Trauma-Focused Cognitive Behavioral Therapy for Commercially Sexually Exploited Youth

Abstract

Commercially sexually exploited children and adolescents (“commercially exploited youth”)present numerous clinical challenges that have led some mental health providers to question whether current evidence-based treatments are adequate to address the needs of this population. This paper 1) addresses commonalities between the trauma experiences, responses and treatment challenges of commercially exploited youth and those of youth with complex trauma; 2) highlights the importance of careful assessment to guide case conceptualization and treatment planning for commercially exploited youth; and 3) describes strategies for implementing Trauma-Focused Cognitive Behavioral Therapy for complex trauma specific to these youth.

Commercially sexually exploited youths’ health care experiences, barriers, and recommendations: A qualitative analysis

“…Second, the girls’ concerns about the quality of mental health services align with provider concerns about the best practices for treating CSE youth (Cohen, Mannarino, & Kinnish, 2017). CSE youth represent a population with a high prevalence of complex trauma, disrupted attachments and loss, substance use, risky behaviors, and poor social determinants of health—including homelessness, poverty, and decreased social supports.…”

“…Research demonstrates that CSE youth experience high rates of childhood emotional, physical, and sexual abuse (Stoltz et al, 2007); one study found the majority of traumatic exposures occurred in the caregiving environment (Cole, Sprang, Lee, & Cohen, 2014). Given the complex trauma in this population—which can be tied to difficulty trusting providers and engaging in treatment, along with demonstrating risky behaviors—clinicians and experts have questioned if current therapy approaches appropriately meet the needs of CSE youth (Cohen et al, 2017). There is a general dearth of research studies on treatment for CSE youth.…”

“…One exception is a randomized controlled trial of CSE youth in the Democratic Republic of Congo which found improved PTSD, anxiety, and depressive symptoms among girls receiving trauma-focused cognitive behavioral therapy (TF-CBT) (O’Callaghan, McMullen, Shannon, Rafferty, & Black, 2013). Building on this, Cohen and colleagues have advocated delivering TF-CBT to CSE youth and tailoring treatment to focus on safety, engagement strategies, and incorporating motivational interviewing techniques (Cohen et al, 2017).…”

Treatment of a Commercially Sexually Abused Girl Using Trauma-Focused Cognitive Behavioral Therapy and Legal Interventions

“…Linda also displayed a common symptom presentation found in youth who are victims of CSE and suffered complex trauma, namely, externalizing behavior problems and associated risky behaviors (e.g., running away, substance abuse, truancy; Cohen et al, 2017). Two of her measures (YSR and CBCL) indicated high levels of externalizing behaviors, which would include truancy, substance abuse, and so forth.…”

“…Although the treatment needs of victims of CSE is strong, few victims are referred for treatment (Goździak & MacDonnell, 2007). Given the prevalence of CSE, Cohen, Mannarino, and Kinnish (2017) state there is a need “for effective interventions to meet victim needs, as well as improved collaboration, coordination and communication across the multiple systems that serve them” (p. 1).…”