Responding to Commercially Sexually Exploited Children (CSEC): A Community Health Center’s Journey towards Creating a Primary Care Clinical CSEC Screening Tool in the United States

Abstract

The commercial sexual exploitation of children in the U.S. is an under-recognized yet prevalent issue. An increasing number of Asian-American adolescents, particularly of Southeast Asian descent, are at risk for commercial sexual exploitation due to a myriad of factors. These factors include poverty and intergenerational conflicts as adolescents attempt to adjust to a U.S. lifestyle and culture vastly different from that of their parents. The issues of commercially sexually exploited children (CSEC) first emerged at Asian Health Services (AHS), a federally qualified community health center (FQHC) in Oakland, California, in 2001. AHS Youth Program staff and providers noticed that several Southeast Asian adolescent patients were seeking care for repeated symptoms of sexually transmitted diseases, reporting multiple sexual partners, disclosing chronic truancy issues, revealing a history of sexual abuse, and exhibited other high risk factors for sexual exploitation. Patients eventually disclosed their coercion into the sex trade and shared concerns for their health and safety. In 2006, AHS and its community partner Banteay Srei co-developed the first primary care clinical screening tool in a federally qualified health center. This paper discusses the need for and development process of the screening tool. The process included gathering perspectives of CSEC patients to ensure the tool was grounded in lived experiences of the affected population, and also incorporated insight from healthcare providers and staff to ensure practical implementation by health practitioners. The paper provides recommendations to raise awareness among community members, healthcare professionals, and policy makers in order to curtail the rising CSEC epidemic, and to address the needs of patients who have been commercially sexually exploited.

Recognizing and intervening in child sex trafficking

“…Some tools have been validated, but only for specific populations such as homeless or incarcerated youth or in emergency department (ED) patients. Tools for sex trafficking identification that may be useful in primary care include the Child Sex Trafficking (CST) screen validated in ED settings (TABLE 2), 9 the Commercial Sexual Exploitation-Identification Tool (CSE-IT) in multiple settings (TABLE 3), 10,11 and the Quick Youth Indicators for Trafficking (QYIT) in homeless youth (TABLE 4). 11 The QYIT is the first validated labor and sex trafficking screening tool in homeless young adults.…”

“…Commercial Sexual Exploitation-Identification Tool (CSE-IT) 10,11 The CSE-IT screening protocol, validated in multiple settings and used to-date in screening more than 5000 children and youth, looks for clues to trafficking that include the items below. (The complete CSE-IT can be found at: www.westcoastcc.org/wp-content/uploads/2017/09/WCC-CSE-IT-ImplementationGuide-FINAL.pdf.…”