Medical, Legal, & Social Science Aspects of Child Sexual Exploitation A Comprehensive Review of Pornography, Prostitution, and Internet Crimes G.W. Medical Publishing, Inc. St. Louis Medical, Legal, & Social Science Aspects of Child Sexual Exploitation A Comprehensive Review of Pornography, Prostitution, and Internet Crimes Richard J. Estes, DSW, ACSW Sharon Cooper, MD, FAAP Angelo P. Giardino, MD, PhD, FAAP Professor Adjunct Associate Professor of Pediatrics Associate Chair – Pediatrics Chair, Concentration in Social and University of North Carolina School of Associate Physician-in Chief/ Economic Development Medicine Vice-President, Clinical Affairs Director, International Programs Chapel Hill, North Carolina St. Christopher’s Hospital for Children University of Pennsylvania School of Social Clinical Assistant Professor of Pediatrics Associate Professor in Pediatrics Work Uniformed Services University of Health Drexel University College of Medicine Philadelphia, Pennsylvania Sciences Adjunct Professor of Pediatric Nursing LaSalle Bethesda, Maryland University School of Nursing Victor I. Vieth, JD Chief , Developmental Pediatric Service Philadelphia, Pennsylvania Director Womack Army Medical Center APRI’s National Child Protection Training Fort Bragg, North Carolina Nancy D. Kellogg, MD Center Professor of Pediatrics Winona State University University of Texas Health Science Center at Winona, Minnesota San Antonio Medical Director Alamo Children’s Advocacy Center G.W. Medical Publishing, Inc. St. Louis FOREWORD In my career as a prosecutor, and now a Congressman, I have seen tremendous im- provements in our nation’s response to cases of child maltreatment. In most commu- nities today, multidisciplinary teams work together for the benefit of children. Many elected district attorneys, sheriffs, and police chiefs have developed specialized units to respond to cases of child abuse. Through the work of the American Prosecutors Research Institute’s National Center for Prosecution of Child Abuse, the National Child Protection Training Center at Winona State University, Fox Valley Technical College, the National Center for Missing & Exploited Children, and other federally funded programs, thousands of frontline professionals are trained annually in the art and science of handling child protection cases. Perhaps the most important development is the Children’s Advocacy Center program. Children’s Advocacy Centers (CACs) are child-friendly facilities where children can be interviewed sensitively and receive medical and psychological services. As a district attorney, I had the privilege of starting the nation’s first Children’s Advocacy Center. As a member of Congress, I championed support for the National Children’s Advo-cacy Center in Huntsville, Alabama, and the National Children’s Alliance, a coalition of CACs from across the nation that is headquartered in Washington, DC. Today there are hundreds of CACs in every part of our country. We can not, however, rest on our laurels. As detailed in the pages of this book, modern technology poses a new threat to our children. It is increasingly easy for perpetrators to exploit children through the Internet, to create and disseminate child pornography, and to solicit children for illicit purposes. The commercial exploitation of children is a global problem that impacts every community in the United States. Through the pioneering work of Dr. Richard Estes and other researchers, we know that hundreds of thousands of children are at risk of commercial exploitation. Although more research needs to be done, there is some evidence to suggest these children are just as likely to come from rural and suburban communities as urban centers. I commend GW Medical Publishing as well as the editors and contributors to this book for producing a treatise that addresses child sexual exploitation from every angle. I am particularly grateful to the survivors of child pornography, commercial exploitation, and online solicitation for sharing their pain with those of us who will read this book. I hope the courage of these survivors spurs all of us to do more to protect children. Finally, I want to commend the frontline investigators, prosecutors, medical and mental health professionals, and other child advocates who are in the trenches daily trying to spare children from every form of exploitation. You labor long hours for little pay or honor on behalf of someone else’s children. Please know that your selfless dedication is not unnoticed. Indeed, your heroism is an inspiration to us all. Congressman Robert E. “Bud” Cramer, Jr. Member of the US House of Representatives (1991-present) Founder of the Children’s Advocacy Center movement ix FOREWORD It is common to hear pronouncements from public figures that children are society’s most important and treasured assets. To an overwhelming majority, this concept is fundamentally true. To a marginal and deviant minority, however, children are viewed as commodities to be traded, imported, and exported like any other merchandise. Parents and professionals need help combating the alarming growth of child exploitation and this book is a valuable tool in the fight to protect our children from predators who would use them for financial gain or prurient reasons. Global in scope, these 2 volumes are written by individuals who represent a wide array of backgrounds, disciplines, and perspectives. Some authors are the authentic voices of those who were victimized and forced to navigate a system that was intended to help but found to be less than helpful. Some speak from distant lands that are growing ever closer with the ease of air travel and where the youth are being sold to travelers seeking to indulge their perverse needs with someone else’s children. Some voices are actually electronic particles from cyberspace delivering images of unspeakable abuse to our home and office computers. Some of the highlights of this book that I found interesting include: — A chapter discussing exploitation in advertising and the need for healthcare providers to be aware of the “slippery slope” that can occur when girls and teens are used in sexualized marketing — A chapter about the resources of the National Center for Missing & Exploited Children with a focus on their Exploited Child Unit — A chapter from UNICEF on the global commodification of children for sexual work and exploitation — A chapter from the University of Washington School of Journalism discussing the importance of addressing child victims of sexual exploitation in an empathetic and nonvictimizing manner in the newspapers; the chapter includes excerpts and photographs from a focused series in the Atlanta Journal Constitution called “The Selling of Atlanta’s Children,” which played an important role in convincing the Georgia State Legislature to change its laws to make the selling of children a felony, as compared to its history of misdemeanor status for over a century — A chapter from the Association for the Treatment of Sexual Abusers (ATSA) regarding the ethical issues in child sex offender assessments and the benchmarks for parole and probation determinations — Chapters relating to the medical and surgical complications of prostitution — A chapter discussing the demographics of girls who are brought into the criminal justice system and recommendations for communities to avoid the incarceration of prostituted children and youths — A chapter that explains the nuts and bolts of “cloning a computer” when an investigation is conducted in a child pornography case — A chapter describing other aspects of federal laws that are involved when children and youths are trafficked into the United States for sexual exploitation purposes, including civil rights violations and labor law violations — A chapter on the AMBER Alert legislation and the several children whose lives contributed to its inception — A chapter detailing the frequently overlooked concept of child sexual exploitation in rural communities xi Foreword This book represents the culmination of the efforts of an impressive collection of premier investigators, judicial participants, child protection agency personnel, and clinicians to gather and organize information about child exploitation. It is the most comprehensive text on this subject and it is a welcome addition to the literature on child maltreatment. Robert M. Reece, MD Clinical Professor of Pediatrics Tufts University School of Medicine Visiting Professor of Pediatrics Dartmouth Medical School Editor, The Quarterly Update xii FOREWORD In 1981, my worst nightmare became a reality when my 6-year-old son, Adam, was abducted and murdered. The prime suspect in Adam’s case was never charged. He died in prison while serving a life sentence for other crimes. With determination to spare other families from enduring a similar tragedy, my wife Revé and I worked to help enact the Missing Children Act of 1982 and the Missing Children’s Assistance Act of 1984. We founded the National Center for Missing & Exploited Children (NCMEC) in 1984. In the past 20 years, the rate of recovery of missing children has increased from 62% to 95%. While the NCMEC is best known for its work in tracking down missing children, the Exploited Child Unit, established in 1997, has also been a primary resource for law enforcement and families in the investigation and prosecution of the sexual exploitation of children. Child sexual exploitation is a worldwide problem, encompassing child pornography, molestation, and prostitution. In recent years, computers