numbers present both a social and economic
imperative for swift action from governments. The
good news is that CSEA is preventable: a range
of interventions can help prevent such violence
from occurring in the first place, and minimize its
impacts on survivors and their families when it
does unfold.
The hour has come for collective
action to bolster protection for children and
increase accountability for perpetrators.
“ Child abuse thrives in shadow and in
secret. And if we don’t talk about it,
we can’t figure out how to fix it.”
Holly Fleming, Program Director, Children’s Advocacy Centers of California
© The Economist Group 2024
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What is the United States Out of the Shadows Index?
Economist Impact’s United States Out of the Shadows Index (the index), supported by World
Childhood Foundation USA, was designed to shine a spotlight on state action—and inaction—to
address CSEA. Using over individual metrics aggregated into indicators and four domains, the
index assesses: state legal protections and criminal provisions; investments in prevention capacity
building; the adequacy of support services; and the delivery of survivor-centered justice processes.
The second iteration of the index builds on the findings of the United States Pilot Out of the Shadows
Index, published in , which assessed states against these metrics. The second index encompasses
an additional states, oering a more comprehensive picture of the trends across states.
© The Economist Group 2024
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Figure 1: Grading the response to CSEA
Score <60 (Grade F) Score >60 (Grade D)
ND
KY
NC
FL
AK
OK
NY
PA
OH
IL
IA
MN
CA
WY
UT
CO
NV
NM
TX
WA
LA
MI
WV
VT
CT
MA
DE
MS
Source: Economist Impact
The key findings of the index and analysis include:
13
Holistic action to address CSEA is lacking
across the US. On average, the states
in the index score just out of . If these
scores were equated to academic grades,
just three states—Connecticut, Delaware and
Washington—would achieve above an F grade.
The absence of comprehensive prevention
strategies remains a significant challenge
for almost all states in the index. All
states have gaps in several key areas: no state
has a statewide plan or strategy to prevent
online child sexual abuse and none have
statewide programs to stop individuals who
are having sexual thoughts about children
from acting on them.
Overall, states score an
average of ten points lower on the Prevention
Capacity Building domain than on the next-
lowest scoring domain (Justice Process).
The states in the second iteration of
the index are: Alaska, California, Colorado,
Connecticut, Delaware, Florida, Illinois,
Iowa, Kentucky, Louisiana, Massachusetts,
Michigan, Minnesota, Mississippi,
Nevada, New Mexico, New York, North
Carolina, North Dakota, Ohio, Oklahoma,
Pennsylvania, Texas, Utah, Vermont,
Washington, West Virginia and Wyoming.
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Wealth is not the primary factor driving
state action to address CSEA. Massachusetts
and New York, the states in the index with the
highest GDP per capita, rank st and th,
respectively. Meanwhile, four of the states with
the lowest GDP per capita (below $, per
annum based on data) come in above the
national average, while two of these states—
Vermont and Florida—are ranked in the top ten.
States with more female lawmakers
tend to have stronger CSEA prevention
and response systems. States with a higher
percentage of female lawmakers tend to score
better on the index overall: six of the top ten states
are among those with the highest percentages
of women in their state legislatures. Colorado,
Vermont and Washington—where women
comprise at least % of the state legislature—
rank eighth, seventh and first, respectively.
This 28-state edition of the
United States Out of the Shadows
Index reiterates some of the core
findings of the pilot index:
Young people are not being provided
with the necessary information to make
informed decisions about their sexuality
and reproductive health. Eleven of the 28
states do not require sex education in all public
schools, while just six require that information
on consent be included in relevant courses.
16
Only one state—Washington—requires that
all students in public schools be provided
with sex education that is medically accurate,
evidence-based and culturally responsive,
while six states—Florida, Louisiana, Mississippi,
North Carolina, Oklahoma and Texas—have
sex education requirements that
explicitly
discriminate
against lesbian, gay, bisexual,
transgender and queer (LGBTQ+) individuals.
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Key stakeholders lack training in identifying
and preventing child sexual abuse and
responding in a trauma-informed way.
While 13 states mandate
17
training for
teachers and other school employees on the
identification and prevention of child sexual
abuse, just two—Texas and Vermont—have
a similar mandate for daycare employees.
18
Meanwhile, Washington is the only state that
requires all three of the key response actors—
child protective services investigators, law
enforcement ocers and prosecutors—to
receive regular training on providing a trauma-
informed response to child sexual abuse.
Children’s Advocacy Centers (CACs)
play a vital role in the response to CSEA;
however, funding challenges continue to
impede their operations. CACs are critical in
providing a multidisciplinary and child-centered
response during the treatment, investigation
and prosecution of CSEA. Currently, 24 of the
28 states provide CACs with state funding
support in the form of General Revenue
or Special Revenue. Despite this funding,
directors of CAC member organizations
continue to cite resource constraints as one
of the primary challenges to the provision
of vital services to children and families.
Source: Economist Impact
Figure 2: How prepared are core stakeholders?
Percentage of states with training requirements (%)
Teachers: specialized
training on child
sexual abuse
Employees of key youth-
serving organizations:
specialized training on
child sexual abuse
Child protective
services: training
on providing a
trauma-informed
response
Law enforcement
training: specialized
training on child
sexual abuse
Law enforcement:
training on providing
a trauma-informed
response
Prosecutors: specialized
training on child
sexual abuse
Prosecutors:
training on providing
a trauma-informed
response
Hospitals/emergency
departments:
specialized providers
available
46.4 7.1 7.1 17.9
17.9 10.7 10.7 21.4
The remainder of this report explores
the findings of the second iteration
of the United States Out of the
Shadows Index. It highlights core
areas for prioritization—within and
across states—to help governments,
advocates and practitioners more
eectively identify gaps, develop
solutions and benchmark progress.
Ultimately, this research aims to raise
awareness and catalyze collective
action, with the goal of protecting the
rights of children and ending CSEA.
© The Economist Group 2024
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Prevention Capacity
Building
Rank
State
Score
1 Illinois 60.4
2 Connecticut 56.2
3 Pennsylvania 47.9
4 Texas 47.0
5 Delaware 44.5
6 Washington 44.5
7 Vermont 44.1
8 Utah 41.2
9 Massachusetts 40.8
10 Florida 40.4
11 Colorado 40.0
12 West Virginia 39.9
13 North Carolina 37.5
- AVERAGE 37.2
14 Oklahoma 34.7
15 Iowa 34.4
16 Ohio 34.1
17 Kentucky 34.0
18 North Dakota 33.7
19 Nevada 32.1
20 New Mexico 32.0
21 Louisiana 31.3
22 Minnesota 31.2
23 New York 30.2
24 Alaska 29.3
25 Wyoming 28.6
26 Michigan 26.9
27 California 26.4
28 Mississippi 17.7
Index rankings
Legal Protections and
Criminal Provisions
Rank
State
Score
1 Colorado 75.5
2 Minnesota 73.1
3 Vermont 73.1
4 Florida 71.6
5 Illinois 67.3
6 Texas 65.2
7 Pennsylvania 64.9
8 Connecticut 64.5
9 Nevada 63.4
10 Washington 63.4
11 New York 62.4
12 Louisiana 62.2
13 Ohio 60.9
13 Oklahoma 60.9
- AVERAGE 60.2
15 Delaware 60.0
16 Utah 59.6
17 Alaska 56.9
18 North Dakota 55.3
19 Iowa 55.2
20 West Virginia 54.0
21 Massachusetts 53.3
22 New Mexico 53.0
23 California 52.7
24 Michigan 52.5
25 Kentucky 51.8
26 Mississippi 51.3
27 North Carolina 50.9
28 Wyoming 49.8
Overall
Rank
State
Score
1 Washington 61.5
2 Delaware 59.6
3 Connecticut 59.5
4 Pennsylvania 57.6
5 Illinois 57.0
6 Texas 56.3
7 Vermont 55.4
8 Colorado 54.7
9 Florida 54.5
10 Utah 52.8
11 Nevada 50.6
12 Iowa 49.9
13 Louisiana 49.4
- AVERAGE 48.8
14 Kentucky 48.5
15 Oklahoma 48.2
16 Ohio 45.9
17 New Mexico 45.6
18 New York 45.6
19 West Virginia 45.0
20 California 44.9
21 Massachusetts 44.5
22 Alaska 44.0
23 North Dakota 43.8
24 Minnesota 43.7
25 Michigan 42.7
26 North Carolina 37.5
27 Wyoming 35.1
28 Mississippi 33.8
Provision of
Support Services
Rank
State
Score
1 Washington 70.5
2 Louisiana 64.7
3 Delaware 63.9
4 Florida 61.8
5 New York 60.5
6 Texas 60.4
7 Colorado 60.2
8 Oklahoma 58.9
9 Illinois 58.4
10 Iowa 58.3
11 Connecticut 57.4
12 Pennsylvania 56.9
13 Utah 56.2
14 New Mexico 53.6
15 California 53.3
- AVERAGE 50.9
16 Massachusetts 49.4
17 North Dakota 49.3
18 Michigan 47. 2
19 Vermont 47.1
20 West Virginia 45.8
21 Nevada 45.5
22 Kentucky 43.8
23 Ohio 41.4
24 Mississippi 40.5
25 Alaska 38.0
26 North Carolina 36.0
27 Wyoming 25.3
28 Minnesota 21.3
Justice Process
Rank
State
Score
1 Delaware 7 7. 3
2 Washington 75.3
3 Kentucky 70.3
4 Nevada 64.3
5 Pennsylvania 61.9
6 Connecticut 59.3
7 Iowa 57.0
8 Utah 56.8
9 Vermont 53.9
10 Alaska 52.8
11 Texas 52.6
12 California 52.3
- AVERAGE 47.3
13 Michigan 47.1
14 New Mexico 46.8
15 Ohio 45.8
16 Florida 42.4
17 Louisiana 42.1
18 Minnesota 40.6
19 Colorado 40.0
20 Oklahoma 38.8
21 West Virginia 38.4
22 North Dakota 36.1
23 Illinois 35.2
24 Wyoming 32.7
25 Massachusetts 31.9
26 New York 28.4
27 Mississippi 24.8
28 North Carolina 18.8
Prevention
Response
© The Economist Group 2024
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Enhancing the Out of
the Shadows Index
The United States Pilot Out of the Shadows Index
provided an important opportunity to test the
framework and refine our approach. Following
the launch of the pilot, and in consultation with
a number of experts, several adjustments were
made to the index framework (see Figure ).
These changes aimed to create a more nuanced
assessment of several key issues and to hold
state governments to a higher standard (see
Figure ). Several new measures were also added
to capture state action around online CSEA, in
recognition of the need to address this evolving
threat and provide safe online spaces for children.
Pillar Domain Summary
Prevention
Legal Protections and
Criminal Provisions
The availability of key measures to protect
children and to hold oenders accountable
Prevention Prevention Capacity Building
State investment in policies & programs critical to
preventing CSEA and for addressing its risk factors
Response Provision of Support Services
The availability of trauma-informed and
survivor-centered services for survivors
Response Justice Process
The capacity of the state’s justice system
to provide a child-centered response
Figure 3: The United States Out of the Shadows Index framework
Source: Economist Impact
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Figure 4: Adjusting the framework
Example change made to the 2024 index framework: indicator 3.2.3 (Child forensic interviews)
First iteration
Does the state have a standardized
protocol or guidelines for conducting
forensic interviews in cases of
suspected child sexual abuse?
Second iteration
Does the state require that all forensic
interviews be conducted at a Children’s
Advocacy Center or by a trained
forensic interviewer in suspected cases
of child sexual abuse?
Rationale for change
Uses a higher standard
(eg, law/policy vs
protocols/guidelines) and
adds an assessment of child
forensic interviewer
qualifications.
Source: Economist Impact
This report and findings are based on the revised
framework, against which all states have
been evaluated. These revisions mean that some
of the data gathered and analysis undertaken
during the pilot are no longer reflective of
state performance, although many of the
findings and calls to action remain relevant.
When developing the index, we began by
consulting the broader landscape of policy
research completed on CSEA in the US. This
search revealed several evaluations that
focused on specific issues or forms of violence
against children, such as CHILD USA’s statute
of limitations tracker and Shared Hope
International’s Report Cards on Child & Youth
Sex Tracking. The index, which seeks to provide
a comprehensive picture of state-level action
to address multiple types of sexual violence
perpetuated against children, seeks to build on
these eorts. Therefore, in addition to completing
our own policy research and analysis, we also
integrated the findings from several other
relevant assessments into our evaluation. As
such, the report and index refer to specific forms
of violence (eg, child sexual abuse, child sexual
exploitation) to distinguish between findings and
areas of focus, as appropriate (see Figure ).
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Another critical component of our research
included engaging with the directors of
CACs and National Children’s Alliance (NCA)
State Chapters—state-level membership
organizations supporting the work of CACs
and multidisciplinary teams within its
state borders.
19
CACs play a pivotal role in
coordinating the response to CSEA across the
country (see section 6). As such, interviews
with NCA Chapter Directors and other CAC
leaders were integral to gaining an on-the-
ground perspective and validating our research
findings. Additional interviews were completed
with other key experts and advocates working
across the prevention and response spectrum.
For more information about the research
methodology and adjustments to the index
framework, please refer to the United States
Out of the Shadows Index Methodology Paper.
More details about the pilot index results and
the frontline response to CSEA are discussed
in the Out of the Shadows Index film.
Figure 5: Dening child sexual exploitation and abuse
Source: Economist Impact, ECPAT International & ECPAT Luxembourg
Contact Contact and/or non-contact
Child sexual abuse
(under age of sexual
consent; or the child
is forced or coerced)
• Rape of a child
• Child sexual assault
• Incest
• Sexual touching of a child
• Harmful practices (eg,
female genital mutilation)
• Corruption of children for sexual purposes (eg,
causing a child to witness sexual activities)
• Sexual harassment of a child (eg, physical or verbal)
• Solicitation of children for sexual purposes (eg, grooming)
• Online-facilitated sexual abuse (eg,
online grooming or harassment)
• Child, early and forced marriage
Child sexual
exploitation
(child sexual abuse +
element of exchange,
or benefit to the
child or others)
• Exploitation of children
in or for prostitution
• Child sexual abuse/exploitation materials (eg,
images or videos depicting child sexual abuse)
• Use of children for sexual performances
• Online child sexual exploitation (eg,
live online child sexual abuse)
• Tracking of children for sexual purposes
• Sexual extortion or ‘sextortion’ of children (ie, threatening
to share sexual images of a child to extort favors or money)
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Understanding how the US is combating CSEA
can be complicated: from public education to child
welfare to criminal justice, state governments
take dierent approaches to administering the
systems key to addressing this issue. With the
addition of states to the second iteration of
the index, however, we are able to gain more
understanding of the trends—in terms of both
strengths and weaknesses—across the country.
At the heart of understanding these trends is
an assessment of the extent to which states are
embracing a holistic approach to ending CSEA.
The index is built around a core question: what
does a holistic approach to protecting children
from CSEA look like? The index framework
includes a series of indicators and metrics
designed to comprehensively assess the extent
to which states have developed systems, policies
and programs in line with this approach.
The index clearly shows that the US nationally
is not taking holistic action to address CSEA.
Stated simply, of the states receive an
F grade, while Washington, Connecticut and
Delaware—the top performers—achieve a
D. Several areas of strength are notable, but
overall, the gaps overwhelm the strengths.
And until we close these gaps, children will
continue to be at risk of sexual violence.
It is critical to emphasize that poor state
performance does not reflect the quality of work
that frontline workers and other stakeholders
involved in addressing this issue (eg, CAC
employees, law enforcement, advocates) are
undertaking. The assessment considers a wide
array of policy, structural and environmental
factors and should not be interpreted as a
measurement of any particular actor or group’s
commitment to or success in combating CSEA.
A nation without a
holistic approach
A holistic approach to addressing CSEA
applies a public health lens, recognizing
the broader social-ecological environment
in which violence occurs, and ensures
that systems and interventions prioritize
the needs and interests of the child
to promote healing and justice.
© The Economist Group 2024
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Figure 6: Closing the gap—where the US should be focusing to build a holistic approach
1 2
4 3
Pillar 1:
Employs a public health approach
Recognizes that child sexual abuse is preventable and seeks to address
various factors at the individual, relational, community and societal
levels that can put children at risk of or protect them from violence
Pillar 4:
Adopts review and oversight processes
Implements processes for reviewing and improving
prevention and response systems
Pillar 2:
Empowers youth to make informed decisions and
promotes the autonomy of survivors
Gives young people the right tools for making informed decisions about
health and safety, while protecting the agency of survivors during the
response to abuse
Pillar 3:
Ensures systems are trauma-informed
and child-centered
Prepares and empowers frontline workers and systems
to lead a trauma-informed response that centers on the
short- and long-term needs of the child
States lack comprehensive prevention plans and strategies
• Just four states have a current child sexual abuse prevention plan
• No state has a plan focused on or including the prevention of online child sexual abuse
States are not doing enough to address risk factors for child abuse
and sexual violence
• Just four states have set the minimum age for marriage at 18 without
exception and require applicants to show ocial proof of age in order
to obtain a marriage certificate
• No state in the index has enacted the full range of key laws to protect women’s rights.
Four states have not enacted any of these measures.
20
Responsible adults and community members are not receiving training
and information to help recognize and prevent abuses
• Just two states require employees of key youth-serving
organizations
21
to receive training on preventing and
responding to child sexual abuse, while 15 states lack
similar mandates for educators
• 19 of the 28 states do not have awareness-raising
campaigns to promote community awareness
of child sexual abuse
22
States do not have strong oversight and accountability mechanisms
• 14 of the 28 states lack a child-specific ombudsman or similar oce responsible for
investigating complaints relating to child protection
• 14 of the 28 states have not undertaken information gathering eorts with survivors
regarding the response to sexual abuse
States are not collecting valuable data to help identify the scale of the problem
and the eciency of key systems
• Just one state has published data on arrests, charges and convictions relating to child
sexual abuse oenses
• 24 of the 28 states do not collect data on the prevalence of child sexual abuse
23
• No states collect data on the prevalence of online child sexual abuse
Too many states lack bodies tasked with reviewing existing prevention approaches
• 16 states do not have a task force charged with making policy and other
recommendations to help prevent child sexual abuse. Task forces in just two states
include a survivor representative
Comprehensive sex education is lacking in public schools
• 27 of the 28 states do not mandate comprehensive sex education and HIV/STI
instruction for public school students, including medically accurate, evidence-based
and culturally appropriate content.
• 24 of the 28 states do not mandate online safety education for students that covers
identifying or avoiding sexual abuse online
Children and teens may face barriers when accessing key sexual and reproductive
health services
• Just eight states protect minors’ privacy when testing for or treating STIs by
preventing providers from informing parents/guardians
• 18 out of 28 states do not explicitly allow minors to consent to a sexual assault
medical forensic examination and related medical care in cases of sexual abuse
• 15 of the 28 states do not allow a minor to access abortion
services without parental involvement in cases of sexual
abuse or incest
Frontline responders are not receiving adequate training
• Just one state requires child protective services investigators to receive regular
training on providing a trauma-informed response to child sexual abuse
• Just three states require law enforcement to receive regular training on providing a
trauma-informed response to child sexual abuse
• Just two states require prosecutors to receive regular training on providing a trauma-
informed response to child sexual abuse
Specialization is not a priority
• 22 of the 28 states do not require personnel specialized in the examination of sexual
abuse victims to be employed at hospitals or on call at emergency rooms
• Just five states mandate that forensic interviews be conducted at a CAC or by a
trained specialist in cases of suspected child sexual abuse
Measures for accessing support do not consider victim trauma
• Just two states have eliminated key eligibility restrictions relating to when a victim of
child sexual abuse can access state compensation programs for crime victims
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National-level trends
The relative wealth of states is not a primary
factor driving performance on the index.
While Washington, a high-income state, tops
the ranking, other high-income states
in the
index—including Massachusetts, New York and
California—come in below the national average of
. Conversely, some of the states with the lowest
GDP per capita—Florida, Vermont, Nevada and
Louisiana—have climbed ahead of this average.
Therefore, while the economic climate of
a state can be significant in determining its
ability to invest in key systems like education,
healthcare and social services, along with
more targeted initiatives to tackle CSEA, it
is by no means the exclusive factor driving
progress on this issue. Indeed, interviews
with experts and advocates underscored the
significance of additional considerations—such
as the level of awareness, political will and
relationship building—that can have a profound
impact on the attention, action and resources
devoted to this issue by decision-makers.
Danielle Vandergri, CEO and Executive
Director of Ohio Network of Children’s Advocacy
Centers, says of the awareness-raising work
undertaken by their Network: “No one wants
to talk about child sexual abuse, but it’s there
and that’s a fact…so we have had CACs contact
their local representatives and say, ‘here is who
we are, here is what we do,’ and bring them in
for site visits. They explained how kids come
in and how we start the healing process. It can
be hard, a lot of visits, a lot of education and
a lot of explaining, because it’s a complicated
issue.” These eorts have paid o: Ohio recently
became the latest state to allocate state funds
to CACs, with $ million a year earmarked
for these centers under the new state budget
signed by Ohio’s governor in summer .
“We [the US] don’t fund [programs] that
prevent sexual abuse for children and
we especially don’t fund programs that
provide support for those who were sexually
abused as children. This is a hidden topic
that we don’t talk about right now. ”
Zach Hiner, Executive Director, Survivors Network of those Abused by Priests (SNAP)
Box 1: Getting to the root of it
Some advocates explain that certain issues,
including human tracking, are more likely
to garner attention, while enthusiasm and
resources to address underlying risk factors
and related forms of violence can be harder
to come by. According to Victor Vieth, Chief
Program Ocer of Education and Research
at the Zero Abuse Project, “We currently
address child sexual abuse on the back
end. In the US, it’s easier to get federal or
state funding for tracking or to get youth-
serving organizations and others engaged
in tracking issues. And I think that’s great,
we should be investing as much as we can
in this issue. But, if we really want to stop
tracking in the US, we need to address
abuse in the home. We know that kids that
have been abused in the home, especially
if they’re abused in multiple ways, are the
ones most likely to run away, going online
asking for help, and the most likely to have a
hole in their heart. And that hole is filled by
those who exploit them all over again. So if
we could also invest more in the front, we
could have huge dividends on the back.”
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Women’s political representation may be
another variable helping to elevate attention
and investment to combat CSEA. We found that
the proportion of women in the state legislature
is positively correlated with states’ overall scores.
Six of the ten highest ranking states—Washington,
Connecticut, Illinois, Colorado, Vermont and
Florida—are also among the ten states with the
highest ratio of female to male lawmakers (see
Figure ). And this relationship is even more
robust when looking at the states with strong
legal protections for women’s and LGBTQ+ rights.
Notably, this finding aligns with other research
indicating that female legislators are more likely
than their male counterparts to sponsor bills
related to children and gender equality,
,
and
that countries with more women in parliament
tend to be more likely to pass comprehensive
laws addressing sexual harassment and rape.
Figure 7: Women in high places
Top ten performers overall and in female presence in state legislatures
Washington
Delaware
Connecticut
Pennsylvania
Texas
Vermont
Colorado
Florida
Illinois
Utah
Nevada (62%)
Colorado (49%)
Washington (46%)
Vermont (45%)
New Mexico (44%)
California (42%)
Florida (41%)
Illinois (41%)
Michigan (40%)
Connecticut (38%)
1
2
3
4
5
6
7
8
9
10
1
2
3
4
5
6
7
8
9
10
Overall, by rank Females in government, by rank
Source: Economist Impact & Center for American Women and Politics
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Areas of strengths and weakness
The greatest strides have been made on
the index domain evaluating states’ legal
frameworks for deterrence and protection.
The Legal Protections and Criminal Provision
domain had the highest overall state average
score, and one of the highest individual state
scores across the four domains was also in
this domain (Colorado, with a score of ).
Underlying states’ strong performance in this
area is the widespread enactment of criminal
laws to deter potential oenders and ensure
that those committing sexual harm against
children can be held accountable. For example,
the criminal code in all of the states the index
assesses makes it an oense for an adult to
engage in sexual penetration with a child under
the state’s legal age of consent,
often with
more severe penalties when victims are younger.
Criminal laws targeting those producing or selling
material representing children involved in sexual
activities have also been universally adopted.
A significant number of states ( of the ) have
also passed legislation specifically prohibiting
those in a position of authority or trust—such as
educators, coaches, priests and social workers—
from engaging in sexual activity with children and
adolescents in their care or under their influence.
In most states ( of the ) it is illegal for an adult
in a position of authority or trust to engage in
sexual activity with a minor in their care (ie, with
someone under the age of ), thereby closing
loopholes that might allow such activity if the
minor is above the state’s age of consent (eg,
in some states). This recognizes the inherent
power dierential between authority figures
and young people in many settings, which can
create opportunities for perpetrators to groom
or coerce children, including older teenagers.
Progress has also been made on background
check requirements. Just one state, North
Carolina, does not require background checks
for teachers, while most ( of ) also require
screening for a range of other employees
working in the school environment.
Domain 1:
Legal Protections and
Criminal Provisions
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Box 2: Ending child marriage
Child marriage—a marriage in which one or both of the parties are under the age of —poses
serious risks to children across the US.
Although the actual number of child marriages in the US
is unknown, Unchained at Last, an organization dedicated to ending forced and child marriage in
the US, estimates that nearly , individuals under the age of were legally married in the
US between and . While this includes some children as young as , the majority of these
minors were older teens—primarily - and -year-olds, with most occurring between girls and
adult men who were on average four years older.
The US does not have a federal law banning child marriage, with individual states being responsible
for determining their own requirements. While all states have set a general age—of at least —at
which individuals can get married, exceptions to these laws mean that some children can be legally
married under this age. Exceptions vary between states, but are often based on parental and/or
judicial approval or pregnancy.
While the majority of states have set a minimum age under which exceptions cannot be applied,
five states have no minimum age for marriage. This means that a child of any age could be married
with the required parental or judicial waiver. Meanwhile, seven states—most recently Connecticut
and Michigan in —have passed legislation banning marriage below without exception. Four
of these states—Massachusetts, Michigan, Minnesota and New York—have further strengthened
protections for children by requiring both parties to provide ocial proof of age before they are able
to obtain a marriage license.
Even among older and more mature minors, getting married early can have deleterious impacts on
health, educational attainment and life-long economic prospects.
In addition, minors often have
limited legal rights that can impede their ability to leave a marriage or seek protection in situations of
abuse: minors are unable to file for divorce or obtain a protective order in many states. Marriage can
also legitimize sex between adults and minors that would otherwise be illegal, as statutory rape laws
do not apply in certain states if a couple is married. Unchained at Last reports that approximately
, of the child marriages that have occurred since happened at “an age or spousal age
dierence that should have been considered a sex crime”.
Source: Economist
Impact & CHILD USA
Figure 8: Minimum age for marriage in the US
Minimum age for marrige without exception and proof of age requirements when obtaining a marriage certificate
Washington
Delaware
Connecticut
Pennsylvania
Illinois
Texas
Vermont
Colorado
Florida
Utah
No minimum marriage age
15 or 16 years old
17 or 16 and proof of age required
18 or 17 and proof of age required
18 and proof of age required
5
8
6
4
5
ND
KY
NC
FL
AK
OK
NY
PA
OH
IL
IA
MN
CA
WY
UT
CO
NV
NM
TX
WA
LA
MI
WV
VT
CT
MA
DE
MS
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Most states lack a comprehensive approach to
prevention capacity building. The average state
score on the Prevention Capacity Building domain
is just —ten points lower than the next-lowest
scoring domain, which assesses the Justice Process
(). The Prevention Capacity Building domain
looks at statewide prevention plans and strategies,
organizational policy and practice, community
education and awareness building and training for
adults well-placed to identify and prevent abuse.
Several nationwide policy gaps—with one or no
states implementing these measures to date—
were identified:
• Comprehensive training on child sexual
abuse for employees of youth-serving
organizations beyond schools, including
daycare centers and youth camps, that
is required at regular intervals or shortly
after starting a new role (see Box );
• State plans or strategies on the prevention
of online child sexual abuse;
• Required instruction for public school
students on the safe use of the internet and
technology, including the risks of creating and
sharing self-generated sexual content; and
• The availability of prevention services to stop
individuals who are having sexual thoughts
about children from acting on them.
Box 3: Beyond the basics
A “mandated reporter” is a person required
by law to report any reasonable suspicions
of child abuse, including sexual abuse, to the
relevant authorities. Most states designate
mandated reporters by the professions
likely to be in contact with children, such as
teachers or medical professionals. At least
some mandated reporters are required
to undergo training in just under half (
of ) of the states in the index. Training
often covers the signs and symptoms
of various forms of child maltreatment
and the process of filing a report.
Some states have introduced additional
measures requiring professionals working
in some youth-serving organizations (eg,
schools, daycare centers), as well as key
response actors (eg, law enforcement,
prosecutors), to undergo more specialized
training on child sexual abuse. The standards
for such training go beyond the legal
obligations of reporting, aiming to equip
these individuals with more comprehensive
knowledge and skill to eectively recognize
child sexual abuse, take preventative action,
and react responsibly (see Box ). Texas,
for example, requires all employees and
volunteers at youth camps to complete
a training and examination program on
sexual abuse and child molestation that
includes child molesters’ and sex oenders’
typical patterns of behavior and the
warning signs and symptoms associated
with sexual abuse or child molestation.
Domain 2:
Prevention Capacity
Building
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Eorts to address child sexual abuse have
historically emphasized a criminal justice
approach, alongside the delivery of services to
survivors.
More recently, however, questions
about the ecacy of this strategy have been
raised. Elizabeth Letourneau, Director of the
Moore Center for the Prevention of Child Sexual
Abuse, explains that “about % of sex crimes
are committed by someone without a prior sex
crime conviction.” As such, the impact of criminal
justice policies—which aim to punish oenders
and prevent re-oending among convicted sex
oenders—fails to address a significant proportion
of the issue. “We have got to take a prevention
focus if we’re going to address the great majority
of the problem,” emphasizes Ms. Letourneau.
More conventional strategies—which focus
on responding to violence after it takes
place—retain their importance. However, a
more comprehensive approach also seeks to
identify and address the root causes of violence
to prevent abuse from occurring in the first
place. Moving toward “a prevention focus” has
the potential not only to ensure that more
children are able to enjoy a childhood free of
violence, but also to reduce the enormous costs
associated with child sexual abuse—such as
the incarceration of oenders, the resulting
healthcare burden and lost productivity.
Overall, the second iteration of the index
illustrates that states are falling short when
it comes to investing in comprehensive
prevention strategies and capacity
building. This section explores some of the
key facets of this finding, underscoring areas
for future development as well as potential
solutions and examples of best practice.
A spotlight on prevention
“The United States spends about $5.4 billion
each year to incarcerate people for sex
crimes against children. We spend about
$2 million to support research on the
prevention of child sexual abuse.”
Elizabeth Letourneau, Director of the Moore Center
for the Prevention of Child Sexual Abuse
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Planning to succeed
Prevention planning must be a priority
for states. State-level plans and strategies
targeting child sexual abuse can help clarify
the goals, action steps and evaluative metrics
for prevention eorts across a state.
,
At
present, however, just four states in the index
currently have a plan that includes clear objectives
around child sexual abuse prevention. It should
be noted that a number of states’ plans have
recently expired; it is unclear if the covid-
pandemic impacted eorts to revise or update
these plans. That said, states should take steps
to refocus their eorts on charting a path
forward to prevent sexual violence in all forms.
The development of prevention plans and
strategies can also provide new and important
opportunities for building or strengthening
relationships among key stakeholders, with
potential for helping overcome more siloed
approaches to prevention. The involvement of
various stakeholders in the planning process—
such as government actors, organizations
serving or representing youth and survivors
of sexual abuse themselves—can help enable
buy-in from the relevant parties during the plan’s
implementation and that strategies are better
informed by individuals with lived experience
(see Box ). In particular, public health agencies
have been noted as powerful “conveners,”
bringing coordination, leadership and resources
to sexual violence prevention planning eorts.
Box 4: A public health approach to preventing child sexual abuse
Adopting a public health approach to preventing child sexual abuse necessitates greater action to identify
the broad set of factors that can impact the likelihood of experiencing or perpetrating sexual violence and
to develop and implement evidence-based prevention strategies and solutions (see Figure ).
Child sexual abuse is not an isolated issue. Rather, various individual, relational, community and
societal factors contribute to the complex dynamics surrounding these distressing occurrences.
,
It is common, for example, for victims of child sexual abuse to experience multiple forms of abuse
in childhood, such as physical or emotional abuse and neglect.
,
Certain groups of children are also
known to be more vulnerable: those with a disability are about three times more likely than their
non-disabled peers to experience sexual abuse,
while sexual minority youth are almost four times
more likely to report such experiences.
Other risk factors include victimization of siblings, social
isolation and parental problems (eg, intimate partner violence).
And experiences of sexual abuse
in childhood can also increase one’s risk of experiencing other forms of sexual violence, such as
child sex tracking.
“We talk about diabetes, we talk about obesity, we talk
about so many health problems, we don’t talk about child
abuse. [Child sexual abuse] is a public health issue, just like
anything else, and deserves a public health response. ”
Dr. Nina Agrawal, Child abuse pediatrician
Domain 2:
Prevention Capacity
Building
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On the other hand, access to present and supportive caregivers, a strong social network and
quality healthcare are some of the factors that may help protect against or buer children from
experiencing child abuse.
The risk and protective factors for child abuse and sexual violence
perpetration have been increasingly explored over the last decade.
,
An eective approach to prevention must extend beyond the individual and encompass families,
institutions, communities and broader social and political structures, using evidence-based strategies
and interventions to address a spectrum of risks, protective factors and maltreatment types.
,
Some
of these approaches include: teaching skills to prevent sexual violence; strengthening family financial
security; supporting caregivers and positive parenting; creating protective education and extracurricular
environments; fostering strong coalitions and networks; intervening to mitigate harm and reduce future
risk; and adopting regulations and shaping norms that promote respect and equality.
,,,
Box continued...
Source: Centers for Disease Control and Prevention & Economist Impact
Figure 9: A public health approach to violence prevention
The four steps to a public health approach
Define and monitor the
problem
Gather data exploring how
frequently this type of
violence occurs, where it
occurs, trends and who the
victims and perpetrators are.
Identify risk and
protective factors
Identify the factors that
protect people or put them
at risk of experiencing or
perpetrating violence.
Design and evaluate
prevention strategies
Develop and test prevention
strategies and interventions
to determine their
eectiveness.
Scale up eective
interventions
Widespread adoption and
dissemination of eective
prevention strategies and
interventions.
1 2 3 4
Prevention planning should not only include
specific initiatives to address CSEA, but also
encompass a wider set of practical solutions that
can help foster the conditions for safe, secure
and supportive environments and relationships
for children and their families and communities
(see Box ). Jess Clark, Director of Sexual Violence
Prevention at the New Mexico Coalition of
Sexual Assault Programs, explains, “Child sexual
abuse prevention must start by centering the
experiences of those at the margins and building
protective communities that allow young people
to exist as their fullest selves. We can do this
by organizing to reduce economic insecurity
for all children and families through policies like
paid family leave, expanding the child tax credit,
further investing in early childhood education, and
addressing the growing housing crisis. By shifting
towards focusing on social determinants of health,
we can prevent child sexual abuse” (see Figure ).
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Source: Economist Impact; Georgetown Institute for Women, Peace and Security; Human Rights Campaign & The Prenatal-to-3 Policy Impact Center
*States with policies of non-discrimination for both sexual orientation and gender, covering education, unemployment and housing; individual
measures taken from the Human Rights Campaign’s State Equality Index and included in the index as composite indicator 1.1.4
†Individual measures taken from Georgetown University’s Women’s Peace and Security Index and included in the index as composite indicator 1.1.1
‡ Individual measures taken from The Annie E. Casey Foundation’s KIDS COUNT Data Book and included in the index as composite indicators 2.1.4, 2.6.6, 2.6.7, and 2.6.8
Some states have established a task force on
child sexual abuse prevention. The remit of
these task forces can dier significantly: the Illinois
Make Sexual and Severe Physical Abuse Fully
Extinct (Make S.A.F.E.) Task Force was established
primarily to developed recommendations
applicable to K– schools,
while the North
Dakota Child Sexual Abuse Prevention Task
Force is responsible for implementing a
comprehensive statewide approach to the
prevention of child sexual abuse more broadly.
Many of these task forces have produced related
reports, recommendations, tools or guidance.
For example, the Massachusetts Legislative
Task Force on the Prevention of Child Sexual
Abuse released a report in outlining clear
steps for youth-serving organizations “to build
environments for children and youth that will
help keep them safe from abuse—with a focus on
preventing the sexual abuse and exploitation of
minors.”
Overall, however, the index highlights
that fewer than half of states ( out of the
) have, or have had, a task force devoted to
the prevention of child sexual abuse that has
developed such materials in the last ten years.
Alaska
California
Colorado
Connecticut
Delaware
Florida
Illinois
Iowa
Kentucky
Louisiana
Massachusetts
Michigan
Minnesota
Mississippi
Nevada
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Pennsylvania
Texas
Utah
Vermont
Washington
West Virginia
Wyoming
Non-discrimination
statutory protections*
Mandated parental
leave†
States with a
legislated minimum
wage above the low-
income threshold†
% of children in
poverty‡
12.4 15.8 11.8 12.7 16.8 17.8 16.0 12.5 22.1 26.9 12.6 17.8 10.8 27.7 18.8 23.9 18.5 18.1 10.5 18.6 21.2 16.9 19.6 8.1 10.4 12.0 20.7 13.4
% chil dren with out
health insur ance†
7.9 3.5 4.6 2.4 3.7 7.3 3.2 3.4 4.0 4.0 1.3 3 3.2 6.2 8.6 6.4 2.6 5.5 7.3 5.1 7.4 4.4 11.8 7.9 1.9 3.1 3.3 11.4
% of income-eligible
children with access
to early head start
26.0 10.4 8.1 8.6 8.8 6.2 11.6 9.9 5.9 6.5 7.9 10.8 11.2 9.6 4.8 9.0 7.9 6.5 16.8 6.3 10.9 9.5 4.5 8.2 24.6 10.9 8.6 18.2
% of eligible children
under age 3 served
in evidence-based
home-visiting
programs
8.1 2.9 12.8 10.7 9.5 7.9 10.1 35.1 11.2 3.9 6.7 21.4 11.6 1.2 0.8 5.7 6.6 6.1 8.9 8.6 8.2 10.1 2.2 4.1 11.7 7.2 7.9 13.2
Figure 10: Addressing the social determinants of health
Performance on indicators related to the social determinants of health by state
Yes No
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Changing organizational culture and practice
Educational settings should adopt stronger
measures to promote a culture that is
intolerant of sexual and dating violence
(see Figure ). Professional standards or codes
of conduct/ethics for educators, for example,
can help establish a set of principles for “ethical
best practice, mindfulness, self-reflection, and
decision-making” to promote accountability and
guide healthy interactions between educators
and students.
Three in five ( of ) states
have developed such standards or codes, which
specifically include information on appropriate
boundaries between teachers and students. Utah
has taken this policy a step further, requiring
each local educational agency to provide
regular training to sta on the code of conduct/
appropriate behavior policy.
The adoption of
teen dating violence policies is another action
that can help safeguard children in their place
of learning: nine states in the index currently
require districts to adopt such policies.
Source: Economist Impact & The National Association of State Boards of Education
Figure 11: Creating safe school environments
Percentage of states with key measures promoting safe school environments (%)
Code of ethics for
educators: healthy
student/teacher
boundaries
Student safety
posters in schools
Social-emotional
learning requirements
Required teen dating
violence policy
School employees:
screening of applicants
for sexual misconduct
60.7%
46.4%
46.4%
32.1%
28.6%
Domain 2:
Prevention Capacity
Building
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Teachers and youth-serving organization
employees are not receiving adequate
training to identify abuse. The circumstances
in which child sexual abuse occurs are often
multifaceted and complex and can counter
mainstream narratives. For example, despite the
perception that child sexual abuse is commonly
perpetrated by a stranger, estimates indicate
that more than % of child sexual abuse
victims know and trust their abusers.
Training
educators and other adults regularly engaging
with children and caregivers can give well-
placed individuals the tools to better recognize,
prevent and respond to abuse (see Box ).
Yet, fewer than half the states ( of ) require
teachers to receive comprehensive training on
child sexual abuse awareness and prevention
before they can work with minors or at regular
intervals. Similar training is even less common for
employees of organizations providing educational
or recreational services or activities to youth:
Vermont and Texas are the only states that
mandate such training for employees of daycare
centers, while Texas is the lone state that requires
training on child sexual abuse for all youth camp
employees having direct contact with campers.
Box 5: Getting book-smart
Education and training for adults have the potential to improve individuals’ knowledge about child
maltreatment and drive shifts in child-protective behaviors. Promising interventions include Darkness
to Light’s Stewards of Children® Program, an evidence-informed training program to educate adults
working with children in order to recognize, intervene and react appropriately to child sexual abuse.
Several evaluations of this program have noted positive results: one study conducted with just under
, Texas educators found that in the year following the training, educators increased their reports of
child sexual abuse to authorities by %.
Another notable initiative is Child Advocacy Studies (CAST), facilitated by the Zero Abuse Project and
currently implemented at the undergraduate or graduate level in more than academic institutions
across states.
Developed to enhance the comprehensiveness of training oered at the university
level, CAST strives to improve student readiness for careers in various child-serving professions such as
social services, criminal justice and healthcare. This includes building awareness of the risk and protective
factors of child maltreatment, evidence-based models for responding to cases of child abuse and
prevention strategies. Several studies have highlighted CAST as an eective model for improving the
knowledge and skill of future professionals.
,
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Empowering young people
Comprehensive sex education is not
consistently mandated across the US, despite
endorsements from numerous health, medical and
advocacy organizations.
,
Such education is not
only crucial for ensuring that young people have
the information and tools to navigate their sexual
development and establish safe and respectful
relationships, but it is also eective at promoting
healthy sexual behavior, while reducing rates of
adolescent sexually transmitted infections (STIs),
HIV and pregnancy.
Yet, the index highlights that
sex education is currently not required in school in
more than one in three ( out of ) states, while
six states do not require instruction on HIV/STIs.
When sex education is provided, questions
about rigor often emerge. The characteristics of
a “quality” sexual health education curriculum
are often defined to include evidence-based,
medically accurate and culturally relevant
information on a range of pertinent topics.
,
Despite this, just four states—Colorado, Illinois,
Iowa and Washington—require that if sex
education or HIV/STI instruction is provided,
it must adhere to these standards (see Figure
).
Meanwhile, just ten states mandate that
information on contraception be included
in relevant courses, while just six require
instruction on consent—a concept crucial to
understanding healthy and safe boundaries.
Alaska
California
Colorado
Connecticut
Delaware
Florida
Illinois
Iowa
Kentucky
Louisiana
Massachusetts
Michigan
Minnesota
Mississippi
Nevada
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Pennsylvania
Texas
Utah
Vermont
Washington
West Virginia
Wyoming
State mandated sex
education
State mandated HIV/
STI instruction
Standards for sex education and HIV/STI instruction (if/when provided)
Instruction on
contraception
Instruction on consent
Medically accurate
Evidence-based
Culturally appropriate
LGBTQ+ inclusive
Figure 12: The state of sex education
Performance on indicators related to sex education by state
Yes No
Source: SIECUS & Economist Impact
Domain 2:
Prevention Capacity
Building
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“ Sex education is
foundational to helping
individuals learn how to
navigate relationships
with respect and integrity.
This needs to happen
from a young age to help
kids understand that
they have the right to give
consent to somebody
else touching their body,
but also to withhold
consent to somebody
else touching their body.
This is foundational to…
the way they manage
and navigate consent in
friendships as kids and,
later in life, in sexual and
romantic relationships.”
Christine Soyong Harley, President & CEO,
SIECUS: Sex Ed for Social Change
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Equally concerning is the lack of sex
education inclusiveness. Only five states have
laws or regulatory guidance that specifically
require instruction to be inclusive of LGBTQ+
youth.
Meanwhile, six states—Florida,
Louisiana, Mississippi, North Carolina, Oklahoma
and Texas—explicitly prohibit or restrict the
provision of LGBTQ+ sexual health content.
The majority of states ( of ) have no clear
guidance either way, leaving decisions on sex
education content up to local school boards,
advisory committees or instructors.
These policy gaps raise questions over the
relevance of information on sexuality and sexual
health that may leave some students without
critical knowledge to stay safe and healthy. Indeed,
research from the GLSEN Research Institute
found that LGBTQ students were more likely than
non-LGBTQ students to consider sex education
courses at school “not useful” (% vs. %),
and
significantly more likely to turn to the internet for
health and medical information (% vs. %),
including for information on STIs and HIV.
Meanwhile, the benefits of delivering more
inclusive sex education are increasingly coming
to light.
,
LGBTQ+-inclusive sex education
not only has the potential to reduce school
bullying based on sexual orientation and gender
expression,
but also to help create safer and
more respectful school environments more
broadly. According to Christine Soyong Harley,
President & CEO of SIECUS: Sex Ed for Social
Change, “When you teach young people about the
diversity of human sexuality and experiences, it
creates a safer and more welcoming environment
for all young people to grow up in…what
they’re being taught is that we don’t have to
act the same, look the same or be the same
for courtesy to be extended to one another.”
Box 6: A not-so-heated debate
Although mainstream media have portrayed sex education as a highly
controversial issue across the US, multiple surveys indicate widespread
support among parents for the inclusion of sex education in high school
curricula.
A Planned Parenthood poll, for example, found that 98%
of likely voters in the US supported the provision of sex education to
high school students.
A large majority of parents (%) also support the
inclusion of sexual orientation as part of sex education in high school.
Such
approval begs the question why have lawmakers failed to institute more
stringent requirements around sex education in schools?
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Schools are not giving children the
knowledge and skills to identify and avoid
risky situations, either in person or online.
The number of school-based child sexual abuse
prevention education programs—that aim to
increase young people’s recognition of abuse
and promote disclosure and help-seeking—
have increased dramatically over the past ten
years.
Increased awareness of these programs
and advocacy for their introduction in schools
have often been led by survivors of child sexual
abuse, including Erin Merryn and Jenna Quinn.
Yet, fewer than half of the states ( of the
) provide an explicit mandate—known as
Erin’s Law or Jenna’s Law in many states—for
such instruction in the classroom (see Box
). While it is positive that a majority () of
the remaining states have laws permitting or
encouraging schools to provide such education
to students, children’s access to such instruction
is not guaranteed under these policies.
Box 7: All prevention education was not created equal
Requirements and specifications of school-based child sexual
abuse prevention education dier drastically among the states
that mandate, encourage or permit such instruction. These
dierences include the rules regarding the scientific backing of
the curricula, the age groups targeted and the qualifications of
the instructors (see Figure ). Some states, such as Alaska, have
established task forces or commissions charged with developing
a standard or model curriculum that schools are required or
encouraged to use, while other states grant districts broad
discretion in implementing mandates. To ensure the eectiveness
and consistency of such education for students, states should
standardize content and require it to be rooted in the best
available evidence.
Connecticut is a good example of a state that has developed
comprehensive guidelines to help local education agencies meet
its requirements to provide age-appropriate education on child
sexual abuse and assault awareness and prevention to students
in kindergarten through to th grade.
The Program Guidelines
set out key standards and performance indicators for the dierent
grade levels and cognitive development stages.
Figure 13: Child sexual abuse prevention
education standards
Percentage of states with child sexual abuse prevention education requirements (%)
Required for at least some
public school students
Encourage or permitted
for at least some public
school students
Required, encouraged or
permitted for all K-12
students
42.9% 39.3% 39.3%
State-provided or approved
curricula, guidance or
standards
Evidence-based or
evidence-informed
Age or developmentally
appropriate
42.9% 25.0% 71.4%
Source: Economist Impact
Amending existing laws to
establish a mandate for child
sexual abuse prevention
education in states where
it is currently permitted or
encouraged would ensure
that over 20 million more
school-age children would
receive critical information
on how to stay safe.
90
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The gap is even wider when considering state
mandates for education on online CSEA. Just
four states—Illinois, Louisiana, Nevada and
West Virginia—have a law mandating that
children receive instruction on online safety
that includes information on identifying and
avoiding sexual exploitation or abuse online.
Meanwhile, West Virginia is the only state that
requires education on the risks of creating and
sharing self-generated sexual content. In a world
increasingly dependent on the internet and
digital tools for school, socializing and dating,
it is essential that young people know how to
engage with online spaces in a safe and respectful
way. The risks of failing to address this gap are
further magnified according to recent research
indicating a high level of exposure to sexual
harms online among young people (see Box ).
Box 8: How common is online
child sexual abuse?
National-level surveys expose concerning trends
when it comes to experiences of online child
sexual abuse. A recent study from the American
Psychological Association found that one in
Americans has been a victim of unwanted, non-
consensual sharing of intimate images, with teens
and young women among the most common
victims.
The University of New Hampshire’s
Crimes against Children Research Center recently
reported that % of young adults experienced
online child sexual abuse before the age of .
Dating partners, friends and acquaintances were
the primary perpetrators of this abuse, almost a
third of whom were also under the age of .
Currently, state-level data on the prevalence
of online child sexual abuse is scarce. Several
states have added relevant questions to surveys
administered in public schools, such as the
Healthy Kids Colorado Survey, which asks
whether students have had a sexual image
or video of themselves shared without their
permission. While such eorts are a good first
step, additional action is required to reach young
people in other settings, such as private, charter
and tribal schools, alternative learning systems
and juvenile correction facilities. Developing a
more comprehensive picture of how diverse
populations are exposed to and aected by
online sexual violence is crucial to ensuring that
planning eorts are well-informed and resources
appropriately allocated.
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Why it matters
Child sexual abuse prevention is a comparatively
new item on the agenda for most states and
many stakeholders within states. While some
states, like Illinois, have forged ahead on building
prevention capacity, many have not. Substantial
prevention gaps exist across the country; yet,
without prevention, we will never be able to
ensure that no child has to suer sexual abuse.
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Child sexual abuse is a highly underreported
crime. Survivors often wait long into adulthood
to report their abuse,
while around %
never disclose at all.
,
Victims may hesitate
to report for various reasons, such as the
potential repercussions, fear of not being
believed or conflicting feelings toward their
abuser.
,
And the short- and long-term
impacts of child sexual abuse can include a
range of adverse outcomes throughout an
individual’s lifetime, including a heightened risk
of depression, substance abuse, eating disorders
and revictimization.
,
Some estimates, for
example, have found that female survivors of
child sexual abuse are almost twice as likely to
experience subsequent sexual victimization.
Such research illuminates the various objectives
of response systems, including the accurate
and early identification of abuse, the prompt
removal of children from harmful situations and
the prosecution of oenders. Furthermore, it
underscores the interdependence of prevention
and response eorts. Although “response”
mechanisms are positioned to react to ongoing
or historical cases of abuse, other aims include
the prevention of further or future victimization
and protection against other harmful outcomes
for survivors. As response mechanisms and
actors are often the gateway to other critical
services—such as medical care, counseling
and advocacy—an eective response is not
only key to the delivery of justice, but also to
facilitating a survivor’s healing and recovery.
While states in the second iteration of
the index generally have higher scores
when it comes to response compared with
prevention, significant work remains to
be done. This section covers some of the
key areas where states can improve their
response eorts, as well as some of the
progress that has already been achieved.
Building stronger
response systems
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Forging a multidisciplinary response
States across the US are adopting a
multidisciplinary approach to responding
to CSEA. Coordination and collaboration
between relevant response actors from various
agencies and disciplines can help minimize
the number of times a victim has to relive
their abuse and provide a more streamlined
path toward justice and recovery. In many
states, Children’s Advocacy Centers (CACs)
are at the heart of this engagement.
The CAC model promotes the use of neutral,
child-focused spaces where key responders—
including law enforcement, child protective
services investigators, medical and mental
health professionals, forensic interviewers
and victim advocates—come together under
one roof as a multidisciplinary team (see Box
). Currently, nearly , CACs are operating
in the US and nearly two-thirds of all cases
handled by these centers involve child sexual
abuse, including , investigations of
alleged sexual abuse in alone.
,
We found that more than four in five states
( of ) in the index have enacted legislation
providing a clear definition of CACs, which
can help CAC leaders obtain state funding
and expand service coverage.
In of these
states, this definition is based on or tied to
nationally recognized standards for conducting
investigations with children. In eight states the use
of CACs is required, where available, in response
to suspected cases of child sexual abuse, while
another encourage their use in such cases.
Several states use a related approach, which
requires the formation of county-level
multidisciplinary investigative teams (MDTs).
Kentucky, for example, requires investigations
involving suspected sexual abuse of a child to
be conducted by specialized, county-based
MDTs following local protocols that a special
commission has approved.
These teams may
operate out of an existing CAC, but can also
function as a freestanding MDT. This approach can
help ensure that more children have access to a
multidisciplinary model of care, even in counties
where no CACs currently exist. Drawbacks include
limited access to the more comprehensive set
of services oered by CACs where a MDT is
freestanding. Overall, states require the use
of a multidisciplinary response in cases of child
sexual abuse—either through a CAC or the use
of freestanding MDTs—while % of states
( of the ) encourage such an approach.
“Before there were CACs, when a child made
an allegation of abuse that child would have
to tell the story of what might be the worst
thing that ever happened to them over and
over: the police officers, the lawyers, judge,
a doctor, maybe a therapist. Sometimes
they’d have to tell up to 21 people. With
a CAC, the child only tells one time. ”
Holly Fleming, Program Director, Children’s Advocacy Centers of California
Domain 3:
Provision of
Support Services
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Box 9: In the best interests of the child
CACs were developed to address several systemic challenges in the response
to severe cases of child abuse.
Inadequate coordination between response
systems and actors can result in lost information or evidence; inconsistent
information being given to families; confusion over responsibilities; and
reduced accountability. A more siloed approach can also involve repeated
interviews and inconsistent standards for conducting investigations with
children, which can be retraumatizing for victims.
The CAC model seeks to increase inter-agency coordination and information
sharing to minimize the duplication of eorts and improve outcomes for
children. Moreover, responders are supported with tools to conduct more
trauma-informed and culturally relevant investigations. The provision of
other critical services—such as psychological care and advocacy services—to
support long-term healing for children and their families is also central to the
CAC model.
The broader CAC movement works to improve the quality and
standardization of service delivery. The National Children’s Alliance (NCA) is
a professional membership organization that provides accreditation and site
evaluations to CACs across the US. To become accredited, CACs must meet
ten core benchmarks—such as the forensic interview standard, mental health
standard and case-tracking standard—to help ensure that all children “receive
consistent, evidence-based services that help them heal from abuse”.
Evidence suggests that CACs can improve agency collaboration in practice
and ensure more access to support services for victims.
Other studies have
indicated that the use of CACs may also result in some improved criminal
justice outcomes,
with one study finding that cases referred to a CAC were
significantly more likely to have charges filed (% vs. %) and more counts
charged (. vs. .) compared with cases referred via a more conventional
service pathway.
“Having a multidisciplinary team allows
for greater focus on processes outside of
the criminal legal response to child sexual
abuse, such as intervention and healing.”
Alexandria Taylor, Executive Director, New Mexico
Coalition of Sexual Assault Programs
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CACs are available in many counties
throughout most states; however, service
provision in rural areas remains a challenge.
In more than half ( of ) of states, NCA Member
CACs
cover at least % of the state’s counties,
while three in four states ( of ) meet this
threshold when non-NCA Member CACs are
also considered.
All counties in six states—
Connecticut, Delaware, Iowa, Massachusetts,
North Dakota and Vermont—are covered by
a NCA Member CAC. The largest CAC service
gaps exist in Minnesota and Wyoming, where
children in % and % of counties, respectively,
have access to a NCA Member CAC.
It is important to note that the existence of CACs
does not necessarily guarantee access. NCA
Chapter Directors spoke of various challenges—
especially with regard to reaching more rural
areas—citing barriers such as long driving
distances and the availability of fewer and less
specialized personnel. As Tracey L. Tabet, Director
of the Utah Children’s Justice Center Program,
explains, “In rural Utah, our goal has been to place
centers near each county’s largest population
base. However, if you have only one or two law
enforcement agencies covering a large county,
investigators may still have a long drive to the
center. You really have to make sure partners
[MDT members] are invested in the model to do
that, because it’s in the best interests of the child.”
Figure 14: Accessing a Children’s Advocacy Center
Percentage of counties served by NCA Member CACs (%)
82
72
72
74
14
73
93
49
50
83
84
35
36
76
84
70
41
80
100
100
100
100
100
91
97
89
96
100
Source: National Children’s Alliance
“ Geography can be a major
hurdle. Some families
have to drive 1.5 hours, or
a 3 hours roundtrip, for a
30-minute meeting with
an advocate or an hour-
long interview. This ends
up being the whole work
or school day which can
be discouraging for some
seeking our services.”
Winn Stephens, Executive Director, Children’s
Advocacy Center of the Bluegrass (Kentucky)
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Funding obstacles can result in dicult
decisions for CACs. While the majority of
states ( of the ) provide some state funding
support to CACs in the form of General Revenue
or Special Revenue (see Box and Figure ),
CACs in four states—Alaska, California, Minnesota
and Nevada—do not receive any support from
the state. Yet, even in the states where CACs
are receiving governmental funds, NCA Chapter
Directors consistently cite a lack of resources
as one of the core challenges to the provision of
vital services, particularly in more remote areas.
Funding shortages can put pressure on
CACs, forcing dicult decisions regarding
sta or services and contributing to higher
levels of burnout and turnover. In many
cases, resource constraints also necessitate
a greater amount of time devoted to
fundraising: car washes, bingo nights and
silent auctions were among the activities CAC
sta have employed to generate funds.
“Funding is a critical issue for all CACs
in Colorado. Every year, the programs
have grown to provide more services to
their communities, and we have seen a
steady increase in the number of kids
seen at the centers. Since the pandemic,
the cases coming to our centers are
often more intense and time-consuming,
and our centers must expend more
resources than before on each child. ”
Ashley Jellison, Executive Director, Colorado Children’s Alliance
Box 10: Overcoming funding roadblocks
While CACs often receive funding from a
variety of sources such as donations and grants,
as well as state and federal support, some
streams are more sustainable than others.
The NCA has identified governmental funds
dedicated to CACs—which currently comprise
about one-third of the money flowing to CACs
nationally—as “one of the most stable sources”.
General Revenue funds are subject to
appropriation by the state legislature and
can appear as a specific line item in a state
budget or beneath a larger appropriation for a
department or division. While General Revenue
funds are a valuable source of funding for CACs
in many states, these are discretionary and
can fluctuate from year to year in response
to changing political and market dynamics.
In contrast, Special Revenue funds are
generally viewed as more stable as their
distribution is typically dedicated in law.
Such laws permit the collection of fines or
fees for specific activities, which are then
distributed to CACs. Washington, for example,
imposes a fee upon conviction for possession
of depictions of a minor engaged in sexually
explicit conduct, a percentage of which must
be used for grants to CACs.
Meanwhile,
Mississippi introduced the “Children’s
Advocacy Centers of Mississippi supporter”
license plate, with a portion of the related fees
being distributed to CACs in the state.
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Questions around the continued access to
Victims of Crime Act (VOCA) funds, a crucial
source of funding for many CACs across the
US, were also raised during the course of this
study. Ashley Jellison, Executive Director of
the Colorado Children’s Alliance, asserts that,
“Our main funding source will be cut by roughly
% in the coming years, and our centers are
already asking how they will be able to keep
their doors open. We have worked very hard to
bolster our response to child abuse in Colorado;
our centers are very worried that that progress
will be lost if we do not find additional funds.”
Thus, the responsibility to fund CACs rests
not only with state lawmakers: federal action
is required to ensure that critical services are
available for the thousands of vulnerable children
seen at CACs across the US on a daily basis.
Source: Economist Impact & National Children’s Alliance
Alaska
California
Colorado
Connecticut
Delaware
Florida
Illinois
Iowa
Kentucky
Louisiana
Massachusetts
Michigan
Minnesota
Mississippi
Nevada
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Pennsylvania
Texas
Utah
Vermont
Washington
West Virginia
Wyoming
3.3.3a Children’s
Advocacy Centers
state funding:
general revenue
3.3.3b Children’s
Advocacy Centers
state funding:
special revenue
Figure 15: Funding Children’s Advocacy Centers
Performance on indicators related to state funding for CACs by state
Yes No
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The need for greater specialization
Key response actors lack essential training
across most states. Response actors—such as
police, child protective services investigators and
medical professionals—are often the frontline
defense in cases of child sexual abuse. The
expertise and proficiency of these actors is,
therefore, critical for the timely identification
of abuse, the eective investigation and
prosecution of potential crimes and the referral
to support services. Yet, the demeanor of
and actions taken be these actors during the
initial response, investigation and resulting
proceedings can also be highly triggering for
survivors without the right precautions.
Across key response groups, little progress has
been made on the introduction of statewide
mandates for specialized training (see Box ).
Law enforcement ocers are the most likely to
receive regular training on responding to sexual
abuse: nine states require ocers to receive
such training at defined intervals, of which
five require training specific to child victims.
Among child protective services investigators
and prosecutors, just one and four states,
respectively, mandate similar training.
Even fewer requirements exist for training
on providing a trauma-informed response
to sexual abuse. Washington is the only
state that that requires ongoing, statewide
training on child sexual abuse for all three
response actors considered in the index,
including techniques for recognizing the
nature and consequences of victimization and
minimizing trauma during investigations.
“Specialization is so important in child abuse
[investigations because] children who
have been abused, or children who haven’t
been abused and come in for suspected
abuse, have already been traumatized by
the investigation process… it’s about
working with agencies and educating
them that just because there are no
medical findings doesn’t mean that the
abuse didn’t happen. And doubting that,
disbelieving that child, can re-traumatize
that child. We want to minimize the trauma
of the investigation processes [itself]. ”
Dr. Nina Agrawal, Child abuse pediatrician
Domain 4:
Justice Process
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Medical personnel with specialized training
and expertise are in short supply. Medical
providers play an important role in the collection
of forensic evidence essential for building a
criminal case. Moreover, their assessments help
ensure accurate diagnoses and appropriate
treatments, even in cases where no forensically
significant findings are expected.
And yet,
we found that just six of the states (%)
require personnel trained in the examination of
sexual abuse victims to be on call or employed
at hospitals and emergency rooms or to have
a transfer agreement in place with a nearby
institution in order to provide these services.
It should be noted that CACs, which oer
specialized medical evaluation and treatment
services as part of the multidisciplinary team
response, are available in many communities and,
in some cases, even within hospitals. However,
even when referral pathways to these centers are
in place, NCA Chapter Directors report challenges
in recruiting and maintaining sucient qualified
providers. In fact, there are fewer than board-
certified child abuse pediatricians—the pediatric
subspecialty responsible for diagnosis and
treatment in cases of suspected abuse of infants,
children and adolescents—across the entire US
(see Box ).
Other key providers, such as sexual
assault nurse examiners and other physicians
with specific training in the evaluation of child
victims, are also reported to be in short supply.
The lack of specialized providers can result in long
driving distances and wait times. For example,
the American Board of Pediatrics estimates
the average driving distance to a child abuse
pediatrician in New Mexico to be miles,
and miles in Wyoming.
In recognition of
these barriers, some states have taken steps to
increase or upskill this workforce. One example is
Colorado’s child abuse response and evaluation
network (CARE Network), established to
enhance the standardization of service delivery
in response to suspected child maltreatment.
Supported by the Colorado Department of
Public Health & Environment, the CARE Network
helps train and support a web of designated
providers in completing medical and behavioral
health assessments for children under years
of age in potential cases of sexual abuse.
The availability of qualified mental health
providers is a further challenge, and one that has
been exacerbated by the impacts of covid-.
As Tamra Jurgemeyer, Executive Director of
Iowa Chapter of Children’s Advocacy Centers,
explains, “There are many shortages and gaps
in mental health providers trained in evidence-
based practices…across the state. Those that
practice often have full caseloads and don’t
necessarily want to receive the extra required
training, on-going assessment requirements,
or work with children and families that have
experienced complex trauma and abuse.”
Box 11: Did you know?
Pediatric subspecialists require ten years of training post-university,
including three extra years of subspecialty training.
Despite this enormous
investment, pediatricians are known to be among the lowest-paid physicians.
Moreover, the career-long earning potential for pediatric subspecialties
is even lower than that of general pediatricians, a gap which continues to
grow.
Recognizing how earning potential can shape decisions to specialize
among medical students, especially in light of rising education costs,
should be high on the list of priorities for universities and policymakers
seeking to nurture a balanced and specialized pediatric workforce.
There are fewer than 400 board-certified child
abuse pediatricians —the pediatric subspecialty
responsible for diagnosis and treatment in
cases of suspected abuse of infants, children
and adolescents—across the entire US.
Domain 3:
Provision of
Support Services
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Protecting the rights of the child
The autonomy of survivors should be
respected and supported throughout
response processes. Some survivors of sexual
violence report a lost sense of control or feelings
powerlessness as a result of the abuse; yet,
research shows these feelings can be somewhat
mitigated if survivors maintain control over
their recovery process.
,
As such, frontline
responders who take steps to preserve the
autonomy of victims—such as by discussing
medical treatment options or whether and how
survivors can assist with a criminal prosecution—
can help support the recovery process.
When a victim is a child or adolescent,
however, additional complexities arise due to
their capacity to make informed decisions, as
well as their dependency on caregivers. For
example, all states generally require medical
providers to obtain consent from a parent or
guardian before providing care to a minor. Yet,
in cases of sexual abuse, these requirements
could be a potential deterrent to help seeking,
especially if the perpetrator is a parent or
relative. Without guarantees of privacy and
confidentiality, survivors’ access to and choice
of which medical services to receive after
experiencing sexual abuse may be impacted.
Some states have introduced measures to ensure
that minors who have been sexually abused can
access care and make more informed decisions
about their treatment following abuse (see Figure
). Ten states explicitly allow minors to consent
to a sexual assault medical forensic examination
without the prior consent or knowledge of their
parents or guardians.
,
Other states have
introduced exceptions for minors with regard
to specific services, such as confidential access
to testing and treatment for STIs. Meanwhile,
the overturning of Roe v. Wade saw a
tightening of abortion access in some states,
even for child sexual abuse victims, the impacts
of which can be particularly devastating for
young people and their families.
Just under half
of states ( of the ) allow minors’ access to
abortion services without parental involvement
in cases of suspected abuse, assault or incest.
Source: Economist Impact & Guttmacher Institute
Figure 16: Minors’ access to key services
Percentage of states guaranteeing minors' access to key services (%)
Medical care following sexual
abuse: right to an advocate
Medical care following sexual
abuse: minors' ability to consent
57.1% 35.7%
Minors' access to abortion
without parental involvement
(cases of rape/incest)
Sexual health services: minors'
ability to consent (HIV
testing/treatment)
46.4% 60.7%
Sexual health services:
minors' right to confidentiality
(STI services)
28.6%
Domain 3:
Provision of
Support Services
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More than half of states ( of the ) have
established the right of survivors to have a
victim advocate present during a sexual assault
medical forensic examination. Although many
children can access specialized medical care
and advocacy through CACs, for young people
receiving treatment at hospitals or emergency
centers, victim advocates can play an important
role in promoting awareness of and access to
relevant services. One study found that survivors
that worked with an advocate in emergency
departments following sexual assault were almost
twice as likely to receive information on STIs and
the risk of HIV, and experienced “less distress”
from their medical contact experiences.
Box 12: Moving toward a Sexual
Assault Survivors’ Bill of Rights
The right to an advocate is guaranteed in
certain states by the state’s Sexual Assault
Survivors’ Bill of Rights—legislation adopted by
an increasing number of states to establish a
more comprehensive set of rights for survivors.
Several pieces of legislation passed at the federal
level have encouraged this trend, including the
Survivors’ Bill of Rights in the States Act (),
which makes additional federal funding available
to states that have, at minimum, “the rights
guaranteed to survivors under federal law”.
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Preventing the retraumatization of children,
irrespective of age, should be prioritized.
Prosecuting child sexual abuse cases presents a
number of core challenges, including the limited
availability of physical or forensic evidence
in many cases. As such, children’s testimonial
statements are often central to the prosecution
of such cases.
Investigations and prosecutions,
however, can also be retraumatizing for sexual
abuse victims, and particularly children. Trials
may not only bring victims into close contact
with their abuser, but direct questions might
be posed about deeply painful experiences,
and cross-examinations may seek to confuse
or discredit them.
,
Recognizing such
challenges, many states have introduced
special measures or testimonial aids to help
prevent children who have been subjected to
sexual abuse from incurring further trauma.
Every state in the index permits child victims of
sexual abuse to testify by an alternative method
outside of the courtroom, such as via closed-
circuit television, so they are not forced to speak
in the presence of the defendant.
Most states,
however, limit this option to children of a certain
age; this protective measure applies to children up
to the age of in just seven states. A hearsay rule
exception—or the admissibility of certain out-of-
court statements made by a child victim, such as
those made to police or forensic interviewers—
have also been widely established for use in
cases involving child sexual abuse. Just five of
the states lack such an exception, although
Texas is the only state where the exception
applies to all children under the age of .
Domain 4:
Justice Process
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Supporting justice and healing
Systems do not always account for the time
period between when child sexual abuse
occurs and when it is disclosed. Zach Hiner,
Executive Director of the Survivors Network
of those Abused by Priests (SNAP), explains,
“It takes survivors a very long time to come
forward, decades of living in silence, in shame
and fear…And when we’re talking about religious
institutions, a priest or a pastor or a bishop is
already placed so high in the community, to
think that one individual person might accuse
someone so powerful and well respected
and be believed, that’s often beyond most
children. So instead they stay silent. They bury
the memories and go on about their lives until
eventually the memories and the trauma and the
repercussions of it become too much to handle.
And that’s when they come forward and start
seeing and start seeking support and justice.”
The statute of limitations (SOL) is the time
frame during which criminal charges or a civil
lawsuit can be initiated for a specific oense.
Given that the average age at which survivors
of child sexual abuse disclose their abuse for
the first time is ,
it is clear that a short SOL
could act as a barrier to oenders being held
accountable and for those seeking civil redress.
Encouragingly, state action to extend or eliminate
SOLs for those who have been sexually abused
as minors has been on the rise in recent years.
Almost all states in the index ( of the ) have
passed legislation eliminating the criminal SOL
for at least some felony child abuse and sexual
assault crimes, while five have done so for all
felonies and misdemeanors (see Figure ).
Meanwhile, just six states have no age cap for
when a survivor of child sexual abuse can bring a
civil action against their abuser, while half ( of
) require survivors to file a claim before the age
of . Delaware and Illinois are the only states that
have eliminated both the criminal and civil SOLs
for all child sexual abuse oenses and claims.
One in two states ( of ) has also introduced a
revival or window law that provides survivors of
historical child sexual abuse with a permanent or
temporary/time-bound period (eg, up to the age
of ) to bring suits for previously expired claims.
Just two states, Delaware and Illinois,
have demonstrated their strong support
for survivors by eliminating both the
criminal and civil statute of limitations for
all child sexual abuse crimes and claims.
Domain 4:
Justice Process
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Source: CHILD USA
Figure 17: Statute of limitations reform
Performance on indicators related to statute of limitations by state
Criminal
SOL for child
sexual abuse crimes
Civil
SOL for child
sexual abuse claims
Expires before the age of 40
Expires age 40 to 50
Elimination for some/all
felonies only
Elimination for some felonies
and misdemeanors
Full elimination for all felonies
and misdemeanors
Age 34 and younger
Age 35-49
Age 50 and older
No age cap for some claims
No age cap - eliminated SOL
ND
KY
NC
FL
AK
OK
NY
PA
OH
IL
IA
MN
CA
WY
UT
CO
NV
NM
TX
WA
LA
MI
WV
VT
CT
MA
DE
MS
ND
KY
NC
FL
AK
OK
NY
PA
OH
IL
IA
MN
CA
WY
UT
CO
NV
NM
TX
WA
LA
MI
WV
VT
CT
MA
DE
MS
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Access to state Crime Victim Compensation
(CVC) programs can help survivors cover the
costs supporting healing and recovery. CVC
programs, which operate in every state in the US,
provide financial assistance for certain crime-
related expenses, such as the treatment of related
injuries or mental health counseling. Each state
has established its own set of criteria determining
eligibility for its CVC program; typically, this
includes requiring victims to file an application
for compensation within a certain period and to
report the crime to law enforcement. Yet, given
reporting delays and the hesitancy victims can
feel over engaging the police,
restrictive criteria
can limit access to critical financial assistance.
Some states have introduced exceptions to
eligibility criteria that apply specifically to victims
of sexual abuse or child crime victims. In most
states ( of ), the laws establishing program
eligibility provide at least some type of time
frame exception that is applicable to survivors
of child sexual abuse (eg, minors have up to
the age of to file a claim). Meanwhile, three
states—Delaware, Utah and Vermont—have no
restrictions on when child sexual abuse survivors
can apply for compensation. And while more
than half (%) of states have established one or
more ways for survivors to access compensation
without making a police report—such as if the
crime was reported to child protective services
or a victim advocate— states have yet to enact
any alternative for overcoming this requirement.
Domain 3:
Provision of
Support Services
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Box 13: Learning from experience
Engaging survivors of sexual abuse and incorporating lived experience into planning, review, and
oversight processes can help ensure that the needs and interests of victims are prioritized. Survivors have
a unique perspective on the real-world impacts of legislation, policy and service delivery that can help
decision-makers identify and address shortcomings. Providing a platform for survivors can also empower
them to share their stories and help validate their experiences.
Currently, half of the states ( of ) have taken steps to engage with and gather insights from individuals
impacted by sexual abuse. Various methods for this outreach include the following:
• The New York State Coalition Against Sexual Assault, with support from multiple state-level
government departments, launched a Survivor Survey in to “create space for survivors…to
share their perspectives and experiences with accessing and seeking services from various social and
legal systems after their victimization”.
• In , Minnesota created the Criminal Sexual Conduct Statutory Reform Working Group to
examine the statutory framework for criminal sexual conduct crimes. Presentations to the Working
Group highlighted the voices of victims and survivors to show “how sexual assault victims are
treated, how their cases are handled, and the barriers and challenges victims face in seeking justice
through the criminal justice system”.
• Several states have engaged survivors of sexual abuse as part of a larger eort to understand the
needs of crime victims in their state more broadly. For example, the State of Iowa Victim Needs
Assessment, sponsored by the Iowa Attorney General’s Oce Crime Victim Assistance Division,
included insights from survivors of sexual abuse collected through focus groups.
“I would like people to listen, look me in the eye, and not be
afraid to hear what I have to say. It’s more comfortable for
me when people can hear what I’m saying and can talk to me
about it. Because I’m no longer uncomfortable talking about
it. It’s not my shame. It is a silent global pandemic. It’s
parents, uncles, neighbors, best friends, teachers, coaches.”
Survivor of child sexual abuse
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Why it matters
Traditionally, responding to child sexual abuse
across the US has focused on catching and
prosecuting perpetrators. There has in recent
years, however, been increased attention
and emphasis on the healing and recovery of
survivors. This push has focused on establishing
more trauma-informed and child-centered
standards for investigations and trials;
ensuring meaningful access to compensation
and justice mechanisms; and building more
comprehensive support systems, including
therapeutic and advocacy services. While
there are many examples of recovery-focused
responses across the country, a concerted
eort is required to scale up these activities and
minimize the ongoing repercussions of CSEA.
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The US is a long way from where it needs
to be to eradicate CSEA. Most states in the
index receive failing grades, and failing grades
mean the US is failing its children. It does not
have to be this way: CSEA is preventable.
No child should ever experience sexual
exploitation or abuse, but to ensure they
do not, states need to focus on building a
more holistic approach. This approach needs
to apply a public health lens, empower youth
and promote survivor agency, ensure systems
are child-centered and trauma-informed, and
incorporate accountability. If states take these
steps, the US can solve this silent epidemic.
Forming a more
perfect union
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Figure 18: No state should be a lone star—good practices across the US
1 2
4 3
Pillar 1:
Employs a public health approach
Recognizes that child sexual abuse is preventable and seeks to address
various factors at the individual, relational, community and societal
levels that can put children at risk of or protect them from violence
Pillar 4:
Adopts review and oversight processes
Implements processes for reviewing and improving
prevention and response systems
Pillar 2:
Empowers youth to make informed decisions and
promotes the autonomy of survivors
Gives young people the right tools for making informed decisions about
health and safety, while protecting the agency of survivors during the
response to abuse
Pillar 3:
Ensures systems are trauma-informed
and child-centered
Prepares and empowers frontline workers and
systems to lead a trauma-informed response that
centers on the short- and long-term needs of the child
The development of comprehensive and holistic prevention strategies
• Alaska’s Pathways to Prevention plan (2019–24) provides a state-level roadmap for
the primary prevention of domestic and sexual violence, including child sexual abuse,
using the social-ecological model as a framework and guide
Addresses risk factors and harmful norms that can perpetuate sexual violence
• Minnesota has raised the minimum age for marriage to 18 without exceptions and
requires ocial proof of age to obtain a marriage certificate
144
• New York has enacted a range of protections to better guarantee equality for
LGBTQ+ individuals, including comprehensive non-discrimination laws, safer school
policies and healthcare access for transgender people
145
Training for adults and communities to help stop violence before it occurs and
respond appropriately when it does
• Vermont requires that individuals working in licensed child care facilities receive
orientation on the prevention and identification of child sexual abuse and grooming
processes
146
• North Carolina requires all school personnel working with students in grades
kindergarten through 12 to receive two hours of training on preventing,
intervening and responding to child sexual abuse and sex tracking
biannually
147
• Pennsylvania’s Oce of Victim Advocate launched a
statewide public awareness campaign focused on child
sexual exploitation. The campaign included print, radio
and social media messaging to help educate communities
on identifying abuse and dispelling myths related to
sexual exploitation
Collecting key data to deepen awareness and gauge ecacy of systems
• The Texas Department of State Health Services funded the Texas Statewide Sexual
Assault Prevalence Study in 2015. This study provides detailed breakdowns on
victimization data, based on gender and age, including experiences during childhood
and young adulthood
• New Mexico’s Interpersonal Violence Data Central Repository collects sexual assault
data, including data on oenses committed against children, from law enforcement
agencies statewide
Promoting greater oversight and accountability
• Massachusetts held a series of six roundtables with survivors across the state
to amplify their voices, lived experiences and gather their input in response to
legislative reforms
• The Ohio Youth and Family Ombudsman Oce, opened in 2022, is an independent
agency tasked with investigating and resolving complaints made by or on behalf of
children and families involved with public children services agencies in the state
Processes and authorities to review existing approaches and pioneer solutions
• The North Dakota Task Force for the Prevention of Sexual Abuse of Children was
convened to study the issue of child sexual abuse and to make recommendations to
the Legislature and Governor’s Oce
Provides children and teens with comprehensive education on safety and sexual
and reproductive health, in both in-person and via online spaces
• Washington requires public schools to provide comprehensive sexual health
education that is medically and scientifically accurate, age-appropriate and inclusive
of all students
148
• Louisiana requires public elementary and secondary schools to provide classroom
instruction on internet and cell phone safety, including recognizing, avoiding and
reporting solicitations by sexual predators
149
Response systems protect survivor autonomy during investigations and with
regard to treatment and care
• Iowa allows the provision of immediate or short-term medical or mental health
services to minors under the age of 18 who have been sexually abused/subjected to
any unlawful sexual contact without the prior consent or knowledge of the victim’s
parents or guardians
150
• California requires law enforcement ocers and medical professionals to provide
victims with information about their rights during their initial interaction, including
the right to have a sexual assault counselor and support person present during
medical evidentiary examinations
151
Training of frontline responders enables more eective interventions and
improves outcomes
• Kentucky mandates biannual training on child sexual abuse for attorneys and county
attorneys and their sta
152
• Nevada requires annual training on the detection and investigation of and response
to cases of sexual abuse or sexual exploitation of children under the age of 18 years
for peace ocers assigned to regularly investigate such cases
153
Prioritizing specialization and child-friendly services that reduce the risk of
further trauma and promote recovery
• Illinois requires that all hospitals either provide medical forensic services delivered
by trained professionals to sexual assault survivors or provide transfers to other sites
with these services
154
• Delaware requires that, absent good cause, all forensic interviews with children aged
3–12 be conducted at a CAC and in line with nationally recognized standards
155
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References
In this study and report, “child” refers to an individual under the age of years.
This figure comes from Child Maltreatment 2021, the latest edition of the annual Child Maltreatment report series published by the Children’s Bureau
of the U.S. Department of Health and Human Services. The statistics on child maltreatment are derived from data collected by child protective
services agencies in states and reported to National Child Abuse and Neglect Data System.
See: https://www.acf.hhs.gov/cb/report/child-maltreatment-
https://www.justice.gov/usao-sdny/pr/ghislaine-maxwell-sentenced--years-prison-conspiring-jerey-epstein-sexually-abuse
https://clergyreport.illinoisattorneygeneral.gov/
https://www.cdc.gov/violenceprevention/childsexualabuse/fastfact.html#:~:text=Many%children%wait%to%report,States%
experience%child%sexual%abuse
This report uses the terms ‘victim’ and ‘survivor’ at various points, often in a context-dependent manner (eg, legal, medical). It is important to
recognize that a person or child that has been subjected to or has experienced sexual harm may prefer or better identify with one of these terms.
See: https://ecpat.org/wp-content/uploads///Terminology-guidelines--EN-.pdf
https://www.naasca.org/-Resources/-StaisticsOfChildAbuse.htm
https://www.jlibrary.org/learn/about-j/life-of-john-f-kennedy/john-f-kennedy-quotations
https://www.iicsa.org.uk/document/iicsa-impacts-child-sexual-abuse-rapid-evidence-assessment-full-report-english.html
https://aifs.gov.au/sites/default/files/cfca/pubs/papers/a/cfca_.pdf
$, is the average lifetime cost for victims of non-fatal female victims of CSA. For male victims, it is approximately $, (although this
lower estimate is likely influenced by the insucient data available on productivity losses). The lifetime cost for victims of fatal CSA per female
and male victim was estimated, on average, to be $,, and $,,, respectively. All estimates, including the total annual economic
burden of CSA, pertains to the year . See: https://pubmed.ncbi.nlm.nih.gov//#:~:text=Estimating%%new%cases%
of,%%C%C%C%respectively%C%and%the%average
https://www.togetherforgirls.org/en/resources/what-works-to-prevent-sexual-violence-against-children-evidence-review
The research for the index was conducted between March and September . As such, the findings reflect the most recent available data at
the time the research was completed.
This indicator considered only primary prevention eorts. Programs aimed at preventing reoending were not considered.
This finding refers to the gross domestic product (GDP) per capita—or the real GDP of a state divided by the number of people in that area. It is
calculated from data provided by the US Census Bureau and the US Bureau of Economic Analysis for the year . This measure was used for our
analysis as it is often regarded as “a core indicator of economic performance and commonly used as a broad measure of average living standards or
economic well-being” (OECD).
This figure includes states requiring that consent be included in sexual education and instruction on HIV/STIs when such education is provided.
The index primarily considers requirements or mandates established by statute. In cases where a broader set of criteria was considered in the
assessment, this is indicated in a footnote.
The related indicators assess training on child sexual abuse for teachers, school employees, and employees of other youth-serving organizations that
is mandated at regular intervals, before these actors are permitted to work with minors, or shortly after their employment begins. Credit is not given
for one-o training.
https://www.nationalchildrensalliance.org/wp-content/uploads///-Chapter-Standards-digitalcopy-SINGLE-COLUMN.pdf
The Georgetown Institute for Women, Peace and Security’s U.S. Women, Peace and Security Index assess states on their enactment of key laws
needed to realize women’s protection from violence, economic opportunities, and reproductive healthcare access (sexual harassment in the
workplace; relinquishment of firearms from abusers subject to domestic violence protective orders; unemployment benefits for domestic violence
victims; mandated paid parental leave; minimum wage of at least $ per hours ratification of the Equal Rights Amendment; permits women to have
an abortion without in-person counseling).
This indicator assesses whether comprehensive training on the identification and prevention of child sexual abuse is required for actors in these
spaces; a separate indicator assesses training requirements for mandated reporters more broadly. The two key youth serving organizations
considered by the index are daycare centers and youth camps.
This indicator considered awareness campaigns focused, at least in part, on the prevention of child sexual abuse. Campaigns singularly focused on
increasing survivors’ access to services were not considered.
This indicator assesses whether the state’s government has conducted, sponsored, or endorsed a comprehensive victimization survey to explore the
prevalence of child sexual abuse in the state. Data on sexual violence collected through the Youth Risk Behavior Survey (see indicator ..) or other
national-level surveys is not considered.
In this context, high-income refers to states with a higher GDP per capita.
https://www.legislature.ohio.gov/legislation//hb
https://www.cambridge.org/core/journals/political-science-research-and-methods/article/womens-issues-and-their-fates-in-the-us-congress/B
CCCCFAAEAAEA
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https://schwindt.rice.edu/pdf/publications/schwindtbayer__unicef.pdf
https://www.aeaweb.org/conference//preliminary/paper/anyEbh
The “age of consent” is the age at which a young person can legally consent to taking part in sexual intercourse. Sexual activity between an individual
and a minor under the age of consent, even if the sexual acts are consensual, is considered a criminal oence. In the US, the age of consent ranges
from to years old, depending on the state. However, some states have established exceptions to their age-of-consent laws if one or both of the
parties engaging in consensual sexual activity are under the age of consent and they are close in age (eg, less than three years apart).
The actors covered by these laws can vary between states, from actors in a single setting, such as those working in the school environment, to those
more broadly responsible for the “health or welfare of minors” or “guidance, leadership, instruction, or organized recreational activities for minors”.
According to UNICEF, “Child marriage refers to any formal marriage or informal union between a child under the age of and an adult or another child.”
https://www.unchainedatlast.org/united-states-child-marriage-problem-study-findings-april-/
https://www.icrw.org/wp-content/uploads///child-marriage-in-the-US-prevalence-impact_-_ICRW.pdf
https://www.unchainedatlast.org/united-states-child-marriage-problem-study-findings-april-/
This indicator assessed only the availability of programs/services to prevent initial instances of abuse from occurring. Programs aiming to prevent
reoending were not considered.
TX Health and Saf. Code § .
https://www.cdc.gov/violenceprevention/pdf/can/factsheetCSA.pdf
https://pubmed.ncbi.nlm.nih.gov//#:~:text=Estimating%%new%cases%of,%%C%C%C%
respectively%C%and%the%average
https://doh.wa.gov/sites/default/files/legacy/Documents/Pubs/--SexualViolencePreventionPlan.pdf
https://dps.alaska.gov/getmedia/b-ece-bd-a-ecc/Pathways-to-Prevention-FINAL-Nov-.pdf
https://www.cdc.gov/violenceprevention/pdf/SV-Prevention-Resource_.pdf
https://www.cdc.gov/violenceprevention/sexualviolence/riskprotectivefactors.html
https://www.cdc.gov/violenceprevention/childabuseandneglect/riskprotectivefactors.html
https://theannainstitute.org/ACE%folder%for%website/TIND.pdf
https://aifs.gov.au/resources/policy-and-practice-papers/rarely-isolated-incident-acknowledging-interrelatedness-child
https://www.thelancet.com/journals/lancet/article/PIIS-()-X/fulltext
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC/
https://psycnet.apa.org/record/--
https://journals.sagepub.com/doi/abs/./
https://www.cdc.gov/violenceprevention/childabuseandneglect/riskprotectivefactors.html
https://www.cdc.gov/violenceprevention/sexualviolence/riskprotectivefactors.html
https://www.cdc.gov/violenceprevention/childabuseandneglect/riskprotectivefactors.html
https://www.cdc.gov/violenceprevention/about/social-ecologicalmodel.html#:~:text=This%model%considers%the%complex,from%
experiencing%or%perpetrating%violence.
https://www.cdc.gov/violenceprevention/sexualviolence/riskprotectivefactors.html
https://www.cdc.gov/violenceprevention/pdf/CAN-Prevention-Resource_.pdf
https://www.cdc.gov/violenceprevention/pdf/SV-Prevention-Resource_.pdf
https://www.nsvrc.org/sites/default/files/-/Publications_NSVRC_Booklets_Sexual-Violence-and-the-Spectrum-of-Prevention_Towards-a-
Community-Solution_.pdf
https://www.togetherforgirls.org/en/resources/what-works-to-prevent-sexual-violence-against-children-evidence-review
https://www.isbe.net/Documents_MSAFE/Make-SAFE-Final-Report-.pdf
https://www.ndstopcsa.com/#:~:text=About%The%Task%Force&text=The%purpose%of%the%North,prevention%of%
child%sexual%abuse.
https://safekidsthrive.org/wp-content/uploads///Child-Sexual-Abuse-Task-Force-Report-Updated-Links--.pdf
https://www.nacctep.org/model-code-ethics
UT R-
https://www.cdc.gov/violenceprevention/childsexualabuse/fastfact.html#:~:text=Although%estimates%vary%across%studies,States%
experience%child%sexual%abuse
As compared with career-averaged reports in the year prior to training.
See: https://www.dl.org/wp-content/uploads///StewardsofChildren-EvidenceInformedPreventionTraining-.pdf
https://www.zeroabuseproject.org/for-professionals/cast/
https://www.zeroabuseproject.org/wp-content/uploads///Child-Advocacy-Studies-CAST_-A-National-Movement-to-Improve-the.pdf
It should be noted that research evaluating these types of interventions have not yet identified an impact on the actual victimization for children.
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https://www.aap.org/en/patient-care/adolescent-sexual-health/equitable-access-to-sexual-and-reproductive-health-care-for-all-youth/the-
importance-of-access-to-comprehensive-sex-education/
https://www.sexedcouncil.org/_files/ugd/cfaa_dfaaeefafa.pdf
https://pubmed.ncbi.nlm.nih.gov//
The evaluation of state sex education and HIV/STI requirements considers state laws and statewide rules, regulations or standards that have the
force of law. Source: SIECUS.
https://www.cdc.gov/healthyyouth/whatworks/what-works-sexual-health-education.htm
https://siecus.org/wp-content/uploads///NSES--web-updated-.pdf
Colorado, Illinois, Iowa, and Washington require that if sex education or HIV/STI instruction is provided in public schools, it must be evidence-
based, medically accurate, and culturally appropriate; however, Washington is the only state in this group mandating that sex education and HIV/STI
instruction be provided in all public schools.
“Inclusive programs” are defined by SIECUS as “those that help young people understand gender identity and sexual orientation with age-
appropriate and medically accurate information; incorporate positive examples of LGBTQ+ individuals, relationships and families; emphasize the
need for protection during sex for people of all identities; and dispel common myths and stereotypes about behavior and identity.”
https://siecus.org/wp-content/uploads///Call-to-Action-LGBTQ-Sex-Ed-Report.pdf?eType=EmailBlastContent&eId=cfc-b--
fd-a
https://www.glsen.org/sites/default/files/-/From_Teasing_to_Tormet_Revised_.pdf
https://www.glsen.org/sites/default/files/-/Out_Online_Full_Report_.pdf
https://www.sciencedirect.com/science/article/abs/pii/SX
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC/
https://www.researchgate.net/publication/_LGBTQ-inclusive_curricula_why_supportive_curricula_matter
https://siecus.org/wp-content/uploads///On-Our-Side-Public-Support-for-Sex-Ed--Final.pdf
https://www.plannedparenthood.org/about-us/newsroom/press-releases/planned-parenthood-new-national-poll-shows-likely-voters-strongly-
support-sex-education-and-federal-funding-for-teen-pregnancy-prevention-programs
Cited in: https://siecus.org/wp-content/uploads///Call-to-Action-LGBTQ-Sex-Ed-Report.pdf?eType=EmailBlastContent&eId=cfc-
b--fd-a
https://jennaquinn.net/the-jenna-quinn-law
This figure represents the number of school-age children (–-year-olds) who live in states where this child sexual abuse prevention education is
currently permitted or encouraged. The calculation is based on the population estimates for the year produced by the US Census Bureau.
CT Gen. Stat. § a-q
https://portal.ct.gov/SDE/Publications/Statewide-K--Sexual-Assault-Abuse--Prevention-Awareness--Program-Guidelines/Section--Sexual-
Assault-Abuse-Prevention-Awareness-Curriculum-Framework
This figure represents the number of school-age children (–-year-olds) who live in states where this child sexual abuse prevention education is
currently permitted or encouraged. The calculation is based on the population estimates for the year produced by the US Census Bureau
https://psycnet.apa.org/doiLanding?doi=.%Fvio
This study found that perpetrators of child sexual abuse were youthful oenders (ie, oenders younger than ) .% of the time, among
perpetrators with known age. See: https://jamanetwork.com/journals/jamanetworkopen/article-abstract/
https://pubmed.ncbi.nlm.nih.gov//
https://journals.sagepub.com/doi/./
https://pubmed.ncbi.nlm.nih.gov//
https://www.sciencedirect.com/science/article/pii/S#b
Interview with Zach Hiner, executive director, SNAP
https://www.iicsa.org.uk/document/iicsa-impacts-child-sexual-abuse-rapid-evidence-assessment-full-report-english.html
https://aifs.gov.au/sites/default/files/cfca/pubs/papers/a/cfca_.pdf
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC/
https://www.nationalchildrensalliance.org/cac-coverage-maps/
https://www.nationalchildrensalliance.org/media-room/national-statistics-on-child-abuse/
https://www.nationalchildrensalliance.org/wp-content/uploads///Issue-Brief-State-Definitions-.pdf
KY Rev. Stat. § .
https://www.nationalchildrensalliance.org/cac-model/
https://calio.org/wp-content/uploads///evidence-for-ecacy-of-the-child-advocacy-center-model-systematic-review.pdf
https://www.nationalchildrensalliance.org/wp-content/uploads///-RedBook-vB-t-Final-Web.pdf
https://www.nationalchildrensalliance.org/wp-content/uploads///-RedBook-vB-t-Final-Web.pdf
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https://www.sciencedirect.com/science/article/abs/pii/SX
https://calio.org/wp-content/uploads///evidence-for-ecacy-of-the-child-advocacy-center-model-systematic-review.pdf
https://journals.sagepub.com/doi/./
This includes NCA-accredited CACs, as well as associate and aliate members.
Areas are considered to be “covered” if there is a formal, signed agreement in place between the CAC and partner agencies in that area.
https://www.nationalchildrensalliance.org/wp-content/uploads///Issue-Brief-State-Funding-.pdf
https://www.nationalchildrensalliance.org/wp-content/uploads///Snapshot-.pdf
Rev. Code WA §§ .A. and .A.
MS Code Ann. § --.
Specific to child victims.
WA Rev. Code Ann. § .. mandates ongoing specialized training for law enforcement, prosecution, and child protective services.
https://www.nationalchildrensalliance.org/wp-content/uploads///-RedBook-vB-t-Final-Web.pdf
https://www.abp.org/sites/public/files/pdf/workforcedata-.pdf
https://downloads.aap.org/AAP/PDF/Advocacy/NewMexico_SubspecialtyFactSheet.pdf
https://downloads.aap.org/AAP/PDF/Advocacy/Wyoming_SubspecialtyFactSheet.pdf
https://www.kempecarenetwork.org/about
Four years of medical school, three years of residency, three years of fellowship and sub-specialty training.
https://publications.aap.org/pediatrics/article///e//Dierences-in-Lifetime-Earning-Potential-for?autologincheck=redirected
https://educationdata.org/average-cost-of-medical-school
https://pubmed.ncbi.nlm.nih.gov//
https://psycnet.apa.org/record/--
Minors’ authority consent in such cases is limited to minors of a certain age (eg, +) in some states.
Assessments considered laws explicitly giving minors the authority to consent to a sexual assault medical forensic examinsation or medical care in
cases of sexual or child abuse. Credit was not given if investigative agencies are permitted to consent in the place of a parent/guardian, if providers
are permitted to treat minors in emergency situations without the consent of a parent/guardian, or if minors deemed to be “suciently mature” are
permitted to consent to medical care more broadly.
https://time.com//a-rape-in-mississippi/
https://pubmed.ncbi.nlm.nih.gov//
https://www.grassley.senate.gov/news/news-releases/survivors-bill-of-rights-in-the-states-act-becomes-law
https://www.ojp.gov/pdles/nij/grants/.pdf
https://www.bu.edu/bulawreview/files///DWARAKANATH.pdf
https://psycnet.apa.org/record/--
The necessity of an alternative method for testifying is often determined on a case-by-cases basis if, for instance, a judge or expert deems that
testifying in open court is likely to cause the child further harm or trauma.
https://pubmed.ncbi.nlm.nih.gov//
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC/
https://www.nyscasa.org/wp-content/uploads///-NYSCASA-Survivor-Survey-Report.pdf
https://dps.mn.gov/divisions/ojp/forms-documents/Documents/CSC%SRWG/FINAL%PHASE/CSC%Working%Group%Report%
to%the%Legislature%-%January%%Final.pdf
https://www.iowaattorneygeneral.gov/media/documents/_Iowa_Victim_Needs_Assessment_F_A.pdf
Minn. Stat. Ann. §§ ., ., and ..d
This indicator is scored using Human Rights Campaign’s State Equality Index : https://www.hrc.org/resources/state-scorecards/new-york-
VT Stat. Ann. §
NC Gen. Stat. § C-.
WA Rev. Code Ann. § A..
LA Rev. Stat. § :
IA Code § .
CA Pen. Code § .
KY Rev. Stat. § .
NV Rev. Stat. § B.
IL Comp. Stat. Ann. /
DE Code Ann. §
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While every eort has been taken to verify the accuracy of this
information, Economist Impact cannot accept any responsibility or liability
for reliance by any person on this report or any of the information, opinions
or conclusions set out in this report. The findings and views expressed in
the report do not necessarily reflect the views of the sponsor.
© The Economist Group 2024
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