A PREVENT Case Study from Minnesota
The Department of Pediatrics at the Mayo Clinic in Rochester, Minnesota cares for children and adolescents from around the world, in addition to patients from their home state of Minnesota and their home community of Rochester. While medical providers generally focus on treating health issues after they have occurred (e.g. antibiotics for childhood ear infections), there are certainly medical efforts, especially in pediatrics, that focus on prevention (e.g. flu vaccinations). Pediatricians at the Mayo clinic treat all the common childhood diseases, as well as many of the rarest ones. They also treat childhood injuries, including sexual abuse (60-70% of sexual assault victims experience their first rape before the age of 18). Treating a traumatized patient in the clinic and responding to the physical and emotional injuries of a sexual assault is the first priority for medical providers (e.g. treatment for sexually transmitted infections and referral to specialized counseling services). But what can be done to prevent child sexual assault in the first place? What is the equivalent to a vaccine for child sexual abuse, and what should the medical providers’ role be in developing and disseminating that “vaccine”?
After a 2007 lecture given at the Mayo Clinic by Dr. Sharon Cooper, MD, a nationally known expert in the areas of child maltreatment, child sexual exploitation, and internet crimes against children a group of providers from the Child and Family Advocacy Program in Mayo’s Department of Pediatrics got really excited about an idea that was relatively new for them: preventing sexual exploitation and abuse. It turned out that the providers from the Mayo Clinic were not the only ones thinking about this issue. Around the same time, the Minnesota Department of Health (MDH) initiated a planning process to develop a statewide strategic plan to prevent sexual violence across the lifespan.
In 2008, the group from the Mayo group joined in this statewide planning process, which culminated in the publication of a 5-year plan to prevent sexual violence in Minnesota. They wanted to support the implementation of this plan, but needed assistance in moving forward. The next layer of synergy came in the summer of 2008 when the team found out about the PREVENT Institute. The group from the Mayo applied and began PREVENT in November 2008.
Using the state plan on preventing sexual violence as their guide, the PREVENT team from the Mayo clinic decided to focus their efforts on the social norms that objectify women and girls, normalize sexual exploitation, and promote the pairing of sex and violence. Specifically they decided to address the highly sexualized media culture that inundates young people. During the first in-person session of the PREVENT Institute the team developed a plan to create an educational tool they could use in the community to teach parents about the pervasive sexualized culture in the media and give them skills and confidence to address it with their children.
Taking the information and tools gained at PREVENT, the team hit the ground running during the 6 month project period between the two in-person sessions of the Institute. They developed a presentation on the sexual exploitation of children, held a pilot presentation to a group of parents in the community, and solicited feedback from the participants in order to adjust and improve the session. Based on this feedback and some of the questions they received from parents (e.g. “what should parents of male children take away from the presentation?” and “what are more specific and do-able steps for parents to take in their everyday lives?”) the group modified their presentation to be ready for wider use in the community.
Eventually, the team discovered that pulling together a strong curriculum or message was not as difficult as they expected, but figuring out how to get to the people it wanted to reach was much harder. PREVENT emphasizes skills in multidisciplinary collaboration, and the team quickly realized they needed to reach out to other partners in Rochester. They were contacted by the County Public Health Department and the County Victim’s Service Department, groups that also have specific interest in sexual violence prevention. They were supported by their County Board, which was likewise actively pursuing the issue of sexual violence locally. These local partners dramatically improved the team’s ability to disseminate their project in the community and provided further venues for offering their presentation. Within six months of the end of the PREVENT experience, the team had worked with these local partners and others to establish a new Prevention Planning Committee to continue and expand the sexual exploitation and abuse prevention efforts started by the team as their PREVENT project. There was broad community interest in the committee from schools, local media, faith community, Rochester’s women’s magazine, and the hotel industry, among others.
The team’s project with the PREVENT Institute also started influencing the Mayo Clinic itself. The team presented their work as part of the Pediatric Grand Rounds in the months just after the Institute ended, which is, as one team member shared, a “big deal” in their institution. Since all of the team members were from the Mayo, the influence on them and their practice also influenced the organization. They reported the experience as unifying their team, increasing their morale and changing their clinical practice. One team member, a physician, shared ways that she now incorporates concepts of primary prevention learned at PREVENT into her practice:
We see a lot of 11 year olds because that is when they come in for their next round of immunizations, and that is a prime time to be talking to them about how to protect themselves against sexual exploitation such as internet safety, texting, and how they approach what they are watching on television. So I do a lot of primary prevention education during those visits. (Team Member Interview, November 2009)
The team also shared about the impact of the PREVENT experience and project on their personal lives.
The project has influenced us as parents. We have become more aware of marketing techniques, internet safety, and media influence on our children. We have changed our consumer habits, and many of us have changed our household rules as we have dialoged with our children and spouses about this project. (Team Member Interview, November 2009)
It is important to remember that the Mayo Clinic is one of the best know medical care facilities in the world, with practitioners accustomed to influencing the practice of patient care both nationally and internationally. The providers in this PREVENT team are no different. They worked at their own institution and in the local community of Rochester on their main project, but their interest and engagement quickly grew broader. Before PREVENT, they had supported the development of the state plan and had one team member on the coalition that worked on its development. After PREVENT, there were three team members on the state coalition and Mayo became a co-sponsor for a statewide summit to gather experts from around the state to move the state plan to the next level. The attention they received for their local and state efforts further encouraged them to work nationally. They developed a collaborative partnership with the National Center for Missing and Exploited Children to co-host a national summit on child sexual exploitation in 2010.
Unfortunately there isn’t anything as simple as a vaccine to prevent child sexual exploitation and abuse. It will take concerted efforts by many people on many issues, including changing social norms that make it normal for American children to grow up with images that portray women as sexual objects and violence as a natural correlate to sex. This PREVENT team from the Mayo has shown that medical providers can have an important role in pushing these norms in a healthier, and safer, direction.
PREVENT Institute 2009 Mayo Clinic Minnesota Team
- Developed community presentation for parents on child sexual exploitation and media literacy
- Piloted presentation and used survey feedback to modify it
- Gave presentation in community settings
- Presented efforts at Pediatric Grand Rounds
- Established County Prevention Planning Committee on Sexual Exploitation and Abuse
- Partnered with public health, victim services, schools and others
- Increased presence on state coalition
- Co-sponsored state summit on sexual violence and exploitation
- Co-hosted a National Summit on Child Sexual Exploitation with the National Center for Missing and Exploited Children