Sex Trafficking of Girls With Intellectual Disabilities: An Exploratory Mixed Methods Study

[Medicolegal assessment of human trafficking victims. Descriptive study of a series of forensic cases in Catalonia (Spain)]

BACKGROUND AND OBJECTIVE

Human trafficking or contemporary slavery is the recruitment and transfer of people by force or deception for sexual, labour or other types of exploitation. Although the violence, abuse and deprivation that trafficking entails are a threat to the health of its victims, in Spain the clinical or forensic data available in this regard is scarce. At the Institute of Legal Medicine and Forensic Sciences of Catalonia (IMLCFC), a unit specialized in the forensic assessment of these victims was created. The objective of this work was to describe a series of forensic cases of trafficking victims.

MATERIAL AND METHOD

Retrospective study of victims in judicial cases opened for an alleged crime of human trafficking registered in the IMLCFC until 06/30/2023.

RESULTS

57 different victims were registered. The majority were women (71.9%). The average age was 30.5 years (s.d. 10.31). All the victims were foreigners, mostly from Latin America (45.5%). The exploitation was mainly sexual (61.4%). There were some sociodemographic differences and in the conditions and consequences of trafficking between victims of sexual exploitation and the rest. Mental health problems were very common in all victims at the time of the assessment (87.5%).

CONCLUSIONS

The consequences of trafficking on health, especially mental health, are notable and the forensic assessment of victims is valuable in judicial proceedings. It is necessary to deepen our knowledge of the phenomenon in our environment.

Risk and Protective Factors for Sexual Exploitation in Male and Female Youth From a Cross-Cultural Perspective: A Systematic Review

Youth are at elevated risk of becoming victims of sexual exploitation, which has a detrimental impact on their physical and psychological well-being. Understanding factors associated with sexual exploitation is key for prevention efforts and adequate and timely treatment. This systematic review sheds more light on this by providing an overview of both risk and protective factors for sexual exploitation in male and female youth from a cross-cultural perspective. In all, 65 studies were selected meeting the inclusion criteria: qualitative or quantitative peer-reviewed studies in English, Dutch, or German with findings on risk and protective factors associated with sexual exploitation in youth aged up to 24 years. Results show that there are common risk factors in male and female youth worldwide (e.g., adverse childhood experiences, lack of a social network, substance use, and running away). Positive and supportive relationships are an important protective factor in mitigating the risk of sexual exploitation. Geographic differences were found. In non-Western continents, more environmental factors (e.g., economic vulnerabilities, residential instability) were cited. Research in countries outside the United States is limited and protective factors and males are underexamined. To fully understand vulnerabilities in youth, their interactions, and possible gender differences and to address the needs of diverse populations, more insight should be gained into the broader range of risk and protective factors worldwide. This systematic review has made a valuable contribution to this by providing practice, policy, and research guidance in the establishment of more targeted prevention efforts, adequate treatment, and areas to address in future research.

Exploring the Role of Prior Sexual Abuse in the Commercial Sexual Exploitation of Boys and Young Men

Although there has been a large body of research conducted on girl and young women victims of commercial sexual exploitation, boy and young men victims do not receive the same attention. The scant research that exists demonstrates mixed findings on the prevalence of boys and young men as victims of commercial sexual exploitation. For example, some studies find they are not as likely to be victims and others find they are victimized equally, or in some cases, potentially even more so than girls and young women, depending on location. ECPAT published a study in 2013 that revealed a lack of awareness and misclassification of boys as victims and the lack of services available to help them. The purpose of this study is to replicate the ECPAT study and determine what changes might have occurred over the past decade. We consulted with key individuals involved in serving boys and young men and conducted a survey of anti-trafficking service agencies to gather current information on the boys/young men being referred to them for care, the dynamics of their victimization, their most pressing needs, the services/programs being offered, and gaps in service in their respective locations. Among other relevant findings, one commonality among the boys and young men served by the responding agencies was a history of sexual abuse. Findings inform service providers and contribute to advocacy efforts and policy recommendations at the local, state, and federal levels.

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.

Physical Disabilities and Low Cognitive Ability Increase Odds of Minor Sex Exchange among Adolescent Males in the United States

Disability is a well-established risk factor for sexual violence victimization among both male and female children. Some research indicates that adolescent females with disabilities are at higher risk of experiencing minor sex exchange (a form of minor sex trafficking victimization) compared to females without disabilities, but there is a dearth of similar research among adolescent males. This study investigates whether physical disability and low cognitive ability are related to sex exchange among minor adolescent males. This cross-sectional analysis using data from a nationally representative cohort study, The National Longitudinal Study of Adolescent to Adult Health (Add Health), included 4,401 male participants who were age 18 or younger at Wave II. Unadjusted and adjusted logistic regression models estimated the odds of adolescent experiences of sex exchange by physical disability and cognitive ability. Both severe physical disability and low cognitive ability in adolescent males were significantly associated with increased odds of exchanging sex, results similar to those found in studies of adolescent females. Because of these associations for both males and females, disability should be taken into account when designing and implementing prevention and intervention programs related to sex trafficking. These results underscore the importance of addressing system-wide gaps contributing to the relationship between disability and the involvement of minors in commercial sex exchange.

Confusing Terms: A Concept Analysis of Naming Youth Trafficking

Human trafficking is a growing population health problem. More than half of all persons experiencing trafficking are youth, with many in the United States unrecognized despite experiencing exploitation. Available peer-reviewed articles report a myriad of descriptions of trafficking, yet the concept and operational definition of youth trafficking, specifically, is lacking and unclear. Youth trafficking is described differently across multidisciplinary researchers and clinicians working with trafficked youth. Furthermore, labor trafficking of youth is largely excluded from the conversation surrounding trafficking. This article presents a concept analysis of naming trafficking of persons under the age of 18 years to clarify the concept specific to youth experiencing all forms of trafficking and approaches professionals can take with this specific subpopulation of trafficked persons and survivors.

Are Screening Tools for Identifying Human Trafficking Victims in Health Care Settings Validated? A Scoping Review

OBJECTIVE

Although many screening tools, resources, and programs for identifying victims of human trafficking exist, consensus is lacking on which tools are most useful, which have been validated, and whether they are effective. The objectives of this study were to determine what tools exist to identify or screen for victims of human trafficking in health care settings and whether these tools have been validated.

METHOD

We conducted a scoping review of the literature on human trafficking identification in health care settings following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) protocol for scoping reviews. We searched the MEDLINE, PsycInfo, Embase, and Scopus databases without language or date limitations. Two independent reviewers screened each citation. We included human research studies in English with populations of all ages, all genders, all geographic locations, and using quantitative and/or qualitative research methods. We excluded studies that were not conducted in a health care setting, review articles, and meta-analyses. We summarized additional screening tools available online and identified through hand-searching.

RESULTS

Database searches yielded 8730 studies, of which 4806 remained after removing duplicates. We excluded 4720 articles based on title/abstract review, we reviewed 85 full-text studies for eligibility, and we included 8 articles. Hand-searching revealed 9 additional screening tools not found in the literature. Through our search for validated screening tools, only 6 had been studied for validation in health care settings.

CONCLUSIONS

Few studies have evaluated screening tools for identifying victims of human trafficking in health care settings. The absence of a gold standard for human trafficking screening and lack of consensus on the definition of human trafficking make screening tool validation difficult. Further research is required for the development of safe, effective approaches to patient screening.

Examining Commonly Reported Sex Trafficking Indicators From Practitioners' Perspectives: Findings From a Pilot Study

Commonly reported sex trafficking indicators have been disseminated widely by government and non-governmental organizations in trainings aimed to increase identification and referral to resources. However, very little research evaluates such indicators. Drawing from survey responses of 86 social service providers, health care practitioners, and justice system officials in a Midwestern City, this pilot study aimed to examine: (a) the pervasiveness of the commonly reported indicators, (b) the salience of domains of indicators, and (c) the extent to which indicators differ across service populations (U.S.-born minors, U.S.-born adults, foreign born minors, and foreign born adults). The most commonly identified indicators included mental health symptoms of depression (M = 3.82); low self-esteem (M = 3.59); anxiety (M = 3.55); low levels of interpersonal trust (M = 3.52); sense of fear (M = 3.36); feelings of shame or guilt (M =3.34); isolation from family, friends, and communities (M = 3.3); and fear/distrust of law enforcement (M = 3.80). The least commonly identified indicators included exhibiting low English proficiency (M = 1.62), previous history of loitering charges (M = 1.74), presenting false documents (M = 1.85), presence of tattoos or branding (M = 1.89), presenting delayed cognitive development (M = 1.91), being unaware of one's location (M = 1.94), owing large debt (M = 1.95), previous history of prostitution or drug charges (M = 1.98, M = 2.01), and physical evidence of torture (M = 2.07). The mental health domain was identified as especially common among U.S.-born adults (M = 3.07). Criminal justice involvement was identified as less common among foreign-born minors (M = 1.82) and foreign-born adults (M = 1.96). The most commonly identified indicators, according to the service providers, health care workers, and justice system officials who work with them, are inconsistent with many of the indicators that are used frequently across governmental and community trainings. Trainings focusing on diverse case examples of trafficking may be important in strengthening identification of sex trafficked individuals, as well as accounting for regional contexts.

Sexual victimization and intellectual disabilities among child welfare involved youth

BACKGROUND AND OBJECTIVE

Youth with intellectual disabilities involved in child welfare systems are at greater risk of sexual victimization than youth who have not been investigated for child maltreatment. This study addresses a gap in the literature regarding older youth with intellectual disabilities who are sexually victimized and pushed to engage in transactional sex while they are transitioning from child welfare systems involvement. It does so by examining risk and protective factors at the individual, micro, exo, and macro systems levels.

PARTICIPANTS AND SETTING

This study included 334 youth ages 18-19.5 from a nationally representative sample of 5,872 child welfare-involved youth.

METHODS

Multivariate logistic regression models were used to conduct a secondary analysis of the National Survey of Child and Adolescent Well-Being II to examine relationships between intellectual ability, social support, and community environment and sexual victimization and engaging in transactional sex.

RESULTS

Results indicate that 2.5 % of the youth experienced sexual victimization in the past 12 months, and 3.9 % had engaged in transactional sex in the past 6 months. The mean intelligence score for these youth was one standard deviation below average (M = 84.62, SD = 19.60). Being female was associated with experiencing sexual victimization (Odds Ratio = 17.29, p = .025). Higher intellectual ability scores were associated with lower odds of engaging in paid sexual activity (Odds Ratio = 0.92, p = .002).

CONCLUSIONS

This study highlights the need for early identification of intellectual disabilities among child welfare-involved youth, provision of informed social supports and services, and building community connections during transition to prevent sexual victimization.

A Public Health Approach to Global Child Sex Trafficking

Human trafficking and child sex trafficking and sexual exploitation in particular are global public health issues with widespread, lasting impacts on children, families, and communities. Traditionally, human trafficking has been treated as a law enforcement problem with an emphasis on the arrest and prosecution of traffickers. However, use of a public health approach focuses efforts on those impacted by exploitation: trafficked persons, their families, and the population at large. It promotes strategies to build a solid scientific evidence base that allows development, implementation, and evaluation of prevention and intervention efforts, informs policy and program development, and guides international efforts at eradication. This article uses the public health approach to address human trafficking, with a focus on child sex trafficking and exploitation. Recommendations are made for public health professionals to contribute to antitrafficking efforts globally.

Disclosing Sex Trading Histories to Providers: Barriers and Facilitators to Navigation of Social Services Among Women Impacted by Commercial Sexual Exploitation

Sex trafficking and commercial sexual exploitation (CSE) can lead to devastating health and mental health consequences for women, such as elevated rates of substance use, trauma, posttraumatic stress disorder, depression, sexually transmitted infections (STIs), and HIV. Consequently, engagement with services that address addiction, mental health, and housing, and provide general advocacy is critically important to women's increased safety, stabilization, and quality of life. The purpose of this study is to identify perceived barriers and facilitators to service access and engagement with social services among women involved in CSE. Drawing from a larger grounded theory study that partnered with an anti-trafficking coalition and a substance use treatment center for women, in-depth, semistructured interviews were conducted with 30 adult women who traded sex as adults and 20 service providers who come into contact with this population. Women engaging in services were sampled through maximum variation sampling (n = 24) and women not engaged with services (n = 6) were recruited through snowball sampling. Providers were recruited through purposive sampling through the coalition (n = 10) and nominations sampling (n = 10). Open and focused coding were conducted. Multiple enhancements to methodological and analytic rigor were taken, including collaboration with multiple key stakeholders, use of nonstigmatizing language, self-reflexivity processes, analytic memo-writing, and member checking. Findings suggest that women experienced judgment when disclosing sex trading in social service intakes, and individual and group sessions from providers and other women in the groups. Although some women saw disclosure as helpful in addressing the complex feelings stemming from sex trading, as well as the desire to help or relate to other women in similar situations, they also identified risk of harm and multiple barriers to disclosing during intake meetings and individual sessions with providers as well as group sessions with providers and other clients. Implications for individual and group practice are discussed.

The Role of Nursing in the School Setting to Lead Efforts to Impact Child Trafficking: An Integrative Review

Registered professional and advanced practice nurses in the school setting, as a specialized practice entity, are leaders in implementation of evidence-based practice, skilled coordinators of care, advocates for students, and experts in designing systems assisting individuals and communities to reach full potential. Child trafficking (CT) is an emerging public health threat impacting safety and well-being of students present in the school setting. This literature review identified four themes in five studies: (1) training impacts nurses' knowledge, awareness, and attitudes; (2) school nursing is underrepresented in training, education, prevention, response, and research; (3) lack of collaboration exists between school staff and school nurses; and (4) formal education and length of experience impact levels of interventions school nurses are able to provide. School nurses are opportunely situated to intervene as advocates for vulnerable children to develop a coordinated, effective response to CT risk factors, mitigating risk and fostering resiliency with systems-based change.

Recognizing the Risk Factors, Signs, and Symptoms of Domestic Minor Sex Trafficking in Mental Health Clinical Practice

The purpose of the current article is to educate psychiatric providers on domestic minor sex trafficking (DMST). Psychiatric providers (e.g., psychiatric-mental health nurse practitioners, psychiatrists, physician assistants, therapists, case managers) interact with victims of sex trafficking but may fail to recognize the signs of victimization and the risk factors associated with becoming a victim of DMST. This educational article offers an overview of the definitions of sex trafficking, and the risk factors, prevalence, and health consequences of DMST. It also summarizes what is known about how those at-risk for DMST and DMST victims interact with the mental health care system. Mental health professionals provide a crucial point of contact with these populations and must strive to prevent, identify, and respond to DMST and at-risk youths. [Journal of Psychosocial Nursing and Mental Health Services, 58(11), 21-28.].

Increasing awareness of the severity of female victimization by opportunistic drug-facilitated sexual assault: A new viewpoint

The victimization of women by opportunistic drug-facilitated sexual assault in leisure contexts was studied in this work by applying a novel approximation. A multifocal analytical strategy based on an intersectional gender-sensitive approach was used to analyse the evidence coming from both forensic case studies and contextual studies about sexual interrelation and drug use. The process of victimization comprises social changes affecting consumption patterns and sexual interaction, intersecting in the hegemonic recreational nightlife model. However, victims experience a range of situations that make it difficult for them to self-acknowledge themselves as such. Widespread myths about the victimization process add to the social questioning faced by victims, stemming from gender-based double standards which condition the expected female behaviors regarding the use of drugs and sexual interaction. The victims usually experience amnesia, lack of injuries and emotional harm, which make difficult the self-acknowledgement as a victim of sexual assault and the reporting of the episode suffered. Consequently, it is an urgent public health need to implement a new viewpoint about the victimization of women by opportunistic drug-facilitated sexual assault in leisure contexts, able to increase awareness of the severity of this form of sexual violence. Society must recognize the existence of this problem within itself to help victims to acknowledge themselves as such, lodge a complaint and seek adequate help. The lack of this social support feeds the perpetuation of the victimization process, which exacerbates the risk of locking victims into spirals of cyclical re-victimization and favors both the underreporting as well as inadequate coping strategies. In addition to focusing on the need to increase awareness of the severity of female victimization by opportunistic drug-facilitated sexual assault in leisure contexts, other recommendations include the use of the term "take advantage", the development of specific criminal approaches, and the in-depth knowledge of the phenomenon via victimization surveys. These steps are necessary for developing well-targeted and evidence-based preventive measures consistent-with-reality.

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

Objectives: To describe the substance use profiles of youth impacted by commercial sexual exploitation (CSE) and explore associations between substance use with mental health diagnoses and child welfare involvement. Methods: Data were systematically extracted from the court files of 364 youth who participated between 2012 and 2016 in Los Angeles County's Succeeding Through Achievement and Resilience (STAR) Court, a juvenile delinquency specialty court for youth impacted by CSE. Descriptive statistics and multivariate regression analyses were conducted to quantify associations between youths' substance use with mental health diagnoses and child welfare involvement. Results: Of the 364 youth impacted by CSE involved in the STAR Court, 265 youth had documented contact with a psychiatrist while in court-of whom, 73% were diagnosed with at least one mental health challenge. Before STAR Court participation, 74% of youth were the subject of one or more child welfare referral; of these youth, 75% had prior out-of-home care. Eighty-eight percent of youth reported substance use, the most prevalent illicit substances were marijuana (87%), alcohol (54%), and methamphetamine (33%). Controlling for age and race, youth impacted by CSE with a diagnosed general mood disorder had more than five times the odds of reporting substance use compared with those without a mood disorder diagnosis (adjusted odds ratio [AOR]: 5.80; 95% confidence interval CI: 2.22-18.52; p < 0.001); and youth impacted by CSE with prior child welfare placements had more than two times the odds of reporting substance use (AOR: 2.24; 95% CI: 1.04-4.86; p = 0.039) compared with youth without prior placements. The association between substance use and general mood disorder was significant and positive for all substance use types (AOR = 3.3, p = 0.033 marijuana; AOR = 4.01, p = 0.011 concurrent alcohol and marijuana; AOR = 9.2, p < 0.001, polysubstance use). Conclusions: High prevalence of substance use among juvenile justice-involved youth impacted by CSE combined with strong associations between substance use with both mental health diagnoses and child welfare system history underscores the need for comprehensive, specialized substance use treatment. Findings suggest an important opportunity for multidisciplinary collaboration among mental health providers, child welfare professionals, juvenile justice practitioners, and other care providers for these youth.

Systematic review of social norms, attitudes, and factual beliefs linked to the sexual exploitation of children and adolescents

BACKGROUND

Despite growing interest in the role of social norms in perpetuating the harmful practice of sexual exploitation of children and adolescents (SECA), little is known about the state of the literature on this issue.

OBJECTIVE

This systematic review aims to summarize what associated norms, attitudes and factual beliefs have been identified by the SECA literature worldwide.

METHODS

Multiple database searches were conducted using controlled vocabulary and keywords referring to SECA.

RESULTS

Our searches identified 3690 unique references. After applying our exclusion criteria, 49 studies, including over 14,000 participants from 37 countries and most world regions, were included. Across studies we identified six injunctive norms perpetuating SECA: owning goods as a social status marker ; being sexually active; exchanging sex for favors; contributing financially to the household; stigma and discrimination against young people who experienced SECA; and lack of social sanctions for SECA perpetrators. These norms were supported by enhanced tolerance of SECA when it involved older or more physically developed adolescents and when it occurred in poverty-affected contexts. Beliefs around markers that denote adolescents' readiness for sex; men's entitlement to sex; and the perceived benefits of intergenerational relationships, also contributed to the maintenance and reproduction of SECA. Findings from all regions suggested that marginalized young people are particularly vulnerable to SECA.

CONCLUSIONS

Interventions to reduce SECA must consider individual, social, and structural factors and how they interrelate. Context-specific social norms interventions are needed to address harmful norms, promote protective norms, and improve services for those who have experienced SECA.

Minor sex trafficking of girls with disabilities

Purpose –

The purpose of this paper is to investigate the associations between minor women' (girls') disability status and victimization via minor sex trafficking.

Design/methodology/approach –

This investigation used data from the National Longitudinal Study of Adolescent to Adult Health, a large, nationally-representative sample of in-school adolescents in the USA that began in 1994. The analysis included bivariate associations between physical disability status or low cognitive ability and minor sex trafficking among female survey respondents (n = 5,430).

Findings –

Girls with any disability had a higher prevalence of minor sex trafficking than their peers without disabilities. Odds of minor sex trafficking were significantly higher for those with severe physical disabilities (5.83) and for those with low cognitive abilities (4.86) compared to the odds of their peers without their respective disabilities. Results for girls with mild or moderate physical disabilities were not statistically significant compared to peers without disabilities.

Social implications –

These nationally-representative survey data reinforce the trends present in smaller populations and case study research: female adolescents with disabilities are at a heightened risk for sex trafficking. On both a national and global scale, the human rights gaps in policy and practice must be addressed to adequately reach, intervene and protect this vulnerable population.

Originality/value –

Research about minor sex trafficking typically relies on small-scale surveys and/or convenience samples. This study used a nationally-representative survey to demonstrate the link between disability status and women's experiences with minor sex trafficking.

Assessment of commercially sexually exploited girls upon entry to treatment: Confirmed vs. at risk victims

BACKGROUND

Research has documented many risk factors for commercial sexual exploitation of children as well as serious emotional and behavioral consequences for such victims.

OBJECTIVE

This study aims to provide an understanding of risk factors and symptom presentation of girls who are victims or at risk for commercial sexual exploitation.

PARTICIPANTS AND SETTING

Ninety-six girls (12-18 years) who were referred to a child advocacy center's specialized treatment program for commercially sexually abused girls served as participants (56 confirmed victims, 40 at risk of commercial sexual exploitation).

METHODS

At intake participants were administered the Youth Self-Report, the Trauma Symptom Checklist for Children, and the UCLA Post-Traumatic Stress (PTSD) Reaction Index for DSM -5. Parents or guardians were asked to complete the Child Behavior Checklist and the UCLA PTSD Reaction Index for DSM - 5(Parent/Caregiver).

RESULTS

Intake information revealed significant differences between groups with confirmed victims reporting higher levels of sex work, kidnapping, physical abuse, physical assault and sexual abuse by a non-family member (p < .05) than at risk victims. All participants were exposed to traumas, were racially and ethnically diverse and lived primarily with their families. At risk girls were significantly more likely to be in school than the confirmed victims. The UCLA PTSD Index revealed that the confirmed victims had experienced significantly more physical abuse than the at-risk group and 26.7% of confirmed victims and 7.7% of the at risk victims met the DSM criteria for PTSD. Twenty percent of the confirmed victims met criteria for Dissociative subtype, while only 7.7% of at risk victims did. On the CBCL, victims from both groups scored in the clinical range on Externalizing Problems and Total Problems and the at risk group scored significantly higher on the School subscale than the confirmed victims group.

CONCLUSION

Commercially sexually exploited girls have experienced multiple traumas in their lives and display emotional and behavioral difficulties. Early detection of girls who may be at risk for sexual exploitation may allow for prevention and intervention as these girls also have traumatic backgrounds and display similar symptoms.

Human Trafficking of Children: Nurse Practitioner Knowledge, Beliefs, and Experience Supporting the Development of a Practice Guideline: Part One

INTRODUCTION

Up to 87% of trafficking victims encounter a health care provider while being trafficked but are not recognized as victims. Most health care providers receive little or no training, and awareness remains low. To describe the knowledge, beliefs, and attitudes of pediatric advanced practice registered nurses about human trafficking.

METHOD

A survey of the National Association of Pediatric Nurse Practitioners membership (n = 8,647) before the intervention measured knowledge, beliefs, and experience regarding child trafficking. An awareness campaign was implemented with continuing education, national media presence, Train the Trainer programs, and creation of a nonprofit organization to direct strategic initiatives.

RESULTS

Overall, 799 (9%) NAPNAP members completed the survey. Although 87% believed it possible that they might encounter a victim of trafficking in their practice, 35% were unsure if they had provided care for a victim. Only 24% reported confidence in their ability to identify a child at risk for trafficking.

DISCUSSION

These survey findings indicate the need for clinical practice guidelines to identify potential and actual victims of human trafficking. Pediatric advanced practice registered nurses are ideally equipped and situated to intervene on behalf of vulnerable children with health disparities in a myriad of care settings, advocating for prevention and optimization of equitable health outcomes.

The views and experiences of families and direct care support workers regarding the expression of sexuality by adults with intellectual disabilities: A narrative review of the international research evidence

BACKGROUND

There is a growing and evolving research evidence base regarding sexuality issues and adults with intellectual disabilities. However, the experiences and views of families and direct care support workers and their support and development needs in the topic area are unclear.

AIMS

The aim of this narrative review was to explore the views and experiences of families and direct care support workers in relation to the expression of sexuality by adults with intellectual disabilities and to identify their distinct support and development needs.

METHODS AND PROCEDURES

A comprehensive search of relevant databases from May 1998 to June 2018 was undertaken. Included studies had to address specific criteria: peer reviewed papers, the use of appropriate research methods, and focus exclusively on the individual views and opinions of families and direct care support workers. The search of relevant databases yielded 313 hits. Following the application of explicit inclusion and exclusion criteria, 11 papers were deemed suitable for the review. The PRISMA checklist was utlised in the process. Quality was assessed using a recognized framework.

OUTCOMES AND RESULTS

The data were analysed and key findings highlighted issues for families and direct care support workers including: attitudes and beliefs; fear of abuse, exploitation and harm; new technologies; supporting developments in practice; and education and training programmes.

CONCLUSIONS AND IMPLICATIONS

Families and direct care support workers have specific support and education needs. Future healthcare initiatives need to be developed that are fully responsive to the identified concerns and requirements of families and direct care support workers.

Friends, family, and boyfriends: An analysis of relationship pathways into commercial sexual exploitation

BACKGROUND

The commercial sexual exploitation of children (CSEC) is a major global issue that affects over two million children each year (Polaris Project, 2014). Large metropolitan cities, such as Las Vegas, have high rates of child prostitution (Shared Hope International, 2009).

OBJECTIVE

The purpose of the current study is to elucidate to what extent interpersonal relationships and contextual factors (e.g. abuse within the home, substance abuse, etc.) influence commercial sexual exploitation.

PARTICIPANTS AND SETTING

Participants for this study include 26 CSEC survivors located within the state of Nevada.

METHODS

The current study utilizes a qualitative content analysis approach to analyze interview transcripts gathered from CSEC survivors. Three stages of analysis were conducted to assess the relationships that influenced the participants' sexual exploitation, as well as the contextual factors shared by the participants.

RESULTS

Analyses indicated that three types of relationships led to commercial sexual exploitation: friends, family, and boyfriends. Of the three relationship typologies, friends were the most common (n = 14). As for contextual factors, it was common for participants to have been abused within their home (n = 15) or to have run away from home (n = 20).

CONCLUSIONS

The narratives provided in this study show that CSEC survivors do not often willingly engage in trading sex; rather this decision is influenced by a need to escape familial abuse or they are forced to trade sex by someone whom they share a relationship.

Human Trafficking of Minors and Childhood Adversity in Florida

OBJECTIVES

To examine the link between human trafficking of minors and childhood adversity.

METHODS

We compared the prevalence of adverse childhood experiences (ACEs) and cumulative childhood adversity (ACE score) among a sample of 913 juvenile justice-involved boys and girls in Florida for whom the Florida child abuse hotline accepted human trafficking abuse reports between 2009 and 2015 with those of a matched sample.

RESULTS

ACE composite scores were higher and 6 ACEs indicative of child maltreatment were more prevalent among youths who had human trafficking abuse reports. Sexual abuse was the strongest predictor of human trafficking: the odds of human trafficking was 2.52 times greater for girls who experienced sexual abuse, and there was a 8.21 times greater risk for boys who had histories of sexual abuse.

CONCLUSIONS

Maltreated youths are more susceptible to exploitation in human trafficking. Sexual abuse in connection with high ACE scores may serve as a key predictor of exploitation in human trafficking for both boys and girls.