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

Abstract

The current study sought to understand commercially sexually exploited (CSE) youths' health care experiences, barriers to care, and recommendations for improving health care services. We conducted focus groups (N=5) with 18 CSE youth from February 2015 through May 2016 at two group homes serving CSE youth in Southern California. We performed thematic content analysis to identify emergent themes about CSE youths' perspectives on health care. Youth described facilitators to care, including availability of services such as screening for sexually transmitted infections, knowledge about sexual health, and a strong motivation to stay healthy. Barriers included feeling judged, concerns about confidentiality, fear, perceived low quality of services, and self-reliance. Overall, youth emphasized self-reliance and "street smarts" for survival and de-emphasized "victimhood," which shaped their interactions with health care, and recommended that health providers develop increased understanding of CSE youth. Our findings suggest that providers and community agencies can play an essential role in raising awareness of the needs of CSE youth and meet their health needs through creating a non-judgmental environment in health care settings that validates the experiences of these youth.

Adolescents Selling Sex and Sex as Self-Injury

“…Even though contact with healthcare is common for this group, few disclose their experience of sexual exploitation (Barnert et al, 2017). Disclosing sexual exploitation or sexual abuse could be difficult, since it is often associated with shame and self-blame (Ijadi-Maghsoodi et al, 2018;McElvaney et al, 2014). Disclosing experiences of SASI or selling sex might be even more difficult since the person has been active in seeking the situation and might even have been raped or abused as a consequence.…”

“…In many countries, prostitution is seen as a criminal act which, of course, is a barrier to seeking help and support (Rand, 2010). The fear of being caught by the police and a sense of feeling judged due to their lifestyle become barriers to seeking healthcare for sexual exploitation (Ijadi-Maghsoodi, Bath, Cook, Textor, & Barnert, 2018). Further, young people who are exposed to commercial sexual exploitation do not always view themselves as victims until later, making it hard to seek help and support (Rand, 2010).…”

Moving Towards Self-actualization: A Trauma-Informed and Needs-Focused Approach to the Mental Health Needs of Survivors of Commercial Child Sexual Exploitation

“…The lack of coordination of resources may make getting comprehensive services for the survivor nearly impossible (Domoney, Howard, Abas, Broadbent & Oram, 2015;Powell, Asbill, Louis & Stoklosa, 2018). Furthermore, services that are insensitive to culture, gender, language, citizenship status may make seeking and receiving services unobtainable or fraught with fear (Clawson, Salomon & Grace, 2008;Domoney, Howard, Abas, Broadbent & Oram, 2015;Ijadi-Maghsoodi, Bath, Cook, Textor, & Barnert, 2018;Powell, Asbill, Louis & Stoklosa, 2018). Long wait lists may delay or extinguish the need to seek services (Domoney, Howard, Abas, Broadbent & Oram, 2015).…”

“…In the case of child abuse, the survivor's development is often seriously compromised by repetitive abuse and inadequate response at the hands of people for whom he or she relies for safety and protection (Courtois, 2004). In addition, survivors reported concerns about protecting their confidentiality; thus, they would avoid sharing their mental health concerns to prevent this information being recorded into their residential home's records (Ijadi-Maghsoodi, Bath, Cook, Textor, & Barnert, 2018). Furthermore, the fear of criminal prosecution may reduce the survivor's desire to enter or continue in treatment (Domoney, Howard, Abas, Broadbent, & Oram, 2015).…”

“…Some cultures do not discern psychological, emotional, and spiritual reactions from physical ones (Rafferty, 2018). That is important especially when feelings of shame, stigma or feeling judged can keep survivors from seeking treatment or continuing treatment (Hardy, Compton, & McPhatter, 2013;Hom & Woods, 2013;Ijadi-Maghsoodi, Bath, Cook, Textor, & Barnert, 2018;Powell, Asbill, Louis & Stoklosa, 2018).…”