Fierce Autonomy: How Girls and Young Women Impacted by Commercial Sexual Exploitation Perceive Health and Exercise Agency in Health Care Decision-Making

Abstract

Prior research has examined the high health care needs and vulnerabilities faced by survivors of commercial sexual exploitation (CSE), yet their perspectives are frequently absent. We sought to understand the narratives and views of individuals affected by CSE on their bodies, health, and motivations to seek health care treatment. Twenty-one girls and young women ages 15 to 19 years with self-identified histories of CSE participated in the study. All participants had current or prior involvement in the juvenile justice and/or child welfare systems. Data collection included brief questionnaires, followed by semi-structured individual interviews. The interviews took place between March and July 2017 and were analyzed using iterative and inductive techniques, using the shared decision-making model as a guide. “Fierce Autonomy” emerged as a core theme, depicting how past traumas and absence of control led the girls and young women to exercise agency and reclaim autonomy over decisions affecting their health.

A Resistance Framework for Racially Minoritized Youth Behaviors During the Transition to Adulthood

“…Bounds et al (2020) offer specific recommendations for working with youth with socially complex needs that emphasize youth independence while balancing their need to belong (Lee & Berrick, 2014). They, along with others, argue for youth-adult partnerships (Bounds et al, 2020;Godoy et al, 2020;Sahl & Knoepke, 2018). In youth-adult partnerships youth engage in higher levels of participation as collaborators in decision-making and governance (Ramey et al, 2017).…”

COVID-19 and Youth Who Have Experienced Commercial Sexual Exploitation: A Role for Child Mental Health Professionals During and in the Aftermath of a Pandemic

“…It is important to note that these youth are often engaged in “adult” activities and may be suspicious of services designated for children, decline services, or resent being categorized as “victims.” There are frameworks that stem from the lived experiences of CSEC survivors that detail how they wish to be treated by health professionals and obtain care, such as the “fierce autonomy” model. 10 …”

“…Child mental health professionals might consider taking a harm reduction approach, utilizing shared decision-making to promote autonomy, and engaging the youth in safety planning – especially online safety planning. 10 …”

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

“…5,14 The literature shows that individuals experiencing CSE are known to access health care treatment at public and private health offices, emergency departments, urgent care centers, and family planning clinics. 12,[15][16][17][18][19] System involvement may also increase access to health care treatment or related services, as treatment is often court-referred or mandated. Yet, utilization or engagement in care can be challenging, often exacerbated by fragmented patterns of care delivery, 20 disrupting one's ability to obtain continuous and consistent care.…”

“…Many youth with histories of CSE are likely to experience increased transience due to frequent changes or instability in housing, making it difficult to form bonds, build trust, or maintain consistent communication with service providers. 9,18,19 The frequency of youth running away from care and back to exploitative circumstances or risky environments pose additional barriers to accessing or engaging in traditional health care services. 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.…”