Visit Data and Telehealth in a Clinic for Trafficked Persons: Virtual Care and Human Trafficking During the COVID-19 Pandemic.

BACKGROUND: Human trafficking involves coerced labor or sex. THRIVE, a multidisciplinary University of Miami clinic for trafficked persons, transitioned to a hybrid telehealth model during the COVID-19 pandemic. Th is paper presents appointment data across THRIVE clinic services during this transition. METHODS: A review of appointments for THRIVE patients (n=156) was conducted to compare pre-pandemic (February 2019 to February 2020) and pandemic (March 2020 to December 2021) appointment trends. RESULTS: There were 15% more scheduled (n=51.1 versus n=44) and 8% more completed (n=30.2 versus n=27.9) appointments per month early in the pandemic period with telehealth use compared to the pre-pandemic period. Telehealth was most used within psychiatry. Rescheduled and no-show appointments per month significantly increased during the pandemic period (p=0.010 in pandemic period 1 and and p=0.028 in pandemic period 2). There were few significant differences in appointment trends according to demographic variables. CONCLUSION: Telehealth succeeded in connecting THRIVE patients during the pandemic, highlighting its potential for long-term use amongst trafficked persons.

Focusing the APA Ethics Code to Include Development: Applications to Abuse.

Extant ethics codes in psychological work generally are not sufficiently developmentally oriented. Here, we examine the American Psychological Association ethics code for its developmental sensitivity, find it lacking in this regard, and make recommendations. Our approach was to place children and youth at the forefront in forming developmentally-targeted principles, meta-principles, values, and rights. To further this aim, we consulted the one ethics code in the field that is developmentally-attuned, the ethics code of the American Academy of Child and Adolescent Psychiatry. We used a revised set of ethical principles for psychological work and developed a set of meta-principles. The five APA ethics code principles are: (a) beneficence and nonmaleficence; (b) fidelity and responsibility; (c) integrity; (d) justice; and (e) respect for people's rights and dignity. The set of ethical principles taken from Young (Revising the American Psychological Association ethics code, Springer International Publishing, 2017) includes: (a) life preservation, (b) caring beneficence/nonmaleficence, (c) relational integrity, (d) respect for the dignity and rights of persons and peoples, and (e) promoting and acting from justice in society. The major meta-principles proposed here include: (a) functioning from responsibility, (b) promoting personhood, and (c) promoting participation. In addition, we added meta-principles for working from appropriate (d) theory and (e) meta-theory (Neo-Maslovian and a combined relationism-empiricism, respectively). Secondary meta-principles in the text refer to (a) systems, (b) the person as unique, (c) the vulnerabilities of people, (d) autonomy, and (e) morality.

Child protection training for professionals to improve reporting of child abuse and neglect.

BACKGROUND: Many nations require child-serving professionals to report known or suspected cases of significant child abuse and neglect to statutory child protection or safeguarding authorities. Considered globally, there are millions of professionals who fulfil these roles, and many more who will do so in future. Ensuring they are trained in reporting child abuse and neglect is a key priority for nations and organisations if efforts to address violence against children are to succeed. OBJECTIVES: To assess the effectiveness of training aimed at improving reporting of child abuse and neglect by professionals and to investigate possible components of effective training interventions. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, 18 other databases, and one trials register up to 4 June 2021. We also handsearched reference lists, selected journals, and websites, and circulated a request for studies to researchers via an email discussion list. SELECTION CRITERIA: All randomised controlled trials (RCTs), quasi-RCTs, and controlled before-and-after studies examining the effects of training interventions for qualified professionals (e.g. teachers, childcare professionals, doctors, nurses, and mental health professionals) to improve reporting of child abuse and neglect, compared with no training, waitlist control, or alternative training (not related to child abuse and neglect). DATA COLLECTION AND ANALYSIS: We used methodological procedures described in the Cochrane Handbook for Systematic Reviews of Interventions. We synthesised training effects in meta-analysis where possible and summarised findings for primary outcomes (number of reported cases of child abuse and neglect, quality of reported cases, adverse events) and secondary outcomes (knowledge, skills, and attitudes towards the reporting duty). We used the GRADE approach to rate the certainty of the evidence. MAIN RESULTS: We included 11 trials (1484 participants), using data from 9 of the 11 trials in quantitative synthesis. Trials took place in high-income countries, including the USA, Canada, and the Netherlands, with qualified professionals. In 8 of the 11 trials, interventions were delivered in face-to-face workshops or seminars, and in 3 trials interventions were delivered as self-paced e-learning modules. Interventions were developed by experts and delivered by specialist facilitators, content area experts, or interdisciplinary teams. Only 3 of the 11 included studies were conducted in the past 10 years. Primary outcomes Three studies measured the number of cases of child abuse and neglect via participants' self-report of actual cases reported, three months after training. The results of one study (42 participants) favoured the intervention over waitlist, but the evidence is very uncertain (standardised mean difference (SMD) 0.81, 95% confidence interval (CI) 0.18 to 1.43; very low-certainty evidence). Three studies measured the number of cases of child abuse and neglect via participants' responses to hypothetical case vignettes immediately after training. A meta-analysis of two studies (87 participants) favoured training over no training or waitlist for training, but the evidence is very uncertain (SMD 1.81, 95% CI 1.30 to 2.32; very low-certainty evidence).  We identified no studies that measured the number of cases of child abuse and neglect via official records of reports made to child protection authorities, or adverse effects of training. Secondary outcomes Four studies measured professionals' knowledge of reporting duty, processes, and procedures postintervention. The results of one study (744 participants) may favour the intervention over waitlist for training (SMD 1.06, 95% CI 0.90 to 1.21; low-certainty evidence). Four studies measured professionals' knowledge of core concepts in all forms of child abuse and neglect postintervention. A meta-analysis of two studies (154 participants) favoured training over no training, but the evidence is very uncertain (SMD 0.68, 95% CI 0.35 to 1.01; very low-certainty evidence). Three studies measured professionals' knowledge of core concepts in child sexual abuse postintervention. A meta-analysis of these three studies (238 participants) favoured training over no training or waitlist for training, but the evidence is very uncertain (SMD 1.44, 95% CI 0.43 to 2.45; very low-certainty evidence). One study (25 participants) measured professionals' skill in distinguishing reportable and non-reportable cases postintervention. The results favoured the intervention over no training, but the evidence is very uncertain (SMD 0.94, 95% CI 0.11 to 1.77; very low-certainty evidence). Two studies measured professionals' attitudes towards the duty to report child abuse and neglect postintervention. The results of one study (741 participants) favoured the intervention over waitlist, but the evidence is very uncertain (SMD 0.61, 95% CI 0.47 to 0.76; very low-certainty evidence). AUTHORS' CONCLUSIONS: The studies included in this review suggest there may be evidence of improvements in training outcomes for professionals exposed to training compared with those who are not exposed. However, the evidence is very uncertain. We rated the certainty of evidence as low to very low, downgrading due to study design and reporting limitations. Our findings rest on a small number of largely older studies, confined to single professional groups. Whether similar effects would be seen for a wider range of professionals remains unknown. Considering the many professional groups with reporting duties, we strongly recommend further research to assess the effectiveness of training interventions, with a wider range of child-serving professionals. There is a need for larger trials that use appropriate methods for group allocation, and statistical methods to account for the delivery of training to professionals in workplace groups.

Mothers Attitudes Toward Child Sexual Abuse Prevention in Schools: A Preliminary Examination.

Providing school-based child sexual abuse (CSA) prevention programs ensures that the majority of children will participate in programming. Since many parents may feel ill equipped to have such discussions with their children, programs offered in education settings can bring awareness to this issue. A sample of mothers (N = 268) from across the United States completed an online survey related to their experiences with and attitudes toward school-based CSA prevention programs. Most mothers (70%) had no exposure to prevention programs during their childhood, but the majority (95%) had a positive attitude toward programming for their children. Most mothers believed that offering CSA prevention in schools was important and could provide a safety net. Mothers desired programming that was age appropriate, involved parents and was activity based. These results can help inform schools' prevention programming.

The collaborative efforts of a multidisciplinary community-based team to address victims of commercial sexual exploitation.

OBJECTIVE: This study explored the perceptions of members of a multidisciplinary team (MDT) when working with victims of commercial sexual exploitation. METHOD: Sixteen members of a state-mandated MDT, representing various professions, were individually interviewed to gain their perspective on the functioning of the MDT, including challenges and strengths. RESULTS: Members of the MDT held basically positive perceptions of the process and reported a sense of teamwork. They emphasized ways in which multiple disciplines are needed to best provide for these victims. CONCLUSION: Results provide support for the role of MDTs in handling cases of commercial sexual exploitation. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Vicarious Traumatization and Burnout among Service Providers for Victims of Commercial Sexual Exploitation.

Victims of commercial sexual exploitation (CSE) are in need of multiple community services to aid in their recovery. Service providers are critical to ensuring these victims receive needed treatment. Given the complex trauma of these victims and the necessity of long-term treatment, these service professionals may experience vicarious trauma (VT) and burnout. This qualitative study interviewed 12 professionals who have provided direct services to victims of CSE about their experiences. They had on average about 8 years of experience and three were survivors of CSE. Almost all reported instances of burnout and VT but also had strategies for the prevention of such experiences. Most participants reported experiences of VT and burnout are inevitable when working with this population, but self-care strategies and peer support are essential to combatting these negative experiences. These results can inform agencies that provide services to victims of CSE so as to ensure their staff stay healthy and avoid burnout.

Adolescent girls with a history of Commercial Sexual Exploitation (CSE): Perceptions and characteristics of social networks.

BACKGROUND: Previous research has demonstrated that social support systems such as family, peers, or social services can play a role in adolescent girls' involvement in commercial sexual exploitation (CSE) (Hargreaves- Cormany & Patterson, 2016; Phillips, 2015, Reid & Piquero, 2016). OBJECTIVES: Few studies have specifically explored the meanings adolescent girls with a history of CSE give to their social networks and how these may be associated with CSE vulnerability. The current study examines how important networks are labeled and characterized by these youth. PARTICIPANTS: This study identifies the social networks used by eight racial/ethnic minority adolescent girls who have experienced CSE. METHODS: Using individual interviews, participants were asked to identify individuals and systems with which they interact and provide meanings about these social supports' roles and value in their lives. Additionally, the degree to which participants viewed each source as influential was explored. Thematic analysis was used to analyze the data. Social Network Theory guided the analysis. RESULTS: Two major themes emerged from the data: a) the social networks perceived as influential in the participants' daily lives and b) the perception of the social network's characteristics as negative or positive. Both positive and negative social networks contained some of the same members. CONCLUSION: The current findings point to key social networks for racial/ethnic minority adolescent girls and the potential role of these networks regarding girls' CSE vulnerability. The duality of some network members illustrate the importance of viewing the role of social networks as both complex and dynamic for girls who have experienced CSE. Clinicians should take care to consider the role of intersectional factors when treating members of this community.

College students' recollections of childhood sexual abuse prevention programs and their potential impact on reduction of sexual victimization.

BACKGROUND: Child sexual abuse prevention programs are offered in many schools globally, but research is scant on whether or not these programs actually decrease the rates of CSA among youth who participate in them. OBJECTIVE: This study sought to determine if participation in a CSA prevention program (based on participant recall), in the US or another country, led to lower rates of self-reported past victimization among youth, affected disclosure and effects on sexual satisfaction. PARTICIPANTS AND SETTING: One thousand five hundred and two students from an ethnically and racially diverse university in the southeast served as participants. METHODS: Participants completed measures on line (Qualtrics). This included demographic information and participation in CSA prevention programs in schools, concepts that were covered, and recollections of sexual victimization. The second measure was a revised version of the sexual satisfaction scale (Derogatis Sexual Functioning Inventory). RESULTS: Students who had not participated in a CSA prevention program were significantly more likely to be abused than those who did participate, regardless of the program or location (χ2 (1,1498) = 19.01, p < .001). Those participating in programs in the US were more likely to disclose abuse than those participating in the programs in other countries (χ2 (1,212) = 5.49, p = .019). No significant difference was found between those who participated in prevention programming and those who did not on sexual satisfaction (χ2 (1,1469) = 1.76, p = .184). CONCLUSION: These results highlight the importance of universal CSA prevention programs in schools worldwide as one part of comprehensive prevention.

Assessment of commercially sexually exploited girls upon entry to treatment: Confirmed vs. at risk victims.

BACKGROUND: Research has documented many risk factors for commercial sexual exploitation of children as well as serious emotional and behavioral consequences for such victims. OBJECTIVE: This study aims to provide an understanding of risk factors and symptom presentation of girls who are victims or at risk for commercial sexual exploitation. PARTICIPANTS AND SETTING: Ninety-six girls (12-18 years) who were referred to a child advocacy center's specialized treatment program for commercially sexually abused girls served as participants (56 confirmed victims, 40 at risk of commercial sexual exploitation). METHODS: At intake participants were administered the Youth Self-Report, the Trauma Symptom Checklist for Children, and the UCLA Post-Traumatic Stress (PTSD) Reaction Index for DSM -5. Parents or guardians were asked to complete the Child Behavior Checklist and the UCLA PTSD Reaction Index for DSM - 5(Parent/Caregiver). RESULTS: Intake information revealed significant differences between groups with confirmed victims reporting higher levels of sex work, kidnapping, physical abuse, physical assault and sexual abuse by a non-family member (p < .05) than at risk victims. All participants were exposed to traumas, were racially and ethnically diverse and lived primarily with their families. At risk girls were significantly more likely to be in school than the confirmed victims. The UCLA PTSD Index revealed that the confirmed victims had experienced significantly more physical abuse than the at-risk group and 26.7% of confirmed victims and 7.7% of the at risk victims met the DSM criteria for PTSD. Twenty percent of the confirmed victims met criteria for Dissociative subtype, while only 7.7% of at risk victims did. On the CBCL, victims from both groups scored in the clinical range on Externalizing Problems and Total Problems and the at risk group scored significantly higher on the School subscale than the confirmed victims group. CONCLUSION: Commercially sexually exploited girls have experienced multiple traumas in their lives and display emotional and behavioral difficulties. Early detection of girls who may be at risk for sexual exploitation may allow for prevention and intervention as these girls also have traumatic backgrounds and display similar symptoms.

Increasing Child Serving Professionals' Awareness and Understanding of the Commercial Sexual Exploitation of Children.

Child serving professionals need increased understanding of the identification and therapeutic needs of child victims of commercial sexual exploitation. This study evaluated the effectiveness of a training program aimed to increase awareness of commercial sexual exploitation of children (CSEC) among professionals likely to encounter victims in their work. Professionals' (N = 227) knowledge level was examined prior to the training, immediately thereafter, and in a 6-12 month follow-up. Despite professional position or years of experience, participants had similar levels of CSEC knowledge before the training and all showed a significant improvement in their knowledge after the training. However, follow-up testing on a smaller subsample demonstrated that knowledge gains were not maintained. The analysis of the participants' responses to how their behavior would change subsequent to the training revealed important themes including: (1) greater ability to identify/assess or recognize CSEC victims, (2) greater understanding and knowledge of CSEC, (3) increased ability to communicate, interact, and engage with CSEC victims, and (4) heightened desire to educate others and raise awareness about CSEC. Results also indicated that participants were very satisfied with the training and found it highly relevant to their work.

Keeping Students Out of Harm's Way: Reducing Risks of Educator Sexual Misconduct.

Sexual misconduct by school staff, which we refer to as educator sexual misconduct (ESM), is a serious and damaging violation of the trust that parents and students put in the educational system. After reviewing the prevalence and consequences of ESM for all parties involved, the authors propose standards of practice based on the Situational Crime Prevention framework to prevent sexual abuse by altering the environment and reducing opportunities for offending. The strategies offered in this paper can help create a comprehensive approach to reducing sexual victimization of students by staff. The standards serve as an operational framework for prevention and reduce the likelihood of ESM and institutional legal liability. The seven standards include safe screening and hiring practices for staff, codes of conduct, ensuring safe environments, staff-student communication policy (including electronic communication), training staff, parents and students, monitoring and supervision, along with reporting questionable conduct. By implementing these standards, educational institutions can help ensure better protection of children from ESM.

Cyberbullying and LGBTQ Youth: A Systematic Literature Review and Recommendations for Prevention and Intervention.

Research has demonstrated that cyberbullying has adverse physical and mental health consequences for youths. Unfortunately, most studies have focused on heterosexual and cisgender individuals. The scant available research on sexual minority and gender expansive youth (i.e., LGBTQ) shows that this group is at a higher risk for cyberbullying when compared to their heterosexual counterparts. However, to date no literature review has comprehensively explored the effects of cyberbullying on LGBTQ youth. A systematic review resulted in 27 empirical studies that explore the effects of cyberbullying on LGBTQ youth. Findings revealed that the percentage of cyberbullying among LGBTQ youth ranges between 10.5% and 71.3% across studies. Common negative effects of cyberbullying of LGBTQ youth include psychological and emotional (suicidal ideation and attempt, depression, lower self-esteem), behavioral (physical aggression, body image, isolation), and academic performance (lower GPAs). Recommendations and interventions for students, schools, and parents are discussed.

Training Mental Health Professionals in Child Sexual Abuse: Curricular Guidelines.

Given the incidence of child sexual abuse in the United States, mental health professionals need training to detect, assess, and treat victims and should possess a clear understanding of the process of victimization. However, many mental health professionals who work with children and families have not been exposed to any training in child sexual abuse during their formal education. This article will examine the need for such training, suggest critical components of child sexual abuse training, and describe various methods of training (e.g., in person, Web-based, and community resources).

Latino parents' plans to communicate about sexuality with their children.

This study investigated 86 Latino parents' intentions to communicate about sexuality issues with their children. They reported on their history of sexuality education, when they would first discuss sexuality-related topics, and their perceived effectiveness of each topic. Compared with a sample of Caucasian parents, Latino parents intended to discuss sexual abuse/molestation at an earlier age, but planned to discuss human reproduction, intercourse, and AIDS at significantly later ages. Suggestions for assisting Latino parents with communications regarding sexuality topics are provided.

Child sexual behavior inventory: a comparison between Latino and normative samples of preschoolers.

There is a relative dearth of research examining normative sexual behavior in Latino preschool children, despite an increased presence of Latinos as a minority population in the United States. To meet this need, a sample of Latino mothers were asked to complete the Child Sexual Behavior Inventory (CSBI; Friedrich et al., 1992 ) on their preschool-aged children (3 to 5 years old; n = 188). When their children's scores were compared to CSBI normative data, significant differences emerged. Compared to the normative sample, Latino boys and girls scored significantly higher on the sexual abuse specific items subscale, and Latino girls scored significantly higher on the developmentally related sexual behavior subscale. Possible cultural explanations for these elevations are explored.

Preventing childhood sexual abuse: an ecological approach.

Childhood sexual abuse is a significant public health problem that negatively affects victims, families, organizations, and society. This special issue presents innovative approaches designed to prevent the sexual exploitation of youth. Using both an ecological approach and the Spectrum of Prevention ( Parks, Davis & Cohen, 2010 ), the articles collected for this special issue highlight cutting-edge prevention approaches educating children, parents, professionals, organizations, and the general public.

Evaluation of a personal safety program with Latino preschoolers.

This study evaluated a personal safety educational program designed for Latino families attending preschools in a large metropolis. Seventy-eight children who participated in the Kids Learning About Safety program were compared to 45 control children. Compared with controls, participating children demonstrated enhanced ability to recognize inappropriate touches, learned correct genital terminology, were able to recognize the inappropriateness of touch requests made by "good" people, demonstrated higher levels of personal safety skills, and learned general safety rules. Gains in knowledge were maintained at three-month follow-up testing for all content areas except genital terminology. Although feedback provided by participating families was positive, recruiting participants and maintaining attendance at sessions was difficult. Discussion includes recommendations for future research and engagement of this population.

Children's abilities to recognize a "good" person as a potential perpetrator of childhood sexual abuse.

OBJECTIVE: This study examined the ability of children to recognize "good" people as potential perpetrators prior to and after completing a personal safety program. There were three objectives to the study. The first was to determine whether young children could recognize the inappropriateness of a sexual request coming from people described as either "good" or "bad." Second, the study examined whether preschoolers could be educated to recognize inappropriate touch requests regardless of the good/bad descriptor. Finally, we explored if children's ability to learn the recognition skill depended upon their age. METHODS: Ninety-three, primarily Hispanic (72%) preschool children (M age=3.9 years) completed the Body Safety Training program (BST; Wurtele, 2007), a classroom-based behavioral program. They responded to questions about "good" and "bad" people requesting to touch their private parts prior to and after the educational program. RESULTS: At pre-testing, children had more difficulty recognizing inappropriate touch requests when made by "good" people compared to "bad" people. After completing the BST program, children improved in their ability to recognize the inappropriateness of requests made by both "good" and "bad" people. At pretesting, correct responding varied across age groups, with a greater percentage of older children (age 5) correctly responding to the "bad" cases compared to 3- and 4-year olds. At post-testing, a marginally significant age difference was found for cases involving "good" people and significant differences were found for cases involving "bad" people. Almost all 4- and 5-year-old children (94% and 96%, respectively) correctly responded to these inappropriate requests compared with only 71% of the 3 year olds. CONCLUSION: Pre-test results demonstrated that young children had difficulty recognizing the inappropriateness of a request when it was made by a "good" person. Post-test findings demonstrated that children as young as 3 years of age can learn the inappropriateness of such requests even when coming from "good" people, although 3 year olds had more difficulty recognizing inappropriate-touch requests compared to 4- and 5-year-old children. PRACTICE IMPLICATIONS: Results support the challenge of helping young children learn to recognize potential perpetrators, especially those described as "good" people.

Mandatory reporting legislation in the United States, Canada, and Australia: a cross-jurisdictional review of key features, differences, and issues.

Mandatory child abuse reporting laws have developed in particular detail in the United States, Canada, and Australia as a central part of the governments' strategy to detect cases of abuse and neglect at an early stage, protect children, and facilitate the provision of services to children and families. However, the terms of these laws differ in significant ways, both within and between these nations, with the differences tending to broaden or narrow the scope of cases required to be reported and by whom. The purpose of this article is to provide a current and systematic review of mandatory reporting legislation in the 3 countries that have invested most heavily in them to date. A comparison of key elements of these laws is conducted, disclosing significant differences and illuminating the issues facing legislatures and policymaking bodies in countries already having the laws. These findings will also be instructive to those jurisdictions still developing their laws and to those that may, in the future, choose to design a system of mandatory reporting.

Family environment in Hispanic college females with a history of childhood sexual abuse.

This study sought to examine the family environments of a sample of Hispanic women who reported childhood sexual abuse. Eighteen women, taken from a larger college sample, were individually interviewed and administered the Family Environment Scale (FES; Moos & Moos, 1994). Cultural values and the relationship of family characteristics to the individual's experience of sexual abuse were explored. The abused women obtained significantly higher scores on the Achievement-Orientation subscale of the FES than the normative group. Qualitative data revealed some patterns in these families regarding sexual discussions and poor conflict resolution skills. Implications for treatment of Hispanic victims are discussed.