It's called "Going out to play": a video diary study of Hmong girls' perspectives on running away.

How do Hmong immigrant adolescent girls decide to run away, return home, leave again, or stay home? Video diaries by 11 sexually exploited runaway Hmong girls, ages 13-16, revealed four themes: "fighting restrictions," or resisting family and cultural expectations and desires to be like other American teens; "not running away, going out to play," which captured impulsive decision making; "unrestrained partying," which described runaway experiences but minimized the dangers faced; and "trying to change," or returning home because of family bonds and wanting to "be someone good." Given their limited ability to anticipate risks, interventions should focus on runaway prevention initiatives for Hmong families and teens.

The illusions and juxtapositions of commercial sexual exploitation among youth: identifying effective street-outreach strategies.

To explore sexually exploited youths' perspectives of how street outreach workers can effectively provide outreach and connections to services, we conducted qualitative interviews with 13 female participants, ages 14 to 22, in a Midwest U.S. city. Participants reported multiple types of exploitation, most first exploited by age 13, plus substance use and recurrent homelessness. Nearly all had a pimp, and all used the internet as a venue for sexual exploitation. Participants wanted outreach workers to use "soft words" to refer to exploitation. They expressed contradictory images of their "boyfriend" pimps and their exploitation. They wanted outreach workers to "provide resources," "be nonjudgmental," "listen," and "care." Street outreach can be one way to support sexually exploited youth but should occur in multiple settings.

Mental Health Outcomes Among Homeless, Runaway, and Stably Housed Youth.

BACKGROUND AND OBJECTIVES: Runaway youth and homeless youth are at risk for adverse mental health outcomes. These 2 populations are frequently pooled together in both research and interventions yet may have unique health needs. We sought to assess differences in mental health outcomes among these populations. METHODS: We conducted a secondary data analysis of ninth- and 11th-graders in the 2016 minnesota Student Survey (n = 68 785). We categorized youth into 4 subgroups based on housing status in the previous year: (1) unaccompanied homeless youth (0.5%), (2) runaway youth (4%), (3) youth who had both run away and been homeless (0.6%), and (4) stably housed youth (95%). We performed multivariable logistic regression to compare 4 mental health outcomes (self-injury, suicidal ideation, suicide attempts, and depressive symptoms) across groups, controlling for demographics and abuse history. RESULTS: Unstably housed youth had poorer mental health outcomes when compared with their stably housed peers (P < .05). For example, 11% of homeless youth, 20% of runaways, and 33% of youth who had experienced both had attempted suicide in the previous year compared with 2% of stably housed youth (adjusted odds ratios 2.4, 4.9, and 7.1, respectively). Other outcomes showed a similar pattern. CONCLUSIONS: Our findings suggest that runaway and homeless youth represent unique populations with high levels of mental health needs who would benefit from targeted clinical and community interventions. Pediatric clinicians represent one potential point of screening and intervention.

Featured Counter-Trafficking Program: The Minnesota Runaway Intervention Program.

This invited article is one of several comprising part of a special issue of Child Abuse and Neglect focused on child trafficking and health. The purpose of each invited article is to describe a specific program serving trafficked children. Featuring these programs is intended to raise awareness of innovative counter-trafficking strategies emerging worldwide and facilitate collaboration on program development and outcomes research. This article describes the Minnesota Runaway Intervention Program (RIP), a Minneapolis-St. Paul based program dedicated to supporting youth aged 12-17 who have run away and experienced sexual violence, including sexual assault and exploitation. It is a comprehensive, health care focused intervention, embedded within a hospital-based Child Advocacy Center. RIP is developed and led by nurse practitioners who provide services tailored to participants' diverse needs, including health care, case management services, and a therapeutic empowerment group.

The Links Between Sexual Abuse Severity, Running Away, and Parental Connectedness Among Youth at a Hospital-Based Child Advocacy Center.

PURPOSE: Runaway adolescents often have strained relationships with their parents. Given parental support is an important protective resource for traumatized young people, understanding differences in support within parent-adolescent relationships could aid in designing more effective interventions. We hypothesized (1) runaway adolescents seen at a Child Advocacy Center (CAC) would have poorer parental relationships than adolescents without a history of running away and (2) severity of diagnosed sexual violence would be associated with lower parental connectedness. METHODS: Data were from 2,042 adolescents aged 10-19 years and their parents evaluated for any reason at our hospital-based CAC from 2008 to 2017. Parent-adolescent relationship scales were completed by adolescents and at least one parent/guardian (usually mothers). Sexual abuse was stratified at four levels, higher levels indicating increasingly severe forms of abuse. T-tests and analyses of variance to tested relationships between supportive and controlling parental behaviors by runaway status, and, among runaways, by the severity of sexual abuse. RESULTS: Runaway adolescents comprised 58.3% of adolescents seen at the CAC; runaways reported lower parental support and higher parental controlling than patients without a history of running away. Those with the most severe forms of sexual abuse (including sexual exploitation and gang rape) reported the least supportive and most controlling relationships with parents, as did their parents. CONCLUSIONS: Findings support our clinical observations that polyvictimization of adolescents who have spent significant time as runaways may further strain parent-adolescent relationships. Future clinical research should focus on developing interventions to promote parental connectedness after a runaway episode.

A nurse practitioner-led intervention for runaway adolescents who have been sexually assaulted or sexually exploited: Effects on trauma symptoms, suicidality, and self-injury.

BACKGROUND: Adolescent victims of sexual assault and exploitation suffer significant mental health distress including PTSD, self-harm, suicidal ideation, and attempts. OBJECTIVE: This longitudinal observational study investigated the Runaway Intervention Program's influence on trauma responses at 3, 6, and 12 months for adolescents who have run away at least once and have been sexually assaulted or exploited. PARTICIPANTS: Runaways (n = 362) received nurse practitioner (NP) home and community visits, intensive case management, and optional empowerment groups. SETTING: An urban Midwestern city's hospital-based Children's Advocacy Center. METHODS: Trauma responses were measured by the UCLA PTSD-RI index, past 30 days emotional distress scale, and self-harm, suicidal ideation, and suicide attempt questions. Repeated Measures ANOVA assessed trauma response changes over time. Growth curve analyses using intervention doses determined which aspects of the intervention predicted change. RESULTS: From program entry to 3 and 6 months, mean values decreased significantly for emotional distress (-0.67, -.91) self-harm (-.30, -.55), suicidal ideation (-.45, -.57), suicide attempts (-.58, -.61), and trauma symptoms (-11.8, -16.2, all p < .001) all maintained at 12 months. In growth curve models, NP visits independently predicted declines in emotional distress (-.038), self-injury (-.020), suicidal ideation (-.025) and attempts (-.032), while empowerment groups predicted trauma symptoms (-.525) and all others except suicide attempts. CONCLUSIONS: The program, especially NP community visits and empowerment group elements, decreased trauma responses in runaway youth with a history of sexual assault. Given high rates of PTSD and emotional distress among runaways, the Runaway Intervention Program offers promise for improving mental health outcomes.

Differences in Abuse and Related Risk and Protective Factors by Runaway Status for Adolescents Seen at a U.S. Child Advocacy Centre.

OBJECTIVES: This study examined the abuse prevalence and characteristics, and risk and protective factors, among both runaway and non-runaway adolescents evaluated at a Child Advocacy Center (CAC) in Minnesota, which had implemented a referral program to assess runaways for potential sexual assault or sexual exploitation. METHODS: A cross-sectional analysis of self-report and chart data for the 489 adolescent girls who were evaluated between 2008 and 2010. Chi-square and t-tests by runaway status compared abuse experiences, trauma responses, health issues, and potential protective assets associated with resilience between runaways and non-runaways. Bivariate logistic regressions explored the relationship of these risk and protective factors to self-harm, suicide attempts, and problem substance use, separately for runaways and non-runaways who had experienced sexual abuse. RESULTS: Runaways were significantly more likely than non-runaways to have experienced severe sexual abuse, to have used alcohol and drugs, and reported problem substance use behavior, higher levels of emotional distress, more sexual partners, and they were more likely to have a sexually transmitted infection (STI). Runaways had lower levels on average of social supports associated with resilience, such as connectedness to school, family or other adults. Yet higher levels of these assets were linked to lower odds of self-harm, suicide attempt and problem substance use for both groups. CONCLUSIONS AND IMPLICATIONS: CACs should encourage referrals of runaway adolescents for routine assessment of sexual assault, and incorporate screening for protective factors in addition to trauma responses in their assessments of all adolescents evaluated for possible sexual abuse, to guide interventions.

Restoring healthy developmental trajectories for sexually exploited young runaway girls: fostering protective factors and reducing risk behaviors.

PURPOSE: To examine effects of the Runaway Intervention Program (RIP), a strengths-based home visiting, case management, and group support program for sexually assaulted or exploited young runaway girls; staffed by advanced-practice nurses, RIP aims to restore healthy developmental trajectories by reestablishing protective factors, reducing trauma responses, and lowering risk behaviors that are common sequelae of sexual violence. METHODS: Quasi-experimental study of RIP girls (N = 68) ages 12 to 15 (mean, 13.75 years), assessed at baseline, 6 and 12 months for changes in family and school connectedness, other adult caring, self-esteem, emotional distress, suicidality, recent substance use, plus risky sexual behaviors. Responses at each time were also compared to nonabused and abused urban ninth-grade girls (mean age, 14.64, N = 12,775) from the 2004 Minnesota Student Survey (MSS). Analyses used paired t-tests, McNemars test, Wilcoxon sign-rank, chi-square, and Pearson's correlations. RESULTS: At entry, RIP girls were most like sexually abused MSS peers, with lower levels of protective factors and higher levels of distress and risk behaviors than nonabused MSS girls (p < .05 to p < .01). However, they saw significant improvements by 6 and 12 months, such that all measures of protective factors, positive development, distress, and risk behaviors more closely resembled nonabused MSS girls by 12 months. Of equal note, RIP girls with the greatest emotional distress, the lowest levels of connectedness, and lowest self-esteem at baseline demonstrated the greatest improvement (all p < .001). CONCLUSIONS: This appears to be a promising intervention for restoring sexually abused runaway girls to a healthy developmental trajectory.

A novel, intensive home-visiting intervention for runaway, sexually exploited girls.

PURPOSE: Few studies have examined interventions that help adolescents who run away. This study both describes a home-visiting intervention program for young, sexually assaulted runaways (10-14 years old) and provides preliminary outcomes from the first 20 female participants. DESIGN AND METHODS: Using a strengths-based approach, advanced practice nurses provided frequent home and school visits and case management, and assisted girls to access an empowerment group over a 1-year period. RESULTS: Teens' risk behaviors decreased, including truancy, runaway episodes, sexually transmitted infections, and substance use. CONCLUSIONS: Preliminary results suggest that this is an effective intervention for reducing risk behaviors and helping younger runaways reconnect to school and family. PRACTICE IMPLICATIONS: Client-centered interventions in community settings can address the complex health needs of vulnerable young runaways.