Understanding and Responding to the Needs of Commercially Sexually Exploited Youth

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• Youth displays a withdrawn, frightened, or guarded affect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

Full article at:   http://goo.gl/P7PRRH

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

^*Corresponding author. Email: ude.alcu.tendem@idooshgamidajir

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“First, Do No Harm”: Legal Guidelines for Health Programs Affecting Adolescents Aged 10–17 Who Sell Sex or Inject Drugs

There is a strong evidence base that the stigma, discrimination and criminalization affecting adolescent key populations (KPs) aged 10–17 is intensified due to domestic and international legal constructs that rely on law-enforcement-based interventions dependent upon arrest, pre-trial detention, incarceration and compulsory “rehabilitation” in institutional placement. While there exists evidence and rights-based technical guidelines for interventions among older cohorts, these guidelines have not yet been embraced by international public health actors for fear that international law applies different standards to adolescents aged 10–17 who engage in behaviours such as selling sex or injecting drugs.

As a matter of international human rights, health, juvenile justice and child protection law, interventions among adolescent KPs aged 10–17 must not involve arrest, prosecution or detention of any kind. It is imperative that interventions not rely on law enforcement, but instead low-threshold, voluntary services, shelter and support, utilizing peer-based outreach as much as possible. These services must be mobile and accessible, and permit alternatives to parental consent for the provision of life-saving support, including HIV testing, treatment and care, needle and syringe programmes, opioid substitution therapy, safe abortions, antiretroviral therapy and gender-affirming care and hormone treatment for transgender adolescents. To ensure enrolment in services, international guidance indicates that informed consent and confidentiality must be ensured, including by waiver of parental consent requirements. To remove the disincentive to health practitioners and researchers to engaging with adolescent KPs aged 10–17 government agencies and ethical review boards are advised to exempt or grant waivers for mandatory reporting. In the event that, in violation of international law and guidance, authorities seek to involuntarily place adolescent KPs in institutions, they are entitled to judicial process. Legal guidelines also provide that these adolescents have influence over their placement, access to legal counsel to challenge the conditions of their detention and regular visitation from peers, friends and family, and that all facilities be subject to frequent and periodic review by independent agencies, including community-based groups led by KPs.

Controlling international law specifies that protective interventions among KPs aged 10–17 must not only include low-threshold, voluntary services but also “protect” adolescent KPs from the harms attendant to law-enforcement-based interventions. Going forward, health practitioners must honour the right to health by adjusting programmes according to principles of minimum intervention, due process and proportionality, and duly limit juvenile justice and child protection involvement as a measure of last resort, if any.

Full article at: http://goo.gl/VX1fHD

By: Brendan Conner§

147 West 24th Street, 4th Floor, New York, NY 10011, USA. Tel: +001 917 345 0404. (Email:moc.liamg@rennoc.leahcim.nadnerb)

  

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