Ready for Relationships Education? Primary school children’s responses to a Healthy Relationships programme in England

ABSTRACT Children’s experience of harm and abuse has a profound impact on their health and well-being. In response, school-based prevention programmes have been developed and delivered by external organisations with the aim of improving children’s awareness and understanding of forms of harm and abuse which may affect them, encouraging them to seek help if needed. In September 2020, Relationships Education became statutory within the primary school curriculum in England and this ratification is likely to increase demand for externally delivered classroom-based programmes, which address the broad range of topics to be covered within this field. However, evidence is required to understand the impact and acceptability of such programmes. This paper presents qualitative findings from a larger mixed-methods study. Focus group discussions with 29 children explored their responses to one Healthy Relationships programme delivered to primary school children aged 10 and 11 in England. Analysis focuses specifically on responses to the topics of sexual abuse prevention and help-seeking. Children’s widespread support for the programme indicates that topics are relevant and the opportunity to explore these issues is valued. However, for effective programme implementation, schools and parents need to be prepared, and prevention messages should continue to be embedded throughout children’s school lives.


Introduction
In the UK, it is estimated that one in five children has experienced severe maltreatment (Radford et al. 2011). The Crime Survey for England and Wales (CSEW) indicated that in the year ending March 2019, 20% of the adult population aged 18 to 74 (8.5 million) had experienced at least one form of child abuse, whether emotional, physical, sexual, or witnessing domestic violence or abuse, before the age of 16 (Elkin 2020). In response to the extensive scale and profoundly damaging consequences of abuse and harm for children, primary prevention has become a central focus of UK government efforts to address the occurrence of violence and abuse in families and relationships. Education is employed as a key strategy to prevent the onset of violence and children and young people are a key target, with prevention programmes often taking place in schools. The intention is that learning about violence at an early age should empower children and young people in their present lives and minimise its prevalence in the future, and schools provide the context in which preventive education can be delivered at scale in an environment dedicated to learning (Tutty et al. 2005). Alongside children's experience of abuse in their families, different forms of violence can affect them at different developmental stages: these include bullying, sexual harassment and interpersonal violence in their own relationships. Schools themselves may be sites of violence perpetration and victimisation and there is an increasing perception that schools are not always safe places for children (House of Commons 2016).

Policy context of sex and relationships education in England
During the mid-1980s, moral panics around sexuality, same-sex relationships, and the use of teaching materials in schools depicting children with same-sex parents (Lee 2021) led to substantial shifts in public opinion and debates about sex education. In 1988, the Local Government Act introduced a clause, known as Section 28, stating that local authorities should not promote teaching around the acceptability of homosexuality as a substitute for heterosexual relationships within the family. This shift undermined the confidence of many of those delivering sex education and led to confusion about the requirement to teach sex education as part of the national curriculum.
A few years later, The Health of the Nation strategy for health in England (DoH, 1992), which among other targets aimed to reduce teenage pregnancy and sexually transmitted diseases, led to a government commitment to a comprehensive programme of sex education for all secondary school pupils. The 1996 Education Act in England and Wales then recommended that sex education should also be taught in primary schools. Legislation was updated in 1999 when sex education became known as Sex and Relationships Education (SRE) to acknowledge that children and young people should be taught about the broader aspects of relationships. This led to SRE becoming firmly embedded in the Personal, Social, Health and Economic (PSHE) curriculum in England and government's first non-statutory SRE guidance on this was published in 2000 (DfEE). From 2006, intensive campaigning for statutory PSHE began, and following a review of PSHE (Macdonald 2009), campaigners and educators were set for the introduction of compulsory PSHE. However, a change of UK government in 2010 meant this was put on hold. Despite this, campaigning and recommendations from the House of Commons Committee on Sexual Harassment and Sexual Violence in Schools (House of Commons Women and Equalities Committee 2016), continued to push for statutory PSHE until March 2017 when an amendment to the Children and Social Work Act confirmed statutory Relationships and Sex Education (RSE) in secondary schools and Relationships Education in primary schools in England from September 2020. Since this point, the government has developed updated statutory guidance on RSE (DfE, 2019) and campaigning continues for mandatory PSHE in England.
State primary schools in England are required to follow the National Curriculum (https://www.gov.uk/national-curriculum). Government's statutory guidance on Relationships Education specifies key areas to be covered within the National Curriculum including friendships, family, boundaries, bullying, stereotypes, and online relationships with an emphasis on taking a 'whole-school approach' (DfE 2019). Teaching on harm and abuse therefore sits within the broader scope of the new Relationships Education curriculum for primary school children. Although RSE is a relatively well-established area of the curriculum in English secondary schools, Relationships Education is an innovative area of learning for many primary school children. Concerns about the responses of parents, particularly in the light of demonstrations in the English Midlands against the implementation of Relationships Education in primary schools (Lee 2021), indicate the need for parents to be engaged and informed of the requirement for high-quality RSE. However, many teachers currently lack the skills and confidence to deliver some aspects of Relationships Education (Stanley et al. 2021) and schools are likely to need support to implement it. Although statutory guidance offers suggestions about the range of topics to be covered, schools have been left to decide themselves how these topics should be taught.
School-based prevention programmes for older children in English secondary schools cover a broad range of topics relevant to RSE, including understandings of consent, domestic violence and sexual violence, and these have been widely developed, implemented and evaluated (e.g. McElwee and Fox 2020;Meiksin et al. 2020;DMSS, 2012;Walton 2007;Bell and Stanley 2006). However, there is a lack of evidence for the effectiveness of integrated programmes for primary school children (age 5-11) in England tackling the full range of harm and abuse that schools are now required to deliver. While there are examples of programmes designed for primary schools, these tend to target specific forms of harm such as sexual abuse prevention (Barron and Topping 2013;Hudson 2018) or bullying (Stallard and Buck 2013). An evaluation of one of the most widely used anti-bullying programmes, the KiVa 1 programme developed in Finland (kivaprogram.net), found programme fidelity and lesson preparation time to be associated with reductions in victimisation (Haataja et al. 2014). The amount of exposure, described as programme 'dosage', along with teacher enthusiasm and support, has also been identified as a factor in programme success (Swift et al. 2017). Fryda and Hulme's (2015) review of child sexual abuse prevention programmes found improvements in children's knowledge across most of the included evaluations, with the biggest change in knowledge relating to who is to blame for abuse. However, evidence-based knowledge is required to inform the content of integrated violence prevention programmes covering the full range of harm and abuse, which will be delivered within the broader Relationships Education curriculum in England.

The Tender programme
The Tender Healthy Relationships Programme for primary schools was selected for this study as it is a relatively well-developed programme arising from a successfully implemented secondary school programme that has been developed and delivered by an independent third sector organisation (Sanders-Mcdonagh et al. 2015). In primary schools, the programme explores friendships and family relationships, with the secondary school programme taking a stronger focus on intimate relationships (tender.org.uk). Tender describes its primary school programme as providing children with the skills to recognise and develop respectful, healthy relationships whilst increasing awareness of their rights to stay safe from abuse. The programme consists of two full days of teaching delivered consecutively to one class of children aged 10 and 11 by two trained facilitators, one male and one female.
Within the programme, children learn how to recognise healthy and unhealthy relationships by exploring different forms of abuse including physical, emotional and sexual abuse as well as bullying and peer-based violence. The National Society for the Prevention of Cruelty to Children (NSPCC) underwear rule (P.A.N.T.S) 2 is introduced on day one during a session on sexual abuse prevention. Children learn about safe and unsafe touch and personal boundaries, and information on how to disclose sexual abuse is included. Day one programme content also addresses healthy and unhealthy relationships, recognising early warning signs of unhealthy relationships, communication and conflict resolution, children's rights, and sources of support. On day 2, the facilitators cover material on peer pressure, bullying and secrets. Throughout the programme, children are encouraged to seek support for themselves or their peers, if needed, from a trusted adult.
Interactive methods of learning, including role play, games, small and whole group discussion, are used to engage children in the programme. A drama-based approach aims to empower children by helping them to acquire skills to recognise potentially harmful situations and allowing participants to experience situations by putting themselves in 'someone else's shoes' (see https://tender.org.uk/schools-programme/primary-schoolslondon/).

Methodological approach
This study utilised mixed-methods including surveys, focus groups and interviews, and this paper reports on qualitative findings in respect of children's experiences of the Healthy Relationships programme. As children's responses to school-based programmes and the extent of their learning from them are closely related (Kirkpatrick and Kirkpatrick 2016), the study aimed to capture children's experiences of programme content.
Ethical approval was received from the University of Central Lancashire Ethics Committee on 15 August 2016 (Ref: Psysoc 292). Three London-based state primary schools that took up the programme between September and November 2016, were included in the study. These comprised one Catholic faith (School B) and two non-faith schools (Schools A and C). All schools followed the same curriculum. Parental consent for their child's participation was acquired on an opt-out basis. Only two parental opt-out forms were returned. To achieve children's informed consent, the first author visited schools to talk with children in advance of the study. Children's written and verbal consent was elicited before and during the study and children were informed that they could withdraw from the study at any time and that any information they provided for the study could be withdrawn within two weeks after completion. In the event of a disclosure of risk or actual harm to themselves or another child, children were advised that relevant information would be passed to the school and that they would be informed beforehand. However, no disclosures were made to the researcher during the study.
A paper-based survey administered by teachers the day following programme completion (Time 2) collected data on children's satisfaction. Children were asked to state whether they enjoyed taking part in the programme by selecting one response from the scale 'yes', 'sometimes', 'no', 'not sure'. A second question asked if there were aspects of the programme they would like to change with the options 'yes', 'no', 'not sure' followed by an open text box for children to explain what they would change. Eighty children took part in the survey: 45 (56%) were girls and 35 (44%) were boys. Twenty-nine of these children attended the Catholic faith school. Children were not asked to identify their ethnicity as teachers considered that children might not know the 'correct' answer.
Focus group discussions, exploring children's perceptions and experiences of the programme more fully, were conducted by the first author in schools one week following the programme. Twenty-nine children took part in focus groups: 13 boys and 16 girls; three groups were mixed-sex and four were single-sex groups.
Observations of programme delivery took place in all schools using a semi-structured schedule, examining children's and adults' reactions, and comments during the programme. Semi-structured interviews were completed with class teachers following programme delivery to explore their views of the programme and its impact.
Qualitative data were managed with the aid of NVivo data analysis software. Short descriptive codes were developed, and data were organised and recorded under each theme. Thematic analysis used both inductive and deductive approaches (Braun and Clarke 2006). Care was taken to anonymise schools and children and pseudonyms are used where quotes are assigned to individuals.

Engagement with the programme
Survey responses immediately following the programme showed that most children (80%) (28 girls and 22 boys) enjoyed taking part in the programme. Eight children reported that they had 'sometimes' enjoyed it and four children (all girls) were either not sure or did not enjoy the programme. As illustrated in Figure 1, most children from School C appeared highly satisfied with the programme: this was the only school in the study where staff reported that RSE and PSHE were taught, perhaps suggesting these children were used to learning about topics similar to those covered by the programme. Responses from children at School B, the Catholic school, were more varied with seven of 20 children reporting that they either sometimes, weren't sure or did not enjoy the programme. A teacher in this school reported that PSHE 'doesn't always get taught and . . . unfortunately the Religious Education does take precedence over it.' As such, and in contrast to those at School C, children at this school were less likely to be familiar with engaging in topics such as relationships, physical or sexual abuse, and the implications of this are discussed further below.
In response to the question of what they would change about the programme, most children reported they would change nothing ( Figure 2). However, several children from the Catholic faith school, School B, reported that they would change aspects of the programme, suggesting that these children were the least satisfied. Suggestions about what they would change mostly related to the method of delivery, for example, children wanted more games and more opportunities to participate. However, two children were dissatisfied with content addressing sexual abuse prevention, with one girl commenting that she would change 'the disgusting bits' and another girl reflecting 'I don't think I was ready to talk about private parts because I just started Year 6'. Again, such comments may be related to children's lack of experience in engaging with programme topics, including sexual abuse prevention.
Findings relating to children's general attitudes towards the programme are significant because most children reported that overall, they were happy to engage with the programme and this is important in the context of the innovative nature of this kind of work in primary schools.

Responses to the programme
Most children participating in the focus groups reported that the material was enjoyable, with several describing the appeal of learning about new subjects. During these discussions, the topics of sexual abuse prevention and help seeking were the two areas of learning that children most commonly reflected on, suggesting that children were both interested in these subjects and that these topics were not commonly addressed with children in this age group. These two areas of children's learning therefore form the focus of the following discussion.

Children's acceptance of content addressing sexual abuse
When reflecting on their learning experience, half of the 29 children reported that their understanding of how to recognise and respond to forms of sexual abuse had increased.
Children recalled a range of key messages including understandings of appropriate and inappropriate touch, awareness of the NSPCC's P.A.N.T.S rule and seeking help by speaking to a trusted adult. For example, one child recalled: These responses indicate that children were able to reflect positively on their learning and had adopted the language used during the programme to describe these concepts. Furthermore, children appeared to not only accept learning about sexual abuse prevention, but also embraced the opportunity to do so: I found it exciting, but at the same time like, I thought like, that it wasn't our age, but at the same time it was exciting. It helped me learn and expand my brain. (Jacob [boy], School B) Children talked of the value of engaging with material on sexual abuse prevention, which they did not usually learn about in school. Yet Jacob, in the extract above, reported being able to overcome his unease and embrace the opportunity to 'learn and expand'.

Feeling unprepared to engage with content on sexual abuse
Although most children appeared to accept this material, some children described feeling discomfort when exploring these topics. Zach, below, describes feeling unprepared to be talking about content addressing sexual abuse, partly due to his understanding that this topic is 'off limits' for children his age: Feeling unprepared meant that Zach was unable to engage in his learning, describing how he shut himself off and 'didn't pay attention'. For some children (and some adults), this is difficult and uncomfortable material to explore particularly when, as this child reveals, it 'wasn't expected'.
Other children were less willing to accept that learning about sexual abuse was relevant to children their age, sensing it to be 'adult knowledge' and something they should not engage with. The extract below illustrates this range of responses: Emily: So it means that, so it says that we need to help stop sexual abuse . . .

Hesam: Yes
Abigail: Don't! Please Jasmine: Ughhhh!!!! Hesam: We're in year 6, we're grown-ups so . . . In this above extract, Abigail is unable to engage in the discussion about sexual content and is resistant to doing so, however by starting to debate this in the peer group, she begins to confront the issue. It is notable that Abigail's friend, Jasmine, starts to change her own position within this short extract: at first, she too appears resistant when Emily uses the term 'sexual abuse', but seems to have shifted her position towards the end of the extract, stating that these are in fact important lessons for them to learn.

Abigail
Feelings of discomfort when discussing these issues are acknowledged by some researchers as appropriate for this age group (Tutty 2014) and some researchers have suggested that, without some level of discomfort, learning about 'sensitive' issues may not be as effective (Fox, Hale, and Gadd 2014). Although some degree of unease was apparent among children in all three schools, it was particularly evident amongst one group of girls in the Catholic school. As one girl explained: 'I don't like talking about private parts', describing it as 'disgusting' and commenting that she didn't want to listen, or have to tell her mother about what she had been learning. Family influences have been identified as a factor in participants' resistance to programme messages and researchers have acknowledged the difficulty for participants to accept messages that counter family and cultural attitudes (Manship and Perry 2012).
While there may be many reasons why these girls were unable to tolerate this material, their collective response may reflect the culture of a school in which such topics were not talked about. For example, staff from the Catholic school reported constraints in relation to teaching that was not in accordance with their faith: 'as a Catholic school, it's very hard for us because we do have restrictions with certain things -Relationships and Evolution . . . '. The language used to describe sexual abuse concepts may be particularly challenging for faith schools, and teachers' reluctance to engage in these subjects is likely to become apparent. If children internalise the understanding that topics such as sexual abuse prevention are forbidden, it is unlikely that they will be able to fully engage with these subjects.
Prior to programme delivery, children were given minimal information about what to expect, other than the title of the sessions. This reflected their teachers' lack of preparedness: interviews with school staff found that communication provided by Tender to schools had not reached individual class teachers. This created some confusion for children who described feeling 'surprised' to be engaging with content on sexual abuse prevention, as Evan explained: Going forwards, situating a programme under the broad framework of 'healthy relationships', can obscure the nature of the content for children and, with no further clarification, children may be unprepared to engage in programme topics. The quotation above suggests that, even by the end of the programme, children remained uncertain of the implication of 'healthy relationships' which also encompassed unhealthy relationships.

Positive beliefs about help seeking as a prevention strategy
Learning about help seeking was widely recalled during focus group discussions, with almost half of the participating children identifying this as an area where their knowledge had grown. Most children considered that, if they spoke out and asked for help, they would be supported appropriately, and children recalled various sources of support they might draw upon. For example, Taylor below recalled: Promoting positive attitudes and beliefs towards help seeking is a valuable outcome. Focus group findings indicated that programme messages expressing positive views about help seeking were effective, with both boys and girls recalling that 'there were so many ways' (Isma [girl], School C) in which they could get support.

Critical response to the consequences of help seeking
However, children also questioned the extent to which help seeking was a confidential process and the following extract, taken from observations of the programme, is typical of discussions that occurred in the three schools. At the start of this discussion, programme facilitators had provided information about Childline (the NSPCC's national helpline service that children can contact directly in their own right), describing it as a 'confidential' telephone service for children: Facilitator: You have a right to feel safe so Childline would be interested in making sure the child is OK. All schools have a safeguarding policy and part of that is confidentiality and the teacher can only pass information to those who need to know.
When it came to understanding the consequences of help seeking, children wanted to know what would happen if they did seek help. If children perceived that there would be negative consequences, for example being taken away from parents, then they may not feel able to speak out freely. Whether help seeking was a completely confidential process was questioned by another girl, and the following extract reveals her understanding of what might happen if she called Childline in view of the messages she heard during the programme: Abigail: Some people say, as they say, that you can call Childline but actually, so let's say if my, like if you call Childline your parents might know and you can get into trouble, that's the thing.
Interviewer: Okay, the number for Childline doesn't come up on any phone bill. Despite being told that she could and should speak out, Abigail did not accept that she could seek help without negative consequences. Understanding that sometimes they may need to speak out and seek support, and that it is permissible to do so, is a difficult concept for children to learn (Tutty 2000) and one that Abigail appeared unable to accept. If children are sceptical of the consequences of speaking out then, although they may know they should, they may not feel confident to do so. Children may also resist programme messages if they are not offered the opportunity to discuss topics and seek clarification, or if the information provided lacks depth and simply reproduces previous learning. The following quote is typical of these criticisms: Like they could have told us about, like we knew where to go for help and stuff. They reminded us, but they said to us that they're going to tell us new things . . . but we didn't really know anything new. They could have told us like how to get to the centre like and, if like, they could have told us more things about Childline. (Jasmine [girl], School A) Insufficient information was reported by other children who suggested that the programme could be improved with 'more details, more stuff and explain more about it'.

Discussion
This study reported here was a small-scale evaluation of one school-based programme delivered to one year group in three London schools. The findings are therefore not generalisable. However, the study found that primary school children could engage meaningfully in learning about harm and abuse, and that opportunities to explore this area of the curriculum were valued. Children's engagement in programmes which aim to raise their awareness of multiple forms of harm and abuse can have a positive impact on their understanding of safeguarding concepts, and their widespread support for the material indicates that such programmes of work are relevant to children aged 10 and 11.
However, children in this study did have some criticisms of the programme and not all children were equally positive about all aspects of the content. Below we consider ways in which children's learning on these topics can be better supported and facilitated, focusing on programme design and content as well as the wider contexts of the peer group, the family and the school.

Providing opportunities for children to explore content in depth
Children in this study wanted messages to be expressed clearly and appealed for opportunities to explore complex topics in depth. Although increasing children's understanding about where and how they can seek support is valuable, such messages may meet resistance if children are not confident about what would happen if they do speak out. Children were critical of learning they considered to be superficial: for example, being offered information about the availability of Childline as a source of support without the opportunity to explore what would happen if they did access the service. Teachers and others delivering important messages about children's rights to seek help need to provide children with opportunities to explore what might happen if they did so, rather than providing simplistic messages about who they should tell. Speaking out against an adult is a complex practice for children to engage in (Tutty 2000) and children's need to explore the consequences of telling may reflect their understanding that empowerment depends on the extent to which adults would be able to help in the way children want.

Situating in children's experience
Children's appeal for 'more' and 'new things' in this study suggests that content needs to be responsive to the needs of children at their current age and learning stage. Although children value repetition and reminders, material should build on previous learning so that, rather than feeling tokenistic, learning is meaningful and relevant to their current lives. This might be achieved by revisiting complex topics once they have been introduced, for example by their teachers if time is limited during the delivery of an externally facilitated programme.
Previous research suggests that when introducing complex ideas about prevention, children may require time for additional discussion, as well as the repetition of ideas (Tutty 2000). Adopting a holistic approach which could include teacher training, so that school staff are better prepared to pick up and reinforce concepts (Ollis 2014), may offer a way forward. A key challenge for programme designers is how to ensure complex prevention messages aimed at empowering children through an understanding of rights, and which encourage them to speak out against adults when required, can be delivered within the school context where children often have very little power (Mayall 2002). Incorporating adult education and training into the design and implementation of programmes, including the education of both teachers and parents, so that they are better equipped to recognise and act accordingly when children need help, may ensure that children feel more confident about speaking out.

Promoting discussion within the peer group
Peer group support emerged as an important sub-theme in the observation of focus group discussions. Although children are positioned in relation to their age and learning stage within the school context, the receptiveness of children taking part in school-based preventive programmes may differ: some children may be open to learning about prevention of sexual abuse, whilst others are less able to accept this learning as relevant to them. Despite such differences, this study provides evidence of how, through discussion within the peer group, children can scaffold and support one another's learning.
Learning within the peer group setting enables children who are more receptive to material on sexual abuse prevention to facilitate those who are less so. When opportunities to discuss topics among themselves are provided, children can start to work through their discomfort together as a group: some children may be able to accept content relating to sexual themes and will find it easier to discuss than others. Children who are more receptive can facilitate the comprehension of those who are less so, and all can start to become more confident in talking openly about topics, which are traditionally viewed as off-limits for younger children.

Facilitating readiness to engage with 'sensitive' topics
Providing information about programme content in advance is likely to help children prepare to engage with the material and may increase both the acceptability of topics and children's willingness to participate. In this study, learning about sexual abuse prevention appeared to be acceptable to most children, however a minority of children were resistant to this material. Although some discomfort was evident amongst boys, resistance was more prevalent amongst girls, particularly those in the Catholic faith school. It is significant that children in this school were not taught RSE, and that Religious Education took precedence over PSHE. Lack of familiarity with topics, such as sexual abuse prevention, may have been a factor for those children who described being taken by surprise by the material, relating to children feeling unprepared to be engaging in such topics.
Conceptualising children as active learners (James, Jenks, and Prout 1998) involves acknowledging that readiness to engage in topics is an important part of the learning process (Howarth et al. 2018;Stanley et al. 2015). Ensuring that the aims of a programme are understood by children, parents and teachers beforehand, may help children to feel better equipped and less surprised to be engaging in this material. A child-centred approach which acknowledges children's right to information, but also their right to withdraw from programmes, would ensure that children who do not want to participate are not constrained to do so, even when adults may feel participation is in a child's best interests.

Family and cultural influences
Children's resistance may also be associated with cultural background or family beliefs. Conflicting family influences are likely to contribute to resistance to messages that children hear outside school and may moderate the effects of programmes (Walsh et al. 2015). Children may find it difficult to accept learning that counter family and cultural attitudes without the support of their family (Manship and Perry 2012). This emphasises the importance of parental engagement so that the messages delivered in school are supported at home, and so that children are less likely to feel uncomfortable to be learning about these issues at school.
However, concerns about raising children's awareness of sexual abuse may also relate to adult discourses about children's innocence, which may be used to restrict children's access to knowledge, particularly those concerning sexual issues (Renold 2005;Robinson 2012). These views can be reinforced by religious and cultural concerns among adults who believe that school-based programmes clash with family morals and values, as demonstrated by parents and faith groups in the English Midlands protesting the introduction of new RSE curriculum in 2019 (Lee 2021). Conflicts can arise between parents and schools who embrace more conservative values, and those who advocate the need to equip children with essential knowledge to help keep themselves safe. To achieve this, parents need to be engaged and informed of the need for high-quality RSE, and schools and parents should work together to make sure children and young people get the information and support they need (DfE 2019). Without parental engagement and support, attempts to empower children may be ineffective.

Schools' readiness
School's readiness to engage with programme topics emerged as a key factor contributing to the acceptability of the programme for children and teachers. The concept of 'readiness' is here used to indicate willingness or preparedness to change and/or engage in an intervention (Howarth et al. 2018). School readiness has been identified as important for the successful implementation of school-based programmes (Stanley et al. 2015) and involves engagement by all members of the school community (Maxwell et al. 2010).
Ofsted (2021) recent review of sexual harassment in schools makes a number of recommendations with an emphasis on the adoption of a whole-school approach including a carefully implemented RSE curriculum in line with statutory guidance (DfE 2019) and high-quality training for teachers delivering RSE. In contrast to one-off programmes delivered by external agencies, a holistic whole-school approach, which generates sustained attitude change across the school community, may help children to engage with 'sensitive' topics over time. Those children who are not quite ready to participate could be assisted to do so by the demonstration of commitment from the whole school and its staff. In this study, teachers were found to be poorly prepared for the programme. Ensuring that both teachers and children are provided with relevant information beforehand, could help children feel less anxious or surprised to be learning about these topics (Humphreys et al. 2006).

Conclusion
This study found that primary school children's responses to the topics of abuse and harm covered by the programme were generally positive. However, children had some criticisms about the programme regarding the depth of information provided on help seeking and some children were unprepared for programme content addressing sexual abuse. Schools and children need to be sufficiently prepared for the material included in these programmes. Parents also need preparation, and this will need to be thoughtfully addressed in some communities. Additional support for schools that are less experienced in engaging with these topics may be required to help them achieve readiness and, as this study revealed, terminology concerning healthy relationships may not be helpful in this respect. Primary schools across England are now implementing Relationships Education on a statutory basis but if doing so is to have a real preventive impact, the design and implementation of the new curriculum for younger children will need to be properly thought through and prepared for.
As much of the expertise and skills required to deliver these subjects is currently located in third sector external organisations, meaningful collaboration between schools and such organisations will be key to ensuring effective implementation of Relationships Education. The extent to which primary school teachers currently possess the skills required to teach these topics effectively is uncertain, and although schools may need support from external organisations in the short term, in the longer term, high-quality teacher education and training is essential to enable school staff to deliver these subjects effectively. This will also require additional funding for schools to buy into such programmes and for the upskilling of current teachers, so they are sufficiently trained and prepared. An approach that is entirely reliant on external organisations delivering one-off programmes so that this aspect of the curriculum is simply 'ticked off' by schools needs to be avoided if children's lives and relationships are to be safer. Relationships Education is an innovative topic for primary schools in England, and it is unlikely that it can be embedded successfully if schools lack the confidence and commitment to engage in this new area of the curriculum.

Notes
1. KiVa stands for Kiusaamista Vastaan, which is Finnish for 'Against Bullying' 2. The NSPCC underwear rule (P.A.N.T.S) reads as follows: Privates are private, Always remember your body belongs to you, No means no, Talk about secrets that upset you, Speak up, someone can help.