Substance Use, Mental Health, and Child Welfare Profiles of Juvenile Justice-Involved Commercially Sexually Exploited Youth

The relationship between commercial sexual exploitation and foster care placement in the U.S.: A scoping review

BACKGROUND

There is evidence youth in foster care may be vulnerable to commercial and sexual exploitation of children (CSEC) in the U.S. Youth in care may show vulnerabilities such as running away, identifying as sexual/gender minorities, or exhibiting complex behavioral and mental health needs. However, the nature and nuances of the relationship between CSEC and foster care placements has been largely unexamined.

OBJECTIVES

This review explores the literature on trafficking among foster care youth to establish what is known about risk factors, vulnerable populations, and leverage points for prevention and intervention.

METHODS

This scoping review was conducted using PRISMA-ScR guidelines. Eight databases were searched, and the screening process resulted in 16 final articles in the analysis.

RESULTS

Sixteen articles were screened into the current study. In reviewing the content, a few distinct themes emerged. First, the articles focused on three different populations of CSEC youth. Second, there was variability in the definitions of CSEC used by scholars. Third, there was a range of terms used to describe youth who were trafficked. Finally, there were broad differences in study methodology. This included the data sources used and the array of outcomes explored (e.g. substance use, mental health diagnoses, housing stability).

CONCLUSIONS

It is important for scholars to use common language and definitions when studying the sex trafficking of minors. Developing national databases and improving state and federal data sharing is needed to inform prevalence estimates and explore various pathways to youth experiencing CSEC.

A Systematic Review of Specialty Courts in the United States for Adolescents Impacted by Commercial Sexual Exploitation

Nationwide efforts to enhance services for adolescents experiencing commercial sexual exploitation (CSE) in the judicial system have led to the emergence of specialty courts, including human trafficking and girls' courts. Given that prior research has documented competing stances on the effectiveness of specialty courts for CSE-impacted populations, we conducted a systematic review of the literature to identify key characteristics of programming, profiles of adolescents served, and effectiveness of these courts. To identify relevant research and information, we systematically searched scholarly databases and information sources, conducted reference harvesting, and forwarded citation chaining. Articles presenting primary data with quantitative, qualitative, or mixed methodologies or programmatic descriptions of specialty courts serving adolescents at risk or with confirmed histories of CSE that were published after 2004 were included. We identified 39 articles on 21 specialty courts serving adolescents at risk or with confirmed histories of CSE, including seven specialty courts with evaluation or outcome data. Across specialty courts, adolescents benefited from an increase in linkage to specialized services, improved residential placement stability, and reduction in recidivism-measured by new criminal charges. Specialty court participation was also associated with improved educational outcomes and decreased instances of running away. A lack of empirical data, specifically of evaluation studies, emerged as a weakness in the literature. Still, findings support that specialty courts can be an integral judicial system response to CSE. Multidisciplinary collaboration can help target and respond to the multifaceted needs of adolescents, encourage healthy behaviors, and promote their overall wellness.

Informal mentoring support as a potential moderator of the relation between adolescent dating violence victimization and substance use

Research links adolescent dating violence (ADV) victimization to negative developmental outcomes, including involvement in substance use. Informal mentoring is associated with several positive outcomes, including reduced risk of substance use. Addressed in this study is whether support from an informal mentor can function to protect victims of ADV from involvement in substance use. Participants were 152 adolescents (grades 9-12). Findings revealed a significant association between ADV victimization and adolescents' involvement in substance use, as well as some evidence that support from an informal mentor moderates that link. When informal mentor support was low or at the mean, ADV victimization was significantly linked to adolescents' involvement in substance use; when informal mentor support was high, ADV victimization was unrelated to substance use involvement. Discussed are research and practice implications of the potential protective role of informal mentors for victims of ADV.

Risk profiles of suicide attempts among girls with histories of commercial sexual exploitation: A latent class analysis

BACKGROUND

Girls impacted by commercial sexual exploitation (CSE) in the juvenile legal system are three times more likely to have suicide attempts than girls without histories of exploitation. Yet, research on risk profiles and correlates that contribute to elevated suicide risk among girls with CSE histories remains scant.

OBJECTIVE

We sought to examine suicide attempts profiles among CSE-impacted girls in the juvenile legal system.

PARTICIPANTS AND SETTING

We partnered with a specialty court for CSE-impacted youth in Los Angeles County.

METHODS

Data were collected from case files of the 360 girls participating in the court from 2012 to 2016. Latent class analysis was used to identify their profiles of risk indicators.

RESULTS

Four risk profiles for suicide attempts emerged: (1) Parental Incarceration (PI; 30 %), (2) Child Welfare Contact (CWC; 25 %), (3) Disruptive Behavior and Sleep Problems (DBS; 25 %), and (4) Pervasive Risk (PR; 22 %). Among youth in the PI group, 5 % had a suicide attempt; however, contrary to our hypothesis, no youth in the CWC group had a suicide attempt. Rates of suicide attempt were significantly higher among youth in the DBS group, as 14 % had a suicide attempt. As hypothesized, youth in the PR were associated with higher risk of suicide attempts, with 28 % reporting a prior suicide attempt.

CONCLUSIONS

Findings underscore the need for standardized suicide screenings and treatment referrals for girls with CSE histories and suggest an important opportunity for multidisciplinary collaboration with courts to improve suicide prevention strategies. The present study also supports the importance of examining risk across the socioecological context.

Psychiatric and Substance-Related Problems Predict Recidivism for First-Time Justice-Involved Youth

Justice-involved youth with clinically significant co-occurring psychiatric and substance-related problems are at increased risk for recidivism. Less is known about how psychiatric symptoms (i.e., internalizing and externalizing) and substance-related problems (i.e., alcohol and cannabis) interact to predict recidivism, especially at first court contact. Among 361 first-time justice-involved youth aged 12 to 18, we used nested multivariate negative binomial regression models to examine the association between psychiatric symptoms, substance-related problems and 24-month recidivism while accounting for demographic and legal covariates. Clinically significant externalizing symptoms and alcohol-related problems predicted recidivism. Moderation analyses revealed that alcohol-related problems drove recidivism for youth without clinically significant psychiatric symptoms and externalizing symptoms predicted recidivism, regardless of alcohol-related problems. After accounting for other predictors, Latinx, Black non-Latinx, and multiracial non-Latinx youth were more likely to recidivate at follow-up than White non-Latinx youth. Systematic screening, referral, and linkage to treatment for psychiatric and substance-related problems are needed to reduce recidivism risk among first-time justice-involved youth. Differences in recidivism rates by race/ethnicity not attributable to behavioral health needs suggest it is imperative to concurrently deploy large-scale structural interventions designed to combat systemic racial bias and overrepresentation of ethnoracial minoritized youth within the juvenile justice system.

A Balancing Act: How Professionals in the Foster Care System Balance the Harm of Intimate Partner Violence as Compared to the Harm of Child Removal

The striking prevalence of child exposure to intimate partner violence (IPV) and its associated adverse health outcomes necessitates a robust response from professionals who must grapple with the ethical dilemma of how to serve and support children in these circumstances. In 2020, 42 participants from four different professional backgrounds (attorneys, nonprofit leadership, licensed therapists, and social workers) were interviewed or participated in a focus group discussion. All groups acknowledged the shortfalls of current intervention practices, which often result in child removal. Group 1, which included social workers that work for children's legal services, minor's counsel, and Los Angeles Department of Child and Family Services social workers, were more conflicted in their recommendations for change. Some Group 1 participants recommended more training, while others thought more training would make little difference and recommended more substantial changes to prevent child removal when possible. Group 2, which included parents' counsel, and Group 3, which included social workers, attorneys, and nonprofit leadership at IPV nonprofits, were more closely aligned in their recommendations, primarily focusing on systemic changes to the child welfare system. Participants whose employment required them to advocate for parents tend to view child removal from a non-offending parent as harmful for both the child and IPV survivor. These findings illuminate how the perspectives of these diverse participants are influenced by their professional and personal experiences.

Exploitation, Labor and Sex Trafficking of Children and Adolescents: Health Care Needs of Patients

Exploitation and labor and sex trafficking of children and adolescents is a major public health problem in the United States and throughout the world. Significant numbers of US and non-US-born children and adolescents (including unaccompanied immigrant minors) are affected by this growing concern and may experience a range of serious physical and mental health problems associated with human trafficking and exploitation (T/E). Despite these considerations, there is limited information available for health care providers regarding the nature and scope of T/E and how providers may help recognize and protect children and adolescents. Knowledge of risk factors, recruitment practices, possible indicators of T/E, and common medical, mental, and emotional health problems experienced by affected individuals will assist health care providers in recognizing vulnerable children and adolescents and responding appropriately. A trauma-informed, rights-based, culturally sensitive approach helps providers identify and treat patients who have experienced or are at risk for T/E. As health care providers, educators, and leaders in child advocacy and development, pediatricians play an important role in addressing the public health issues faced by children and adolescents who experience exploitation and trafficking. Working across disciplines with professionals in the community, health care providers can offer evidence-based medical screening, treatment, and holistic services to individuals who have experienced T/E and assist vulnerable patients and families in recognizing signs of T/E.

Commercial Sexual Exploitation Outcomes in a Community Sample of Youth

PURPOSE

Researchers have suggested that victims of commercial sexual exploitation (CSE) have deleterious long-term outcomes; however, longitudinal trajectories of youth who experience CSE have not been explored. For the current study, the National Longitudinal Study of Adolescent to Adults Health (Add Health) survey was used to compare trajectories of youth who had experienced CSE with their nonexploited peers.

METHODS

Propensity score matching was used to match youth at waves 1 and 2 who experienced CSE and who did not experience CSE but had similar risk profiles. Youth with low-risk profiles were also matched. Our sample included 430 youth who experienced CSE, a matched sample of 430 youth who did not experience CSE but had a similar risk profile, and a sample of youth who did not experience CSE and had low-risk profiles (n = 782). Outcomes of interest included psychological, behavioral, physical, and interpersonal well-being.

RESULTS

Youth who had experienced CSE had higher levels of injection drug use, more police stops, more emergency room visits, and lower relationship satisfaction than their nonexploited peers. Well-being for individuals who experienced CSE as youth changed some over time, but those changes were comparable to the changes experienced by individuals of similar risk who did not experience CSE. Well-being measures for low-risk youth were universally higher compared to high-risk youth, regardless of CSE.

DISCUSSION

Youth receiving drug treatment, experiencing delinquency, or being seen in emergency medical settings may benefit from CSE screening, so that victims can be identified and provided immediate and comprehensive services.

Service providers' perspectives on substance use and treatment needs among human trafficking survivors

INTRODUCTION

Understanding substance use and treatment needs for survivors of human trafficking remains an underdeveloped area in the field of substance use treatment. This study assessed the nature of substance use among survivors of all types of human trafficking and identified treatment barriers and needs, as reported by human trafficking service providers in one Midwest major metropolitan area.

METHODS

Participants were purposively selected from agencies that served foreign-born and domestic-born survivors of human trafficking. The study interviewed fifteen key informants across 13 agencies directly serving survivors of trafficking.

RESULTS

Providers highlighted frequent use of alcohol and marijuana, as well as polysubstance use. They noted survivors' significant use of opioids, associated concerns regarding fentanyl-related deaths, and increased frequency of stimulant use. Barriers for addressing substance use problems with survivors included low self-perceptions of need, lack of available residential or inpatient treatment options, and prioritizing basic needs such as housing over substance use treatment.

CONCLUSIONS

Results underscore how broader trends in substance use and overdose in a region can mirror substance use patterns and treatment needs of human trafficking survivors. Further, a need exists for broader substance use screening and low-barrier referral services to address emergent needs of survivors of trafficking.

Child Labor and Sex Trafficking

Regardless of their practice setting or subspecialty, pediatricians are likely to encounter children who have experienced sex or labor trafficking or who are at risk for exploitation. Only 24.1% of health professionals in one study reported receiving previous training on human trafficking; after a brief presentation on the topic, 39.6% indicated that they knew or suspected they had cared for a trafficked person in the past 3 months. Trafficked and exploited children can present with myriad physical or mental health conditions; most have experienced repeated, significant trauma; and few are likely to spontaneously disclose their exploitative situation. As a result, clinicians face challenges in recognizing and appropriately responding to potential human trafficking. Knowledge of common risk factors and potential indicators of exploitation can assist the pediatrician in recognizing affected and at-risk youth. However, health professionals report that existing training tends to focus on general information about trafficking, with relatively little time spent discussing the specifics of the trauma-informed approach to patient interactions. Given the critical importance of building patient trust, empowering patients to share their concerns, and engaging them in their own care and safety planning, this article focuses on the practical aspects of working with trafficked and exploited children. A brief overview of human trafficking is followed by an extensive discussion of rights-based, culturally sensitive, trauma-informed strategies for interacting with vulnerable patients.

Development of a Multi-Session Curriculum Addressing Domestic Minor Sex Trafficking for High-Risk Male Youth

Males, in particular adolescents and young adults, have been increasingly recognized as involved in domestic minor sex trafficking (DMST). However, there are very sparse resources and organizations that provide prevention, identification, and interventions for boys and young men who are involved in or at-risk for DMST involvement. The objective was to develop and assess an educational curriculum to prevent adolescent male involvement in DMST through a three-pronged educational approach: as victims of sexual exploitation; receiving financial benefit as exploiters; as buyers of sex. Through quality improvement cycles, changes were made to enhance the curriculum by utilizing the outcome measures of participant questionnaires and feedback from a steering committee of clinical experts. Male youth at the state's juvenile detention center were asked to participate in pilot groups, as they were identified as a high-risk population of adolescents to become involved. The curriculum was modified by adding sessions, including additional community guest speakers, and providing a more holistic educational experience that involves trafficking prevention from both a victimization and perpetration standpoint. Our goal is to expand this educational opportunity to be utilized in multiple settings (e.g., schools, hospitals) across the country.

Perspectives of Girls and Young Women Affected by Commercial Sexual Exploitation: mHealth as a Tool to Increase Engagement in Care

Objective

We gathered the perspectives of girls and young women affected by commercial sexual exploitation (CSE) to understand the acceptability and feasibility of mobile health (mHealth) for enhancing access and engagement in health and social services during judicial involvement.

Methods

We conducted four focus groups with 14 girls and young women (ages 14 to 21) with self-identified CSE histories.

Results

Participants perceived mHealth as viable for accessing and engaging providers, and health and social services, and navigating judicial systems. Participants expressed that mHealth tools increased self-efficacy and self-navigation of required services. Recommendations to improve mHealth functionality included push-notification appointment reminders, wellness and safety promotion, enhancement of provider communication, peer-to-peer support, and access to health education and community resources.

Conclusions

Findings provide insight for how mHealth may be leveraged to increase self-management skills, fulfill judicial obligations, and improve access and engagement in health and social services for CSE-affected girls and young women.