Rethinking research on sexual exploitation of boys: Methodological challenges and recommendations to optimize future knowledge generation

Sexual exploitation of young men: Background characteristics and needs from a life-course perspective

BACKGROUND

Sexually exploited young men are prevalent, yet underrepresented in clinical practice, policy and research. There are multiple barriers that often prevent young men to disclose and to seek or receive support, such as gender norms, limited awareness of victimization and feelings of guilt and shame.

OBJECTIVE

By gaining more insight into the background characteristics of young men who experienced sexual exploitation and their needs, this study aims to raise awareness and to better inform policymakers, care- and educational professionals on adequate prevention and intervention efforts.

METHODS

Twenty-six young men (age 14-32) who experienced sexual exploitation or other forms of sexual violence in their youth or were at high-risk, participated in this qualitative study that was conducted in The Netherlands. By means of semi-structured interviews and case-file analyses, data was collected to identify risk and protective factors in their life-course and support needs.

RESULTS

Several vulnerabilities (e.g. previous experiences of abuse and neglect, household dysfunction, social rejection, running away, substance use) and a lack of positive and supportive relationships led young men into high-risk situations. Among these were involvement in pay dates, criminality and having to survive from day to day, which contributed to victimization. Prevailing gender norms and experiences of stigmatization were often a barrier to express vulnerabilities and to disclose victimization. There was a wide variety in support needs, including peer-to-peer support, therapy, support with day-to-day practices and anonymous support.

CONCLUSIONS

These results will contribute to adequate prevention and trauma-informed intervention strategies that meet the unique needs of young men at risk for, or victim of sexual exploitation.

Prevalence and correlates of depressive disorders in commercially sexual exploited children: A cross-sectional study in Mombasa, Kenya

BACKGROUND

Commercial sexual exploitation of children (CSEC) is a global concern and is among the common forms of sexual violence against children. In Kenya, about 32 % of girls and 16 % of boys experience sexual violence before the age of 18 years. While much has been written about the impact of child sexual exploitation, there's little on the prevalence of depressive disorders among CSE children.

OBJECTIVES

This study was conducted to assess the prevalence and correlates of depressive disorders among CSE children in Mombasa, Kenya.

PARTICIPANTS AND SETTING

The study was conducted among CSE children (10-17 years) in Mombasa County.

METHODS

A cross-sectional study conducted between May 2021 and June 2022. A total of 409 CSE children were enrolled, using a case management approach. Data was collected using the child identification tool and the Patient Health Questionnaire (PHQ-9), at the first counselling session to determine the prevalence of depression levels.

RESULTS

Of the 409 children, 367 (90 %) were girls while 42 (10 %) were boys. The mean age was 15 years (10-17) (SD = 1.4, t = 0.765). In 286 (70 %) 'Depression unlikely' was recorded, while 123 (30 %) 'Depression likelihood.' Prevalence of mild to severe depression was significantly higher in girls than boys (p = 0.002). Other determinants of depression were having a primary level of education (p = 0.03) and being an orphan. (p = 0.03).

CONCLUSION

It is important to prioritize mental health interventions such as screening and early diagnosis of mental health among CSE children in order to prevent and manage both short and long term effects.

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.

Frontline support services for boys who have experienced child sexual exploitation: A thematic review of survey data from seven countries

Child sexual exploitation and abuse (CSEA) affects all children, but research on the needs and experiences of boys is lacking, support services are limited, and workers lack specialized training to meet their specific needs. This paper explores the perspectives and experiences of 404 Frontline Support Workers providing services to children with CSEA experiences in seven countries, considering trends and implications for boys. A mixed-methods online survey of 121 questions explores characteristics of cases, perceived vulnerabilities, and gender-based challenges in CSEA response. A descriptive analysis of survey data, disaggregated by country, was conducted, allowing for a discussion of broad themes and trends. Despite differences, participants described similar vulnerabilities for boys across these contexts, including poverty as well as sex and sexuality-related taboos, stigmas, and other gendered beliefs, which were perceived to not only increase vulnerability to CSEA but also complicate disclosure in all countries. The implications of these findings on service delivery and recommendations are discussed.

Sexual exploitation of children: Barriers for boys in accessing social supports for victimization

BACKGROUND

The global evidence regarding sexual exploitation of children (SEC) is expanding, however, the majority of research continues to focus on girls. ECPAT International's Global Boys Initiative is a major contribution to broadening knowledge by exploring how sexual exploitation impacts boys specifically.

OBJECTIVE

This discussion paper explores data from the initiative to better understand how boys and children of all genders may be impacted by sexual exploitation.

PARTICIPANTS AND SETTING

During 2019-21, research was undertaken by ECPAT member organizations into the sexual exploitation of boys in 10 primarily low-and-middle income countries globally. The initiative also supported a global systematic scoping review of published and gray literature published in this issue (Moss et al., in press).

METHODS

Gender norms analysis of Initiative data identifies critical thematic issues impairing access to support services for victimized boys.

RESULTS

Most disconcerting is gender-based stigmatization from services that can compound children's trauma. Justice-based, rather than trauma-informed models of support predominate in responses for boys. Legal frameworks create barriers when binary gendered terminology defines sexual violence, thereby excluding anyone other than women and girls from protection.

CONCLUSIONS

Three solutions emerged to improve access to support for more children affected by sexual exploitation: (1) challenge problematic gender norms and consequent practices, such as gendered terminology in legislation, that create barriers for boys and gender-diverse children; (2) create psychologically, emotionally, and physically safe circumstances (i.e. trauma-informed care) for all children to know help-seeking is possible; and (3) undertake proactive support that specifically connects boys and gender-diverse children to therapeutic services like drop-in centers, night-time counseling, and emergency shelter.

A global systematic scoping review of literature on the sexual exploitation of boys

BACKGROUND

Sexual exploitation of children (SEC) is a widespread crime which impacts the child victim across developmental, health and well-being domains. As victims, boys have received much less clinical and research attention. While context-specific factors likely shape the SEC risk, under-recognized gender norms can deny boys' vulnerability. Professional failures to recognize and respond adequately to boys' sexual exploitation may prevent access to support.

OBJECTIVE

This systematic scoping review updates and broadens a previous review of literature addressing prevalence, victim/offender/facilitator characteristics, control mechanisms, as well as the health correlates and outcomes regarding sexual exploitation of boys. This review included international peer-reviewed and gray literature from 38 countries in 14 languages.

PARTICIPANTS AND SETTING

Studies from the years 2000 to 2022 that included samples of boys under age 18, or sex-disaggregated data for children under 18, were included. Case studies, systematic reviews, and those reporting on retrospective experiences by adults over 18 were excluded. A total of 254,744 boys were represented across 81 studies.

METHODS

A systematic scoping review considered qualitative and quantitative peer-reviewed publications from eight, English-language databases. English and non-English non-peer reviewed publications ('gray literature') was identified by both ECPAT International's global network of member organizations and citation chaining.

RESULTS

Overall, 81 peer-reviewed (n = 51) and gray literature (n = 30) documents from 38 countries were included. In total, 254,744 youth participated in peer-reviewed studies (N = 217,726) and gray literature (N = 37,018). General prevalence of sexual exploitation of boys was reported at up to 5 %, with higher rates noted in specifically vulnerable sub-populations (e.g., 10 %, trans youth; 26 %, street-connected youth). The literature indicates that sexual exploitation of boys is reported as occurring primarily between 12 and 18 years old. Multi-level factors are linked to SEC, including individual (e.g., disability status), relationship (e.g., child maltreatment, dating violence), community (e.g., community violence), and societal domains (e.g., discriminatory beliefs). SEC victimization is linked with youth mental and physical health concerns, particularly sexual health. Post-traumatic stress symptomatology or disorder was rarely evaluated. Evidence-based treatments were not available, which may be related to a lack of gender-based theoretical models for understanding SEC specifically.

CONCLUSION

The sexual exploitation of boys is a prevalent public health, child rights, and clinical issue. All young people experiencing sexual exploitation face sex- and gender-specific challenges, and this remains the case for boys with indications including family rejection, implicit community tolerance for abuse to service accessibility barriers. Actioning our duty to care for all children requires gender- and trauma-informed lenses. Ongoing surveillance of all forms of violence against children, with gender disaggregation, is essential for practice and policy advancement.

Sex Trading Among Adolescent Cisgender Boys

OBJECTIVES

Cisgender girls and boys report trading sex for something of value at roughly equal proportions; yet, boys are understudied and underserved. We compare boys who reported trading sex to those who never traded sex to address this gap in knowledge and practice.

METHODS

The study is a secondary analysis of the Minnesota Student Survey, a triannual, census-style survey. The sample included 32 311 cisgender boy students in ninth and 11th grades who answered a question about sex trading. Bivariate descriptive statistics and multivariate logistic models were used to identify associated factors and determine the odds of trading sex on the basis of specific experiences.

RESULTS

We found that 1.2% of boys reported trading sex. In bivariate analyses, boys who reported trading sex were more likely than those who did not to: identify as Black or Indigenous; report a marginalized gender identity or sexual expression; have had sexual intercourse; have experienced sexual harassment and harassment on the basis of sexual identity and race, ethnicity, and national origin; and to have experienced homelessness, food insecurity, foster care, and substance treatment (P < .001). In multivariate models, we found increased odds of trading sex for some variables, including a marginalized sexual identity, identifying as Black, and experiences of unstable housing, foster care, substance treatment, sexual harassment, and harassment based on gender (P < .001).

CONCLUSIONS

These findings contribute new knowledge about boys who trade sex using a large, population-based sample and counter false assumptions and stereotypes. These data suggest new avenues of research, intervention, and prevention.

Commercial Sexual Exploitation of Children and Adolescents in Europe: A Systematic Review

OBJECTIVES

The objective of this review is to provide a systematic and critical summary of findings regarding empirical studies conducted on commercial sexual exploitation of children (CSEC) in Europe. The purpose is to gain an understanding of the characteristics and main topics addressed in European research on CSEC, identify gaps, and give suggestions for future studies.

METHOD

The review was guided by the "Preferred Reporting Items for Systematic Review and Meta-Analysis-Protocols". A comprehensive search on several databases was conducted to identify published and unpublished empirical research on CSEC in Europe, revealing 3,846 documents. In total, 56 research papers that focused specifically on CSEC in European samples were included.

SYNTHESIS

Research concerning European studies of CSEC and trafficking for purposes of sexual exploitation has developed significantly over the last 20 years but is still rather limited and mainly focused on the UK and Sweden. Most of the studies reviewed suffer from important methodological flaws such as an inaccurate definition of the phenomenon analyzed, small and convenience samples, and nonvalidated and nonspecific instruments.

CONCLUSIONS

Findings from this study demonstrate the need for greater exploration and research around a number of areas of sexual exploitation of children in Europe. Further work is necessary in terms of capacity building, training, and awareness-raising for society as a whole and, specifically, professionals providing direct support to children and young people at risk of exploitation.

"She was willing to send me there": Intrafamilial child sexual abuse, exploitation and trafficking of boys

BACKGROUND

Boys subject to intrafamilial child sexual exploitation and abuse (CSEA) - in particular, cases which begin as incest and later evolve into child trafficking for sexual exploitation - face many barriers in disclosing their exploitation, often leaving victims and survivors feeling isolated from society and dismissed or mishandled by service providers such as law enforcement officers, child protection specialists, medical staff and mental health professionals.

OBJECTIVE

This study explores the unique characteristics of intrafamilial CSEA through the sex trafficking of boys, and the barriers to disclosure and recovery experienced by male victims and survivors.

PARTICIPANTS AND SETTING

Ten adult male survivors of intrafamilial child trafficking for sexual exploitation were interviewed multiple times to gain a deeper understanding of intrafamilial CSEA and how it compares and contrasts with non-familial CSEA. Participants in this study primarily came from North America.

METHODOLOGY

Multiple semi-structured online interviews were conducted with these 10 adult male survivors because they experienced 1) intrafamilial CSEA and 2) being trafficked by their families to be sexually exploited by non-familial perpetrators. The participants were then asked to compare and contrast intrafamilial and non-familial CSEA. The research team employed a descriptive phenomenological approach and interview transcripts were coded, analyzed, and compared to identify patterns of non-verbal CSEA indicators and thematic narratives. The study also explored the internal and external barriers to disclosure reported by participants. Trauma-informed, person-centered practices were used throughout the entirety of the study to minimize harm to participants. The research team employed a co-productive approach using participants' initial interviews and feedback to formulate new questions for later rounds of interviews and by having the participants confirm the accuracy of their respective quotes and case summaries.

RESULTS AND DISCUSSION

This study highlights several CSEA modalities, such as "boy-swap" events and local/national/transnational trafficking rings engaged in CSEA of boys. It also discusses how survivors' experiences differed between intrafamilial and non-familial CSEA and trafficking, and how familial settings may facilitate concealment of CSEA. Participants described various modus operandi used by abusers, traffickers, and buyers of all genders. While all 10 intrafamilial CSEA cases included male perpetrators, female perpetrators were also present in nine of them. In addition, participants identified various psychological and physiological CSEA and trafficking indicators that evidenced their victimization during their childhood years. All 10 survivors reported long-term health consequences into adulthood and scored highly on Adverse Childhood Experiences (ACEs) questionnaires.

RECOMMENDATIONS AND CONCLUSION

Findings underscore the importance of trauma-informed practices for identifying, liberating, and rehabilitating victims and survivors. Participants reported receiving more effective assistance from service providers that exhibited trauma-informed practices. Traditional gender stereotypes may hinder the ability of service providers to recognize and provide support to boys victimized and trafficked by their families for CSEA. Consequently, service providers may stand to benefit from training on 1) trauma-informed, person-centered practices and 2) conscious and unconscious biases, particularly those related to gender. Survivors in recovery require expanded support services, such as the provision of safe housing, online/in-person support communities, and professional/life skill training. Co-productive research methods that integrate the views and experiences of CSEA and trafficking survivors are also recommended.

Correlates of Exchanging Sex for Drugs or Money for Adolescent Males: A Hidden Population

Research from prostitution, sex trafficking, and commercial sexual exploitation (CSE) literature have found risk factors that can lead to both male and female youth becoming involved in this sex trade. These behaviors have been clearly defined and institutions have begun to address known risk factors. Youth who have reported involvement in trading/exchanging sex still remain hidden with limited information known about this group. The exchanging/trading sex literature has failed to explore correlates of involvement for adolescent males. This study explores factors found in prior research related to prostitution, sex tracking, and CSE to begin to understand adolescent males who exchanged sex for drugs or money. A secondary data analysis was used to examine the exchange of sex for male youth aged 12 to 18 in the United States. Results reveal that sexual activities were significant in predicting exchanging sex indicating a need for a more in-depth analysis of current and potential correlates for males.

Children's exposure to trafficking, sexual exploitation and community-based violence in Canada: A narrative summary and policy perspective

BACKGROUND

Given the formidable health burdens associated with children's exposure to community-based violence (CBV) and trafficking and exploitation (TE), continued investments in determining their epidemiology constitute an important focus for Canada.

OBJECTIVE

The objective of the present study is to provide a narrative summary and policy perspective concerning the quantitative studies reporting on the risk and protective factors and prevalence of children's (<18 years) exposure to CBV and TE in Canada.

METHODS

To identify literature, we searched eight electronic databases. English and French citations from database inception to December 2018 were included; this was supplemented with citation chaining for peer-reviewed publications and grey literature up to December 2019. Evidence is synthesized via a narrative summary.

RESULTS

There are few studies that have investigated children's exposure to TE and CBV in Canada. Self-reported exposure to these forms of violence varies according to the type investigated, with estimates ranging from 2 % - to - 23 % and 5 % - to - 53 % for TE and CBV, respectively. Literature focused on risk and protective factors for these forms of victimization are also limited.

CONCLUSIONS

Canada has the infrastructure in place to make significant gains in their data collection and monitoring of children's exposure to TE and CBV via five national-level studies. To help realize the goal of ending all forms of violence against children by 2030, incorporation of reliable measures of these forms of exposure in new and ongoing national-level data collection systems is urgently needed.

When Did I Become a Victim? Exploring Narratives of Male Childhood Sexual Abuse

This report presents narrative data of adult men self-identifying as victims of sexual abuse occurring in childhood or adolescence (CSA). Preliminary data were derived from written public stories posted by men to the Internet (n = 90). Many of these accounts indicate same-sex sexual abuse (male victim, male perpetrator). The primary research question: "how have adult male victims of childhood sexual abuse constructed written narratives of victimization?" The men in this study who posted public narratives about their sexual abuse demonstrated evidence in of two (turmoil and taking control) of six life course themes uncovered by Draucker and Martsolf (2010). Two temporally related additional subthemes emerged within the category "taking control": during the abusive event/relationship and after abuse in adulthood. Understanding how male victims organize and make sense of the trajectory of their victim and/or survivor identity may contribute to a more integrated healing for victims. This could also shape programs for outreach and support. The result of the study would aid in the development of diagnostic tools and frameworks for interviewing abuse victims who are not publicly presenting or formally reporting their stories.

Challenging the Stereotypes: Unexpected Features of Sexual Exploitation among Homeless and Street-Involved Boys in Western Canada

Research about the sexual exploitation of homeless and street-involved boys is limited and often combined with that of girls. As aggregation can distort unique issues among genders which are exploited, this study provides information about the context of exploitation for homeless boys. Boys participated in the anonymous, multi-city British Columbia (BC), Canada Homeless and Street-Involved Youth Health paper surveys of 2006 and 2014. Measures included questions about trading sex for money, shelter, or other consideration; age first exploited; for whom; where they were living when first traded sex; gender of exploiters; and demographics. Analyses, separately for younger/older boys, explored the prevalence, timing of exploitation vs. homelessness, and ANOVAs to evaluate the patterns of the age of first exploitation by the genders of exploiters. Just over one in four boys reported exploitation (n = 132), with a median age of 14–15 in most groups. Most were runaway or homeless before their first exploitation, but 25.5% (2006) and 41% (2014) were living with family. Most boys were exploited by women (78%–85%), with 62%–65% were exclusively exploited by women.

Gender, rights and responsibilities: The need for a global analysis of the sexual exploitation of boys

The United Nations Convention on the Rights of the Child confirmed child and youth rights globally. Their right to participation is a critical driver for the 2030 Sustainable Development Goals (SDGs). Youth prioritize the need to end violence against them, charging adults with safeguarding, and identify gender inequality as an underlying cause of child sexual exploitation (CSE). SDG 5 includes targets for ending sexual exploitation of girls; however, it is critical to review whether we are supporting both boys and girls adequately. Based on recent research, it is clear that male victims of CSE are prevalent, yet they have been relatively excluded in policy, research, and interventions. The aim is not to minimize the importance of understanding and eliminating CSE of girls, but to acknowledge that vulnerable sub-groups of boys exist in community (street-connected boys, refugees, sexual minorities) and service systems (justice, child welfare, humanitarian aid). Gender-based challenges persist in protection, disclosure, help-seeking, professional recognition, programming and prevention. In this discussion article, we outline responsibilities in human rights law to understand and address boys' CSE and overview key literature on its impact on boys. It is argued that gender-, trauma-, and violence-informed approaches are expanded to address the contribution of harmful gender norms, and to target prevention in the adolescent years for sexually transmitted infections, mental health, and substance abuse and violence problems. This discussion advances a pressing need for a global analysis of CSE among boys.

Post-trafficking stressors: The influence of hopes, fears and expectations on the mental health of young trafficking survivors in the Greater Mekong Sub-region

BACKGROUND

Human trafficking and labor exploitation are prevalent in Southeast Asia and have substantial health consequences for children and adolescents. Research on pre-departure circumstances and trafficking experiences show that gender plays a key role in shaping the experience of exploited children and adolescents.

OBJECTIVE

This study estimates how youth's concerns and hopes for the future influence the mental health outcomes of male and female children and adolescents.

PARTICIPANTS AND SETTING

Data were collected in face-to-face interviews with 517 children and adolescents (10-19 years old) who attended post-trafficking services between year 2010 and year 2013 in Cambodia, Thailand or Vietnam.

METHODS

Multivariable logistic regression models were fitted to estimate the association of children and adolescents' post-trafficking concerns and hopes for the future with mental health outcomes, namely symptoms of depression, anxiety and Post Traumatic Stress Disorder (PTSD). The analysis was stratified by sex.

RESULTS

In adjusted analysis, children and adolescents' concerns about social ostracization and maltreatment by others in their community of origin were associated with all three outcomes in males and with depression in females. Being concerned about their own mental health was associated with all outcomes, with a potentially stronger effect observed in males for depression (AOR 9.14, CI:1.21-68.68), anxiety (AOR 13.47, CI:1.70-106.48) and PTSD (AOR 8.36, CI:1.22-56.9) than in females where the odds for depression (AOR 3.24, CI:1.92-5.48), anxiety (AOR 3.05, CI:1.82-5.11) and PTSD (AOR 1.85, CI:1.08-3.14) were much lower.

CONCLUSIONS

Young people's post-trafficking care needs and reintegration planning should be designed based on their current mental health, personal security, family and financial resources and age-related capacity.

Overcoming Disclosure Reluctance in Youth Victims of Sex Trafficking: New Directions for Research, Policy, and Practice

An alarming number of youth worldwide are victims of commercial sexual exploitation, particularly sex trafficking. Normative developmental processes and motivations across the adolescent period-the age when youth are at greatest risk for trafficking-combined with their history, make them highly likely to be reluctant to disclose their exploitation to police, who often encounter victims because they are suspected of delinquency and crime and who interrogate the victims as suspects. Little scientific and policy attention has been devoted to understanding how to question these victims in a way that reduces their disclosure reluctance and increases their provision of legally relevant information. In the current review, we describe research concerning trafficking victims' histories and exploitative experiences, juvenile suspects' and victims' encounters with the legal system, and best-practice forensic interviewing approaches to elicit disclosures from child victims. We highlight the implications of these areas for understanding the dynamics between how police encounter and interact with adolescent trafficking victims and whether and how the victims disclose trafficking details during these interactions. We close with an agenda for research to test interviewing methods for suspected victims of sex trafficking and with policy and practice recommendations for interviewers.

Adolescents' motives for selling sex in a welfare state - A Swedish national study

In addition to money or other compensation, other motives for selling sex may be important in a welfare country such as Sweden. The aim of this study was to carry out an exploratory investigation of adolescents' motives for selling sex in a population-based survey in Sweden. A total of 5839 adolescents from the third year of Swedish high school, mean age 18.0 years, participated in the study. The response rate was 59.7% and 51 students (0.9%) reported having sold sex. Exploratory factor analysis and hierarchical cluster analysis were used to identify groups of adolescents according to underlying motives for selling sex. Further analyses were carried out for characteristics of selling sex and risk factors. Three groups of adolescents were categorized according to their motives for selling sex: Adolescents reporting; 1) Emotional reasons, being at a greater risk of sexual abuse, using sex as a means of self-injury and having a non-heterosexual orientation. 2) Material but no Emotional reasons, who more often receive money as compensation and selling sex to a person over 25 years of age, and 3) Pleasure or no underlying motive for selling sex reported, who were mostly heterosexual males selling sex to a person under 25 years of age, the buyer was not known from the Internet, the reward was seldom money and this group was less exposed to penetrative sexual abuse or using sex as a means of self-injury. In conclusion, adolescents selling sex are a heterogeneous group in regard to underlying motives.

Predicting running away in girls who are victims of commercial sexual exploitation

Youth that are victims of commercial sexual exploitation of children (CSEC) have a host of clinical problems and often run away from home, residential care, and treatment, which complicates and limits treatment effectiveness. No research to date has attempted to predict running away in CSEC victims. The present study aimed to 1) characterize a clinically referred sample of girls who were victims of CSEC and compare them to other high-risk girls (i.e., girls who also have a history of trauma and running away, but deny CSEC); and 2) examine the utility of using the Youth Level of Service/Case Management Inventory (YLS/CMI) to predict future running away. Data were collected from de-identified charts of 80 girls (mean age = 15.38, SD = 1.3, 37.9% White, 52.5% CSEC victims) who were referred for psychological assessment by the Department of Child Services. Girls in the CSEC group were more likely to have experienced sexual abuse (χ² = 6.85, p = .009), an STI (χ² = 6.45, p = .01), a post-traumatic stress disorder diagnosis (χ² = 11.84, p = .001), and a substance use disorder diagnosis (χ² = 11.32, p = .001) than high-risk girls. Moderated regression results indicated that YLS/CMI scores significantly predicted future running away among the CSEC group (β = 0.23, SE = .06, p = .02), but not the high-risk group (β = -.008, SE = .11, p =.90). The YLS/CMI shows initial promise for predicting future running away in girls who are CSEC victims. Predicting running away can help identify those at risk for and prevent running away and improve treatment outcomes. We hope current findings stimulate future work in this area.

Interventions that Foster Healing Among Sexually Exploited Children and Adolescents: A Systematic Review

Sexual exploitation of children and adolescents is a pressing, yet largely under-recognized form of child abuse. The goals of this review were to identify interventions that have been implemented with sexually exploited children and adolescents and to better understand their effectiveness for fostering healing with this population. Our systematic search generated 4,358 publications of which 21 met our inclusion criteria. Based on their objectives and delivery, we organized the interventions into five categories: (a) focused health and/or social services, (b) intensive case management models, (c) psychoeducational therapy groups, (d) residential programs, and (e) other. Most programs were gender-specific, targeting girls and young women with just one being for boys and young men only. Studies reported on a range of outcomes including psychosocial outcomes, risky behaviors, trauma responses, mental health, protective factors, and public health outcomes. Despite differences in delivery, most of the interventions did, to some degree, appear to foster healing among sexually exploited children and adolescents. Findings from this review have implications for researchers, policy and program developers, and frontline practitioners who, through partnerships with one another, can advocate for the creation of evidence-informed, purpose-built, and thoughtfully delivered interventions.

A systematic review of the state of the literature on sexually exploited boys internationally

This systematic review assessed the current state of the literature on sexually exploited boys internationally. We aimed to describe what is known about sexual exploitation of boys, identify gaps in the literature, provide implications for practice, and make recommendations for future research. Multiple database searches were conducted using a combination of controlled vocabulary and keywords to capture child and adolescent sexual exploitation. Our search identified 11,099 unique references and excluded studies that did not include male participants less than 18 years old or disaggregate results by relevant age groups and/or by sex. This review identified 42 studies from 23 countries, providing evidence that sexual exploitation of boys is an issue in both high- and low-income countries. Seventeen articles had sexual exploitation as their primary variable of interest, the majority of which sampled boys who accessed services (i.e., shelters, health care, social, and justice services). Boys' experiences of sexual exploitation varied in terms of venue, exploiters, and compensation. Compared to their non-sexually exploited peers, sexually exploited boys more commonly reported experiences of child abuse, substance use, conduct problems, and mental health problems such as anxiety, depression, and self-harm. Despite increasing evidence that boys are sexually exploited around the world, the current literature provides limited data about the antecedents, sequelae, and the specific features of sexual exploitation experiences among boys. Further research is needed to inform, policy, social services and health care delivery specific to the needs of sexually exploited boys.

Sexual exploitation of unaccompanied migrant and refugee boys in Greece: Approaches to prevention

In this essay, Julie Freccero and colleagues discuss resources to prevent the sexual exploitation of unaccompanied and separated refugee boys in Greece.