Commercial sexual
exploitation of children (CSEC) is a critical human rights and public health
issue that child psychiatrists and other mental health providers can play an
important role in addressing.
Although commercially sexually exploited youth
often go unidentified by health providers, these youth may have frequent
contact with health care, juvenile delinquency, and foster care systems, and
therefore, likely interact with mental health providers who work in these
settings.
Although the data on commercially sexually exploited youth are
limited, studies show that these youth are at high risk for medical and
psychiatric problems and have challenging psychosocial histories, including
having experienced childhood abuse, homelessness, and foster care placement.1–4 The exact
numbers of commercially sexually exploited youth are unknown given the
clandestine nature of the exploitation and underreporting. Experts suggest that
the number of sexually exploited children in the United States may be growing.1
Understanding
the risk factors for commercial sexual exploitation, the health and mental
health implications, and treatment options can help improve detection and care
for this underserved population.
Psychiatric interview: potential associated signs, mental health
symptoms, and red flags for detecting commercially sexually exploited youth
Appearance and behavior
- Youth is accompanied by an individual that appears
controlling or does not want the youth to be interviewed alone
- Youth displays a withdrawn, frightened, or guarded
affect
- Youth gives vague or changing demographic information
- Youth appears intoxicated or impaired by substance
use
- Youth has evidence of branding or tattoos (including
facial tattoos, gang-related tattoos)
- Youth has evidence of physical injury (scars, burns,
lacerations, fractures, traumatic brain injury)
- Youth appears to be in poor physical health (evidence
of skin infections, poor dentition, malnourishment)
- Youth is carrying large amounts of money or expensive
items that appear beyond the youth’s means
Social history
- Youth has a history of homelessness (includes running
away, being abandoned, or forced to leave home)
- Youth has an older boyfriend and/or history of
multiple sexual partners
- Youth has a history of juvenile justice system
involvement
- Youth has a history of involvement with child welfare
services (including living in a group home/foster care home)
- Youth does not attend school or is frequently truant
Medical history
- Youth has a history of pregnancy, abortion, ectopic
pregnancies
- Youth has a history of multiple sexually transmitted
diseases, pelvic inflammatory disease
- Youth has frequent emergency room visits (including
for physical injuries, reproductive concerns, or sexually transmitted diseases)
Mental health symptoms
- Youth has symptoms of depression
- Youth is suicidal
- Youth has symptoms of posttraumatic stress disorder,
traumatic stress, and/or anxiety symptoms
- Youth has symptoms of a substance use disorder
- Youth has problems with anger
- Youth has self-harming behaviors
- Having these signs does not mean that a child is
being commercially sexually exploited, and lack of these signs does not rule
out that a child is being commercially sexually exploited.
Adapted from Greenbaum
VJ. Commercial sexual exploitation and sex trafficking of children in the
United States. Curr Probl Pediatr Adolesc Health Care 2014;44(9):245–69; with
permission. Data fromRefs.2,4,18,27,39
Below: Ecological Framework for Contextualizing and Conceptualizing Commercial Sexual Exploitation of Children
By: Roya Ijadi-Maghsoodi, MD,a,b,* Mekeila Cook, PhD,c Elizabeth S. Barnert, MD, MPH, MS,d Shushanik Gaboian, MSW,eand Eraka Bath, MDf
aVA HSR&D Center for the Study of
Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles
Healthcare System, 11301 Wilshire Boulevard, Building 500, Room 1601, Office of
Healthcare, Transformation and Innovation, Mail Code 10–C, Los Angeles, CA
90073, USA
bDepartment of Medicine, David Geffen
School of Medicine, University of California Los Angeles, Los Angeles, CA
90095, USA
cIntegrated Substance Abuse Programs,
Department of Psychiatry and Biobehavioral Sciences, Semel Institute for
Neuroscience and Human Behavior, University of California, Los Angeles, 11075
Santa Monica Boulevard, Suite 100, Los Angeles, CA 90025, USA
dDepartment of Pediatrics, David Geffen
School of Medicine, University of California Los Angeles, Los Angeles, CA
90095, USA
eDepartment of Neuroscience and Human
Behavior, University of California Los Angeles, Los Angeles, CA 90095, USA
fChild Forensic Services, Department of
Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and
Human Behavior, University of California Los Angeles, 300 Medical Plaza, Room
1243, Los Angeles, CA 90095, USA
