Portugal preschool program shows promise for preventing child sexual abuse

A pilot study tested the CARE program and found it was acceptable and safe, with early gains in children’s knowledge.

Editorial illustration — not from the study.

Researchers evaluated the CARE program, a primary prevention effort for child sexual abuse (CSA) aimed at preschool children aged 3 to 6, in Portugal. In a pragmatic waitlist-controlled study across five schools, they assessed acceptability, safety, feasibility, and children’s CSA-related knowledge using child vignettes and educator interviews.

In the intervention group, children showed significant improvements in emotional recognition and rejection of secrecy. Changes related to disclosure were less consistent across analyses, but overall the program showed strong adherence and retention; school-level recruitment, however, was challenging.

Program was safe and acceptable

The CARE Program showed high acceptability and safety for both preschool children and educators. Feasibility indicators were generally favorable, including strong adherence and retention, although recruiting schools was difficult. In children assigned to CARE, there were significant improvements in emotional recognition and rejection of secrecy. No comparable improvements were observed in the waitlist/control group. Findings about disclosure were less consistent across analytic approaches and should be interpreted with caution.

Supports next trial steps

The results suggest that a preschool CSA prevention program can be delivered in real-world settings in Portugal while remaining acceptable and safe for children and educators. The preliminary knowledge gains support the idea of testing the program more rigorously in a larger, fully powered cluster randomized controlled trial.

Pilot evidence with cautions

This is a pilot feasibility trial with a pragmatic, parallel-arm, waitlist-controlled mixed-methods design. It provides early evidence on safety, acceptability, feasibility, and preliminary knowledge changes, but the abstract notes limitations for some outcomes: disclosure-related findings were not consistent across analytic approaches. The study also faced recruitment challenges at the school level, which may affect how easily such programs can be scaled and evaluated.

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