A Preliminary Assessment of “Framework for Addressing Re-Traumatization of Survivors of Commercial Sexual Exploitation of Children (CSEC)” based on Stakeholder Input Open Access

Lakshman, Maya (Spring 2019)

Permanent URL: https://etd.library.emory.edu/concern/etds/r207tq370?locale=en


Survivors of Commercial Sexual Exploitation of Children (CSEC) experience severe mental and emotional trauma, as well as re-traumatization due to the repetition of distressing experiences to multiple professionals. The system that is currently in place to address survivors’ mental health needs is limited and does not take re-traumatization into account. A multi-disciplinary framework was created by the principal investigator to display specific ways that law enforcement, clinicians, and social workers can collaborate with one another. The purpose of this project is to assess the feasibility of implementing this framework designed to reduce re-traumatization among survivors of CSEC.

Focus group discussions (FGDs), and in-depth interviews (IDIs) were utilized to explore the perspectives of four groups of stakeholders on the framework, as well as determine the changes that should be made to the framework to increase feasibility and effectiveness. From November 2018 to January 2019, three mixed FGDs and three IDIs were conducted. Law enforcement, clinicians, social workers, and survivors were recruited for the FGDs, and survivors were recruited for the IDIs. The FGDs were used to generate group conversation regarding the feasibility of the four parts of the framework and the effect the framework would have on reducing re-traumatization. The IDIs were informed by results from the FGDs and focused on attaining adult CSEC survivors’ perspectives on the framework.

The majority of stakeholders believed that the framework could effectively reduce re-traumatization among CSEC survivors because of its promotion of inter-professional collaboration. They proposed various suggestions that were integrated into a revised framework, such as the creation of consistent, case-by-case protocols for professionals, allocation of resources toward ensuring mandated therapy attendance, and an alert and contact system for collaboration during data sharing. Survivors also provided suggestions for a more survivor-centered framework.

The findings of this project indicate the importance of studying re-traumatization of CSEC survivors and affirm the need for a comprehensive framework. The findings additionally provide insight into the resources currently available in Georgia and the ways that a framework such as this one could be implemented. The findings serve as the foundation for future collaboration and research on the ways that each part of the framework can be implemented. The stakeholder perspectives documented in this project may be transferable to other counties and states, and can be used to improve available mental health resources for CSEC survivors. The results will be used to guide pilot implementation of the framework.

Table of Contents

Narrative                                                                                                1

Definitions                                                                                             3

Introduction                                                                                          8

           Commercial Sexual Exploitation of Children                                   8

CSEC, Trauma, and Mental Health                                                                9

           Limitations of Current Mental Health Resources                            9

           Proposed Framework                                                                             11

           Theoretical Foundations                                                                       11                   

Purpose of this Project                                                                                      13

Literature Review                                                                                   15

           An Overview of CSEC in the United States                                         15

           Risk Factors for CSEC                                                                              17

           Recruitment of CSEC Victims                                                                20

           Trauma                                                                                                       21

           Mental Health Consequences of CSEC                                                24

           Stigma                                                                                                       27

           Mental Health Resources Currently Available for CSEC Survivors        28

Re-Traumatization of Survivors of CSEC                                                         30

Gaps in the System: What Needs to be Done?                                                31

Conclusion                                                                                                            34

Methods                                                                                                    35

           Setting                                                                                                          35

           Study Ethics and Informed Consent                                                      35

           Research Methods                                                                                     36

                       CIs                                                                                                     39

                       FGDs                                                                                                 40

                       IDIs                                                                                                    41

Data Management and Analysis                                                                         42

Results                                                                                                       46

Protocols for Interagency Data Sharing                                                            47

Type of Data Reported                                                                                   47       

Alert and Contact System                                                                               49

Implementation                                                                                              51

Training Priorities for Stakeholders                                                                51

Victim and Risk Factor Identification                                                             53

Consistent, Up-to-Date Protocols                                                                  55

Survivor-Informed Trainings                                                                       57

Trainings for Foster Parents                                                                         58

Therapy for Survivors and their Families                                                      59

           Court-Mandated Attendance to Therapy                                            60

           Therapy for Guardians                                                                            62

           Referrals and Risk Evaluation                                                                63

           Foster Placements for Survivors                                                            64

Potential Impact of Framework on Stakeholders                                          65

Benefits                                                                                                           65

Re-Traumatization                                                                                         67

Challenges                                                                                                     68

Elements of Survivor-Centered Care                                                             70

Trauma-Informed Focus                                                                               70

An Environment of Trust: Reclaiming Power and Control                      72       

Survivor Involvement in the Framework                                                    74

Conclusion                                                                                                        75

Discussion                                                                                             76

           Effects on Re-Traumatization                                                            89

           Limitations and Strengths                                                                   90

           Conclusion and Implications                                                              91

References                                                                                             94

Appendices                                                                                           104

I: Semi-structured Focus Group Discussion Guide                                    104

II: Semi-structured In-Depth Interview Guide                                            107

III: FGD and IDI Combined Coding Tree                                                       110

IV: FGD and IDI Combined Codebook                                                           112

V: Framework for Addressing Re-Traumatization Among Survivors       126   

of Commercial Sexual Exploitation of Children (CSEC)

VI: Framework for Addressing Re-Traumatization Among Survivors      127

of Commercial Sexual Exploitation of Children (CSEC)-Revised (1)

VII: Framework for Addressing Re-Traumatization Among Survivors       128

of Commercial Sexual Exploitation of Children (CSEC)-Revised (2)

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