Help Wanted: Evaluating a Prevention Intervention for People With Sexual Interest in Children

The study seeks to conduct a randomized controlled trial (RCT) to evaluate the Help Wanted Prevention Intervention (Help Wanted). Help Wanted is a novel, online, self-paced intervention designed to support the needs of people with a sexual attraction to children, who wish to keep children and themselves safe. The intervention includes an introductory welcome place, five training sessions that deliver core intervention content, and a resources page that provides links to external sources of support.

The RCT will be conducted in two phases to a) evaluate the effects of Help Wanted on child sexual abuse offense behaviors, grooming behaviors, and proclivity to offend, as well as the impact on targeted psychosocial stressors that are associated with child sexual abuse perpetration; and b) examine psychosocial stressors both as outcome measures and as potential mediators and moderators.

In phase one, the investigators will beta-test RCT study procedures with a sample of adults with a sexual attraction to children who have never abused a child (N = 10). Participants in this phase will be asked to:

1. Provide a non-identifying email address to receive correspondence from the study team and verify the correspondence is working (i.e., reminders to complete assessments, a link to access study surveys and Help Wanted)..
2. Complete the pre-intervention survey (approximately 20-30 minutes).
3. Complete (i.e., click through) each of the five Help Wanted sessions and review the resources page.
4. Complete the post-intervention survey (approximately 20-30 minutes).
5. Participate in a 30-60-minute anonymous audio call (e.g., Zoom) with a member of the study team to discuss their feedback on the study procedures. These calls will be scheduled between the participant and a study staff using the participant's non-identifying email address and will take place over an online platform such as Zoom that allows participants to take part in an audio-only meeting by only providing their non-identifying email address. When using an online audio call platform, anonymity of participants will be protected by disabling video and no personal identifiable information will be collected during the call. Calls will be audio-recorded and transcribed to ensure that concerns are accurately captured and addressed as needed.

The pre-intervention and post-intervention surveys contain all survey measures so the investigators will not require beta participants to complete the additional survey (i.e., the 1-month post-intervention survey), which includes only a portion of the measures in the pre- and post-intervention surveys. Information gathered from beta participants will only inform changes to the study procedures before launching phase two of the RCT.

In phase two, the investigators will conduct a RCT to evaluate Help Wanted. Three hundred men with a sexual attraction to children who have never harmed a child will be randomly assigned to the Help Wanted intervention condition (HW; n = 200) or to a 1-month waitlist condition (WL; n = 100). HW participants will be assessed at three timepoints: recruitment (baseline), after reviewing the HW intervention for 1-month (post-intervention), and at 3-months post-intervention (follow-up). WL participants will be assessed at recruitment (baseline), after being provided alternative resources as a control for 1-month (2nd baseline), after reviewing the HW intervention for 1 month (post-intervention), and at 3-months post-intervention (follow-up). Thus, the RCT broadly follows a 2 (interventions) x 2 (timepoints) factorial design.

The alternative resources provided to the waitlist control group will include suicide prevention, mental health, and CSA prevention helplines. Specific resources for Australia, Canada, the United Kingdom, and the US, as well as a link to a list of suicide prevention, mental health, and emergency contact numbers in over 30 countries to provide additional resources for English speaking participants who may reside in these areas.

Data include measures of offense-related outcomes, internalizing problems, social deficits, sexual problems, offense-supportive cognitions, externalizing problems, adverse childhood experiences, as well as demographics.

Recruitment: The study team will design communications and plans to promote the study recruitment flyers for the beta test and RCT samples. Recruitment flyers will be provided to organizations and people who provide resources and support for people with a sexual attraction to children. These organizations will assist in recruitment by sharing the study recruitment flyer with people who utilize their services and, for the RCT, with others who may know people that may be eligible to participate in the study.

Screening Procedures: In order to monitor the number of participants in the study and ensure all study participants (in each phase) meet eligibility criteria, study team members will manually screen participants using an audio only call before allowing the participants to enroll in the study. Using approaches from a previous study with this population, all interested people will be asked to fill out a scheduling form with a date/time the participants are available to speak to a study team member and a non-identifying email address that can be used to confirm the screening call and provide the potential participant with the audio call information. Using a non-identifying email address will allow participants to remain anonymous throughout all study activities. A link with instructions on how to create a non-identifying email address will be provided on the recruitment form and the scheduling page. The scheduling form will also provide a link to a Portable Document Format (PDF) version of the appropriate Institutional Review Board-approved consent form so the participants are aware of the study details before scheduling a screening call. When an interested person signs up for a time, the participants will receive an email to their non-identifying email address with a Zoom link to complete the audio call. A trained study team member will conduct these screening calls and any responses that are not easily determined as eligible or ineligible will be run by a study investigator for review before the interested person is invited to proceed to the consent stage of the study. Screening calls are anticipated to last about 5 minutes. People who do not respond to an asked question or are deemed to not meet the study eligibility criteria will not be enrolled in the study. Ineligible people will be provided with a set of resources for general mental health, suicide prevention, and CSA prevention to the email address the participant provided. People who meet eligibility requirements will be provided with a secure study link to access the online consent form, which will be housed within the Quest system, a data collections platform.

People who are deemed eligible to participate based on their responses to the study screening questions, will be provided with a secure study link to access an Institutional Review Board (IRB) approved consent document through the Quest system (a data collections platform). The secure study link will be provided by the recruitment team via an email to the non-identifying email address the potential participant provided. Upon logging in to Quest, each participant will be required to complete a consent form before participating in any study activities. Consent documents will not ask for any identifying information (e.g., name, date of birth) and both the screening questions and consent form will only ask for information to confirm the person is eligible to participate in the study (e.g., age). People who consent yes will automatically be provided with access to the baseline survey (within Quest) to begin participation in the study.

RCT Data Analysis: the investigators will assess the pre-post effects of Help Wanted on primary outcomes (i.e., offense behaviors, and proclivity to offend) and targeted psychosocial stressors (e.g., cognitions/attitudes, coping skills, self-image) using analysis of covariance.

In an analysis of covariance (ANCOVA) study in which means of the two groups with 2:1 allocation is to be compared; the investigators estimated a total sample size of 150-300 to detect an effect size of 0.30-0.10. The total sample of 150-300 subjects achieves 80-90% power to detect differences among the means versus the alternative of equal means using an F test with a 0.05 significance level. A target sample size of 300 participants should suffice if the investigators assume a dropout rate of 15%.

The investigators will also conduct a series of mediation and moderation analyses. The mediation analyses will examine the potential mediating role of change in secondary outcomes (i.e., psychosocial stressors in five dynamic risk domains) in the association between change in primary outcomes and intervention status (HW vs. WL). The estimated sample size of 300 in Aim 1 will have 90-100% power to detect a mediation effect of at least 0.40 (regression coefficient of the mediator variable).

To test for moderation the investigators will assess whether Adverse Childhood Experiences (ACE), a pre-randomization characteristic uncorrelated with the intervention condition, moderates or buffers the association between change in primary outcomes and intervention status (i.e. intervention outcome is conditional on the level of ACEs experienced).

Data management: The security and confidentiality of data is of the utmost concern and appropriate data management procedures have been established to ensure confidentiality. The confidential nature of the data will be maintained by using study identifiers(SID)s. A limited number of study staff will have access to a linking document containing the only possible identifying information for participants, the participants non-identifying email address. This linking document will be destroyed once all data have been collected, downloaded from the Quest system (described below), cleaned, and analyzed.

Data will be collected using Quest, a data collection program. Participants will access Quest using the participants non-identifying email address and a password the participants create. All study data will be collected anonymously; therefore, no data will be connected to participant personal information. The confidentiality and security of data files on staff computers will be maintained by ensuring password protection on all computer accounts and storage of all data on Johns Hopkins University (JHU) One Drive. Electronic backup of all database files will occur daily per JHU backup procedures. Access to all study forms will be password protected and available only to the study team.

The use of an online consent form will allow participants to retain anonymity. All audio data (from phase 1 interviews) will be encrypted and saved on JHU One Drive until it is transcribed and analyzed, at which point audio files will be permanently destroyed. Access to all data will be password protected and data will be backed up daily to a secure location on the Quest system (for phase one and two survey data) and on JHU One Drive (for phase one audio data and linking document).

Any study problems or concerns will be brought to the attention of the project manager and PI immediately and the IRB and Centers for Disease Control will be notified according to IRB policies (when applicable). Three experts selected for the ability to comprehend clinical research data, understanding of the population under study, or understanding of prevention interventions were selected to serve on a Data Safety Monitoring Board (DSMB) for this project. The DSMB will meet bi-annually throughout the RCT.