APPENDIX A: TRAINEE HANDOUTS



CSEC 102: Engaging and Serving Children and YouthTrainee GuideVersion 1.2 | February 2016CSEC 102: Engaging and Serving Children and Youth TRAINEE GUIDETable of ContentsSegmentPage TOC \h \z \t "Style13,1" Acknowledgments PAGEREF _Toc442310185 \h 3Introduction to Materials PAGEREF _Toc442310186 \h 4Learning Objectives PAGEREF _Toc442310187 \h 6Agenda PAGEREF _Toc442310188 \h 8CSEC/Y 101 Recap PAGEREF _Toc442310189 \h 9Stages of Change PAGEREF _Toc442310190 \h 12Stages of Change Scenario Worksheet PAGEREF _Toc442310191 \h 20Motivational Interviewing Script PAGEREF _Toc442310192 \h 22Motivational Interviewing Worksheet PAGEREF _Toc442310193 \h 28How Would You Respond? PAGEREF _Toc442310194 \h 29Safety Planning PAGEREF _Toc442310195 \h 30Harm Reduction PAGEREF _Toc442310196 \h 36Working Toward Safety Scenario Worksheet PAGEREF _Toc442310197 \h 37Screening PAGEREF _Toc442310198 \h 39Screening Script and Worksheet PAGEREF _Toc442310199 \h 42Screening Activity Worksheet PAGEREF _Toc442310200 \h 47Lily Scenario and Worksheet PAGEREF _Toc442310201 \h 48Application Scenario Role Play Worksheet PAGEREF _Toc442310202 \h 50Prompts for Small Group Vicarious Trauma Discussion PAGEREF _Toc442310203 \h 52Personal Goals PAGEREF _Toc442310204 \h 53Appendix A: Trauma-informed Practice PAGEREF _Toc442310205 \h 54Appendix B: Client-Centered Care PAGEREF _Toc442310206 \h 58Appendix C: Intervention PAGEREF _Toc442310207 \h 59Appendix D: Sample Agendas for MDT PAGEREF _Toc442310208 \h 68References PAGEREF _Toc442310209 \h 70AcknowledgmentsCalSWEC and the curriculum developer would like to thank and acknowledge those who contributed to the curriculum.The following organizations provided funding support, collaboration, curriculum review, and information sharing:The Child Welfare Council CSEC Action TeamThe County Welfare Director’s AssociationThe California Department of Social ServicesThe Central Training AcademyThe Northern California Training AcademyThe Resource Center for Family-focused PracticeThe Bay Area AcademyThe Public Child Welfare Training AcademyWest Coast Children’s ClinicThe following individuals contributed to the development of the curriculum through providing source material, feedback on drafts, and participation in the pilot:Nola BrantleyRayan CruzCatie HartLillian JungleibPatty PoulsenAnzette ShackelfordLeslie ZeitlerLynn Mackey, Director, Student Programs, Alameda County Office of EducationAlex Masden, Services for Victims of Human Trafficking Project, Contra Costa County Zero Tolerance for Domestic Violence Initiative Lesha Roth, Contra Costa County Probation DirectorNicole Heron, Public Defender, Contra Costa County Whit Griffinger, Staff Attorney, Youth Justice Project, Bay Area Legal AidCristina Hickey, Child Abuse Prevention Council of Contra Costa CountyNeely McElroy, Continuous Quality Improvement and Violence Prevention Division, Contra Costa County Children and Family ServicesRobin Lipetzky, Public Defender, Contra Costa CountyCalSWEC would also like to thank the curriculum writer, Carly Devlin for her work to develop and pilot this curriculum and Nola Brantley for her generosity in sharing materials for use in this curriculum. Introduction to MaterialsPhilosophyThis training is shaped by an experiential education framework and social justice-oriented values. It is based on the understanding that people learn through synthesizing their own knowledge and experiences, learning from each other, and gaining meaningful facility with new material by practicing skills. It also acknowledges that working with the population of commercially sexually exploited children and youth is an issue of addressing inequalities and understanding systems of oppression. Training OverviewThis training is intended to provide participants with an opportunity to learn and practice engagement skills to more effectively work with children and youth who have experienced commercial sexual exploitation.The training uses scaffolding techniques, interactive discussion, and skill practice exercises to help adult learners integrate knowledge and skills and transfer learning into their practice. Participants will learn strategies to:Engage commercially sexually exploited children and youthIncrease receptivity to services among children and youth who have experienced commercial sexual exploitationIn order to more easily integrate these strategies into practice, participants will have an opportunity to discuss challenges and brainstorm possible solutions with trainers and colleagues. The target audience for this training is child welfare social workers and probation officers working with commercially sexually exploited children and youth. CSEC 101 is a prerequisite to CSEC 102.Citation and UseThe curriculum is intended for public use, to be distributed widely and at no cost, providing that proper citation is noted, as indicated:Use of the curriculum in unmodified form must be cited as follows:California Social Work Education Center (Ed.). (2015). CSEC 102: Engaging and Serving Children and Youth. Berkeley, CA: California Social Work Education Center.Use of the curriculum after any modification must be cited by placing the following text at the top of the first page of the modified curriculum:“This curriculum is based on the curriculum cited below, but has been modified. CalSWEC is not responsible for modifications to the curriculum. For more information, or access to the original CalSWEC curriculum, visit the CalSWEC website at , or call 510-642-9272.California Social Work Education Center (Ed.). (2015). CSEC 102: Engaging and Serving Children and Youth. Berkeley, CA: California Social Work Education Center.”Questions regarding usage of the curriculum should be addressed to CalSWEC. Contact Melissa Connelly mconnelly@berkeley.edu.Learning ObjectivesKnowledgeK1:The trainee will be able to identify best practices for the delivery of services to children and youth who have experienced commercial sexual exploitation, including:Establishment of physical and emotional safety in the service delivery relationshipKnowledge and application of cultural and SOGIE (Sexual Orientation, Gender Identity and Gender Expression) affirming practicesIntegration of youth development practice models and/or principlesTrauma-informed practicesK2: The trainee will identify a continuum of services to meet the holistic immediate and long-term needs of children and youth who have experienced commercial sexual exploitation, including but not limited to:Physical health, including comprehensive reproductive health information and servicesHarm reduction strategiesBehavioral healthK3: The trainee will be able to identify how to reinforce resilience of children and youth who have experienced commercial sexual exploitation through the development, identification, and utilization of:Trauma-informed practicesStrengths-based practicesIdentifying unsafe and unhealthy situations and relationshipsK4: The trainee will be able to define the Stages of Change Model and identify the appropriate stage to incorporate a trauma-informed approach when working with children and youth who have experienced commercial sexual exploitation.K5:The trainee will be able to define trauma bonds (e.g., Stockholm Syndrome) as they relate to children and youth who have experienced commercial sexual exploitation.K6: The trainee will be able to define compassion fatigue and vicarious trauma and will be able to identify symptoms.SkillsS1: Using a comprehensive scenario, trainees will identify which stage of change correlates with a child/youth’s described behaviors or statements, and articulate how to appropriately respond to the child/youth using a trauma-informed, developmentally appropriate, culturally responsive and SOGIE affirming approach. S2: Using the same comprehensive scenario, the trainee will demonstrate engagement with a child/youth that incorporates a trauma-informed approach and will exhibit an understanding of the Stages of Change model. In crafting their approach, trainees will be able to identify and recognize:The child’s strengths and needsAvailable CSEC specific services and providersGaps in servicesStrategies to meet the child’s needsObstacles and barriersNext stepsValuesV1: The trainee will value culturally responsive, SOGIE affirming, and trauma-informed practices. V2: The trainee will value collaboration with a multidisciplinary team of service providers and community supports in identifying strengths, needs, and resources for CSEC/Y survivors.V3: The trainee will value working with youth who have experienced commercial sexual exploitation as a whole person, not just a victim of abuse.V4: The trainee will value and seek out the survivor voice and CSEC-specific services and resources for service planning and delivery.AgendaSegment 1: Welcome, Framing, Values and IntroductionsSegment 2: Recap of CSEC/Y 101 Segment 3: Stages of ChangeBREAKSegment 4: Motivational InterviewingSegment 5: Working Toward SafetyBREAKSegment 6: ScreeningSegment 7: Strengths and Needs AssessmentBREAKSegment 8: Application ActivitySegment 9: Self Care Segment 10: EvaluationCSEC/Y 101 RecapCSEC 101 introduced social workers and probation officers to the concept of Commercial Sexual Exploitation of Children and Youth (CSEC/Y), including the definition of CSEC/Y and the role of child welfare and probation in working with youth who have been exploited. Key content included:Youth who have been exploited are not criminals and being involved in commercial sexual activity as a youth under the age of 18 is not a crime committed by youth, but is a form of child abuse.Child welfare is the agency charged with addressing CSEC/Y, as required by statewide policy changes.Ending the exploitation is not something youth can do on their own. Tackling the issue is about providing support AND addressing individual and systemic factors that lead to its occurrence.LanguageCSEC 101 also provided social workers and probation officers with important information about the power of language and attitudes. Remember to avoid language that blames the victim and connotes choice on the part of the young person being exploited. View exploited youth as victims, not criminals.?It is also important to use “person-first” language. Rather than referring to youth as “CSEC,” refer to them as youth who have experienced exploitation. This recognizes that each person is complex and has more to his or her identity than the commercial sexual exploitation they experienced.Factors Linked to VulnerabilityAs discussed in CSEC 101, there are several factors linked to increased vulnerability to exploitation:HomelessnessFrequently leaving family home or placement Abandonment by parents or primary caregiversFamily homelessness (living out of car, couch surfing)Being pushed out of a home or placement, particularly due to homophobia/transphobia/racismPovertySystem involvementTrauma Dislocated relationshipsLack of systemic support systemStructural oppressionExplicit and intentional tactics of exploitersSexual Orientation, Gender Identity and Expression (SOGIE)Because youth who are gay, lesbian, transgender or gender non-conforming are over-represented in the population of youth who are commercially sexually exploited, it is very important to be SOGIE affirming in our interactions with youth. Ask youth about their gender identity and expression and follow their preferences in use of pronouns or other gender identifiers. Talk to youth about their sexual orientation in a way that allows them to disclose what they want to disclose and gives them control over who the information is shared with.ExploitationExploiters target youth who are lacking systems of support. They intentionally seek out vulnerable youth. Exploiters often make false promises of a romantic relationship, financial success, excitement, or safety. This is often known as “grooming.” Exploiters may use youth to recruit other youth or may employ some of the following tactics of coercion and control:Compliments Professions of care and loveOffers of protection or safetyIsolation (physical and social)Monopolization of perceptionInduced debility or exhaustionThreats to youth, family, or petsEnforcing trivial demandsPhysical or sexual forceDegradationOccasional indulgencesValidating youth as being a “favorite” or being on top of the “hierarchy”Including youth in “special activities” Dividing the multiple youth that are being exploited by the same personTrauma bondingTrauma BondingTrauma bonding is a product of exploiters’ tactics of coercion and control resulting in youth feeling a positive emotional connection towards their exploiters and seeking to protect and care for the exploiter. ?It is a form of self-protection and keeps youth anchored to their exploiters. Youth experiencing trauma bonding may not be able to identify exploiters’ behavior as being coercive, controlling, manipulative, or unsafe. Youth may perceive that their exploiter(s) are caring, supportive, and/or protective. It is difficult to address as their relationship with their exploiter(s) can fill many legitimate social, material, and psychological needs.Trauma bonding can be an empowering concept to convey to youth. Intervention can be compromised if the service provider does not consider and address trauma bonding. Youth who are trauma bonded are more likely to leave their placement, and more likely to recruit from within placement. When a youth is trauma bonded, the exploiter has almost full mind control over them. A trauma bond must also be continuously reinforced, so it is important to keep that in mind when developing a safety plan. The exploiter is going to try desperately to keep in contact with their victim, even if just over online messaging. Youth who are trauma bonded are going to have very different circumstances & things that need to be considered for safety than those who are not. Survival SexSurvival sex is a form of commercial sexual exploitation. Survival sex involves using commercial sexual activity to meet the following needs:FoodShelterProtection from dangers of commercial sexual activityPsychological and psychological needs, involving perceived:ConnectionCareSupportIdentity Multi-disciplinary Teams (MDT)The MDT is designed to coordinate the development of a case plan for each youth to provide appropriate services, develop a safety plan, address basic needs, and create a plan for an effective placement. MDTs should be convened post-identification, at regular intervals, major changes such as change in school placement, and at key change points in youth’s trajectories, including leaving a placement or being initially identified and needing an immediate placement. ? Stages of ChangeThe Stages of Change concept is the key construct of the Transtheoretical Model of Change, an evidence-based model that has been the basis of developing effective interventions to promote behavior change. The model conceptualizes change not as an event but as a process that progresses over time through a series of stages. The process incorporates cognitive, emotional and behavioral activities that facilitate change. It was initially developed for thinking through addiction and involves a non-linear cycle of varying levels of motivation, changing attitudes, and voluntary change-related behavior. Each of the stages described below represents tasks in period of time and the tasks of each stage must be addressed in order to move to the next stage. It is important to understand that the interventions we develop with youth must be designed to meet the youth at his or her particular stage of change. Harm can occur if interventions are mismatched to the youth’s current stage. Precontemplation: Not yet acknowledging that there is a problem behavior to be changedYouth may share things like:“My boyfriend loves me and I like supporting him,”“I don’t want to stop what I’m doing.”“I’m independent and can take care of myself.” “Everything is fine.” Youth may: Continue to engage in commercial sexual activityActively display behaviors stemming from trauma bonding (protecting exploiter, denying there is anything harmful going on or denying any negative consequences, present as defiant or disengaged)Leave placement or home (especially if they will not disclose where they are staying or say they are staying with their boyfriend), not attend school or engage in activities such as sports or after-school programsDisengage from or refuse supports or servicesExploitation issues in this stage:For a victim with a 3rd party exploiter it is important to consider the impact of trauma bonding in the precontemplation stage. Trauma bonding usually prohibits a person from thinking logically. It is crucial that law enforcement is notified about the exploiter. If the youth has access to their cell phone, it is a good idea to see if a restraining order can be filed, in order to keep the exploiter from making any contact, as constant contact is needed to maintain the trauma bond. Also, the chance the victim recruit others from within their placement is much higher, as exploiters often direct their victims to do so. This should be taken into account when considering placement options.For a victim who does not have a 3rd party exploiter, it is important for the service provider to try to figure out what needs are being met via the victim’s sex work. Is their home setting safe? Does the victim have access to food and other necessities? Is their involvement related to where they are living (i.e., are their family members and/or peers participating in sex work)? Goal for this stage:Gain awareness about what change would look like and how it might help.How to identify when this stage is ending: There may be an external event or “reality” that interrupts the precontemplation stage, for both victims who do and those who do not have an exploiter. Social workers should be on the lookout for this event to occur. As soon as a youth starts asking questions about how their life might look once they make a change, it is a good sign they are in stage two. For instance, youth will say something like, “I’m worried that if I leave my ‘boyfriend’, he won’t be able to support him/herself,” or “I am worried I will never be able to have a real job”. Any sign at all that the youth is beginning to even consider other options is a fabulous sign that he or she is starting to move through the stages of change. This should be taken seriously and celebrated when appropriate.What not to do during this stage: Push someone into action, give up, enable. This stage can be very frustrating for service providers. It is important to manage that frustration so that youth do not feel pressured or shamed.Contemplation: Acknowledging that there is something they intend to change but not being ready, prepared, or sure of wanting to make a change. The pros of continuing the behavior still outweigh the cons of changing during this stage. Youth may share seemingly contradictory things like:“I don’t really like some things about this situation (being assaulted, verbally harassed, fear of being robbed/other dangerous things happening, feeling guilty, unpleasant, or “dirty” for having been exploited).” “I don’t always like the way I’m treated.”“I still believe my boyfriend loves me even though he doesn’t treat me well all the time.”Youth may display seemingly contradictory behaviors like:Begin to engage more in services or with family and other supports Spend less or the same amount of time with exploiters/other individuals associated with commercial sexual activityDecrease or maintain engagement in commercial sexual activityActively display behaviors stemming from trauma bonding (protecting exploiter, denying there is anything harmful going on may present as defiant or disengaged)Spend more time or decrease time spent away from placement or home, spend more time or decrease absences from school, engage more in other activities or ask about opportunities to engage in other activities including finding a jobGoals for this stage:Develop capacity to make change, become interested in positive outcomes change will bring.How to identify when this stage is ending: Youth will show a thoughtful evaluation that leads to a decision (commitment) to changePreparation/Determination: Getting ready to change, express intention to take action in the immediate future, make plans or have made plans to change behavior. This is a critical stage for service providers and supports to assist the child in taking concrete action. Youth may share things like:“I want to do things differently.”“I can tell he just wanted to take my money.”“This is a dangerous situation that makes me nervous.”Youth may:Make concrete plans to changeCommit to staying at a placement or home or decrease the number of times they leaveBegin to re-engage in efforts to attend school or get involved in other activitiesTake steps to identify ways they can stay away from their exploiterEngage in services and be open to accepting help with finding social supports (note that the onus to find social supports should not be with the youth [although their efforts to do so should be validated and supported], but this is a critical moment for providers to assist the child with taking action in a timely and coordinated manner.)Goal for this stage:Become ready to change – have a plan and supports in place to facilitate successful action.How to identify when this stage is ending: Youth will have an action plan to be implemented in the near futureAction: Has enacted specific life-style and/or behavior changeYouth may share things like:“I’m really excited to be back in school.”I love my job.” “I like my therapist/counselor/case manager/group,etc.” “I feel motivated and like I’m on the right path.”Youth may:Stay at a placement or homeAvoid commercial sexual activityAvoid interacting with their exploiterEngage more frequently and actively in services and build other support systemsEngage in positive activitiesExploitation issues in this stageFor those with an exploiter, the act of leaving is usually absolutely terrifying and it is imperative that safety mechanisms are in place to provide protection. Youth without an exploiter will need help disengaging from aspects of commercial sexual exploitation such as changing phone numbers so that clients cannot contact them and disabling online connections such as ads or email addresses. The social worker should support the youth in the logistics of how this action will take place. Goals for this stage:Gain comfort with the new status quo so that change no longer feels “new” and old habits and behaviors are replaced by new ones.How to identify when this stage is ending: Youth will exhibit successful action for changing the current patternMaintenance: Maintaining the behavior changeYouth may share things like:“I feel motivated and like I’m on the right path.”“It’s great to be working towards my goals.”“I’m looking forward to the future.”Youth may: Stay engaged in services, activities, and support systems--usually not as frequently as during action stageDisplay increased self-efficacy and confidenceRemain disconnected from their exploiter as well as places and other individuals and activities connected with commercial sexual exploitationOngoing interventionDuring this stage, trauma therapy should always be sought; if the youth isn’t ready, the topic should be revisited as often as is appropriate. It is a good idea to talk to the youth about what they guess might make them vulnerable to returning to unsafe situations. If there is/was a trauma bond, service providers should do their best to educate the youth about trauma bonding. This is a good time to check out pairing the youth with a mentor. If they are in school, work with the foster youth liaison to assess eligibility for specialized services through a 504 plan or IEP (PTSD, other trauma issues, or the history of exploitation may qualify the youth for these services). Anything positive, any strengths the youth has should be very mindfully supported; even the tiniest of things; maintaining is not necessarily about being a rock star right away; it is about making small steps in any direction that is positive.Exploitation issues in this stage:If there is a 3rd party exploiter, it is critical to discuss what the youth will do if the exploiter contacts them. It is important to engage law enforcement (the best way to keep an exploiter away from the victim is for the exploiter to be in custody). It is also important to discuss a safety plan if the youth finds themselves missing their exploiter at some point (it can be assumed that these feelings will come up at some point, as is the nature of the trauma bond). If the exploiter is in custody for any reason, one should know their release date, and talk about what the youth will do if the exploiter attempts to reengage upon release.Goal for this stage:Long-term sustained change of the old pattern of behavior and establishment of a new pattern of behaviorReturn to Unsafe Situations (commonly referred to as Relapse, Regression, or Recycling): Reverting to a previous stage of change and associated behaviors The term relapse is a common term used for the return to unsafe situations stage due to the Stages of Change being utilized widely in addiction treatment. The more accurate term for this stage is Return to Unsafe Situations. Care should be used to refer to the youth's return to unsafe situations, as opposed to relapse because youth cannot relapse into abuse.Youth may share:“It was really hard to keep that change up.”“I needed to go back to making money.”“I really missed him.”“This life is much more exciting.” Youth may:Return to unsafe situationsDisengage in services (though not necessarily)Display behaviors and emotions stemming from trauma bondingGoal for this stage:It is important to remember that if youth return to unsafe situations, the youth is doing so with the benefit of what they learned in stages 1-5. For all victims, service providers should take some time to think about how the victim can be supported upon their return. Returning to unsafe situations behaviors is part of the change process and when they are ready to move on again youth should be welcomed back with love and support, rather than judgment. Exploitation issues in this stage:If there is a 3rd party exploiter that should be taken into account and law enforcement should be notified. Concerns Regarding the Stages of Change Model With individual variances in mind, it is common for people to move through this process in a cyclical way rather than linear. In fact, the process is most often cyclical and the stages are not static - youth can cycle through multiple stages in minutes. They might go from preparation (making plans to avoid the behaviors), back to contemplation (weighing their options). Additionally, this model does not necessarily capture the context of exploitation. For example, trauma history, poverty, sexism and racism are all systemic elements that impact a young person’s ability to make decisions about their lives. Furthermore (and perhaps more importantly), tactics of exploiters also impact a young person’s actions and their capacity to engage in interventions. Commercial sexual exploitation is abuse and individuals do not choose to be abused; rather, there are many forces at play, including coercion and emotional manipulation, traumatic bonding, need for basic necessities, and the normalization of exploitation that impacts re-victimization. This model is predicated upon the idea that young people are making rational, calculated decisions about their behavior. Adolescent development must be taken into consideration in terms of youth’s ability to determine the long-term consequences of their decisions and behaviors. Trauma and other factors such as hunger, thirst, and sleep deprivation may impact youth’s ability to make well thought out decisions.It is important to meet youth where they are and to remain supportive, building trust for future change behavior. It is also very important to respond with interventions and counseling strategies that are appropriate to each stage.While this model was not developed to apply to youth who have been commercially sexually exploited, it is an evidence-based model for promoting behavior change that has been effectively and successively implemented and utilized for working with this population. Moving Through the Stages: CeCePart 1: PrecontemplationCeCe is a 16-year-old female who was recently arrested for loitering and was in juvenile hall for 15 days. Her caseworker recently placed her at a level-12 group home. CeCe is not open to talking about her exploitation and denies being exploited. Anytime anyone asks her about CSEC related topics, she becomes defensive saying, “Bitch, you don’t know me.” When asked what her goals are, she responds, “to get the hell out of here as fast as I can!” The next day at school, she runs away to reunite with her exploiter. Part 2: ContemplationOver the course of the last 2 months, CeCe has AWOL’d 4 times. This most recent AWOL was the first time she came back on her own - all the other times she was picked up by law enforcement. CeCe is open to talking about her life on the streets but denies having an exploiter. She has started talking about wanting more out of life and wanting to finish school, but at the same time, still wanting a relationship with her “boyfriend.” She’s in love with him and wants to be with him, but wants more out of life for herself.Part 3: PreparationIt’s been 6 months now and CeCe has taken major steps in her treatment. She’s meeting with her therapist on a consistent basis and she is working on increasing her regulation skills. She’s continues to contemplate her relationship with her boyfriend and how that fits with what she wants out of life. All of CeCe’s support has been with her folks on the street and she’s now open to working with her therapist on developing a plan to increase her support system. Part 4: ActionIt’s now been 12 months, CeCe is going to school every day and she has started to work with an educational advocate on obtaining her previous school credits. She’s using some of her regulation skills when she gets distressed. Rather than running away, she has started to listen to calming music and talk to her staff. She’s been focused on increasing her support system and is working with her case manager on getting a mentor and volunteering at a local animal shelter. CeCe doesn’t have contact with her exploitative “boyfriend” anymore. Part 5: MaintenanceCeCe has been continuing to progress in therapy, school, and increasing her support system. CeCe has even started to take on a peer leadership role at her placement. CeCe reports that she has no desire to go back to “the life.” Part 6: RevictimizationCeCe was walking home from school and before she knew it, a car pulled up. Her exploiter jumped out of the car and grabbed her closely. He shoved his gun into the side of her head and told her, “Bitch, you’re mine. Get your ass in the car now before I make you disappear forever.”Part 7: LapseCeCe has been doing really well and has started talking with some of her friends about wanting to show everyone that she’s making something of herself. So, CeCe calls her exploiter to tell him how she’s doing. He’s genuinely proud of her and asks if it would be ok to take her out to dinner to celebrate how well she’s doing. After thinking about it and felling confident that nothing bad will happen, she says ok. They end up meeting up, having dinner, and over the course of dinner they start talking and he tells her, “I wish you nothing but the best. Let’s stay in touch.” Part 8: RelapseTwo weeks later, she got into a heated fight with her mom in family therapy and wanted someone to talk to. After calling her mentor, who wasn’t available, she called the one person she knew would answer. CeCe was right. On the first ring, he answered the phone and listened to her vent. He offered to pick her up from placement so they could talk more. Before she knew it, she was starting to have all those feelings for him again and they ended up having sex. He sweet talked her into spending the night together and the next day he took her shopping and little by little she was lured back into exploitation.Stages of Change Scenario WorksheetMia is a 16 year old girl who has been identified as someone who has experienced commercial sexual exploitation and has been leaving her group home frequently. She has explained that she goes back to her family.? The family lives in a neighborhood with significant community violence.? Many people live in close quarters in the house and there has been past child welfare involvement (Mia and her siblings were in foster care for 2 years).? This case has been reported as a human trafficking case and a new child welfare worker has been assigned. You are the investigating child welfare worker. When you meet Mia she shares, “I just want to live with my family. I hate living in group homes and don’t want to be doing this (being exploited via commercial sexual activity).” Which stage of change is Mia in?River is a 13 year old transgender girl being released from juvenile hall after being detained for several months following a weapons charge for holding her exploiter’s gun.? While in juvenile hall, she experienced discrimination and mistreatment from staff and other youth because she is transgender and has been detained on the boy’s unit even though she identifies as a girl. It is unclear whether she will go to a probation placement or child welfare placement. Her family does not accept her identity and will not take her back into their home. She is very distraught and nervous about her placement situation and her longer-term housing options. You are her probation officer and are discussing placement with River. She shares, “No one has ever been able to understand. I don’t trust you and you are not here to help me.” Which stage of change is River in?A team has convened for an emergency multidisciplinary team meeting (MDT) after Efram has been identified as being commercially sexually exploited. ? The 15 year old child arrived late and once he got there, he was quiet and presented with a flat affect.? He is from a state 1,500 miles away and was identified in a rural area of California at a bus stop after a report was made.? During the initial meeting with the child welfare worker, he said his “daddy” had paid for his ticket and that he was expected to engage in commercial sexual activity on the street once he got to an urban area. He explains that he did not plan to meet up with his “daddy” and wanted to go to a shelter. You are facilitating an MDT as the child welfare worker. Which stage of change is Efram in?Juliana is a 15 year old girl detained in juvenile hall.? She has been both angry and volatile on the unit, starting fights and initiating conflict with other girls and staff. The unit therapist understood her behavior as stemming from trauma, including a history of sexual and physical abuse by a family member and her experience of exploitation. The therapist reported the abuse and exploitation. You are the child’s assigned child welfare worker discussing placement with her. She shares, “I have nowhere to go and need to take care of myself, but I’m really hoping to slow down.” Which stage of change is Juliana in?As an assigned child welfare worker, you are interviewing 17-year-old Ardent for the first time after picking up the case because her previous worker had left the job. The youth has been previously identified as being commercially sexually exploited. Ardent developed a close relationship a close relationship with her previous worker. ? The youth had been away from her exploiter for some time, but recently reconnected. ?She has experienced a great deal of trauma, and has reattached to her exploiter, who is currently in jail for human trafficking charges. She tries to protect him when asked about him and says, “I just want him to get out and not be on probation. I don’t care what happens to me.” Which stage of change is Ardent in?Motivational Interviewing ScriptPremise: This is a child welfare worker’s first check in conversation after Rachel has been placed at a child welfare placement several days ago after an Emergency Multi-disciplinary Team Meeting (MDT). She is 16 years old. She had been identified by law enforcement as having experienced commercial sexual exploitation. While they were interviewing her, she had been tearful and was afraid she would be arrested. Her family lives across the country she has had many exploiters over the course of a year and a half. She expressed that she was being exploited. Because she was so upset, she was not able to give many specific details about her exploiters. Note: In this example, the youth is relatively forthcoming. Youth will present in a variety of different ways, especially when talking to someone they don’t know. With individual variances in mind, a youth’s demeanor, circumstances, and physical/emotional/mental state will influence their ability to converse about their needs and situation. While some may be able to communicate their fears and needs, others may respond with hostility towards any authority figure, and still others may be emotionally disengaged or be unwilling to speak. It is important to pay attention to the language being used, and make sure that the youth understands the words you are using as you are initiating this conversation. Further, it is important to recognize that Motivational Interviewing is a good fit for working with youth who have experienced exploitation, but one training will not make you an expert on this technique. This training provides an introduction to Motivational Interviewing but should be followed by additional training. Observation:While you are observing the interview, identify the following elements:Open ended questionsAffirmationsReflective statementsSummariesExpressing empathySupporting self-efficacyDeveloping discrepancy Rolling with resistanceScript:Social Worker (SW): Hi Rachel, it’s been a few days since I’ve seen you. How have things been going?Rachel (R): Ok. Not bad. It’s different.SW: Yeah, it must be a big change from where you were before. R: It is. I’m not used to the rules and people telling me what to do. SW: It can definitely be a shock if someone is used to something else. How is it different?R: Well, on the street I could do what I wanted. For a long time, I could do what I wanted.SW: So you had more freedom.R: Exactly. SW: And freedom feels good.R: Yes. SW: That’s completely understandable. People generally want to have freedom...R: Yeah, and I don’t have it here. There are so many rules. And people everywhere. SW: Moving between such different environments can be difficult. R: Right. One day, I’m on the street. I’m getting my nails done and I’m looking pretty, my makeup done. I don’t have any makeup here right now. I’m so much prettier when I’m not here. It felt different before. SW: You are used to something else.R: Right. …SW: Just so I get it right, what else did you like about having freedom?R: I didn’t have to be stuck in one place. I could go places and hang out with interesting people. And I was able to take care of myself. SW: You were independent. R: Yes. And I liked it. SW: Makes sense. Being independent is nice. How long would you say things had been like that?R: Well, I’ve had it for a while. My family wasn’t really around. I was always leaving. I left for good a few months ago and came here. They hadn’t been around for a while so I have been taking care of myself for a while by…doing different things, ho’ing, you know, you saw me the other night. SW: People do what they feel they need to do to take care of themselves. R: Yeah, but I didn’t really want to be doing it. I was only doing what I needed to do. It didn’t feel good a lot of the time.SW: That makes a lot of sense. In what ways did it not feel good?R: I was tired. I was hungry. I was scared sometimes. You never know what the johns are going to do. I’ve been robbed, one had a gun. SW: That does sound scary. R: I’ve been beat up too. Lots of times…SW: How was that?R: Well, it happened a lot. I guess I got used to it though.SW: To be being beat up?R: Yeah….SW: That seems like it could be really hard on you.R: Maybe. I don’t know. I don’t like thinking about that part. SW: It’s hard stuff. We don’t have to talk about anything you don’t want to talk about. This is your space. Would you like to talk about something different?R: Yes. SW: Of course. I came here also to talk to you about things that have been challenging and also things that have been going well. Is there anything going on here that you would say has been working for you?R: Umm. I don’t know. I might have to think about it.SW: It’s a hard question, especially since you’ve only been here a few days. R: Well I’ve been sleeping more.SW: Oh yeah? Is that something you wanted to do?R: Well, yeah, I was exhausted when I got here. I hadn’t slept in days. Months really. Since I got to California, I’ve had three or four pimps since then. SW: How did you meet them?R: Which one? The first one approached me on the street. I had just gotten to the area. I had taken a bus. I didn’t have anywhere to stay. He pulled up in a car and told me I was beautiful. He asked if I needed something to eat. I was really tired and hungry so he got me something to eat. After that, he asked me if I needed a place to stay. We stayed in a motel that night- for a week, actually. SW: So it seemed like he was helping you out.R: Yeah, I guess. After the week was up, he told me we were out of money. He said that I needed to work so we could have somewhere to stay that night. He said he knew of a way that we could make money. At first, I didn’t get what he was saying. Once he explained, I said no. But then I felt bad. He had put us up in the motel for a week. He was being really nice to me. I knew some people who had done it from where I’m from, and I thought maybe it would be fine. SW: There was a lot going on when you first got here. It seems like you were in a place where you needed food and somewhere to stay.R: Right. I guess that’s a good thing about being here. I have somewhere to stay. SW: I’m glad you have somewhere to stay. What else has been going on here?R: Well, it’s weird to be around these girls. They go to school. They seem to be normal. SW: What do you mean by normal? I want to make sure I understand where you’re coming from.R: They go to school. They come back. They’ve never been on the street. They are doing what they are supposed to. SW: Do you feel like you are supposed to do those things?R: Yes. I hadn’t for a while. I haven’t been to school in over a year. Even when I was in school, I didn’t want to be there and didn’t go a lot of the time. I didn’t feel normal then and I don’t feel normal now. SW: That’s understandable. You feel like you’ve experienced different things and it’s hard to connect with other people sometimes.R: Exactly. SW: Is normal something you are looking to have?R: I don’t know. All these people tell me to do things a certain way. I don’t know if I want to. Sometimes, yes. I kind of want to go back to school. I need to have a high school diploma if I want to get a real job or go to college. SW: So you want to go to school and you also don’t want to be told what to do, which makes school hard to imagine liking. Both of those things can be true at the same time. R: Yeah. But I know I need to go to school. I guess I want to. SW: Have there been times when you enjoyed going to school earlier?R: Yes. SW: When was that?R: When I was a little kid it was fun, in elementary school. I had a bunch of friends. We did fun things in school. It got harder as I got older. I moved schools in second grade and I didn’t have friends anymore. The classes got harder too. That was when they put me in special ed.SW: Having friends makes school better for you, then.R: Yes.SW: What were your favorite classes?R: I really liked math. I had a really good math teacher, maybe about two years ago. When I was still in school. I guess I was kind of good at it too.SW: I know math is hard for a lot of people. That’s great you were into it!R: Thanks. I don’t know, I am probably behind on credits now. SW: So as we are thinking about finding you a school around here, you are looking for a place where you can make up some credits?R: Yes! SW: There are a couple of different schools around here who have programs that can help you with that. We can see if there’s one that works better for you. R: Ok, thanks, that sounds good. SW: Ok, great. There are a couple of other things I came here to talk about with you. Is it ok if we talk about those?R: Ok.Motivational Interviewing WorksheetActivity InstructionsReview the Stages of Change scenarios (Mia, River, Efram, Juliana, Ardent).For each scenario, identify questions you might ask the youth using motivational interviewing elements and the Stages of Change. Formulate an approach and questions for helping each youth meet the goals of their current stage to facilitate movement along the cycle.MiaRiverEframJulianaArdentHow Would You Respond?Sarah just told you, “Bitch, don’t tell me what to do.” Let’s learn a little more about Sarah.She was abandoned by her mother when she was 3-years-old, and raised by her grandmother. Her grandmother wasn’t equipped to raise a baby, and consequently, Sarah endured years of physical and emotional abuse until she was removed from her custody at the age of 10. Sarah is now 15-years-old and already has a history of multiple failed placements and psychiatric hospitalizations. Throughout her time in placement, Sarah has struggled to interact with female staff, often becoming angry and verbally lashing out at them. Knowing this background info, would it change how you would respond to her comment of “Bitch, don’t tell me what to do.”Safety PlanningYouth VoiceIn addition to building upon strengths when establishing safety, it is important to take the lead from youth when making decisions about safety. Youth often define safety in different ways than providers, so it is necessary to have a conversation about what safety looks like and what goals around safety are meaningful to a young person. The most effective safety plans will be those that belong to youth and are driven by their voices and experiences. Safety PlansSafety plans can be created in multiple contexts, working individually with a child welfare worker or during an MDT. A safety plan is a step-by-step guide in which possible unsafe situations are assessed and potential solutions identified. Safety plans are living documents and should be revised frequently to reflect youth’s changing needs, experiences, and opinions. Social workers will use standardized safety assessment tools and safety planning forms when working with youth who have been commercially sexually exploited, but may experience challenges when what the social worker identifies as safe is not acceptable to the youth. Social workers and probation officers must:Follow local protocols and tools for safety planningRely on MDTs to provide creative solutions to meet youth’s needsFind ways to honor youth agency and develop ways to reduce harm if the youth is unwilling to follow the plan that meets agency safety criteriaCrisis Safety ConsiderationsThere are many factors that should be considered when a crisis situation for CSEY has emerged. The following considerations are a resource for providers, but it should be emphasized that youth voice should be prioritized when conceptualizing a case and coming up with solutions. Youth may not consider every element a priority and may not be receptive to certain services. Food and waterRest and sleepEmergency housing and placement (either back with the guardian or in a child welfare placement)Crisis intervention for mental health needsEmergency medical needs (physical injuries, sexual assault)Dangers stemming from exploiter (i.e. threats of physical violence, stalking)Maintenance Safety ConsiderationsOther factors emerge when thinking through continuing safety in non-crisis situations. As mentioned above, the following considerations are a resource for providers, but it should be emphasized that youths’ voice should be prioritized when conceptualizing a case and coming up with solutions. Youth may not consider every element a priority and may not be receptive to certain services. Ongoing, stable placementHealth (including services that include physical, dental, sexual health, substance abuse, responses to physical injuries, tattoo removal, specific health care for transgender youth)Mental health (anticipating escalation to crisis, ongoing therapy, medication management, school and residential related mental health services)State-sponsored benefits Civil, child welfare, and juvenile justice advocacyEducationProsocial activitiesSupports (i.e., case management, therapy, survivor mentor, CASA worker)Job trainingIndependent living skillsAssessing for Safety ConcernsWhen assessing for safety concerns in the home and community, take into account the presence of the following dimensions, both historic and current:Physical or sexual harm to self or familyThreats of physical or sexual harm to self or familyPrevious or current child welfare system involvementForced to do things they don’t want to doExposure to:DrugsWeaponsPeer or family illegal activityLikelihood of leaving placementWhere youth would go/has gone?Why youth would/did leave?Triggers for leaving placementStatus of exploiterLocationInvestigationOthers in the community who may have contact with the exploiterYouth’s perception of exploiter (sympathetic? scared? Trauma bonded?)Sample Safety PlanThe sample safety plan below addresses two key safety concerns for youth: feeling the need to leave placement and contact with an exploiter. The plan addresses these safety concerns from the perspective of the youth, service providers, and systemic changes. In this example, the youth is in the Action Stage in the Stages of Change.SAFETY CONCERNYOUTH’S PLANSERVICE PROVIDER’S PLANSYSTEMIC PLANLeaving placementIdentify a list of people to talk to when feeling like leaving placementUse therapy to explore the benefits and risks of leaving placement and triggers that may prompt leavingHave contact and visits with supportive family membersIdentify a list of safe places to go besides back to an exploiter (friends, parents, shelter)Group home staff will focus on building relationships to engage with youth and help them feel welcome and safe in her home. Therapist commits to working with youth long termTrained group home staff will regularly check in with youth about how they are feeling in the group home (i.e. safe and supported? Getting along with other youth?) and assess likelihood of leaving. Should youth want to leave, group home staff will connect them with other supports (advocate, therapist) upon identifying riskA social worker or probation officer will regularly go to the group home Service providers will remain connected with youth even when they transition placements or leave a placementProviders commit to working with youth long termDevelop protocols around accepting youth back into placements after they have leftTrain group home staff on identifying when a youth is at risk of leaving and establish protocols around alerting other providersProximity to traffickerUse therapy to build skills for recognizing safe and unsafe relationshipsYouth will alert someone if the exploiter contacts themYouth agrees to have no contact with exploiterLaw enforcement will let youth know if the exploiter is arrested Group home staff will supervise cell phone useCreate systems that ensure smooth communication between law enforcement/Probation or social services and the youthDevelop protocols for maintaining safety when youth testify against their exploiters, including transportation and protections for youth and their families Safety of RelationshipsGiven the level of disruption that exploitation and previous trauma have had on a young person, a major source of healing takes place in the context of creating new, safe relationships to counter the many poisonous relationships they have encountered. This work involves supporting youth in identifying unsafe and unhealthy relationships, in addition to helping them build new, healthier relationships. Supporting youth in identifying unhealthy relationships is a delicate process. Care must be taken to avoid telling them what to do and avoid placing judgment on these relationships. Their relationships with exploiters fill many legitimate needs for youth and are meaningful to them. Strategies for supporting youth in identifying unhealthy relationships include:Ask youth what their ideal and non-ideal relationships look like, what support means to them, and who has played the role of support in their lives (they may identify this as being their exploiter; however, it is important to draw out what makes them feel supported by their exploiter, even if we disagree with the relationship as a whole)Collaboratively identify goals and evaluate what support people and resources are necessary for making it happenProvide support around any strong emotional reactions or triggers that may come up for youthThe above conversational topics can be useful in working with youth to identify and develop healthy relationships. Providers can also create supportive and consistent collaboration with youth, including child welfare workers. Other relationships that can be developed are those with peers, caregivers, and other adults, like coaches or teachers. Because youth may have struggled with creating these relationships in the past, it is important to provide support in the event relationship forming is scary or challenging for them. This includes asking questions about how these relationships are going and supporting them in problem solving conflicts or difficulties as they emerge. It also involves providing logistical support, including rides/ transportation vouchers to prosocial activities or school.Recruitment: A Safety ConcernSome commercially sexually exploited children and youth are further used by exploiters to recruit other youth to engage in commercial sexual activity or become attached to an exploiter. This presents as a tricky issue in terms of intervention. Youth who are recruiting are doing so as victims and their actions should be seen in that context while necessary steps are also taken to ensure the safety of others. Recruitment can take place in many settings, including in group homes, juvenile hall and at school. In these settings, psychoeducation around commercial sexual exploitation must take place. It is important to take a trauma-informed approach to presenting this information. Youth in the child welfare or juvenile justice system have most likely already experienced trauma, and it may be triggering to engage with information about sexual exploitation, especially if they have experienced sexual abuse; if they are connected to individuals who are being commercially sexually exploited; or if they are being commercially sexually exploited themselves. Information must be delivered sensitively and in a safe manner. When delivering information, give youth an appropriate amount of time to let them know the topic will be discussed and provide space for processing and reactions. For example, conversations should be framed by acknowledging the sensitivity of the topic, giving participants permission to take space if they would like it, providing space to process reactions and ask questions, and giving resources. Care should also be taken in determining who will have these conversations with youth. The best person to connect with youth on this topic will vary from youth to youth. It may be a social worker, probation officer, group home staff, foster parent, therapist or other trusted adult.Staff must also be comfortable with and proactive about identifying recruitment. One-on-one conversations with youth, with both those who are recruiting and those who are being recruited, about what specifically is going on is important. Vulnerabilities, risks, and outcomes should be discussed in a nonjudgmental and caring fashion. Hard conversations should not be shied away from. Also important is establishing clear and transparent ground rules around recruitment. Finally, a crucial element of this work is relationship building. If youth feel authentically supported, the information presented and discussions facilitated will be more meaningful to them. Above all else, safety should be preserved. A crucial element of providing support to youth who have experienced commercial sexual exploitation is establishing physical and psychological safety to provide stabilization. In the process of establishing safety, youths’ individual, family and community strengths must be drawn upon. Youth are more than their trauma, abuse, and exploitation. The following list is designed to be a basis for identifying strengths. ?However, identifying strengths must come from an authentic place. ?This list is also not exhaustive; the youth we work with are unique, having different individual strengths that should be highlighted. ?Family and community strengths may not necessarily need to be stated, but should be built upon when developing interventions. ?Individual Strengths: MotivatedCaring of family and friendsResourcefulThoughtfulSmartIndependent MatureHaving hobbiesHaving goalsStanding up for themselves LoyalProtectiveLovingFamily Strengths:Close knitLovingSupportiveLoyalFinancial stabilityCommunity Strengths:Strong sense of community within the neighborhoodStrong sense of cultureConnections to religious groups, community groups, etc.The community takes care of each otherThe community is family-likeHarm ReductionThe goal of the harm reduction model is to reduce negative consequences of exploitation and increase safety through small steps in the right direction. For example, harm reduction could mean helping a young person reduce the number of days or nights they are exploited, using safer sex supplies, knowing who to call for help, and connecting with service providers. In the case of CSEC, the following interventions follow the harm-reduction model:Providing education around options to leave. Child welfare workers can provide psychoeducation in a nonjudgmental manner in which the young person and worker collaboratively identify risk behaviors, potential outcomes of these behaviors, and alternatives. A major piece of this involves identifying alternative coping mechanisms, which are embellished below in the positive youth development section. Providing the resources to support the engagement in positive activities is crucial.Creating safety plans that include a discussion of safe places (i.e., shelters, public places to receive support from bystanders) to go if youth feel threatened or unsafe (i.e., being stalked, threats or acts of physical or sexual violence, etc.)Providing transportation vouchers (a more general intervention).Discussing ways to reduce risks, including, for example, the use of condoms, and regular STD/HIV testing.Harm reduction allows us to be youth-centered and meet the youth where they are in the Stages of Change. It can seem counterintuitive because we want them to get out of risky situations and be safe, but telling youth who have experienced commercial sexual exploitation what to do is not an effective strategy. It is ultimately about respecting their perspectives, giving them agency to make decisions about their lives, and supporting their feelings to encourage healthier decisions.Working Toward Safety Scenario WorksheetMaria is a 16 year old girl and was just reported as being commercially sexually exploited to child welfare by law enforcement while they were out on patrol. Maria has left her home sporadically for three years. She and her family have had a history of drug addiction, trauma, and gang involvement in another city one hour away. She does not identify her exploiter (who she calls her “boyfriend”) as being her trafficker. She has shared that she is scared about what will happen to her and him. She was upset and scared. An emergency multi-disciplinary team meeting (MDT) was called.What are your safety concerns?Within the meeting, what are some things you can do to establish physical safety?Within the meeting, what are some things you can do to establish psychological safety?Within the meeting, what are some things you can do to establish relationship safety?After the meeting, what are some things you can do to establish physical safety? After the meeting, what are some things you can do to establish psychological safety?After the meeting, what are some things you can do to establish relationship safety?Screening Screening and assessment are two important elements of responding to the issue of the commercial sexual exploitation of children, though their purposes are different. Screening tools are designed to be brief and to identify commercially sexually exploited youth or those who are at risk. Screening is used to identify and refer to appropriate resources. Assessment is a lengthier process that involves gathering information to inform case planning. Assessments can be conducted with youth who have just been identified or those who have been identified previously, which may take a slightly different form. The decision about which screening tools and assessments are to be used will be decided on the county level. There are currently many different forms of screening tools and assessments being circulated, and there are options to choose from. While some are not identified as being a screening tool or assessment, it is important to differentiate them because their purposes are different. The following questions should be asked when selecting screening tools and assessments:Would it be more appropriate to use it as a screening tool or assessment?How long is it?Are the questions open ended or close ended?What is its format?What are the sources of information? Self-report? Observations by providers or caregivers? Previous reports?Can it be used to identify youth who are at risk of exploitation and not yet actually exploited?It is specific to CSEC?Is it relevant across many dimensions of difference? (race, gender, sexuality, urban/rural environments)What setting is it designed to be used in? (Child welfare? Medical setting? Juvenile justice?) *This is especially important to consider as the policies shift towards a collaborative, interagency approachHas it been evaluated and validated?Does the screening tool take into account trauma bonding? Does it help the provider decipher whether or not there is a 3rd party exploiter? If not, how can a service provider do that? Principles of Screening and AssessmentThe following principles are suggested for conducting screenings or assessments with a commercially sexually exploited youth:Use open-ended questions when possible.Choose language carefully—youth may not recognize themselves as being victimized or abused so referring to them as a CSEC victim may be triggering, in addition to their level of vocabulary needing to be at an appropriate level for understanding in the language of the assessment. Understand youth may be reluctant to talk given mistrust of systems.Actively and empathetically listen.Be patient and caring.Frame questions in a nonjudgmental manner and do not use leading questions (for example, don’t ask “How did your exploiter get you to stay?” but ask more open ended questions about the relationship.)Refrain from expressing strong reactions—youth need to feel supported, not judged.Assess for youth’s safety—give young people permission to not answer questions, take a break, or stop the interview and ensure the interview is separate from family members or others (such as possible exploiters).It should also be noted that if there is a 3rd party exploiter, they have probably given the youth a scripted story to tell and it may be necessary to ask more specific questions when/if it feels as though the youth is answering the questions from a script. For example, if the youth says they work promoting nightclubs, which clubs? What kind of music? What is their favorite part about their job?, etcWhile taking into account the above principles, develop your own authentic and organic style.Screening SettingsGiven the extent of the issue and the many systems youth touch, there are a variety of settings that youth can be identified. They can be screened and identified by:Child welfare (at various points, including in the emergency response unit and after having been in the child welfare system)Law enforcement (while out on patrol)Probation (upon detention, if they have committed a crime (not a “prostitution-related offense),” or have a warrant for a crime)Medical settings (primary care, reproductive health clinics, Emergency Department, County Mental Health)Mental health settings (therapists, psychiatric hospitalizations)Schools (i.e. by teachers, school social workers)It is important to note that the purpose of screening is identification, not case planning.Strategies for Conducting a ScreeningBefore beginning a screening, the focus should be on engagement.Screening questions do not have to be asked in rapid succession. Use reflective statements to provide validation and support. For example, if a youth shares, “My neighbor molested me, which stuck with me for a while,” you could say, “that experience has been hard for you for a long time.” Avoid judgmental or accusatory language. Phrase questions in a way that do not place blame or responsibility on a young person. For example, instead of staying, “why were you involved in the child welfare system?”, you could say, “what was going on when you were involved in the child welfare system?” Examples of Screening QuestionsDoes the youth have a history of running away from home, AWOL, being thrown out of the home? Does the youth experience unstable housing, including multiple foster care placements? Does the youth experience periods of homelessness, including living on the street or couch surfing? Does the youth access social services or community resources to meet basic needs (e.g., hygiene, shelter, food, medical care)?Does the youth receive or have access to large amounts of cash, credit cards, prepaid cash cards, hotel keys, gifts, cars? Is the youth’s dress or appearance atypical of his/her age or peer group? Is the youth’s dress or appearance inconsistent with the weather or situation?Screening Script and WorksheetFollow along as the trainer and a volunteer act out a screening scenario using the script below. As you listen, note the following screening elements:Open ended questionsNonjudgmental reflective statementsEngagementHousing instabilityExploiter relationshipSupportsBasic needsSystem involvementPremise:Michael is a 15 year old biracial boy. He has been homeless for about a year after leaving his family several hundred miles away, within the state of California. He is being screened by the responding child welfare worker after arriving at a youth shelter in a major city. Shelter staff were concerned he was being commercially sexually exploited. Screener (S): Hi Michael, how are you doing today?Michael (M): I’m fine.S: Good. I’m here today because I am a child welfare worker and the shelter staff called me. I wanted to check up on you and see what has been going on and what we could do to provide some support to you. Shelter staff told me that you’ve been homeless for about a year? M: Yeah. I didn’t want to stay at home. S: Ok, do you mind telling me a little about what was going on?M: Yeah, my family didn’t have any money. My mom was addicted to meth. My dad was around, but he had another family. He was racist too. My mother is black and my dad is white. He was always saying I was biggest mistake he made I had been staying with him for a little bit when I was 13 when it was really bad with my mom and meth. He kicked me out though. I had to sleep in the dirt one time. So yeah, I didn’t want to stay.S: Where did you go after your dad kicked you out?M: I went back to my mom for a week. She had a boyfriend though who would beat me up, a guy who she saw sometimes. He was the one who got her meth. S: That sounds like a difficult time. M: It was. It has been. I left my mom’s after a week. S: How were you getting your basic necessities, like food and somewhere to stay?M: Well I was out on the street for a little. I met this guy pretty quickly. He said he’d take care of me. And he did. I liked him a lot. I called him daddy. We worked the street together. S: Were you exchanging sex for money and shelter?M: Yes. We did it together.S: How was that for you?M: It was what it was. It was fine since we were doing in together, really. S: And just to understand where you are coming from, you have been with him for the last year?M: YesS: I hear you when you say he was taking care of you. Sometimes we see both good and bad things happen in relationships. Did he ever harm you in any way?M: Not really. He’d sometimes get mad if we didn’t make enough money to pay for a motel. S: Did he ever hit you?M: Once or twice, but it was never that bad.S: Did you ever go to the Emergency Room?M: Just once. S: Well I’m glad you are ok now. M: YeahS: Just to ask as well, have you been to a doctor recently besides the Emergency Room? M: Not really. Figured out I had a disease a couple of times, but that’s been it. S: So you got it taken care of?M: RightS: That’s good. Who took you there?M: My daddy. He stayed in the car though.S: Did he want you to go quickly?M: Yes, he said we had to get somewhere, I forget where, soon. We like to be together too, so I think that was going on too. S: Was he usually like that?M: Yeah. We liked to be together.S: Do you have other people you can go to when you need help?M: No, not usually. S: You have some support though.M: RightS: What about the shelter? Has it been supportive there?M: Kind ofS: How’s it been going overall? How long have you been here?M: About three days. It’s ok. I had nowhere else to go and I met someone on the street who told me they come here when they need itS: Do you mind me asking what was going on when things changed? You decided to switch from staying in hotels to going to the shelter.M: Well my daddy was arrested. He was stopped on the street and he had guns in the car.S: Had you known about the guns?M: Yeah, but he usually kept them hidden. S: Gotcha. And where were you when he was arrested? M: I was a little further away on the street. No one noticed me. S: So you didn’t get caught upM: No. I was approached by the police a couple of times, but I’ve never been arrested. S: That might have changed things for you.M: Exactly. I’m really glad it didn’t happen. S: So what are you looking for right now? M: I don’t know. What do you mean?S: Where you want to stay, for example.M: I don’t know. I miss my daddy, but he’s still locked up. I guess I’m fine being here for now though.S: It’s hard to think long term sometimes.M: Yeah, I usually think about tonight or tomorrow. S: Right. Well, we are here to help you think about tonight and tomorrow and also into the future a bit. We can continue to talk about what would work for you. We want you be supported and doing what you want and choose to do. I’ll be in close touch with you and the staff here. Just so you know what our process is, we will probably be having a meeting with you and some other people, like group home staff and child welfare, relatively soon. You don’t have to go if you don’t want to, but it would be great if you chose to go so we could hear directly from you about what you want for tonight, tomorrow and the future. How does that sound?M: Sounds fine.S: We can talk further about what that meeting will look like next time we meet or talk, which will probably be within the next day or two. Here is my number if you have any questions I can answer for you. Do you have any questions for now?M: No, not really.S: Thanks so much for meeting, Michael. It can be hard to share what’s going on for you, so I really appreciate it.M: OkScreening Activity WorksheetWorking in pairs, formulate 5 motivational interview questions for someone who is in precontemplation stage and has a 3rd party exploiter (and is therefore likely trauma bonded). 1. 2.3.4.5.Lily Scenario and WorksheetRead the scenario and answer the questions that follow.ScenarioLily is a multiracial 16-year-old who lives in an urban area that sees a great deal of community violence. Her father was in and out of prison during her childhood and died when she was 12. Lily’s mother was 15 when she was born and was diagnosed with schizophrenia in her early 20s. Due to substantiated sexual abuse by her mother’s boyfriend, Lily was placed in foster care when she was 12. Lily and her mother are very close even though they have not lived together for several years. Lily has two younger brothers under the age of 8 and she describes loving them very much and spending time taking care of them, even after she was placed in foster care. Lily reports that she never had friends growing up and that she struggled with school, which became appreciably harder for her at the age of 8. She was in special education from 10 on, but the school she went to was understaffed and under resourced. Lily always enjoyed drawing and had a teacher she connected with when she was 13, who shared that she was intelligent and talented. The teacher moved schools one year after they met, which made it harder for Lily to engage in school.Lily frequently bounced between foster care placements. Several foster parents reported that she was sweet, but could be difficult to provide care for at times. She would refuse to do her school work and left home frequently. She ended up placed in a child welfare group home at 14. Lily also frequently left her group home, usually leaving to be closer to her mother and brothers. Around age 14, group home staff noticed she had expensive possessions and multiple cell phones. Other youth at the group home shared that they saw her getting into cars with older men, but when group home staff asked, she was evasive and said, “they are my friends.” At 15, Lily was arrested on a petty theft charge. Juvenile hall staff overheard conversations between Lily and other girls on the unit who were identified as youth who have been exploited. Staff let the unit therapist know. After several weeks of meeting with the therapist, Lily disclosed that she had been having sex for money. She did not explicitly mention that she had an exploiter, though the therapist was able to identify some indicator signs. Lily described having a gang-involved boyfriend, whose age and name she would not disclose, who drove her around and provided “protection,” to prevent her from getting robbed. She shared that she gave him the money so he could keep it safe and said that he was the one who controlled it. She said, “this is a choice for me and something I do to take care of myself. No one else has been there to take care of me so I can do it on my own. My family struggles and I need to help out with taking care of my younger brothers.” The therapist reported the exploitation to child welfare. QuestionsIdentify three of Lily’s strengths:Identify three priority needs for Lily:What Stage of Change is Lily in?What might be an appropriate intervention for Lily?Application Scenario Role Play WorksheetDirectionsUsing the worksheet below, develop an outline for a 5 minute conversation that the child welfare worker or probation officer would have with Lily in a specific Stage of Change. Other group members may take on roles as members of the MDT if needed. Each group will be assigned a Stage of Change for this activity.Identify who will play each role during the demonstration. Identify who will capture the group’s ideas on the Outline Worksheet below.Use content from throughout the day (Motivational Interviewing, Stages of Change, safety considerations, screening and assessment) in developing your outline. Each group will present their conversation to the whole group as a role play between Lily and a social worker or probation officer.If you are playing Lily, be thoughtful about the way you portray her. Avoid making assumptions or stereotypes. Outline WorksheetWhat Stage of Change is Lily in?How will Lily express this during the role play?What are Lily’s priorities and perspectives in her current situation?What potential manifestation of trauma will Lily show in this conversation?What is one need Lily will share during the conversation?What is one strength Lily will share during the conversation?What is one next step Lily and her social worker or probation officer will agree to during the conversation?What intervention could be provided to Lily to help her meet the goal of her current stage in the Stages of Change?Prompts for Small Group Vicarious Trauma DiscussionWhat makes working with youth who’ve been exploied hard/what would you imagine being difficult?What specific things make you/would make you feel upset, disengaged, or anxious? Having children? Hearing about trauma? Seeing a child seem apathetic or hopeless?What can you do when you are feeling upset, disengaged, or anxious? How can you stop the impulse to want to “save” or “protect”?How can you slow down when doing this work?For further resources, please see Beverly Kyer’s resource list, “Surviving Compassion Fatigue, Help for Those Who Help Others.” GoalsWhat is one thing you learned today?Describe how you will apply something you learned today in your work?What is one thing about working with children and youth who have been commercially sexually exploited that you still want to learn or want to learn more about?Appendix A: Trauma-informed PracticeTrauma-informed practice involves recognizing the existence and impact of both acute and ongoing trauma, understanding what it looks like, and incorporating these understandings when creating interventions. Trauma has a deep and lasting impact on youth and their relationship formation, brain development, and way of thinking about the world. ?Trauma can shape youth’s perceptions of the way people treat each other, leading to the normalization of negative and abusive relationships.Trauma can impact brain development and cause youth to struggle to regulate emotions and think through decisions.Trauma can shape the expectations they have for youth have for own lives. For example youth may think about the world as an unsafe place, which becomes normalized and expected.Trauma can take many different forms. ?It can be a one-time event, acute trauma, like an injury or single instance of sexual assault. ?It can be ongoing and multiple traumas can be occurring at the same time, which is called complex trauma. ?This can look like combinations of?ongoing neglect, persistent physical or sexual abuse, or domestic violence. ?Other examples of trauma include community violence, natural disasters, or school violence.Trauma is correlated with child welfare involvement, which renders youth vulnerable emotionally (lacking a support system) and physically (leaving a placement).Exploitation is in and of itself a trauma. Exploiters use a variety of tactics to coerce and control youth. These tactics include: Compliments Professions of care and loveOffers of protection or safetyIsolation (physical and social)Monopolization of perceptionInduced debility or exhaustionThreats to youth, family, or petsEnforcing trivial demands*(for example: requiring the person being exploited to only use a certain amount of toilet paper)Physical or sexual forceDegradationOccasional indulgencesValidating youth as being a “favorite” or being on top of the “hierarchy”Including youth in “special activities” Dividing the multiple youth that are being exploited by the same personTrauma bondingExploiters’ tactics of coercion and control, in combination with the dangers of commercial sexual activity (sexual assault, physical assault, robbery, etc.), are part of the trauma of exploitation and youth’s larger trauma histories. Two things that can result from commercial sexual exploitation include trauma bonding and behavioral health needs. Trauma bondingTrauma bonding is a result of exploiters’ tactics of coercion and control.Youth feel a positive emotional connection towards their exploiters and seek to protect and care for them. ?It is a form of self-protection and keeps youth anchored to their exploiters.Youth may not be able to identify exploiters’ behavior as being coercive, controlling, manipulative, or unsafe.Youth may perceive that their exploiter(s) are caring, supportive, and/or protective.It is difficult to address as their relationship with their exploiter(s) can fill many legitimate social, and material psychological needs. Trauma bonding is also known as Stockholm Syndrome.Behavioral health needsTrauma manifests itself in a variety of mental health disorders, including substance abuse issues. Behavioral health disorders are often precursors to exploitation due to early trauma, which are reinforced or established by the trauma of exploitation.One study, with a sample size of 113 youth, found over half had a clinically significant mental health disorders, including a high prevalence (76%) of depression, anxiety (55%), anger control (58%), and attachment disorder (51%).Attachment disorders, which result from the disruption of earlier relationships, make a youth vulnerable to the emotional manipulation of exploitation.Due to these behavioral health needs, youth often turn to maladaptive coping mechanisms, including substance abuse, self-harm, suicidality, tolerance of unhealthy relationships, and behaviors like leaving home or a placement, which leads to significant vulnerability to exploitation.Trauma-informed Practices Not asking youth to repeat their story multiple times or, if they don’t want to, at all. For example, minimize the number of interviews that child welfare or probation conduct. Establish systems of data collection and sharing that allow for the easy exchange of information while maintaining confidentiality.Respecting the various emotional manifestations of trauma and staying calm in the face of them—some youth become volatile as a result of trauma, while others disengage. These are expected reactions to trauma that make sense given traumatic experiences. These reactions might take place during an MDT, screening, assessment, or in ongoing work. Develop ways to engage youth and build relationships. In intervening, service providers must not place blame on youth for these reactions, but understand and respond to them within a broader context. Watching for youth’s triggers, which may be locations (towns where they were exploited words, or people (i.e., men, certain family members, or people in positions of authority). For example, when placing a young person, take into account their relationships with the placement location. Assign child welfare or probation workers by gender in a way that feels comfortable to youth. Holding the MDT in a space that feels safe and comfortable for them. Be wary of conducting an MDT in the home or a place that could be triggering.Using neutral and nonjudgmental, and non-blaming language. Avoid words like “working,” “prostituting,” and “prostitute” when discussing commercial sexual activity.Respecting and understanding youth’s resistance to testifying. For example, as workers, provide safe transportation and connect youth with advocates who can support them during the process. Discuss the safety of the family while testifying (due to potential threats from exploiters) and provide assistance in maintaining safety.Avoiding retraumatizing youth. For example, consider how incarceration may be retraumatizing when making a decision about a young person’s legal status. Take the lead from them about what topics they feel comfortable discussing with probation or child welfare worker. Understand that they could have experienced system involvement in a negative way and that involvement in and of itself can be retraumatizing. Understanding the impact of trauma and mental health needs of youth and developing strategies of intervention that honor these needs. For example, it is crucial to connect young people with treatment, including CSEC-specific psychotherapy, that can support addressing behavioral health needs. Providers must be sensitive to their unique needs, as well as being able to view youth as individuals with complex stories beyond their exploitation. Having an understanding of how trauma manifests itself in people, and how we can overcome the cycles of violence that trauma often triggers, is the first step in understanding what trauma-informed care is. Trauma-informed care is about acknowledging how trauma is impacting survivors’ daily lives and impacting how they interact with us. Being trauma-informed means meeting survivors where they are and recognizing that many youth will not be able to immediately leave a situation. Youth may not necessarily identify trauma as the issue that is most important to them. While it is important to understand their thoughts, behaviors, and emotions in terms of trauma, addressing it explicitly may not be appropriate at that time. Additionally, it is crucial to understand that youth are more than their trauma and that there is a larger context at play when approaching the issue and supporting them.Appendix B: Client-Centered CareThe idea behind client-centered care is to take the lead from youth who have experienced commercial sexual exploitation and not impose any opinions or our version of their story on them. Respect is important, even if a practitioner disagrees. General strategies include: Actively listeningAsking permission to offer your opinionCompartmentalizing your own beliefsProviding choicesCollaborating with the youth (and the MDT) when developing a planTrusting their stories and opinionsIdentifying what they are doing wellAsking youth how they got through tough situationsHighlighting skills they use to get through tough situationsLetting them know that skills are transferrable to other situations if they want to use themStrategies specific to child welfare workers include:Holding meetings and interviews in spaces that feel safe and comfortable to youth (which may not be homes/placements)Prioritizing youth’s visions of their own placementsPrioritizing youth’s attendance at MDTs, if they want to attendAsking youth about their desires to engage in services and taking them into account when connecting young people with resourcesSetting short-term and long-term goals for education, placement, etc.Providing consistency of workers to ensure continuity of servicesMaking connections to youth mentors and survivor leadershipAppendix C: Intervention Creating effective responses to the commercial sexual exploitation of children is still in its infancy. Evidence-based practices have largely not been established. This is in part due to the newness of the field and the need to respond to youth as individuals with specific needs and experiences. Individual-level interventions that respond to the uniqueness of the young person are necessary, as well as interventions that include macroscopic change on the levels of the child welfare and juvenile justice systems. The following interventions will be discussed in this section from both an individual and systemic perspective:Providing early and intensive supervisionVictim Survivor Leader ModelPracticing cultural sensitivity Incorporating a positive youth development perspectiveProviding Early and Intensive Supervision A crucial element of supporting youth who have experienced commercial sexual exploitation involves holistic, strengths-based, and intensive supervision provided by multiple parties. Major changes in legislation have taken place over the last several years that restructure previous policies. New Legislation - SB 855In June 2014 the California legislature passed SB 855, Chapter 29, Statutes of 2014 (SB 855). This legislation accomplished two primary things: 1) clarified that child welfare agencies are required to serve commercially sexually exploited children, as specified; and 2) created the CSEC Program. As well, separate budget authority was approved to appropriate $14 million annually and ongoing for the program. The goal of SB 855 was to develop a collaborative, interagency framework to coordinate interventions for CSEC and provided funding to do so. All 58 counties received allocations for training foster youth to recognize and avoid commercial sexual exploitation as well building their capacity to serve CSEC. The state also received funding to train social workers, probation officers, group home providers, foster parents and placement providers. Specifically, the following general mandates were put into place by SB 855:Reiterates that exploited youth would fall under the purview of child welfare agencies (as opposed to being identified by probation if the involved youth committed a crime, including a prostitution-related offense), leading to a sea change of framework and practices. Permits counties to provide supplementary financial supports to foster homes or group homes providing housing to exploited youth, among other allowable activities.Establishes the Commercially Sexually Exploited Children Program within CDSS, a voluntary program that counties can opt into as of July 2015. To opt-in, this program requires:The development of a county plan and an interagency protocol, as specified, relying heavily on an MDT model; andA formal mechanism by which funds are allocated.The Child Welfare Council CSEC Action Team, a product of the original Child Welfare Council, has created recommendations for best practices for working with youth who have experienced commercial sexual exploitation. They identify the first 72 hours post-identification as being a crucial time for stabilizing youth. The Model Protocol, which sets the stage for the development of county protocols (MOUs), calls for a Multidisciplinary Team Meeting (MDT) after a youth is identified as experiencing commercial sexual exploitation. It is a collaborative approach that involves representatives from different systems. Mandated members include juvenile court (if applicable), Child Welfare (provided there is a basis for jurisdiction), probation, (provided jurisdiction exists), Department of Public Health, Department of Mental Health (including substance abuse), youth, and family (if appropriate). The Model Protocol also calls for other types of MDT meetings. MDTs should be held:Upon initial identificationPost identification and regular intervalsWhen events require a change to placement (completing high school, emergency of a new safety concern, etc.)Triggering events like leaving a placement (AWOL), immediate safety concerns (threats from trafficker) law enforcement contact, hospitalizationsCircumstances that would necessitate an emergency MDT include when child welfare identifies an immediate safety concern through either a hotline call or the emergency response social worker, identification by law enforcement, and identification by a medical provider. The following intensive services should be provided:Food and other basic necessities/hygiene bagPlacement (determined by child welfare and/or probation)Medical and mental health treatment (within 72 hours)Transportation to placement Safety plan Engagement and rapport building (CSEC Advocate, with the goal of remaining connected and receiving support in negotiating systems and being linked to further support)The Model Protocol is a recommended structure that meets the array of state’s requirements; while each county is responsible for generating specific protocols for an MDT process, it should be noted that services must be available 24/7 should the need for an emergency MDT arise. The goal is to develop an emergency response in a way such that youth do not feel stifled or disempowered, which can be a difficult task given the relationships they may have with various systems. Resistance from youth should be expected given trauma bonding, trauma histories, and mistrust of systems they have had previous interaction with. Developing trust is an important element of this work, as well as consistency and transparency around services. New PlacementsPlacement decisions will be made collaboratively by stakeholders at the MDT. This could take place at an emergency MDT or any of the ongoing MDTs. When making the decision about a new placement, participants should consider:SafetyProximity to exploiterProximity to areas where the youth was exploitedAccess to the internet or phonesRunaway riskRecruitment risk—to youth or other youthSecurity of placement (how much supervision is needed)Whether the placement and caregivers are affirming of a young person’s unique identityProximity to resourcesSchoolMedical careMental health careActivitiesProximity to social support systemsA young person’s history of leaving placementsHow to transition between different placements, especially if the young person is moving between child welfare and probation—allow a sufficient amount of time to allow for planning for the most appropriate and sensitive placement AWOLing and Reintegrating into a Previous PlacementIn another scenario, stakeholders and the young person will decide that staying at a previous placement—whether it be with family members, a foster care providers, or group home—makes more sense than placing youth in a new setting. Suggested individual and systemic action steps include:Group homesDeveloping protocols for reserving beds for youth who have left the placementUpon the young person’s return, facilitating conversations about why the youth left and identifying barriers and potential solutions to stayingEnsuring that relationship building and engagement of the youth is taking place—this can take the form of staff-youth relationships or youth-youth relationshipsEnsuring youth-youth conflict is addressed quickly and in a supportive and empathetic fashionIdentifying what needs the placement is not filling—what new elements of a successful placement would a young person need?Ensuring smooth communication between child welfare workers and group home staffMaintaining accountability for group home staff and systems by monitoring and evaluating their work through data and conversations with youthDeveloping CSEC-specific elements of group homes informed by focus groups involving both CSEC themselves and providersConducting ongoing trainings on CSEC-specific issues (harm reduction, relationship building, trauma-informed practice) and providing sufficient support to group home staff, including supervisionEnsuring providers are sensitive to the specific needs of the particular youth with whom they are working, whether it be gender, race, sexuality, gender expression, etc.Family membersProviding support to family members while CSEC are both in the home and while they have left—develop a plan for creating these supports collaboratively Ensuring family members’ needs (including basic needs, mental health needs, etc.) are met if they encounter a time in which they struggling—connect with services if necessaryInteracting with family members in a nonjudgmental and non-blaming way—family usually care and are invested in the youth’s success, even if they have experienced struggles themselvesSeeking to understand issues they are facing as unique individuals and familiesProblem solving struggles with family members and anticipating future challengesFoster care providersProviding CSEC-specific training (harm reduction, relationship building, trauma informed practice) and support for foster care providers before and during placement—consider support groupsMaintaining accountability for foster care providers by monitoring and evaluating their work through data and conversations with youthEnsuring foster care providers are sensitive to the specific needs of the particular youth with whom they are working, whether it be gender, race, sexuality, gender expression, etc.Encouraging long term commitments to youth to provide consistency of relationshipsVictim, Survivor, Leader ModelGirls Mentoring and Education Services (GEMS), founded by survivor Rachel Lloyd, has been pioneering, innovative, survivor-led, and empowering approaches to responding to the commercial sexual exploitation of children since 1998. A central tenet of the work is that action and response to commercially sexually exploited youth should be driven by youth as they empower themselves. Lloyd identifies a “rescue” mentality among many systems and providers involved with the issue and offers an empowering alternative called the Victim, Survivor, Leader Model. In this model, youth are seen beyond their victimization (which is also recognized), and focus is on building upon strengths they already have and offering opportunities for leadership development. The Victim, Survivor, Leader Model reframes the way we can often think about commercial sexual exploitation and offers a clear path for supporting youth and helping them see beyond their trauma. A key element of this work is survivor leadership. The Victim, Survivor, Leader model involves offering: Room to grow in a supportive and nonjudgmental place where they are accepted no matter where they are at in the process of healing: they can learn positive narratives about themselves that they have not gotten from peers, families, or society regarding themselves or their exploitationOpportunity to develop knowledge and skills to understand the issue of commercial sexual exploitation from a larger, systemic perspective and take action in a way that is empowering and not shamingOpportunity to learn communication skills, like public speaking and facilitation, so they can express themselves with confidence, advocate for themselves in various systems, and develop healthier relationshipsSpace and opportunities to regain control and develop a sense of self-worth through activities and relationshipsProgramming that supports youth in thinking about themselves as resilient and strongOpportunity to provide support to others, connect with other youth, and have concrete ways to put skills into actionA way to imagine their future, potential, and goals in a new way“Survivors not only needed consistent messaging about their potential, their value and their worth but a safe, non-judgmental place within which to grow, the opportunity to gain knowledge and skills, particularly in building healthy relationships and learning effective communication skills.The young women talked at length about the direct relationship between these supports and their increased sense of self-worth and confidence, a vital component of their healing and recovery. Once they gained confidence, the young women felt strongly about ‘giving back’ and supporting and educating others and they needed concrete opportunities within which to explore and practice their leadership skills.These opportunities opened up additional possibilities to them and they began to see themselves truly moving forward with healthy and productive futures.”—Rachel LloydPracticing Cultural Sensitivity Culturally sensitive practices not only involve the recognition of specific points of identity, but they actively validate and center cultural factors when addressing the multifaceted needs of youth who have experienced commercial sexual exploitation. It is based on the recognition that everyone has an identity and perspective, that they are all valid and meaningful, and that we should not privilege one over another. Other words that have been used to capture this idea are cultural competence and cultural humility. When implementing culturally affirming practices, stakeholders do not impose their values or identities on the young person. They recognize their personal, implicit biases, perspectives, and identities and validate those of the youth with whom they are working. Stakeholders do not assume they know what a young person’s experience or identity is, and ask questions to further understand. Planning a response to a youth’s experiences and identity is based on their own understandings of themselves, and thus involves compassion and curiosity. Identity can be broken down into various categories. As previously mentioned, we must understand that everyone has a different understanding of their identity and what these terms mean to them. These points of identity are important in that they shape the nature of the provided interventions, which is crucial so these youth can be most effectively supported. The following are major dimensions of identity, although this is not an exhaustive list. RaceEthnicitySexSexualityGender expressionClassImmigration status (i.e. lacking documentation for being in the United States/undocumented individuals)Native/spoken languageDisabilityAgeReligionPregnancyPossible gang or other affiliationsIt is of important note that discrimination and oppression fall along these lines of identity. Discrimination can be loosely defined as: “unequal or different treatment or harassment that causes harm based on larger systems of power and control.” Oppression involves the unequal distribution of power or resources that enables one group to marginalize another through exerting power or control (this can occur across different identities at the same time and is not “all or nothing”). , Issues of gender, sexuality, race, and gender expression are of particular note, especially because significant discrimination exists around these points of identity. While young men can be commercially sexually exploited (and these cases are most likely underreported), commercially sexually exploited youth are overwhelmingly young women. Youth of color, LGBTQ youth, and transgender or gender nonconforming youth are also disproportionately being commercially sexually exploited. , It is important to acknowledge these specific points of identity as being particularly relevant to both recognition of the issue and intervention. It should also be noted that sexual orientation and gender identity are not risk factors by themselves; rather, these points of identity are associated with discrimination and family rejection leading to homelessness and increased vulnerability to exploitation.To make a final point on culturally sensitive practice, we must recognize that commercially sexual exploitation and trauma histories can be points of difference. We must be aware that these experiences can be expressed in a variety of ways, including a young person’s mistrust of people who have not shared the experience of sexual exploitation, potential volatility, or disengagement, among other reactions. Part of being culturally sensitive involves recognizing this dimension of the issue and responding in a non-blaming fashion. It is not youth’s faults that they have experienced trauma—we should not place the onus of dealing with these trauma responses on them.The following are several examples of culturally sensitive practices:Providing translators for youth or parents who do not have a working knowledge of English during MDTs or family workProviding trauma-informed care to counter the effects of trauma, which can be both a concrete event or systemic (see trauma informed practice section)Linking youth and/or families to services to address any needs that emerge from points of identity (legal services for immigration issues, mental health treatment)Including stakeholders of many different identities in the support work we are doing for youth who have experienced commercial sexual exploitationNot assuming we know anything about a youth’s identity just by looking at them (gender, the sex of the people they have sex with, race)Asking for clarification if lacking understandingStaying supportive, calm, or engaging if a young person presents as volatile or disengaged. These reactions are to be expected.Ultimately, culturally sensitive practices involve taking the lead from a young person and responding to their unique needs and identities in context, not simply their experiences of being commercially sexually exploited. Incorporating a Positive Youth development PerspectiveAccording to the positive youth development perspective, youth already have strengths and capacities that can be built on. Instead of focusing on the things that they have done wrong or deficiencies, we focus on collaboratively creating skills and knowledge with them that enable them to move in safer and more positive directions, that is ideally self-defined. Goals include supporting youth in developing confidence, facilitating a sense of belonging and connection to adults and other youth, and creating a set of useful and meaningful skills. With the goal of facilitating healthy development, Positive Youth Development takes several different forms:Increased opportunities and avenues for positive use of timeIncreased opportunities for positive self-expression Increased opportunities for youth participation and civic engagementOther goals of Positive Youth Development involve supporting youth in building a community of supports, interacting with others, and identifying adaptive coping mechanisms, including engagement in these activities as alternatives to more unhealthy behaviors. Positive Youth Development activities are sometimes called “prosocial activities.” In developing a response to commercially sexually exploited youth, the following types of programming may take a Positive Youth Development perspective (it is important to check before referring) and support positive changes in a young person’s life:Sports/going to the gymVolunteering/ jobs/job trainingArt/writing/journalingBeing or having a mentorTeaching or providing childcare to childrenSpending time with animalsActivismAttending cultural eventsConnecting to a religious communityIn the case of commercially sexually exploited youth, this involves the recognition that although they have been victimized and experienced trauma, that is not all they are and we need to emphasize recognizing, utilizing, and developing positive things they identify in their lives.Appendix D: Sample Agendas for MDTMDT agendas will be broken down into two categories in this section, which are the initial MDT and ongoing MDT. This handout is a suggestion, as stakeholders will establish MDT protocols and procedures during a pre-MDT convening held on the county level. AGENDA FOR INITIAL MDTGo over agenda and community expectations of MDT (which are written down and posted - see next page for sample community expectations):Acknowledge that there are many people in the room and that it may be uncomfortable for the youth, but reiterate commitment to them.Ask if anyone has any questions or additions to the expectations.Lead introductions:NameRoleEach person’s goal for the meeting (facilitator writes these down to ensure coverage and organizes and prioritizes goals into themes while writing them down. For example, goals might be exploring placement alternatives, establishing increased school supports, helping youth set and achieve personal goals, preparing for court cases a young person is testifying in, making sure the youth is on track with the terms of their probation. The facilitator will note these, divide them into themes such as placement, school, and legal issues, and then prioritize them based on immediacy of need and youth’s main concerns.)Any questions from participants (facilitator writes down)Ask young person what they want to start with, if they are there.Go through each theme:Reiterate the goals within this theme.Identify relevant strengths, worries, what’s working well, what’s not working, what supports are neededCreate a safety plan Identify timeline for actions and who is responsible for follow-up for each action stepUse identified strengths to help build next-steps and action plansClose the meeting:Each person will summarize their next stepsEach person will validate young person and recognize their strengths.AGENDA FOR ONGOING MDTGo over agenda and community expectations of MDT (which are written down and posted):Acknowledge that there are many people in the room and that it may be uncomfortable for the young person, but reiterate commitment to the young personAsk if anyone has any questions or additions to the expectations.Lead introductions:NameRoleQuestions you have (facilitator writes down)Ask young person what they want to start with, if they are thereGo through each theme:Review themes and action steps from previous meetingSolicit new goals or concerns from participantsAsk if anyone has any follow-ups from previous action steps for each theme (bring these back from previous meeting, which have been written down)Discuss newly emerging strengths, ongoing strengths, what’s working well, worries, what’s not working, newly emerging safety concernsGo over last safety plan:Make revisionsUse identified strengths to help build next-steps and action plansClose the meeting:Each person will summarize their next stepsEach person will validate young person and recognize their MUNITY EXPECTATIONSHear and prioritize youth’s voiceRespect each other’s perspectives, even if they are different or conflicting with our ownIntentionally participate—Watch if you are talking too much or too little and adjust accordinglyDon’t rush, but also be aware of timeActively listenSpeak positively and be hopefulAddress strengths and resilience factors including positive changesReferencesAhmed, S, Wilson, K.B, Henriksen, Jr., R.C., & Jones, J.W. (2011). What Does it Mean to be a Culturally Competent Counselor? Special Issue on Multicultural Social Justice Leadership Development (3)1. Retrieved from University School of Public Health. (2013). The Transtheoretical Model (Stages of Change). Retrieved from . Boston University School of Public Health. (2013). [Graphic Illustration of the Stages of Change Model]. The Transtheoretical Model (Stages of Change). Retrieved from . California Child Welfare Council CSEC Action Team. (2015). Holistic Needs of Commercially Sexually Exploited Children. Retrieved from . California Child Welfare Council CSEC Action Team. (2015). Memorandum of Understanding Template for the Commercially Sexually Exploited Children (CSEC) Program. Retrieved from Child Welfare Council CSEC Action Team and WestCoast Children’s Clinic. Memorandum Summarizing the Available Screening Tools to Identify Commercially Sexually Exploited Children. Retrieved from . Contra Costa County Zero Tolerance Initiative for Domestic Violence (2015). Human Trafficking 101 Training.Ending the Game (2015). What is Ending the Game? Retrieved from . Foster Family Based Treatment Association (2014). Domestic Minor Sex Trafficking. Retrieved from . Watch (2014). [Graphic illustration of Alameda County CSEC Data]. Children At Risk: A Snapshot. Retrieved from Rights Legal Support Centre. What is Discrimination? Retrieved from Gluck, E., Mathur, R., & Focus First. (2014). Child Sex Trafficking and the Child Welfare System. Retrieved from , B. (2013). Surviving Compassion Fatigue: Help for Those who Help Others References. Retrieved from . Lloyd, Rachel. From Victim to Survivor, from Survivor to Leader. Retrieved from . National Association of Social Workers. Diversity and Cultural Competence. Retrieved from Child Welfare Resource Center for Youth Development. (2008). Positive Youth Development Toolkit: Engaging Youth in Program Development, Design, Implementation, and Service Delivery. Retrieved from Traumatic Stress Network. Types of Trauma Stress. Retrieved from Health Network. (2009). Training for Change: An Integrated Anti-Oppression Framework. Retrieved from , K. (2009). Motivational Interviewing Glossary and Fact Sheet. Retrieved from . State of California, Department of Social Services. (2014). All County Information Notice No. I-23-15. Retrieved from Walker, K. (2012). Ending the Commercial Exploitation of Children: A Call for Multi-System Collaboration in California. Retrieved from . WestCoast Children’s Clinic. (2012). From Research to Action: Sexually Exploited Minors’ Needs and Strengths. Retrieved from . ................
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