Behavioral health treatment “Buy-in” among adolescent females with histories of commercial sexual exploitation

Abstract

Background: Adolescent females with histories of commercial sexual exploitation (CSE) have high mental health and substance use treatment needs, yet little is known about their perspectives regarding behavioral health and behavioral health treatment. Objective:We sought to understand the attitudes of adolescent females with histories of CSE regarding behavioral health to identify factors influencing "buy-in" to behavioral healthcare. Participants and Setting:Participants included 21 adolescent females, affiliated with our partner organizations (two group homes, a service agency, and a juvenile specialty court), who reported having exchanged sex for something of value. Methods:In-depth qualitative interviews explored participants' perspectives towards behavioral health. We conducted thematic analysis to identify themes concerning behavioral health.Results: Participants provided insightful definitions of "mental health" that included positive and negative aspects of emotional and cognitive states (e.g. "being happy with yourself' and "not thinking suicidal"), indicating intensified mental health challenges and resilience. Substance use was viewed as a coping mechanism for childhood trauma and their exploitation. Trusted relationships with providers and navigable health systems that encourage autonomy were key to promoting "buy-in" and thus engagement in behavioral health treatment. A conceptual model emerged illustrating factors leading to treatment engagement.

Experiences of surviviors of commercial sexual explotation availing rehabilitation at R&P homes in India

“…Similarly, other organisations can integrate their knowledge and experience and contribute with available resources to achieve more effective rehabilitation. Consistent with Barnert et al, (2020) and Mendonca (2014), the findings of the current study recommend an inclusive rehabilitation model for the survivor of CSE involving every stakeholder that acts as a pillar of efficient rehabilitation, namely the legal profession, criminal justice professionals, mental health professionals, social workers, medical practitioners, NGOs, government representatives, and volunteers from the general public. This would promote the involvement of all relevant stakeholders, reducing the risk of any lapse in attaining the goal of R&P Homes.…”

“…UNICEF (2003) suggested that the most effective preventive and proactive measures to prevent sexual exploitation and deter sexual revictimisation are conducted by organisations which are close to the source of the problem and connected to the community. Barnert et al (2020) emphasise the role of care providers through behavioural health treatments to overcome various psychological traumas related to experience. This study focused on extensive vocational and employment training for the beneficiaries to increase financial independence.…”

“…The challenges faced by children to escape commercial sexual exploitation were isolation, drug dependency, and financial necessity (Williams & Frederick, 2009). Coping mechanisms of female adults with a history of commercial sexual exploitation include substance misuse and selfharm (Barnert et al, 2020). Loza et al (2010) found that the vulnerabilities of adult female sex workers becoming survivors of commercial sexual exploitation were based on the need for basic amenities, and lack of education and skill.…”

A transgender girl’s experience: sexual exploitation and systems involvement

“…Notable efforts in the juvenile justice system include specialty court programs that reshape traditionally punitive responses into restorative, multidisciplinary service delivery (Bath et al , 2019; Cook et al , 2018; Liles et al , 2016). Additionally, emergent conceptual models emphasize the need for service providers to address the multiple intersectional identities of survivors (Kelly et al , 2018; Showden and Majic, 2018) and increase survivors’ level of agency and autonomy within decision-making processes (Barnert et al , 2019). The available literature on this topic is largely focused on cisgender girls and young women, rarely addressing the perspectives, voices or experiences of youth who identify as transgender or gender nonconforming.…”

Perspectives of Girls and Young Women Affected by Commercial Sexual Exploitation: mHealth as a Tool to Increase Engagement in Care

“…12,20,21 Further, youth have identified additional factors that create barriers to treatment engagement, such as long wait times, feeling judged by providers, staff changeover (forcing them to repeat reporting their history), not having accessible transportation, and fear of legal ramifications resulting from presenting for health care. 12,14,22 The general lack of agency afforded to youth when accessing health care treatment has shown to further compromise their willingness to engage in services, 20,22 creating an additional barrier to obtaining continuous care. 23 These factors threaten continuity of care and lead to increased fragmentation of health-related treatment or mandated services.…”