What If Prevention Meant Stopping the Abuser?

What child sexual abuse survivors know that public health doesn’t always say aloud

I’ve spent decades in public health, and I understand the comfort of numbers. We reach for statistics because they seem stable, objective, persuasive. They let us speak about terrible things without getting too close. A professor once told me, “Doing public health work in your own neighborhood is more difficult than doing it across the globe.” And it’s true.

We tally rates of child sexual abuse, suicide, and domestic violence. We present them in slides, cite them in grants, use them to justify budgets and laws.

But numbers are not stories.

Not to be trite, but we all know that behind every percentage point is a person—someone who didn’t get the help they needed, or whose voice never made it into the data at all. I’ve met too many of them to forget what gets left out. That’s why mixed-method research is essential to showing the whole story. We need to give voice to the data point, and more urgently, we need to understand how perpetrators move through our systems unchecked.

Like the Bosnian college student who told me her story of incest. Her aunt believed her, but the world didn’t offer much else. There were no trauma-informed therapists nearby. They had nowhere to turn. Their physician told the aunt to help her niece forget and move on. He said it was best for everyone.

But the college student didn’t accept that answer. Instead, she asked, “What can be done?” She sat in her college dean’s office for three days, asking for a letter of support so she could apply for a grant we hoped would bring training to her region. It wasn’t funded. No stories were counted. No perpetrators held accountable. Forget about it, move on, nothing to see here.

Or the patient who, in the last season of his life, finally whispered to his nurse, “It happened to me too.” He was 70. He hadn’t told a soul until then. His story won’t be in the statistics, but it belongs somewhere. He had used alcohol his whole life to numb the pain of untreated trauma, of his secret, of his shame. No one had ever asked who harmed him, or how the person who did it was allowed to keep going.

And me, I was counted, eventually. But not when it mattered most. Not when the man who harmed me could have been stopped. Not when those around him could have intervened. Not when the systems that claim to protect children had clear warning signs and looked the other way.

My small community of 90,000 people failed me and shielded the perpetrator. Each of these institutions had staff who learned of my story, and each failed me:

St. Clare’s Hospital failed me.
Albany Medical Center failed me.
The Roman Catholic Diocese of Albany failed me.
An Albany County social worker failed me.
The teachers at school failed me.
And my neighbors, who knew and tried to intervene, met a silencing of their own.¹

They could have done so much more.

The hospitals could have trained their staff to recognize the signs of an abuser; not just the bruises left behind, but the patterns of behavior that signal risk. They could have asked better questions, documented concerns, followed up. The Catholic Diocese could have screened priests for potential abuse, and when notified, removed the man who harmed me, reported him, warned others, and cooperated fully with law enforcement. The social worker and the teachers could have been trained to identify and approach suspected abusers in safe, informed, and proactive ways that protected children. They could have listened more carefully, looked deeper, and refused to be turned away. And my neighbors, they could have been supported by systems that took their concerns seriously instead of silencing them.

In a culture that prioritized preventing child sexual abuse rather than reacting to it after the fact, any one of them could have potentially stopped the harm.

The systems I’ve worked in often teach us to focus on “risk factors,” to manage “vulnerabilities,” to design interventions for “at-risk youth.” But what if we started by asking a simpler, more urgent set of questions: Where are the perpetrators? Why are they so rarely the ones studied, tracked, or named?

And who are the adults in the lives of these so-called “at-risk youth”? What histories do they carry? What patterns of harm are they repeating? Do they need services to prevent them from harming children? Why aren’t we offering early intervention to the adults who are closest to the harm?

We pour resources into trauma recovery for survivors, an essential and sacred act, but rarely do we demand accountability for those who harm. We build a language around healing but stay silent about the choices and behaviors that cause the harm in the first place.

So many questions remain.

What is the perpetrator’s story?
Why did they choose to harm a child?
Who could have helped the perpetrator and prevented the harm?
What are we doing, as a society, that allows perpetrators to believe they can harm children without consequence?
How can we change our culture so that perpetrators are no longer emboldened to act?
What would it take to create a world where protecting children is not the exception, but the norm?

If we are serious about prevention, these are the questions we must begin to ask, out loud, without hesitation.

If we truly want child sexual abuse prevention, we have to stop circling around pain and start interrupting power. We have to stop designing programs that teach children to protect themselves and start designing systems that refuse to protect abusers. We need a system that identifies potential abusers before they abuse, one that prevents the abuser from abusing in the first place.

That is what I mean by The Second Silence.
The first silence is what happens to you.
The second is what happens when you tell, and the world averts its eyes.

So yes, keep your data. Use it wisely. But remember: statistics are scaffolding, not substance. Prevention doesn’t live in bar charts. It lives in the brave, complicated, sometimes messy act of naming what really happened and believing the ones who speak.

And survivors? We are more than our pain. We are storytellers, truth-tellers, and builders of a world that doesn’t look away.

Stay strong.

Photo Credit:
Portrait by Sarah Blesener, a visual journalist whose work captures the intimate, often unspoken truths of our time. I’m grateful to have collaborated with her on this ongoing project of memory, visibility, and survival.

Note: If this piece resonated with you, I invite you to learn more about the work we’re doing at The Hope Institute—a collaborative initiative using evidence-based frameworks like Hope Theory to support children and communities affected by trauma. You can also explore policy advocacy and professional development opportunities through the New York State Public Health Association (NYSPHA), where I continue working alongside other public health professionals to change the systems that too often fail survivors.

Thank you for being here. For reading, for thinking, for listening between the silence.

With hope,
Jo

1. What I share here reflects my personal experience and memory. These are the institutions that, in my view, failed to protect me when I needed them most.