Laurel Edinburgh

Restoring Healthy Developmental Trajectories for Sexually Exploited Young Runaway Girls: Fostering Protective Factors and Reducing Risk Behaviors

PURPOSE To examine effects of the Runaway Intervention Program (RIP), a strengths-based home visiting, case management, and group support program for sexually assaulted or exploited young runaway girls; staffed by advanced-practice nurses, RIP aims to restore healthy developmental trajectories by reestablishing protective factors, reducing trauma responses, and lowering risk behaviors that are common sequelae of sexual violence. METHODS Quasi-experimental study of RIP girls (N = 68) ages 12 to 15 (mean, 13.75 years), assessed at baseline, 6 and 12 months for changes in family and school connectedness, other adult caring, self-esteem, emotional distress, suicidality, recent substance use, plus risky sexual behaviors. Responses at each time were also compared to nonabused and abused urban ninth-grade girls (mean age, 14.64, N = 12,775) from the 2004 Minnesota Student Survey (MSS). Analyses used paired t-tests, McNemars test, Wilcoxon sign-rank, chi-square, and Pearsons correlations. RESULTS At entry, RIP girls were most like sexually abused MSS peers, with lower levels of protective factors and higher levels of distress and risk behaviors than nonabused MSS girls (p < .05 to p < .01). However, they saw significant improvements by 6 and 12 months, such that all measures of protective factors, positive development, distress, and risk behaviors more closely resembled nonabused MSS girls by 12 months. Of equal note, RIP girls with the greatest emotional distress, the lowest levels of connectedness, and lowest self-esteem at baseline demonstrated the greatest improvement (all p < .001). CONCLUSIONS This appears to be a promising intervention for restoring sexually abused runaway girls to a healthy developmental trajectory.

Assessing exploitation experiences of girls and boys seen at a Child Advocacy Center

The primary aim of this study was to describe the abuse experiences of sexually exploited runaway adolescents seen at a Child Advocacy Center (N = 62). We also sought to identify risk behaviors, attributes of resiliency, laboratory results for sexually transmitted infection (STI) screens, and genital injuries from colposcopic exams. We used retrospective mixed-methods with in-depth forensic interviews, together with self-report survey responses, physical exams and chart data. Forensic interviews were analyzed using interpretive description analytical methods along domains of experience and meaning of sexual exploitation events. Univariate descriptive statistics characterized trauma responses and health risks. The first sexual exploitation events for many victims occurred as part of seemingly random encounters with procurers. Older adolescent or adult women recruited some youth working for a pimp. However, half the youth did not report a trafficker involved in setting up their exchange of sex for money, substances, or other types of consideration. 78% scored positive on the UCLA PTSD tool; 57% reported DSM IV criteria for problem substance use; 71% reported cutting behaviors, 75% suicidal ideation, and 50% had attempted suicide. Contrary to common depictions, youth may be solicited relatively quickly as runaways, yet exploitation is not always linked to having a pimp. Avoidant coping does not appear effective, as most patients exhibited significant symptoms of trauma. Awareness of variations in youth’s sexual exploitation experiences may help researchers and clinicians understand potential differences in sequelae, design effective treatment plans, and develop community prevention programs.

Caring for young adolescent sexual abuse victims in a hospital-based children's advocacy center

OBJECTIVES This study compared health care assessments, referrals, treatment, and outcomes for young adolescent sexual assault/sexual abuse victims seen at a hospital-based Child Advocacy Center (CAC), to that provided to similar victims evaluated by other community providers. A second purpose was to document how common DNA evidence is found among such cases. METHOD A retrospective matched case-comparison design matched index CAC cases diagnosed with extra-familial sexual assault to non-CAC cases referred for prosecution in the same county, matched by age and sex of victim, age and sex of perpetrator, and type of assault (N=128 pairs). Since the case-comparison design produces paired data, analyses used paired t-tests, McNemars test, and Wilcoxon signed-rank tests. Health care outcomes included whether victims received a health exam, indicated tests, findings of trauma on genital exams and counseling referrals; legal outcomes included whether cases were prosecuted, verdicts, and length of sentences. RESULTS CAC cases were significantly more likely to receive a physical exam, a genital exam when indicated, and referral for counseling (all p<.001). In the CAC group 26.7% vs. 4.8% had positive genital trauma findings, and only 6.3% of CAC cases failed to get indicated sexually transmitted infection (STI) tests or prophylactic treatment for STIs vs. 80% of the comparisons (p<.001). There were no differences in decisions to prosecute, convictions, or sentence lengths between the groups. DNA was documented in only 27.3% of acute cases, although evidence kits were completed. CONCLUSIONS Young adolescent sexual abuse victims received markedly different health care in a hospital-based CAC compared to elsewhere. DNA is not commonly found in acute cases. IMPLICATIONS FOR PRACTICE Community health care providers and law enforcement should be encouraged to refer victims to hospital-based CACs for specialized examinations and treatment.

Gender Differences In Extrafamilial Sexual Abuse Experiences Among Young Teens

Extrafamilial sexual abuse experiences of young adolescents (ages 10–14), particularly young teen boys, are not well studied. This retrospective chart review study compared psychosocial correlates and victimization experiences between young adolescent girls (n = 226) and boys (n = 64) referred to a hospital child advocacy center. Several differences in risk behaviors and abuse experiences were found: Girls were more likely to have run away, to be truant from school, to report substance use, to have multiple perpetrators, and to have physical findings from the abuse. Boys were more likely to have a diagnosis of attention deficit disorder and to report anal penetration, and rarely disclosed abuse at the time of the incident. Peers were girls’ most common choice for disclosing abuse, whereas boys confided most often in their mothers or other adults. These findings suggest sexually abused young adolescent girls and boys need distinct, developmentally appropriate screening and care in school and health care settings.

The Hmong Youth Task Force: evaluation of a coalition to address the sexual exploitation of young runaways.

The Minnesota Wheel of Public Health Nursing Interventions identifies coalition building and community organizing as effective strategies for addressing population health issues. One program that exemplifies these strategies is the Hmong Youth Task Force, a coalition formed to address a growing issue of young Hmong girls in a Midwest state running away from home, being truant from school, and experiencing subsequent sexual exploitation. This is an evaluation of the Task Force. It draws on existing records and semi-structured interviews with Task Force members from various sectors of government, health services, and community organizations, including public health nurses. The results, evaluated in the context of best practices identified by the Wheel of Interventions, document the Task Forces development, accomplishments, challenges faced, and community changes that have resulted from the coalitions efforts to date.

Multiple perpetrator rape among girls evaluated at a hospital-based child advocacy center: seven years of reviewed cases.

The aim of this study was to describe contextual events, abuse experiences, and disclosure processes of adolescents who presented to a hospital-based Child Advocacy Center for medical evaluation and evidentiary collection as indicated after experiencing multiple perpetrator rape during a single event (n = 32) and to compare these findings to a group of single perpetrator sexual assaults (n = 534). This study used a retrospective mixed-methods design with in-depth, forensic interviews and complete physical examinations of gang-raped adolescents. Patients ranged from 12 to 17 years (M = 14 years). Girls who experienced multiple perpetrator rape during a single event were more likely to have run away, to have drunk alcohol in the past month, and to have participated in binge drinking in the past 2 weeks. Acute presentation of these victims were rare but 30% had hymenal transections and 38% had sexually transmitted infections (STIs). Forensic interviews revealed alcohol was a common weapon used by offenders, and its use resulted in victims experiencing difficulty in remembering and reporting details for police investigation or physical and mental health care. Most victims were raped at parties they attended with people they thought they could trust, and they felt let down by witnesses who could have helped but did not intervene. Although relatively rare, multiple perpetrator rape during a single event is a type of severe sexual assault experience and has significant risks for deleterious health outcomes. These victims require health care by trained providers to diagnose physical findings, treat STIs, screen for trauma, and support victims.

It's called "Going out to play": a video diary study of Hmong girls' perspectives on running away.

How do Hmong immigrant adolescent girls decide to run away, return home, leave again, or stay home? Video diaries by 11 sexually exploited runaway Hmong girls, ages 13–16, revealed four themes: “fighting restrictions,” or resisting family and cultural expectations and desires to be like other American teens; “not running away, going out to play,” which captured impulsive decision making; “unrestrained partying,” which described runaway experiences but minimized the dangers faced; and “trying to change,” or returning home because of family bonds and wanting to “be someone good.” Given their limited ability to anticipate risks, interventions should focus on runaway prevention initiatives for Hmong families and teens.