CSEC 102: Building a CSEC/Y Multidisciplinary Team
Participant Guide
Version 1 | December 2015
CSEC 102: Building a CSEC/Y Multi‐disciplinary Team
PARTICIPANT GUIDE
Table of Contents
Segment Page Acknowledgments ...... 3 Introduction to Materials ...... 4 Agenda ...... 5 Introduction Questions ...... 6 Understanding the Issue ...... 7 Vignettes ...... 15 Introduction to the Multi‐disciplinary Team (MDT) Structure ...... 17 Values Discussion Guide ...... 23 Best Practices ...... 24 Communicating, Facilitating, and Participating ...... 32 Facilitation Tips ...... 34 Overview of Each Stakeholder ...... 37 Sample MDT Agendas ...... 40 Planning Worksheet ...... 42 Personal Goals...... 46 Appendix A: Harm Reduction ...... 47 Appendix B: Examples of Strengths ...... 48 Appendix C: Checklist for MDT Facilitator ...... 49 Appendix D: Trauma‐informed Practice ...... 50 Appendix E: Client‐Centered Care ...... 54 Appendix F: Intervention ...... 55 References ...... 62
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Acknowledgments
CalSWEC 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 Team ● The County Welfare Director’s Association ● The California Department of Social Services ● The Central Training Academy ● The Northern California Training Academy ● The Resource Center for Family‐focused Practice ● The Bay Area Academy ● The Public Child Welfare Training Academy ● West Coast Children’s Clinic
The following individuals contributed to the development of the curriculum through providing source material, feedback on drafts, and participation in the pilot: ● Rayan Cruz ● Catie Hart ● Lillian Jungleib ● Patty Poulsen ● Anzette Shackelford ● Leslie Zeitler ● Lynn Mackey, Director, Student Programs, Alameda County Office of Education ● Alex Masden, Services for Victims of Human Trafficking Project, Contra Costa County Zero Tolerance for Domestic Violence Initiative ● Lesha Roth, Contra Costa County Probation Director ● Nicole Heron, Public Defender, Contra Costa County ● Whit Griffinger, Staff Attorney, Youth Justice Project, Bay Area Legal Aid ● Cristina Hickey, Child Abuse Prevention Council of Contra Costa County ● Neely McElroy, Continuous Quality Improvement and Violence Prevention Division, Contra Costa County Children and Family Services ● Robin Lipetzky, Public Defender, Contra Costa County
CalSWEC would also like to thank the curriculum writer, Carly Devlin for her work to develop and pilot this curriculum.
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Introduction to Materials
This manual serves as a guide to the Multidisciplinary Team Meeting (MDT) for identified commercially sexually exploited children and youth (CSEC/Y) in California. State guidelines are requiring that county agencies hold these meetings for each identified youth upon identification and as needed (more specific policy background will be provided below).
The content sets the stage for understanding the issue of commercial sexual exploitation of children. It contains several case studies, legal background, and the scope of the issue in the California. It includes information about youth’s backgrounds, the process of exploitation, warning signs, and current interventions. The CSEC 101 training is available for hose who are more unfamiliar with the issue.
The content also includes the policy background of the MDT, the guiding principles of the MDT and how to put them into action, strategies for collaborating in the context of a meeting, principles of effective communication, examples for how to put them into action, and facilitation basics.
The manual is designed to be both a tool and resource guide. MDT participants can return to specific sections of the manual as needed in the future.
Citation and Use The curriculum is intended for public use, to be distributed widely and at no cost, providing that proper citation is noted, as indicated: 1. 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. 2. 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 http://calswec.berkeley.edu, 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 [email protected].
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Agenda
Segment 1: Framing
Segment 2: Introductions
Segment 3: Understanding the Issue
BREAK
Segment 4: Current Roles, Responsibilities, and Protocols
BREAK
Segment 5: Action Planning (Part 1)
BREAK
Segment 6: Action Planning (Part 2)
Segment 7: Closing
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Introduction Questions
1) Introduce yourself by sharing the following: a) Your name b) The agency or role you represent at the MDT (service agency, Child Welfare, Probation, Resource family, etc.) c) What your previous experience with team meetings been like d) What you envision the MDT process will be like
2) Be aware of time and limit yourself to 2 minutes
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Understanding the Issue
Commercial Sexual Exploitation of Children/Youth 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.
Language 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.
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.
Legal Background The commercial sexual exploitation of children is defined by the 2000 federal law called the Victims of Trafficking and Violence Prevention Act (TVPA) as a form of sex trafficking in which the victim is under the age of 18. Sex trafficking, which is a form of human trafficking, is defined as the “recruitment, harboring, provision, transportation, or obtaining of a person for the purpose of a commercial sex act.” A commercial sex act is defined as a sex act that is exchanged for something of value, including shelter, money or food.1 By definition, children cannot legally consent to sex and therefore different standards for the burden of proof for defining a sex crime inflicted against a youth exist. Force, fraud or coercion, which need to be proven for adult sex trafficking, are not required for proving the commercial sexual exploitation of children (CSEC).
The Scope of the Issue2 The commercial sexual exploitation of children in California is a significant issue. Of the thirteen CSEC “hot spots” the FBI has identified, three are located in California. The metropolitan areas of San Francisco, Los Angeles, and San Diego are all hubs for CSEC. For example, according to data collected by the Human Exploitation and Trafficking (H.E.A.T.) Institute, a project of the Alameda County District Attorney’s Office, 432 youth were identified between January 1, 2011 and August 17, 2014 within the county, which is located within the San Francisco Bay Area.3
1 http://www.state.gov/documents/organization/10492.pdf 2 http://www.justice.gov/oig/reports/FBI/a0908/final.pdf 3 http://toolkit.heatwatch.org/community/files/race_ethnicity.pdf 7 CSEC 102: Building a CSEC/Y Multi‐disciplinary Team | Participant Guide | Version 1 | December 2015
Context of the Issue In collecting the data, stark patterns emerge. A history of trauma and neglect is a clear trend. Being a victim of trauma puts youth at risk of future trauma and sexual exploitation. A WestCoast Children’s Clinic study of Alameda County youth that draws upon the experiences of 113 girls, found that the majority (75%) have experienced prior and ongoing victimization, including neglect, emotional abuse, sexual abuse, physical abuse, family violence and community violence, all of which can normalize exploitation. Trauma can lead to risk‐taking behavior and struggles with mood regulation, disruption in caregiving relationships, and potential lack of supervision and social isolation.
Homelessness and leaving home, which are often facilitated by traumatic or neglectful situations, also represent vulnerabilities. Homelessness correlates with a lack of access to resources, creating unmet needs exploiters can take advantage of. A lack of social support is also relevant. Additionally, one out of three youth report being approached by an exploiter within 48 hours of leaving home.
An important element of the dynamics of commercial sexual exploitation of children is system involvement. Many youth who have experienced commercial sexual exploitation have connections to the juvenile justice system, the child welfare system, or both. The H.E.A.T Institute data confirms this trend and additionally identified that 63% of youth were currently or previously on juvenile probation. In Los Angeles County, the juvenile court for CSEC supervised 72 young people in 2012, finding that 42 (58%) had prior or current child welfare system involvement.
The Process of Exploitation Exploitation takes a variety of forms, including emotional manipulation, the promise of meeting basic needs, or physical force. When emotionally manipulating youth, exploiters (known as pimps, boyfriends, or daddies to youth who have experienced commercial sexual exploitation) can step in to seemingly play a role of emotional or economic support to mask exploitation. Youth lacking social and economic systems of support are particularly vulnerable to this type of exploitation. Exploiters emotionally manipulate youth into believing they are in caring, supportive relationships. This can lead to a phenomenon called trauma bonding or Stockholm Syndrome (see below).
Young people‐‐including girls, cisgender boys, transgender youth, and gender non‐ conforming youth‐‐can be drawn to exploiters or commercial sex activity as a means of survival due to a lack of basic needs. In other cases, youth are forced into sex work, having been kidnapped or beat and sexually assaulted into submission. In addition to being exploited by strangers, either older or their same age, youth can also be exploited by their own families. Exploiters actively recruit from group homes, continuation schools, impoverished neighborhoods, through other youth and the use of drugs.
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Commercial sexual exploitation takes place in a variety of places, including the street, hotels and motels, private residences, truck stops, massage parlors, and strip clubs. The internet is used for exploitation and to arrange sex acts through websites such as craigslist and backpage.com.
It is important to note that this population is incredibly mobile. Exploiters will often transport youth up and down the West Coast, sometimes going to other states (note, however, that youth experiencing commercial sexual exploitation do not need to be transported across state lines for a federal crime to be committed). Las Vegas and Reno are hotspots for sexual exploitation as well.
Exploiters 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 love Offers of protection or safety Isolation (physical and social) Monopolization of perception Induced debility or exhaustion Threats to youth, family, or pets Enforcing trivial demands Physical or sexual force Degradation Occasional indulgences Validating 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 person Trauma bonding
Identification of Youth who are Experiencing Exploitation There are a variety of warning signs youth will display when being commercially sexually exploited. While there is no one factor that will confirm whether youth are being been exploited, these indicators can help screen for exploitation.
General warning signs: ● Having an older “boyfriend” ● Spending significant time with adults ● Conflictual or abusive relationships ● Marked change in attire (e.g., possessing unexplained expensive clothing, shoes, technology, etc.) 9 CSEC 102: Building a CSEC/Y Multi‐disciplinary Team | Participant Guide | Version 1 | December 2015
● Marked change in mood or behavior, including increased hypervigilance, depression, mood swings, acting out, or volatility ● Keeping late hours ● Leaving home for periods of time or running away ● Secrecy about whereabouts ● Using specific slang ● Possessing multiple cell phones ● Switching phone numbers frequently ● Spending a great deal of time on social media sites, texting, and calling ● Reporting spending time in areas known for sex work ● Lacking identification ● Signs of physical or sexual abuse ● Being consistently tired or hungry ● Homelessness, which youth may describe as “couch surfing with a friend”
Warning signs for school staff: ● Frequent absences ● Poor school performance ● Negative relationships with peers, including fighting or bullying ● Appearing exhausted or sleeping throughout class
Warning signs for medical providers: ● Repeated sexually transmitted infections (STIs) ● Being accompanied by an older adult, male or female ● Displaying nervousness about keeping someone waiting during the appointment ● Leaving an appointment or hospital stay midway ● Frequently utilizing the emergency room for treatment of unexplained or poorly explained physical injuries
Warning signs for law enforcement: ● Being accompanied by an older adult, male or female ● Being unwilling to give details about age, name, and home ● Frequent brushes with the law ● Standing on the street with the same car frequently passing ● Observing imminent or current violence on the street ● Domestic violence ● Hotel keys ● Lacking identification ● Being under the influence of drugs
Warning signs for probation: ● Repeated juvenile justice system involvement
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● Unwillingness to engage with terms of probation due to leaving home and leaving the area, cutting off their ankle monitor (these are common for other youth as well, but there may be specific reasons behind these things happening for youth who have experienced commercial sexual exploitation and it is worth screening for their involvement) ● Spending time with other youth who have been identified experiencing commercial sexual exploitation while in detention ● Attempting to recruit other youth while in detention
Warning signs for mental health providers: ● Histories of trauma (particularly child sexual abuse) and system involvement ● Substance use ● Mental disorders, particularly PTSD (check this)
Warning signs for Child Welfare: ● Involvement with child welfare in and of itself is a vulnerability, requiring consistent screening of all youth ● Frequently leaving placements, including group homes and foster homes ● Indications of recruitment taking place within group homes ● Frequently necessitating a new placement due to issues with foster care providers ● Frequently losing possessions
Factors Linked to Vulnerability There are several factors linked to increased vulnerability to exploitation: Homelessness o Frequently leaving family home or placement o Abandonment by parents or primary caregivers o Family homelessness (living out of car, couch surfing) o Being pushed out of a home or placement, particularly due to homophobia/transphobia/racism Poverty System involvement Trauma Dislocated relationships Lack of systemic support system Structural oppression Explicit and intentional tactics of exploiters
Other vulnerabilities include: ● A lack of peer or family connections ● Being bullied or bullying ● A history of fighting
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● Truancy ● Poor grades ● Behavioral health disorders ● Family involvement with sex work or the criminal justice system ● Community violence or gang involvement ● The presence of sex work/prostitution within the neighborhood ● Age (a recent WestCoast Children’s Clinic study revealed that 60% of youth who have experienced commercial sexual exploitation had been recruited before reaching the age of 14. The average age of exploitation is decreasing as exploiters are increasingly targeting middle schools and younger populations, with girls as young as 10 being recruited) ● Family rejection and/or school problems related to sexual orientation, gender identity, or expression
Sexual 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.
Trauma Bonding Trauma 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.4 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
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different circumstances & things that need to be considered for safety than those who are not.
Survival Sex Survival sex is a form of commercial sexual exploitation. Survival sex involves using commercial sexual activity to meet the following needs: Food Shelter Protection from dangers of commercial sexual activity Psychological and psychological needs, involving perceived: Connection Care Support Identity
Implications The above information has implications in a variety of areas. The following major points are outlined below. ● Youth who have experienced commercial sexual exploitation experience many negative health outcomes, including physical injuries, interpersonal relationship violence/domestic violence, unplanned pregnancies, mental health disorders, substance abuse, and repeated sexually transmitted infections (STIs) ● Youth can often be difficult to work with due to trauma, presenting with a variety of behaviors. Some young people may be volatile, explosive, or oppositional, while others may be disengaged. This especially expresses itself in working with probation, law enforcement, and child welfare. Understanding and responding to these behaviors is an important piece of working with youth who have experienced commercial sexual exploitation. ● Their extensive system involvement indicates that child welfare and probation indicate that they can be effective places to intervene. Although youth may distrust these systems, further developing these systems to become more responsive to their needs is a crucial piece of addressing the issue. ● Issues of race, gender, sexual orientation, class, and trauma histories necessitate specific attention. ● The mobility of the population presents a challenge. When exploitation spans multiple jurisdictions, counties, or states, legal action against exploiters becomes more difficult. It also becomes a challenge to track youth who may be involved in prosecuting exploiters or for service providers to stay connected and provide services. ● Due to various reasons, including trauma bonding, agreeing to testify may be a challenge for youth who have experienced exploitation. They may fear retaliation from their exploiters that target either themselves or their families. They may be trauma bonded to their exploiters and unable to identify their
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exploitation as a crime. They may additionally be mistrustful of law enforcement or the legal system. ● A major element of working with commercially sexually exploited children involves recognizing both patterns and differences among young people’s experiences. ● Youth who have experienced exploitation have a set of complex and varied needs. WORKING WITH THEM REQUIRES SPECIFIC SKILLS AND KNOWLEDGE.
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Vignettes
Vignette 1: Layla Layla is a fifteen year old Black girl who has spent her life living in an urban area and is currently detained in juvenile hall. She has just shared her story with the behavioral health clinician. She grew up in poverty and speaks about how she had no shoes, bounced from small apartment to small apartment with her mom who had been using meth, and never had enough food. From a young age, she was bullied, often fought and did not have social connections with her peers. She reports that she never did well in school and was distracted by things going on in her home, including ongoing sexual abuse by one of her mother’s boyfriends that happened over the course of a year and a lack of food in the home. When she was fourteen, during her first year of high school, she met a thirty two year old man when she was walking home from school. He had an expensive car, which caught her eye. She got in the car and he took her out for McDonald’s. He was charming and immediately started saying how beautiful she was and how he had feelings for her. The beginning of their interactions started off calm and she started calling him her boyfriend. One month into their relationship, he told her that money was tight and that he needed her help. She didn’t quite understand, but after he explained that he wanted her to go on the street and do sex work, she got the point. While she was uncomfortable with the idea, she knew that she loved him and wanted to help. Within weeks, she was working all night, several days a week, exchanging sex for money that she would give him. He would put advertisements for her on backpage.com, a website used for advertising sex services. She would say that he took care of her and that they were in it together. She stopped going to school and was staying with him in motels all over California, cutting off contact with her mother. She would often be hungry and tired and started using cocaine to stay awake. At one point, she was beat up by one of the men who was buying sex from her. Although she was scared, she felt like the man she considered to be her boyfriend needed her and would support her. After six months, he started to encourage her to attract other girls to what they were doing together, but he assured her that she would always be his favorite girl that he cared the most about. Two days after her fifteenth birthday, the police detained her after finding her on the street in possession of a gun, which she explained she was holding for him. An emergency MDT was called after the police identified her as having been commercially sexually exploited.
Vignette 2: Michelle Michelle is a White seventeen year old girl who lives in a suburb of a major city. Her parents are wealthy and she attended well respected public schools for most of her life. While many people would view her family’s life as stable, her mother was diagnosed with a significant mental disorder and her father used alcohol. There had been previous Child Protective Services involvement when she was thirteen after her mother had assaulted her. Her mother was arrested for this incident. Michelle has a short fuse 15 CSEC 102: Building a CSEC/Y Multi‐disciplinary Team | Participant Guide | Version 1 | December 2015
herself. At the age of seventeen, she met an eighteen year old male on Tinder (an online dating service). He introduced her to several of his friends, who told her that they’d be able to get her drugs if she had sex with all of them. After a month of exchanging sex for money and drugs in private residences, one of the men withheld money from her. After becoming angry, she told her parents about the experience and made a police report. It was reported to CPS and the emergency response social worker convened an MDT.
Vignette 3: Marissa Marissa is a sixteen year old Latina girl living in a major city on the United States‐Mexico border. Her family, who has a long history of gang affiliation has been living in the United States for several generations. She experienced a great deal of community violence and at the age of eight, saw one of her uncles shot in front of her. At the age of thirteen, one of her cousins told her she could be initiated into the gang if she had sex with his friends. This was the start of years of having sex with gang members. She felt a sense of belonging within the gang and wanted to do what she could do participate. Marissa was been identified as having experienced commercial sexual exploitation at the age of 15 and had been placed in a group home after CPS had become involved. For the time being, she was staying in her group home, although she was still involved in the gang and exploitation. Marissa’s social worker has convened an MDT to review Marissa’s safety plan and involvement with services.
Vignette 4: Kayleen Kayleen is a Black seventeen year old girl who is nearing her eighteenth birthday. She identifies as female, but was assigned the male gender at birth. Kayleen has been in foster care since the age of six, bouncing between foster homes because of her sometimes volatile behavior. She ran away from her last foster home at the age of fifteen due to discrimination within her foster home. After leaving the foster home, she had nowhere to go and became homeless. Engaging in survival sex, the exchange of sex for basic necessities like shelter and food, she was exploited on the street by a man who approached her after she ran away. Kayleen has been picked up by the police in response to a warrant issued by the child welfare agency. The social worker convened an MDT to talk about placement for Kayleen.
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Introduction to the Multi‐disciplinary Team (MDT) Structure
Multi‐disciplinary Teams (MDT) The MDT is designed to help survivor youth obtain timely access to services through individualized multi‐disciplinary case planning. MDT members work with youth to coordinate the development of a 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.
Policy Background In 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 youth. All 58 counties received allocations for trainings for foster youth to recognize and avoid commercial sexual exploitation as well building their capacity to serve exploited youth. 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: 1. Reiterates that commercially sexually exploited children would fall under the purview of child welfare agencies (as opposed to being identified by probation if they committed a crime, including a prostitution‐related offense), leading to a sea change of framework and practices. 2. Permits counties to provide supplementary financial supports to foster homes or group homes providing housing to youth who have experienced commercial sexual exploitation, among other allowable activities. 3. Establishes the Commercially Sexually Exploited Children Program, a voluntary program that counties can implement as of July 2015. To opt‐in, this program requires the development of a county plan and an interagency protocol that relies heavily on an MDT model.
The Commercially Sexually Exploited Children Program and the Model Framework5 The Child Welfare Council CSEC Action Team, as part of its ongoing work to support the Commercially Sexually Exploited Children Program, has put forward a Model Interagency County Protocol that counties can use as a basis to develop their own
5 http://www.dss.cahwnet.gov/lettersnotices/EntRes/getinfo/acin/2015/I‐23_15.pdf 17 CSEC 102: Building a CSEC/Y Multi‐disciplinary Team | Participant Guide | Version 1 | December 2015
protocols. Two major elements include an interagency governing body, called the Steering Committee, and the required stipulation of an MDT structure.
● The Steering Committee involves the participation of a variety of mandated stakeholders, including Child Welfare, Probation, Behavioral Health, Public Health, and the Juvenile Court. The team may also include representatives from law enforcement, the local school district, the District Attorney, various community‐based organizations, and survivors. The Steering Committee will develop, monitor, and adjust the overall protocol and encourage development of individual protocols or policies and procedures within their agencies to address the provision of services to exploited children.
The Model Framework identifies the following stakeholders as MDT participants. Required: 1. Child Welfare 2. Probation 3. Behavioral Health 4. Public Health 5. Substance Use Disorder Treatment Providers
Suggested: 1. Youth 2. Caregiver/Placement Provider 3. Local Law Enforcement 4. Children’s Dependency Attorneys 5. Local School District 6. Local CSEC Provider Agencies 7. Survivors/Mentors
Guiding Principles of the MDT The purpose of the MDT is to provide effective, collaborative, and authentic support to youth who have experienced commercial sexual exploitation. The following principles have been identified as being core to this process: 1. Prioritizing youth voice means youth are included in the development and implementation of their treatment plan, with their opinions’ actively solicited, experiences validated, and plans for themselves valued and taken into account. Examples include: a. Beginning an MDT by inviting the young person to describe their goals, including safety plans, educational goals, and placement desires b. Actively engaging with and inviting the important people in the youth’s life to the meeting c. Addressing youth directly in an MDT, taking care not to talk as if they are not in the room d. Continuously asking youth’s opinions on what is being talked about 18 CSEC 102: Building a CSEC/Y Multi‐disciplinary Team | Participant Guide | Version 1 | December 2015
e. Ensuring that stakeholders at the MDT are talking in teen‐friendly language, explaining any jargon or stakeholder‐specific language
2. Culturally sensitive work is being respectful of a young person and their family’s experiences of gender, sexual orientation, race, immigration status, age, education and class (etc.). It also recognizes that everyone in the room have opinions that are different from one another, based on different points of identity. Examples included: a. Having a translator present if the youth and/or family prefers or can only speak in a non‐English language b. Understanding that different communities may not feel respected or cared for by the justice system and that there may be resistance to participating in the meeting c. Scheduling a meeting at a time when a working parent or care provider can attend d. Providing childcare in the event a family needs that support e. Not assuming that a young person is heterosexual or only having relationships with someone of the opposite sex f. Using young people’s desired names and personal gender pronouns g. If LGBTQ youth disclose their identity to you, allowing youth themselves to determine whether you are permitted to disclose it to other staff
3. An empowerment framework assumes that power is unequally distributed in the world and that change necessitates that a sense of power be fostered in those who do not have as much power due to either individuals or systems. When applied to CSEC, the framework rests upon the idea that some of their power has been taken away from them due to their exploitation and other factors, but that they can be built back up and build themselves back up. Examples include: a. Recognizing when youth have been treated unfairly by people or systems and validating that the youth is deserving of respect, fairness, and justice b. Encouraging youth to share their experiences and validating them when they do c. Helping youth identify times when they have felt powerful or in control d. Developing a treatment plan with youth that encourages goal‐setting e. Viewing youth as more than a victim or a product of sexual exploitation
4. Trauma‐informed practice means recognizing the existence and impact of both acute (recent) and ongoing trauma, understanding what it looks like, and incorporating these understandings when creating interventions. Above all else, trauma informed practice seeks to avoid retraumatizing youth. Examples include: a. Not asking youth to repeat their story multiple times or, if they don’t want to, at all
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b. 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 c. Watching for youth’s triggers, which may be locations (towns where they work(ed), words, people (i.e., men, certain family members, or people in positions of authority), or sensations (i.e., smells, lighting) d. Affirming young people’s sexual orientation, gender identity, and expression to avoid triggering trauma from previous rejection e. Holding the MDT in a space that feels safe and comfortable for them f. Using neutral, nonjudgmental, and non‐blaming language g. Respecting and understanding youth’s resistance to testifying
5. A strengths‐based perspective understands that even though youth may be experiencing challenges or have deficiencies in their lives, they ultimately are strong and capable people who have both internal and external resources that will support their process of improving their lives. An important understanding is that strength takes many forms. See Appendix E for a list of strengths. Examples of the strengths‐based perspective in action include: a. Highlighting things youth have done or are doing well, both in their lives and within the meeting space b. Asking youth what they think they have done or are doing well c. Validating youth’s agency (self‐determination), while recognizing that exploiters or other people may have hurt them or limited what they could do (i.e. “your pimp treated you badly and took things away from you, but you were able to get away and stayed strong the entire time”) d. Recognizing youth’s capacities (i.e. “I can tell you are really motivated to do well in school”) e. Maintaining hopefulness about a young person’s life
Collaboration Because youth who have experienced exploitation interact with so many different systems (i.e. child welfare, juvenile justice, community‐based organizations, etc.), an important element of the work with youth will be cross‐system collaboration, particularly in the context of the MDT. Collaboration presents a variety of both benefits and challenges.
Benefits include: ● Bringing together stakeholders to develop a holistic and cohesive plan of action ● Ensuring a diverse set of perspectives, which include expertise from a variety of stakeholders, are included ● Providing an opportunity for youth to share their experiences and hopes for their own treatment plan, minimizing the number of times youth need to share potential trauma
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● Providing a space for participants to develop a treatment plan that all or most of the stakeholders can buy into ● Allowing participants to troubleshoot challenges to implementing the treatment plan ● Providing a space that enables participants to identify gaps in services and create novel ways to address the issue
The MDT structure also presents several challenges: ● People come with varying levels of experience with commercial sexual exploitation of children and youth ● It may be an unfamiliar structure for many of the participants, which will require the development of new skills, including the specific skill of communication within an MDT ● Various participants will have different bottom lines or mandates, leading to potential conflict of interests, which will necessitate negotiation between different stakeholders ● Various stakeholders have previous relationships with each other that may be both positive and negative ● Resources and services may be scarce or in need of development ● The MDT process is labor intensive and will require a substantial investment of time and energy
Despite these challenges, there are a variety of ways in which these challenges can be overcome. With education around the issue, structure, and effective communication, the challenges of unfamiliarity with the issue and discussing it may be solved. Conversations around various participants’ mandates are necessary; it is recommended that participants meet together before the MDTs take place with youth in order to have the larger discussions around working together. Participants must also have conversations to establish internal protocols, including their capacities to participate in a time intensive MDT process in order to effectively contribute to the MDT.
Building an MDT As recommended by Epstein and Edelman6 the activities of today’s MDT convening will facilitate building a cohesive MDT to work together and address the needs of youth. The following components are included today. Educate MDT members about the roles of each participating agency Walk through case studies together to practice working collaboratively to meet youth’s needs Establish a mission mutually agreed upon by all members Share information about youth’s needs for services, treatment, and placement, while addressing confidentiality and privacy concerns Create a plan to resolve conflict when it arises
6 https://www.traffickingresourcecenter.org/sites/default/files/Blueprint%20‐%20GL.pdf 21 CSEC 102: Building a CSEC/Y Multi‐disciplinary Team | Participant Guide | Version 1 | December 2015
Additional work needed to build a team includes the following elements. Ensure all team members have training on best practices related to commercial sexual exploitation of children and youth Identify existing gaps in services for youth Develop a protocol or MOU defining the group’s purpose, protocols, and procedures Evaluate the effectiveness of the team from the perspective of team members, youth, service providers, caregivers, and families Meet regularly to update protocols, resolve issues and share information
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Values Discussion Guide
Discuss the following question in small groups. Use the space below for personal note taking to bring ideas back to your agency.
How can you incorporate the following values into the MDT? Cultural sensitivity (gender, sexual orientation, race)
Empowerment
Prioritizing youth voice
Trauma informed
Strengths based
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Best Practices
Safety A crucial element of providing support to youth who have experienced commercial sexual exploitation is establishing immediate physical and psychological safety to provide stabilization.
Establishing safety is relevant in both crisis situations and situations in which a young person is maintaining stability. Crisis situations involve initial identification or seminal events like running away from a placement or an arrest.
Safety Considerations7 Factor Resource
Emergency housing/placement Children and Family Services, Probation, and law enforcement (in the event of a 5150)
Food and water First Responders (law enforcement, Advocates)
Rest and sleep First Responders (law enforcement, Advocates), placements
Crisis intervention for mental health Advocates, mental health staff needs
Emergency medical needs (physical Emergency Department/other medical injuries, sexual assault) providers
Dangers stemming from exploiter (i.e. Law enforcement threats of physical violence, stalking)
New county protocols should include establishing collaborative systems to address these emergency needs, including calling a Multidisciplinary Team Meeting.
7 adapted from: http://youthlaw.org/wp‐content/uploads/2015/05/Holistic‐Needs‐of‐CSEC.pdf
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Assessing for Safety Concerns8 When 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 family ● Threats of physical or sexual harm to self or family ● Forced to do things they don’t want to do ● Exposure to: ○ Drugs ○ Weapons ○ Peer or family illegal activity ● Likelihood of running away ○ Where youth would go/has gone? ○ Why youth would/did leave? ● Status of exploiter ○ Location ○ Investigation ● Youth’s perception of exploiter (sympathetic? scared?)
Safety Planning A safety plan is a step‐by‐step guide in which possible unsafe situations are assessed and potential solutions identified. An example of a safety plan follows:
Maria is 16 years old and was just released from juvenile hall. She will be in a probation placement in a group home. Maria has run from several group homes previously. She and her family have had a history of drug addiction, trauma, and involvement in gang activity in another city one hour away. She is close with her family. She does not identify her exploiter as being a trafficker, but she does not know his whereabouts. At the Multidisciplinary Team Meeting, stakeholders and Maria came up with the following safety plan:
Risk Type of Risk Plan
Running High‐her history of running and A probation officer will meet with away the subsequent vulnerabilities and Maria to talk about her AWOL safety concerns make this a triggers and establish a priority. communication plan for talking about how Maria is feeling using scaling questions. The probation
8 Adapted from: http://www.missingkids.com/en_US/documents/DomesticMinorSexTrafficking.pdf
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officer will then regularly go to the home to see how Maria is doing. Group home staff will regularly check in with Maria and assess her flight risk. If Maria wants to run away, she has agreed to call her advocate. Maria has identified several places she would feel comfortable going to besides back to her exploiter.
Sympathy Medium‐although she still has Maria has agreed to attend towards positive feelings towards her weekly therapy. As part of the trafficker exploiter, she does not know his terms of her probation, she will whereabouts. not be permitted to be in contact with her exploiter. Her cell phone use will be monitored by her probation officer and group home.
History of Medium‐while relevant, this is not Maria has agreed to try out drug drug use an immediate safety concern. treatment and be in conversation with her probation officer and therapist about it. Regular drug testing will be part of her probation.
Gang Low‐this poses a lower risk due to Her probation officer will monitor involvement gang being one hour away. her whereabouts.
Trauma Medium‐while relevant, this is not This issue will be addressed in history an immediate safety concern. weekly trauma‐informed therapy.
Family Low‐ this is less pressing because Her relationship with her family behaviors the family relationship is positive should be monitored. Her family and she is not living with them. will receive community‐based services so they are prepared in the event she is placed back with them.
Culturally Affirming Practices Culturally affirming practices not only involve the recognition of specific points of identity, but they actively validate and incorporate cultural factors into addressing youth’s multifaceted needs. It is based on the recognition that everyone has an identity and perspective, that they are all valid and meaningful, and we should not privilege one 26 CSEC 102: Building a CSEC/Y Multi‐disciplinary Team | Participant Guide | Version 1 | December 2015
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 only the young person.9 They recognize their personal biases, perspectives and identities. Stakeholders do not assume they know what a young person’s experience of their identity is and ask questions to further understand. Planning a response to a youth’s experiences and identity is based on the youth’s understanding of themselves.
Identity can be broken down into various categories. The following are major dimensions of identity, although this is not an exhaustive list. As previously mentioned, we must understand that everyone has a different understanding of their identity and what these terms mean to them. ● Race ● Ethnicity ● Sex ● Sexual orientation ● Gender expression ● Class ● Immigration status (i.e. lacking documentation for being in the United States/undocumented individuals) ● Native/spoken language ● Disability ● Age ● Religion ● Pregnancy
It is important to note that discrimination falls along these lines of identity.10 Discrimination can be loosely defined as: “unequal or different treatment or harassment that causes harm based on larger systems of power and control.”11
A relevant term is SOGIE, an acronym that stands for Sexual Orientation, Gender Identity, and Gender Expression, which is intended to reference issues of both homophobia and transphobia.12 Transphobia involves discrimination based on these points of identity, referencing the experiences of those who identify as gender nonconforming or transgender, in which someone’s understanding of their gender sometimes or does not always correlate to the gender associated with their sex at birth (i.e. a child born female but prefers to sometimes express their gender in a way traditionally associated with men). This is
9 http://www.psysr.org/jsacp/ahmed‐v3n1‐11_17‐28.pdf 10 http://www.naswdc.org/pressroom/features/issue/diversity.asp. 11 adapted from http://www.hrlsc.on.ca/en/what‐is‐discrimination 12 http://www.prearesourcecenter.org/sites/default/files/content/sogie_information_gathering.pdf. 27 CSEC 102: Building a CSEC/Y Multi‐disciplinary Team | Participant Guide | Version 1 | December 2015
particularly relevant because transgender youth make up a disproportionate percentage of youth who are being commercially sexually exploited.13
To make a final point on culturally affirming practice, we must recognize that being commercially sexually exploited and having trauma histories are often points of difference between us and the youth we work with. 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 sex work and potential volatility or disengagement, among other reactions. Part of being culturally affirming involves recognizing this dimension of the issue.
The following are several examples of culturally affirming practices: ● Providing translators for youth or parents who do not have a working knowledge of English ● Providing trauma‐informed care to counter the effects of trauma, which can be both a concrete event or systemic ● 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 with youth ● Not 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 understanding ● Staying supportive, calm or engaging if a young person presents as volatile or disengaged
Ultimately, culturally affirming practices involve taking the lead from a young person and responding to their unique needs and identities.
Positive Youth Development According to the Positive Youth Development, youth 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 using existing capacities and creating skills and knowledge with them that enable them to move in safe and positive directions, ideally as defined by themselves. 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. Some youth may be self‐conscious or resistant to participating at first and social workers or probation officers will need to engage with the youth to learn what activities might be appealing. It may help to connect youth with a mentor who will share in activities.
With the goal of facilitating healthy development, Positive Youth Development takes several different forms:
13 http://childwelfaresparc.org/wp‐content/uploads/2014/07/Sex‐Trafficking‐and‐the‐Child‐Welfare‐ System.pdf 28 CSEC 102: Building a CSEC/Y Multi‐disciplinary Team | Participant Guide | Version 1 | December 2015
● increased opportunities and avenues for positive use of time ● increased opportunities for positive self‐expression ● increased opportunities for youth participation and civic engagement
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 gym ● Volunteering ● Jobs/job training ● Art ● Writing/journaling ● Being or having a mentor ● Teaching or providing childcare to children ● Spending time with animals ● Activism ● Attending cultural events
In 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 in their lives.14
Early and Intensive Supervision Post Emergency Identification A crucial element of supporting youth who have experienced commercial sexual exploitation involves holistic, strengths‐based and intensive supervision provided by multiple parties. We can also think about it as wraparound support provided throughout their trajectories.
The Child Welfare Council CSEC Action Team identifies 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, calls for an Emergency Multidisciplinary Team Meeting (MDT) that should take place within two hours of identification. It is a collaborative approach that involves representatives from different systems. Mandated members include Child Welfare (provided there is a basis for jurisdiction), (probation, provided jurisdiction exists), CSEC Advocate, Department of Public Health, Department of Mental Health, youth and family (if appropriate). Circumstances that would necessitate an emergency MDT include when child welfare identifies an immediate safety concern through either a hotline call or the emergency
14 adapted from: http://www.nrcyd.ou.edu/publication‐db/documents/2008‐positive‐youth‐ development‐toolkit.pdf
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response social worker, identification by law enforcement, and identification by a medical provider. The following intensive services should be provided:
● Placement (determined by child welfare and/or probation) ● Medical and mental health treatment (within 72 hours) ● Transportation to placement ● Safety plan ● Basic necessities/hygiene bag ● 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 also calls for other types for MDTs, which will be enumerated below.
http://youthlaw.org/wp‐content/uploads/2015/05/Memorandum‐of‐Understanding‐ Template‐for‐the‐CSEC‐Program.pdf
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, but developing trust through consistency and transparency around services can help engage with youth.15
Placement Considerations:16 At the emergency MDT, placement decisions will be made collaboratively by stakeholders. When making this decision, participants should consider:
● Safety ○ Proximity to exploiter ○ Proximity to areas where the youth was exploited ○ Access to the internet or phones ○ Runaway risk ○ Recruitment risk‐‐to youth or other youth ● Security of placement (how much supervision is needed) ● Whether the placement and caregivers are affirming of a young person’s unique identity ● Proximity to resources ○ School ○ Medical care
15 http://youthlaw.org/wp‐content/uploads/2015/05/Holistic‐Needs‐of‐CSEC.pdf 16 Adapted from: http://youthlaw.org/wp‐content/uploads/2015/05/Holistic‐Needs‐of‐CSEC.pdf
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○ Mental health care ○ Activities ● Proximity to social support systems ● A young person’s history of running away from placement ● How to transition between different placements, especially if the young person is moving between child welfare and probation
Over time, the intention is for more CSEC‐specific placements to be developed.
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Communicating, Facilitating, and Participating
MDTs can be complex to facilitate and participate in. As previously mentioned, there are a variety of different stakeholders in the room with different mandates. There may be many participants, or perhaps the meeting will not be well attended. Emotions may run high‐‐this is a sensitive issue and we are dealing with questions that relate to a young person’s well‐being. Success can sometimes seem far away and working with youth can seem like an uphill battle if they are disengaged or angry.
The following section details general principles of effective communication. Actively listening, displaying empathy, speaking from personal experience, intentionally participating, asking open‐ended questions, and assuming positive intentions, are all crucial to communicating in an MDT.
Actively Listening Active listening is often contrasted with hearing. Hearing is a one‐way form of absorbing what someone is saying, while active listening involves engaging with conversation through body language, non‐judgment, internally reflecting on what is being heard, and sharing what is being heard with the person talking to confirm understanding. For example:
Youth: I don’t want to be here. Nobody cares and this is a waste of my time. Social Worker: I know this system can be complicated and frustrating, but I’m here and I care. Youth: I know. I really hate it. Social Worker: Which is understandable. We definitely want to work with you in a way that makes you feel better.
Displaying Empathy For example, empathy is not “feeling bad” for someone who has experienced something difficult, but rather, seeking to understand their experience from their perspective.
Speaking from Personal Experience A key element of effectively communicating within the context of an MDT is speaking from personal experience and avoiding generalizations. This often takes the form of speaking with “I‐statements” and the recognition that individuals are coming from different perspectives.
Intentionally Participating Intentionally participating in an MDT involves monitoring the extent on one’s participation in the meeting. There are two main roles in the meeting, the facilitator and participant. The role of the facilitator is to organize conversation within the meeting. 32 CSEC 102: Building a CSEC/Y Multi‐disciplinary Team | Participant Guide | Version 1 | December 2015
Participants play a different, but just as crucial role. In addition to following the general principles of communication outlined above, participants should monitor how much they are participating (too much or too little), ensure that they are present, paying attention, and representing their specific perspective while focusing on the youth’s needs rather than on what the participant thinks should occur. In order to intentionally participate, stakeholders should ask the following questions: ● Am I paying attention to what is going on? ● Am I speaking too much and a great deal more than other participants? ● Am I quiet and underrepresenting a certain perspective? ● Am I including or excluding any participants? ● Am I open to hearing others’ perspectives? ● Am I approaching the meeting from a calm and supportive perspective? ● Am I keeping any strong emotions I have in check?
Asking Open‐Ended Questions One way to approach a meeting with non‐judgment and provide support to others’ perspectives is to ask open‐ended questions. Rather than posing a yes or no question (a close‐ended question), open‐ended questions elicit longer responses and typically begin with or include the words “what,” “how,” and “in what way.” Below are several examples of close‐ended and alternatives for asking them in an open‐ended way:
Close ended: Do you want to go to back to living with your mom? Open ended: Where would you want to live, if you could decide?
Close ended: Are you going to follow the terms of your probation? Open ended: What are you thinking about following the terms of your probation? What would make it easier for you to complete the terms of your probation?
Close ended: Do you think you’ll run from your group home? Open ended: What would make you run from your group home?
Assuming Positive Intentions Participants in the MDTs may be approaching the meeting from a variety of different perspectives, some of which may conflict and lead to tension. One way to move through this is to start with the idea that everyone, even if they disagree, is approaching the meeting with a desire to support and care for the young person in their own way. Reminding oneself that others’ are coming from a positive place is another way to hold on to empathy throughout this process. Facilitators will be responsible to step in and redirect if a participant shows negative intentions or demands a particular outcome that others disagree with.
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Facilitation Tips17
The facilitator is responsible for managing meetings, keeping conversations on track, and ensuring each member’s voice is heard. This tip sheet gives some tips for how to accomplish these tasks.
What Do Facilitators Do? ● Smoothly manage the flow and discussions of a meeting or event ● Guide dialogue and attempts to maximize the effective use of member’s time and energy by keeping the event and discussions on track – in terms of time and topic ● Recognize and utilize the unique and valuable contributions of each member
What Makes a Good Facilitator? Competent facilitators have both personal characteristics and acquired skills that make them good at what they do. Many good facilitators make a difficult process seem very natural and intuitive, even when lots of planning and training goes into the craft. We’ve listed some key characteristics here.
Good facilitators ● Value people and their ideas ● Think quickly and logically ● Are excellent communicators ● Are both product and process oriented
What are the Facilitator’s Basic Responsibilities? Prepare in Advance Take into consideration the “who, what, why, and where” of your MDT to help you figure out the “how.”
Plan and Distribute the Agenda The agenda guides participants in knowing what to expect and how to prepare.
Assign a Note Taker Assign a note taker to document the issues discussed, plans, and action steps.
State your objectives at the beginning of the MDT
17 Adapted from the Centers for Disease Control 34 CSEC 102: Building a CSEC/Y Multi‐disciplinary Team | Participant Guide | Version 1 | December 2015
Members will be much better prepared to contribute and help you meet the objectives if they know what they are. Your job as a facilitator is to ensure that the group understands what needs to be accomplished.
Establish Community Expectations. These ground rules help participants establish appropriate ways to interact with each other during the meeting or event. You want the group to agree to a respectful, collaborative process. By stating the rules up front and getting agreement from the group, you’re more likely to see that happen. If negative behaviors occur, refer back to the expectations.
Guide the group in presenting and sharing information. Your methodology may vary, but the methods you use should include all members in the discussion and prevent one or two members from dominating the dialogue. Everyone may not talk, but no one should feel excluded from the process.
Provide closure and reiterate action items. As part of ensuring that all ideas and points are captured accurately, it is also the role of the facilitator to ensure that action items are noted and that follow‐up on the item is assigned to someone.
Don’t use the facilitator role to prioritize or make a lot of space for your opinion Facilitators can be tempted to use their role as a platform for prioritizing their opinions, so be sure to pay attention to when and what you are sharing. If you want to share your opinion, let the group know you are doing so not as a facilitator, but as a participant coming from a specific position.
What Do I Do? Some Trouble‐Shooting Tips As a facilitator, you may be required to intervene to keep the MDT on track and obtain optimal productivity. Listed below are some tips for intervening in particular circumstances.
Staying on‐task and on‐time. Your community may have a lot to get accomplished in a short amount of time. With groups of passionate and knowledgeable people, it is easy to veer off onto other topics or easily get side‐tracked by minute details of a conversation. In order to help the group stay focused on the youth, you may want to: Remind the group of the “keep focused” expectation Don’t be afraid to directly re‐focus the group on a particular agenda item Try to close the item (process or system issues) or set it aside in a “parking lot” for consideration later Let the team decide
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Dealing with unproductive behavior. Difficult behavior is often unintentional or occurs as the result of an emotionally charged situation. You might be dealing with inattentive members who are engaging in side‐bar conversations, taking calls or indiscreetly dealing with e‐mail. You might also be dealing with personal agendas or disrespectful behavior. Progressive intervention will most often assist you in dealing with behavior that does not help the community achieve its meeting goals or objectives. Use gentle and appropriate humor for redirection Restate the ground rules directly Direct your questions to the individual for clarification Seek help from the group Address the issue at a break or offline
Stimulating productive inquiry. While passionate people often have a lot to say and suggestions for action, it is not uncommon for communities to experience lulls in an on‐going conversation or a stand‐ still in a single event. You might want to use the following techniques to keep the conversation going. Use probing questions Invite the experts to speak up Call on individuals in the group Invite debate
Confidentiality Have team members sign a confidentiality statement No verbal information from the meeting may be used in court If a person on the team violates confidentiality, he or she will not be permitted to participate again
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Overview of Each Stakeholder
The issue of the commercial sexual exploitation is a complex one that necessitates collaboration between multiple stakeholders. The following appendix outlines the major stakeholders who are involved in the issue. Not all stakeholders are required to be at the MDT, but their role is outlined due to relevance. Bolded stakeholders are recommended participants (based on the CSEC Action Team Model Framework).
While youth are not required to be at the MDT, it is important to include the youth’s voice as much as possible in the planning process. Youth may not be willing to participate, but if they are, it is important to center conversation on their understanding of their needs. Understanding them as victims who have experienced exploitation and trauma, as well as survivors with strengths, is crucial to this process.
Child welfare is now the central institution holding the issue. As the commercial sexual exploitation of children is now grounds for a mandated report, the child welfare hotline is the first point of intervention. After mandated reporters make the call to the hotline, child welfare triages the situation and makes a decision as to whether they will investigate the case immediately or within 10 days. If immediate intervention is deemed necessary, the Emergency Response worker will go out, assess the situation, call an emergency MDT, and carry out any placement decisions that are made. Child welfare will be responsible for coordinating and providing logistical support for placement decisions, should jurisdiction be established by the Welfare and Institutions Code. Child welfare will also provide ongoing support and supervision to the young person and their family, if relevant, connecting them to resources and advocating for the child within dependency court.
Probation also plays a significant role in this process. If young people have outstanding warrants for other crimes or are arrested for other crimes, probation will take the lead and coordinate intake and detention processes. If youth are identified as being exploited after being detained, Probation is responsible for making a mandated report and connecting youth to services. Probation should be present at all MDTs. Even if youth who have experienced exploitation have committed crimes, it is important to understand them in the context of exploitation and abuse.
Law enforcement are often First Responders and a major source of CSEC identification. They are responsible for calling Child Welfare to make a mandated report and helping determine placement for a child, depending on the presence of many factors, including whether the child is the subject of a missing persons report, if they have a warrant out for their arrest for another crime, or whether there are grounds for a forced psychiatric hold (5150).
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Education representatives are present to support the coordination of a young person’s educational placement. This decision is very important, as a child can be both strengthened and weakened by their school placement. There are a variety of different types of schools youth can attend, so it is important to assess what a young person’s capacities and interests are to create the best educational fit possible.
Mental Health, Public Health, and Substance Use providers should be involved at the MDT and will provide comprehensive services to youth, as well as giving input into the coordination of necessary services through the county or other providers
Caregiver or placement providers could be parents or other family members, foster parents, or group home staff. Their voices are important so they can share what experiences the youth have had at their placement, what placements they believe will be most supportive of the young person, and describe their capacity to support the youth.
Survivor and mentors are another form of support youth can receive, which many report as being incredibly powerful and crucial to their experiences with making changes and overcoming exploitation. They provide a very important perspective in the context of the MDT, providing advocacy for youth and an understanding of the issue coming from direct and personal experience with exploitation. When survivors and mentors participate in MDTs, it is important not to just pay lip service to their perspective, but view it as a powerful resource that is unique and legitimate.
Local CSEC provider agencies coordinate and provide direct service, including therapy; 24/7 emergency support; accompaniment to forensic interviews, court or other evidence gathering efforts; acting as a First Responder and advocate; and case management. This can be another venue for hearing what the young person wants directly for themselves. They can also provide culturally competent and specific support to other stakeholders as they learn the issue.
Children’s dependency attorneys represent youth within dependency court once they are officially brought into child welfare. These attorneys can provide a perspective on where the child is in terms of their dependency case and gather information relevant for dependency court.
If a young person is involved in the juvenile justice system, Defense Attorneys, which include Public Defenders and court appointed attorneys for the child, play the major role of providing the context of exploitation when advocating for a child who has committed a crime in court. Due to attorney‐client privilege, Defense Attorneys will only share specific information about exploitation when the young person gives permission.
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Prosecutors can be prosecuting either the youth themselves if they have committed a crime or be prosecuting exploiters. Through the entire course of their involvement, like every other stakeholder, it is important to center the work on the needs of the child.
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Sample MDT Agendas
AGENDA FOR INITIAL MDT ● Go over agenda and community expectations of MDT (which are written down and posted ‐ see next page for sample community expectations): o Acknowledge that there are many people in the room and that it may be uncomfortable for the youth, but reiterate commitment to them. o Ask if anyone has any questions or additions to the expectations. ● Lead introductions: o Name o Role o Each 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.) o Any questions from participants (facilitator writes down) o Ask young person what they want to start with, if they are there. ● Go through each theme: o Reiterate the goals within this theme. o Identify relevant strengths, worries, what’s working well, what’s not working, what supports are needed ● Create a safety plan o Identify timeline for actions and who is responsible for follow‐up for each action step o Use identified strengths to help build next‐steps and action plans ● Close the meeting: o Each person will summarize their next steps o Each person will validate young person and recognize their strengths.
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AGENDA FOR ONGOING MDT ● Go over agenda and community expectations of MDT (which are written down and posted): o 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 person o Ask if anyone has any questions or additions to the expectations. ● Lead introductions: o Name o Role o Questions you have (facilitator writes down) o Ask young person what they want to start with, if they are there ● Go through each theme: o Review themes and action steps from previous meeting o Solicit new goals or concerns from participants o Ask if anyone has any follow‐ups from previous action steps for each theme (bring these back from previous meeting, which have been written down) o Discuss newly emerging strengths, ongoing strengths, what’s working well, worries, what’s not working, newly emerging safety concerns ● Go over last safety plan: o Make revisions o Use identified strengths to help build next‐steps and action plans ● Close the meeting: o Each person will summarize their next steps o Each person will validate young person and recognize their strengths.
COMMUNITY EXPECTATIONS 1. Hear and prioritize youth’s voice 2. Respect each other’s perspectives, even if they are different or conflicting with our own 3. Intentionally participate—Watch if you are talking too much or too little and adjust accordingly 4. Don’t rush, but also be aware of time 5. Actively listen 6. Speak positively and be hopeful 7. Address strengths and resilience factors including positive changes
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Planning Worksheet
1. Who are the participants/stakeholders for the MDT in our county / region?
2. What is the shared mission of our MDT?
3. Who will call the meeting if Probation identifies the need for an MDT?
4. Who will call the meeting if Child Welfare identifies the need for an MDT?
5. Who will call the meeting if Law enforcement identifies the need for an MDT?
6. Who will lets stakeholders know where and when the meeting will be?
7. Is the same stakeholder participating every time or will there be multiple possible participants filling each role?
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8. How does this change if Probation identifies the need for an MDT?
9. How does this change if Child Welfare identifies the need for an MDT?
10. How does this change if Law enforcement identifies the need for an MDT?
11. Who will be the point person for scheduling the MDT?
12. Who will be the point person for organizing where it is held?
13. Who will facilitate? How will the facilitator be determined?
14. What will everyone’s internal protocols be for alerting the representative from each discipline?
15. What does the ongoing process of recruitment for MDT participation look like?
16. Who will make sure the correct participants are attending?
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17. What are the agreements among the group about preparing in advance for MDTs?
18. How many days before the meeting should agenda items be submitted?
19. What does it mean to be prepared?
20. When/where will our next meeting after this training be?
21. What will our goals for this first meeting be?
22. What information do we still need in order to hold a successful MDT?
23. What are each of our responsibilities going forward?
24. What is our plan for supporting ongoing communication among MDT members?
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25. What additional work is needed regarding setting internal protocols for participating agencies or developing and MOU?
26. What process will we use to resolve conflicts when they arise?
27. Identify additional questions needing attention to ensure the MDT process is successful.
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Personal Goals
1. What is one thing you learned today?
2. Describe how you will apply something you learned today in your work?
3. 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?
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Appendix A: Harm Reduction
The 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.
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Appendix B: Examples of Strengths
Coming from a strengths‐based perspective can build rapport, increase a youth’s self‐ esteem, and inform interventions. The following lists a variety of CSEC’s individual, family and community strengths. This 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: ● Motivated ● Caring of family and friends ● Resourceful ● Thoughtful ● Smart ● Independent ● Mature ● Having hobbies ● Having goals ● Standing up for themselves ● Loyal ● Protective ● Loving
Family Strengths: ● Close knit ● Loving ● Supportive ● Loyal ● Financial stability
Community Strengths: ● Strong sense of community within the neighborhood ● Strong sense of culture ● Connections to religious groups, community groups, etc. ● The community takes care of each other ● The community is family‐like
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Appendix C: Checklist for MDT Facilitator
Before the MDT: ● Has everyone been reminded of the location, time, length and anything they need to bring? ○ Ongoing list of who should be there ● Has everyone RSVPed? ● Has the youth’s attendance been prioritized? ● Have you asked for agenda items with a deadline? ● Have the agenda items been submitted? ● Has the agenda been sent out? ● Has a copy of the previous safety plan been printed out? ● Has a copy of the previous goals/actions been organized
During MDT: ● Is the list of community expectations posted? ● Is a list of goals/action steps from the previous meeting posted? ● Do participants have copies of the previous safety plan? ● Has everyone signed in? ● Are there name tags? ● Is there someone taking notes? ○ Including action steps and who is responsible for following up on each step ● Has the date/location of the next meeting been decided/how to decide the date/location next meeting?
After the MDT: ● Have the notes been sent out?
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Appendix D: Trauma‐informed Practice
Trauma‐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. o Trauma can shape youth’s perceptions of the way people treat each other, leading to the normalization of negative and abusive relationships. o Trauma can impact brain development and cause youth to struggle to regulate emotions and think through decisions. o 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. o It can be a one‐time event, acute trauma, like an injury or single instance of sexual assault. o 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. o Other examples of trauma include community violence, natural disasters, or school violence.18 ● 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 love • Offers of protection or safety • Isolation (physical and social) • Monopolization of perception • Induced debility or exhaustion • Threats to youth, family, or pets • Enforcing trivial demands*(for example: requiring the person being exploited to only use a certain amount of toilet paper) • Physical or sexual force
18 From http://www.nctsn.org/trauma‐types 50 CSEC 102: Building a CSEC/Y Multi‐disciplinary Team | Participant Guide | Version 1 | December 2015
• Degradation • Occasional indulgences • Validating 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 person • Trauma bonding
Exploiters’ 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 bonding • Trauma 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 needs ● Trauma 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.19 Trauma‐informed Practices
19 From WestCoast Children’s Clinic Research to Action: Sexually Exploited Minors’ Needs and Strengths 51 CSEC 102: Building a CSEC/Y Multi‐disciplinary Team | Participant Guide | Version 1 | December 2015
● 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 52 CSEC 102: Building a CSEC/Y Multi‐disciplinary Team | Participant Guide | Version 1 | December 2015
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.
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Appendix E: Client‐Centered Care
The 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 listening ● Asking permission to offer your opinion ● Compartmentalizing your own beliefs ● Providing choices ● Collaborating with the youth (and the MDT) when developing a plan ● Trusting their stories and opinions ● Identifying what they are doing well ● Asking youth how they got through tough situations ● Highlighting skills they use to get through tough situations ● Letting them know that skills are transferrable to other situations if they want to use them20
Strategies 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 placements ● Prioritizing youth’s attendance at MDTs, if they want to attend ● Asking youth about their desires to engage in services and taking them into account when connecting young people with resources ● Setting short‐term and long‐term goals for education, placement, etc. ● Providing consistency of workers to ensure continuity of services ● Making connections to youth mentors and survivor leadership
20 Contra Costa County Zero Tolerance Initiative for Domestic Violence Human Trafficking 101 Training 54 CSEC 102: Building a CSEC/Y Multi‐disciplinary Team | Participant Guide | Version 1 | December 2015
Appendix F: 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 supervision ● Victim Survivor Leader Model ● Practicing cultural sensitivity ● Incorporating a positive youth development perspective
Providing 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 Placements Placement 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: ● Safety o Proximity to exploiter o Proximity to areas where the youth was exploited o Access to the internet or phones o Runaway risk o Recruitment risk—to youth or other youth ● Security of placement (how much supervision is needed) ● Whether the placement and caregivers are affirming of a young person’s unique identity ● Proximity to resources o School o Medical care
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o Mental health care o Activities ● Proximity to social support systems ● A young person’s history of leaving placements How 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 placement21
AWOLing and Reintegrating into a Previous Placement In 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 homes o Developing protocols for reserving beds for youth who have left the placement o Upon the young person’s return, facilitating conversations about why the youth left and identifying barriers and potential solutions to staying o Ensuring that relationship building and engagement of the youth is taking place—this can take the form of staff‐youth relationships or youth‐youth relationships o Ensuring youth‐youth conflict is addressed quickly and in a supportive and empathetic fashion o Identifying what needs the placement is not filling—what new elements of a successful placement would a young person need? o Ensuring smooth communication between child welfare workers and group home staff o Maintaining accountability for group home staff and systems by monitoring and evaluating their work through data and conversations with youth o Developing CSEC‐specific elements of group homes informed by focus groups involving both CSEC themselves and providers o Conducting ongoing trainings on CSEC‐specific issues (harm reduction, relationship building, trauma‐informed practice) and providing sufficient support to group home staff, including supervision o Ensuring 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 members
21 From the Child Welfare Council CSEC Action Team: Holistic Needs of Commercially Sexually Exploited Children 56 CSEC 102: Building a CSEC/Y Multi‐disciplinary Team | Participant Guide | Version 1 | December 2015
o Providing support to family members while CSEC are both in the home and while they have left—develop a plan for creating these supports collaboratively o 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 necessary o Interacting 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 themselves o Seeking to understand issues they are facing as unique individuals and families o Problem solving struggles with family members and anticipating future challenges ● Foster care providers o Providing CSEC‐specific training (harm reduction, relationship building, trauma informed practice) and support for foster care providers before and during placement—consider support groups o Maintaining accountability for foster care providers by monitoring and evaluating their work through data and conversations with youth o Ensuring 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. o Encouraging long term commitments to youth to provide consistency of relationships
Victim, Survivor, Leader Model Girls 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 57 CSEC 102: Building a CSEC/Y Multi‐disciplinary Team | Participant Guide | Version 1 | December 2015
narratives about themselves that they have not gotten from peers, families, or society regarding themselves or their exploitation ● Opportunity 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 shaming ● Opportunity 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 relationships ● Space and opportunities to regain control and develop a sense of self‐worth through activities and relationships ● Programming that supports youth in thinking about themselves as resilient and strong ● Opportunity to provide support to others, connect with other youth, and have concrete ways to put skills into action ● A way to imagine their future, potential, and goals in a new way22
“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 Lloyd
Practicing 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.23 They recognize their personal, implicit
22 From Rachel Lloyd, From Victim to Survivor, from Survivor to Leader 23 From “What Does It Mean to be a Culturally Competent Counselor” 58 CSEC 102: Building a CSEC/Y Multi‐disciplinary Team | Participant Guide | Version 1 | December 2015
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.
● Race ● Ethnicity ● Sex ● Sexuality ● Gender expression ● Class ● Immigration status (i.e. lacking documentation for being in the United States/undocumented individuals) ● Native/spoken language ● Disability ● Age ● Religion ● Pregnancy ● Possible gang or other affiliations
It is of important note that discrimination and oppression fall along these lines of identity.24 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”). 25, 26
Issues of gender, sexuality, race, and gender expression are of particular note, especially because significant discrimination exists around these points of identity. While boys are also commercially sexually exploited (and these cases are most likely underreported), commercially sexually exploited youth are overwhelmingly girls. Youth of color, LGBTQ youth, and transgender or gender nonconforming youth are also disproportionately
24 From http://www.naswdc.org/pressroom/features/issue/diversity.asp 25 From Training for Change 26From the Human Rights Legal Support Centre 59 CSEC 102: Building a CSEC/Y Multi‐disciplinary Team | Participant Guide | Version 1 | December 2015
being commercially sexually exploited. 27, 28 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 work ● Providing 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 exploitation ● Not 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 understanding ● Staying 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 Perspective According 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
27 From the H.E.A.T. Watch Toolkit 28 From Child Sex Trafficking and the Child Welfare System 60 CSEC 102: Building a CSEC/Y Multi‐disciplinary Team | Participant Guide | Version 1 | December 2015
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 time ● Increased opportunities for positive self‐expression ● Increased opportunities for youth participation and civic engagement
Other 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 gym ● Volunteering/ jobs/job training ● Art/writing/journaling ● Being or having a mentor ● Teaching or providing childcare to children ● Spending time with animals ● Activism ● Attending cultural events ● Connecting to a religious community
In 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.29
29 From the National Child Welfare Resource Center for Youth Development: Positive Youth Development Toolkit
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References
Ahmed, 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 http://www.psysr.org/jsacp/ahmed‐v3n1‐11_17‐28.pdf.
Boston University School of Public Health. (2013). The Transtheoretical Model (Stages of Change). Retrieved from http://sphweb.bumc.bu.edu/otlt/MPH‐ Modules/SB/SB721‐Models/SB721‐Models6.html.
Boston University School of Public Health. (2013). [Graphic Illustration of the Stages of Change Model]. The Transtheoretical Model (Stages of Change). Retrieved from http://sphweb.bumc.bu.edu/otlt/MPH‐Modules/SB/SB721‐Models/SB721‐ Models6.html.
California Child Welfare Council CSEC Action Team. (2015). Holistic Needs of Commercially Sexually Exploited Children. Retrieved from http://youthlaw.org/wp‐content/uploads/2015/05/Holistic‐Needs‐of‐CSEC.pdf.
California Child Welfare Council CSEC Action Team. (2015). Memorandum of Understanding Template for the Commercially Sexually Exploited Children (CSEC) Program. Retrieved from http://youthlaw.org/wp‐ content/uploads/2015/05/Memorandum‐of‐Understanding‐Template‐for‐the‐ CSEC‐Program.pdf.
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