Last updated: August 2014 www.ojjdp.gov/mpg 

Commercial Sexual Exploitation of Children and Sex 

Trafficking 

Commercial Sexual Exploitation of Children (CSEC) refers to a “range of crimes and activities involving 

the sexual abuse or exploitation of a child for the financial benefit of any person or in exchange for 

anything of value (including monetary and non-monetary benefits) given or received by any person.” 

(OJJDP n.d.). There are no Federal, national estimates of the extent and prevalence of CSEC in the 

United States due to a variety of issues including general underreporting of the crime and the 

difficulties associated with identifying and measuring victims and perpetrators. Academic efforts to 

quantify the extent of the problem have included estimates that range from a few thousand to millions 

(IOM and NRC 2013; Bryan 2014; The Polaris Project 2012). When estimates are presented, they often 

come with numerous qualifiers and caveats (IOM and NRC 2013). 

Commercial sexual exploitation manifests in numerous forms, such as sex trafficking, prostitution, sex 

tourism, pornography, early marriage, performance in sexual venues, and online or electronic 

transmission of children engaged in sexual activities (OJJDP n.d.). Sex trafficking is also a form of 

human trafficking (President’s Interagency Taskforce to Monitor and Combat Trafficking in Persons 

2014, 5). Human trafficking can appear in several other forms, including forced labor, bonded labor, 

involuntary domestic servitude, child soldier recruitment, and debt bondage among migrant laborers 

(U.S. Department of State 2011). Recent estimates by global organizations suggest that around 27 

million people worldwide are current victims of human trafficking (Williamson 2012). Sex trafficking 

is most common in Europe, Central Asia, and the Americas (Greenbaum 2014). 

Governmental and nongovernmental organizations define human trafficking as the exploitation of 

another person through the use of fraud, coercion, or force. The U.S. Trafficking Victims Protection Act 

of 2000 (TVPA) states that “any commercial sex act if the person is under 18 years of age, regardless of 

whether any form of coercion is involved, is defined as human trafficking” (U.S. Department of State 

2011, 8). Therefore, if the victim is considered a minor, then force, fraud, or coercion do not need to be 

established; the sex act is automatically sex trafficking. 

A recent U.S. Department of Justice report found that 82 percent of suspected U.S. trafficking incidents 

between 2008 and 2010 were classified as sex trafficking. This included over 1,000 reported allegations 

of adult sex trafficking and over 1,000 incidents of child sex trafficking (Banks and Kyckkelhahn 2011). 

Similarly, other studies have found that as many as 79 percent of human trafficking cases are identified 

as instances of sexual exploitation (van der Laan et al. 2011). A 2012 report by the United Nations Office 

on Drugs and Crime found that victims from 136 countries worldwide were trafficked in 118 countries, 

demonstrating the global impact and reach of human trafficking (Greenbaum 2014). 

Suggested Reference: Development Services Group, Inc. 2014. “Commercial Sexual Exploitation of Children/Sex Trafficking.“ 

Literature review. Washington, D.C.: Office of Juvenile Justice and Delinquency Prevention. 

https://www.ojjdp.gov/mpg/litreviews/CSECSexTrafficking.pdf 

Prepared by Development Services Group, Inc., under cooperative agreement number 2013–JF–FX–K002. Points of view or opinions 

expressed in this document are those of the author and do not necessarily represent the official position or policies of OJJDP or the 

U.S. Department of Justice.

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Antitrafficking Legislation

The Trafficking Victims Protection Act (TVPA) a law enacted to end human trafficking. It provides an 

evaluation tool that rates nations on their efforts and ability to end human trafficking. Through the U.S. 

Department of State, each country is assigned a “tier” that is used to measure how individual nations 

comply with U.S. antitrafficking policies (Goodey 2008). Tier 1 is given to nations that comply with U.S. 

antitrafficking polices, and Tier 3 is the lowest ranking, assigned to nations with the lowest level of 

compliance. Designation as a Tier 3 nation can have serious consequences and can lead to sanctions 

from the U.S. government, which affect nonhumanitarian and non-trade-related aid (Goodey 2008). 

Additionally, the TVPA sets a minimum standard for countries to follow as they strive to actively 

combat trafficking through the use of a “3 Ps” paradigm: Prevention of human trafficking; Protection 

of victims; and Prosecution of trafficking offenders (U.S. Department of State 2011; President’s 

Interagency Taskforce to Monitor and Combat Trafficking in Persons 2014). The prevention and 

prosecution elements of the “3 Ps” approach are rooted in the victim-response model to human 

trafficking. Responding to the needs of trafficking victims is generally less complicated compared with 

trying to resolve the root causes of human trafficking, which often include unequal economies or 

conflicts and war (Goodey 2008). 

The U.S. Congress has reauthorized TVPA four times. The most recent reauthorization, which was part 

of the Violence Against Women Reauthorization Act of 2013, includes a particular focus on sex 

trafficking of minors (President’s Interagency Taskforce to Monitor and Combat Trafficking in Persons 

2014). 

These “3 Ps” are also included in the Palermo Protocol, an anti-trafficking law created by the United 

Nations, that resembles the TVPA. The Palermo Protocol emphasizes “effective action to prevent and 

combat trafficking in persons... [it] includes measures to prevent such trafficking, to punish the 

traffickers, and to protect the victims of such trafficking” (U.S. Department of State 2011). The protocol 

requires the prohibition and punishment of all human trafficking crimes. A majority of nations, 

including the United States, have ratified and implemented the Palermo Protocol. 

Since the implementation of this protocol, the numbers of prosecutions and convictions for human 

trafficking has steadily risen worldwide, with 6,017 prosecutions and 3,319 convictions in 2010, almost 

2,000 more combined prosecutions and convictions than in 2008 (U.S. Department of State 2011). The 

Palermo Protocol and the TVPA are international examples of measures that can be used to combat 

trafficking and legal precedents requiring state parties to act and be accountable for ending CSEC and 

Sex trafficking. 

Characteristics of CSEC and Sex Trafficked Children 

Identifying victims of CSEC and sex trafficking, can be difficult because of a general lack of public 

awareness about the issue; the reluctance of many exploited children to identify themselves as victims; 

and extreme measures taken by exploiters to hide their victims and their crimes (Walker 2013; 

President’s Interagency Taskforce to Monitor and Combat Trafficking in Persons 2014). On average, 

children first fall victim to CSEC between ages 12 and 14 (Adams, Owens, and Small 2010; Greenbaum 

2014). Many youth CSE victims tend to come from vulnerable populations with a serious history of 

previous abuse. Some research suggests victims are now increasingly younger because exploiters are 

worried about contracting HIV or AIDS from victims (Adams, Owens, and Small 2010). Research on 

people who are trafficked shows that victims (juvenile and adult) come from all backgrounds, sexes, 

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nations, and economic levels. In a 2011 report by the Bureau of Justice Statistics on the characteristics 

of suspected human trafficking incidents, almost 95 percent of sex trafficked victims were female. Over 

half (54 percent) were 17 years of age or younger. About one fifth of the victims were white, one fifth 

of Hispanic/Latino origin, and one third were black/African American. The vast majority of sex 

trafficking victims were U.S. citizens or permanent U.S. residents (approximately 77 percent), while less 

than 15 percent were undocumented or qualified aliens (Banks and Kyckkelhahn 2011). 

The degree of traumatization experienced by CSEC victims is well documented. Sexually exploited 

persons suffer from high rates of posttraumatic stress disorder (PTSD), Stockholm Syndrome, memory 

loss, aggression, fear, depression, anxiety, hostility, anger issues, sexually transmitted disease/infection 

(STD/STI), physical trauma from beatings, and emotional and psychological trauma from engaging in 

unwanted sex (Greenbaum 2014; Cohen, Edberg, and Gies 2011; Raymond and Hughes 2001; Hughes 

1999). Furthermore, minors exploited through prostitution are 70-90 percent more likely than nonexploited youth to have been victims of child abuse and they are also 28 times more likely to be arrested 

for prostitution in their lifetime (Goodman and Laurence N.d.). CSEC victims often suffer extreme 

shame about their experiences and they may face the stigma associated with being “sexually 

promiscuous” (Walker N.d.). 

Many risk factors at the societal, community, relationship, and individual levels increase youths’ 

vulnerability to CSEC. The individual level factors include sexual or physical abuse or maltreatment, 

being a runaways or homeless, system-involvement, such as with the juvenile justice and child welfare 

systems, being lesbian, gay, bisexual, or transgender, substance abuse, earlier pubertal maturation, and 

early adversity experiences (IOM and NRC 2013). In addition, CSEC victims also tend to suffer higher 

rates of poverty, live in high-crime neighborhoods/environments, have increased rates of mental health 

issues and higher rates of substance abuse/use or parents who abuse/use substances, and are less likely 

to be educated or exposed to employment opportunities (Bryan 2014). Societal risk factors include 

glorification of pimp culture, objectification of women and girls, gender bias, and widespread use of 

Internet and social media (Greenbaum 2014). Environmental risk factors that allow for higher rates of 

CSEC and sex trafficking of children include geographical areas with large and international airports, 

large transient male populations, community violence, street-involved culture/economy, and higher 

rates of prostitution (Greenbaum 2014). 

Although research has indicated that most CSEC victims tend to be girls, in recent years the literature 

has expanded to recognize the victimization of men and boys. While research is limited on male victims 

of CSEC, new studies suggest that the number of boys and girls involved in child sex trafficking is likely 

to be similar in numbers (Walker 2013; Greenbaum 2014). A study in New York City found that 40 

percent of CSEC cases in the city involved male victims (Bryan 2014). The gender disparity in awareness 

and research could be due to the fact that boys are less likely to be identified as commercially sexually 

exploited or at risk for victimization (Walker 2013; Bryan 2014). Currently, very few organizations 

provide services for boys and young men who are victims of sexual exploitation. Consequently, few 

resources provide valuable information about exploitation of boys and young men. It is known that 

many CSE boys are homeless or runaways and are significantly less likely than girls to have a pimp or 

other adult exploiting them (Walker 2013). Boys and young males likely share many of the risk factors 

for involvement in CSE as girls, such as child maltreatment and family violence (IOM and NRC 2013). 

Theoretical Foundation 

A majority of jurisdictions in the United States treat child victims of sex trafficking as offenders (Epstein 

and Edelman 2013). Girls are often picked up for prostitution and then charged for selling sex or other 

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related offenses. They are kept in custody and often have little to no access to a support system or 

treatment options (Epstein and Edelman 2013). This punitive treatment of CSEC and trafficked victims 

can be traced back to how prostitution is viewed in many cultures. A literature review suggests two 

prevailing views when examining prostitution: the view of prostitution as inherently bad and the belief 

that it should be decriminalized (Cohen, Edberg, and Gies 2011). 

Those who see prostitution as immoral tend to operate under an “oppression” paradigm in which 

prostitution and sex work is seen as degrading and a prime example of patriarchal aggression and 

domination (Cohen, Edberg, and Gies 2011). This perception is further demonstrated by the choice of 

terms used to describe women and youths engaged in sex work, such as “victim,” “survivor,” and 

“prostituted persons.” The ‘prostitution as oppression’ paradigm categorically denies prostitution as 

legitimate work, suggesting that entering into sex work cannot be a rational choice. 

Conversely, those who support legalization of prostitution see it from an “empowerment perspective.” 

From this view, sex work becomes equivalent to all other types of economic transactions (Cohen, 

Edberg, and Gies 2011) and is essentially seen as another good that can be purchased. Proponents of 

this approach use different terminology from those favoring the oppression paradigm. For example, 

those in the sex industry are referred to as “sex workers” or “providers” (Cohen, Edberg, and Gies 

2011). The empowerment paradigm accepts that these individuals face dangerous situations, abuse, 

exploitation, and/or coercion, but this view also accepts that selling sex as a commodity can be a 

rational and legitimate choice for those who choose to engage in it. 

The judicial system often seems to follow the empowerment paradigm system and views these young 

girls as rationally choosing to engage in selling their bodies for sex. As Epstein and Edelman (2013) 

note, many trafficked girls may not even see themselves as victims initially. They may not conform to 

the stereotypical image of how a “victim” looks. With the empowerment model, the system sends CSEC 

victims into the juvenile justice system on prostitution or other related charges. Instead of receiving 

treatment for their abuse, they are treated punitively, which creates a higher risk for revictimization 

(Epstein and Edelman 2013). In recent years there has been a movement in the academic and treatment 

community to recognize commercially exploited children and youth as victims, reflected in the use of 

such language as “sexually exploited children,” “trafficked children,” or “sex trafficked children” 

(Greenbaum 2014). 

Pathways to Commercial Sexual Exploitation of Children

Commercial sexual exploitation of children creates a culture that perceives children as commodities 

that can be bought and sold with little regard for their well-being. In many cases of CSEC and child sex 

trafficking, victims are exploited through more than one form of abuse. For example, predators may 

take pornographic images of children, sell those images to other child sex abusers, or use the pictures 

to advertise the victim for sexual services (Walker N.d.). 

Research suggests several common manners of entry for CSEC victims. In addition to the risk factors 

mentioned above (Epstein and Edelman 2013; IOM and NRC 2013), other CSEC cases begin when 

family members trade or sell a child for drugs and/or money. In addition, a growing number of CSEC 

and child sex trafficking incidents occur through peer recruitment (Greenbaum 2014; Adams, Owens, 

and Smalls 2010). 

A combined study from Mexico, the United States, and Canada on CSEC found that several core factors 

often fuel this phenomenon: 

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1) Reliance on prostitution by runaway and thrown-away children to provide for 

their subsistence needs; 2) preexisting adult prostitution markets in communities 

with high concentrations of street youth; 3) prior history of child sexual abuse and 

child sexual assault; 4) poverty; 5) large numbers of unattached and transient 

males in communities, including military personnel, truckers, conventioneers, and 

sex tourists; 6) for some girls, membership in gangs; 7) promotion of juvenile 

prostitution by parents, older siblings, and boyfriends; 8) recruitment of children 

by organized crime units for prostitution; and increasingly, 9) illegal trafficking of 

children for sexual purposes to the United States from developing countries in 

Asia, Africa, Central and South America, and Central and Eastern Europe. [Estes 

and Weiner 2001, 2] 

“Survival sex” is another type of entry into commercial sexual exploitation, where sex is exchanged for 

necessities such as food or housing. Gang involvement is another common entry for girls into sexual 

exploitation. Girls are seen as having little to no value other than how they can be used, such as for the 

sexual gratification of male gang members (IOM and NRC 2013). 

Traffickers (commonly called “pimps”) play another large role in the recruitment and subsequent 

sexual exploitation of children. They prey upon children from disadvantaged homes/settings and 

exploit victims through promises of love, food, money, or shelter (Epstein and Edelman 2013). Several 

different types of pimps participate in CSEC. The term “gorilla pimp” is used when a child has been 

kidnapped and held against his or her will. This type of pimp is likely to use violence and intimidation 

to force victims to comply (Kennedy et al. 2007). The “Romeo pimp” is also referred to as the “boyfriend 

pimp.” He will use courtship techniques to romance girls and make them feel special and appreciated. 

Once he has charmed and manipulated them, he then introduces the idea of selling sex (Kennedy et al. 

2007). 

The Urban Institute reported how young women and girls are recruited into the commercial sex 

industry (Dank et al. 2014). Analysis of information gathered from eight major U.S. cities suggested that 

women and girls entered the commercial sex industry as a result of economic need, family and peer 

encouragement, need for social acceptance, and previous childhood trauma. The report assessed pimps 

and their recruitment strategies and found that pimps used many different kinds of coercion, force, and 

fraud when recruiting, managing, and retaining control over their “employees.” Pimps used tactics 

such as promising material comforts; feigning romantic interest; creating mutually dependent 

relationships between pimp and employee; using physical violence, emotional abuse, or sexual abuse; 

and manipulating individuals already under the pimp’s control to recruit and manage other employees. 

The Urban Institute study also found that the widespread availability and use of the Internet created 

new ways for pimps to recruit and advertise employees (Dank et al. 2014). 

Outcome Evidence 

Outcome evidence on prevention and intervention programs for minors at risk or exposed to CSEC is 

limited (IOM and NRC 2013; President’s Interagency Taskforce to Monitor and Combat Trafficking in 

Persons 2014). Available research tends to focus on adults who are commercially and sexually exploited 

and is skewed towards those who engage in street prostitution, which represents only a small fraction 

of CSEC victims. The research base has been able to provide push/pull factors that contribute decisions 

to enter into CSE. 

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A 2013 Institute of Medicine (IOM) and National Research Council (NRC) report on commercial sexual 

exploitation and sex trafficking of minors in the United States found that CSE and sex trafficking of 

minors creates serious short and long-term problems, not just for children being abused but also for 

affected families, communities, and society. The report noted that while efforts to prevent CSE of 

minors are essential, actual prevention programs are largely absent. Furthermore, programs that 

identify victims and respond to their unique needs are beginning to emerge, but at present are still 

largely insufficient, uncoordinated, under-supported financially and on the community level, and 

under-evaluated. The study called for collaborative approaches to meet all aspects of identifying, 

rescuing, treating, and ending CSEC. Finally, the report authors strongly emphasized the need to 

directly confront the demand created by individuals who seek to abuse and sexually exploit children 

(IOM and NRC 2013). 

In 2011 the Campbell Collaboration conducted a systematic review of prevention and intervention 

strategies that are used to reduce sexual exploitation in human trafficking. The evaluation focused on 

instances of cross-border trafficking for sexual exploitation. The researchers found that out of 19,398 

citations focusing on sex trafficking, only 4 studies presented evaluation research. Of these four, none 

met the requirements of Level 3 on the Maryland Scientific Methods Scale (SMS) (a Level 3 on the SMS 

scale requires that studies use a controlled design with both pretest and posttest measures and 

comparable control conditions). According to the review authors, “no substantive conclusion about the 

effectiveness can be made, resulting in neither support nor rejection of present anti-trafficking 

initiatives” (van der Laan et al. 2011, 24). Little is known regarding which programs are effective or 

ineffective for treating victims of human trafficking for sexual exploitation. 

A few examples exist of evidence-based prevention and treatment programs for youth who are sexually 

abused or traumatized. However, relatively few programs (including those discussed below) have 

specifically focused on researching the impact of services on CSEC. One of the first implementations on 

the local, national, and global levels has been to educate lawmakers, judicial members, communities, 

and treatment providers about CSEC and child sex trafficking through the use of targeted and specific 

training programs. 

Training on Human Trafficking 

Organizations such as the United Nations, the North Atlantic Treaty Organization, and the 

Organization for Security and Co-Operation in Europe have made efforts to combat human trafficking 

(U.S. Department of State 2011). All three organizations implemented zero-tolerance human trafficking 

policies for their members. Additionally, these organizations developed and regularly implement 

trainings for their staff on how to recognize, combat, and prosecute human trafficking crimes. However, 

a large gap still remains between the actual training of individuals and the implementation of 

intervention strategies identified in those trainings. Specifically, there is a huge disparity in the 

prosecution of traffickers. A study conducted by Farrell and colleagues (2012) found while the U.S. 

Department of Justice had received a substantial increase in its budget as an effort to fund the 

prosecution of federal human trafficking cases, just a small number of prosecutions continued to occur. 

As of 2012, only 700 cases of trafficking suspects have been prosecuted federally. Furthermore, “only 

18 states had brought forward prosecuting charges under state human trafficking statutes” (Farrell et 

al. 2012, 5). 

Farrell and colleagues discovered several factors that discouraged prosecutions of suspected human 

traffickers on the federal and state levels, including 1) low awareness among law enforcement, 

prosecutors, judges, and jurors about the crime of human trafficking, 2) victims’ needs were often 

unmet and they lived in great fear for their lives or the lives of families and friends, discouraging them 

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from testifying against their traffickers, 3) negative attitudes from prosecutors and law enforcement 

against human trafficking victims, who were often seen as responsible for their own victimization, 4) 

general lack of knowledge among state and federal police and prosecutors about the existence and 

requirements of state and federal human trafficking laws, and 5) serious state prosecutorial 

inexperience using new state human trafficking laws. 

A 2008 study by Newton, Mulcahy, and Martin on finding victims of human trafficking found similar 

results from a survey of law enforcement and prosecutors from 60 counties across the United States. 

The authors reported confusion and lack of awareness among respondents about anti-trafficking 

statutes and the characteristics and elements of trafficking. The report also included an examination of 

records on human trafficking cases from four sites. Although recordkeeping to track investigations was 

incomplete, available data suggested that in the jurisdictions with specialized training, investigators 

appeared to write well-detailed reports, even when cases were later identified as not being trafficking 

incidents. Such detailed information can be useful when later prosecuting trafficking perpetrators 

(Newton, Mulcahy, and Martin 2008). 

Training that increases awareness and knowledge of anti-trafficking laws and allows individuals to 

notice and identify some attributes of trafficked individuals is just one step in ending the sex trafficking 

business. However, there are numerous barriers to the identification of sex trafficking victims. Victims 

are often unaware where to report their abuse, or they may be so traumatized that they cannot vocalize 

their experiences. Victims are usually told that their families will be hurt if they report the abuse, so 

many stay quiet out of fear for their loved ones’ safety. Additionally, victims may come from cultures 

and/or countries where there is a general mistrust or fear of the police or where police and criminal 

justice corruption are rampant (Goodey 2008). All these factors likely influence the reporting of abuse 

and the identification of victims and those responsible for trafficking. 

President’s Interagency Taskforce to Monitor and Combat Trafficking in Persons 

In 2012, President Obama created an interagency task force to monitor and combat trafficking in 

persons. The task force included 17 agencies and members such as Attorney General Eric Holder, 

former Secretary of Health and Human Services Kathleen Sebelius, and Secretary of Homeland Security 

Jeh Johnson. They created an action plan for 2013–2017 and sought to create a victim-centered approach 

to treatment, public awareness, and outreach efforts for those affected by human trafficking. The task 

force outlined four major goals: 

• Align efforts: Promote a strategic, coordinated approach to the provision of services for victims 

of human trafficking at the federal, regional, state, territorial, tribal, and local levels 

• Improve understanding: Expand and coordinate human trafficking–related research, data, and 

evaluation to support evidence-based practices in victim services 

• Expand access to services: Provide and promote outreach, training, and technical assistance to 

increase victim identification and expand the availability of services 

• Improve outcomes: Promote effective, culturally appropriate, trauma-informed services that 

improve short and long-term health, safety, and well-being of victims (President’s Interagency 

Taskforce to Monitor and Combat Trafficking in Persons 2014) 

The coordination of federal agencies to work towards and implement these goals will hopefully lead to 

the development of sustainable victim services for those currently suffering as sexually trafficked 

individuals. Currently, however, the initiatives proposed by the taskforce have not been evaluated. 

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Safe Harbor Laws 

Safe Harbor (SH) laws were developed from protections afforded victims of sex trafficking and CSEC 

created by the TVPA in 2000. They concentrate on rescuing and protecting minors exploited through 

prostitution, diverting them from the juvenile justice system, and offering them specialized treatment 

and services (Wayman 2013). While SH laws may consist of a variety of provisions, there are generally 

two major elements: the decriminalization of prostitution for minors and the provision of services for 

youths exploited through prostitution. Most states tend to focus on either decriminalization or the 

provision of services rather than simultaneously addressing both elements. Connecticut and Tennessee, 

for instance, prohibit the prosecution of minors but offer little else in protection or specialized services. 

Massachusetts, New York, Ohio, Vermont, and Washington do not decriminalize youths engaged in 

prostitution (Wayman 2013; Geist 2012) but do offer diversion programs designed to provide needed 

services. Minnesota and Illinois use a combination of both decriminalization and diversion to provide 

the most comprehensive legal reform (Geist 2012). Some states that have passed SH laws have also 

included additional features, such as increasing penalties for pimps and johns, establishing training for 

law enforcement, and providing access to housing or safe shelters for victims (Wayman 2013). 

Decriminalization under SH laws allows minors exploited through prostitution to avoid arrest and 

prosecution, since they are viewed as victims of trafficking (Wayman 2013). The provision of 

specialized treatment and services under SH laws concentrates on the emotional, physical, and 

psychological trauma associated with CSEC and sex trafficking of minors (Geist 2012). Services include 

shelter/housing, child care, medical care, substance abuse and mental health treatment, job training, 

and continuing education (Cohen 1987; Cohen, Edberg, & Gies 2011). In some states, youths receive 

services through state agencies, such as child welfare, because the juvenile justice system may be ill 

equipped to address the unique needs of CSE and trafficking victims (Geist 2012). 

SH laws attempt to change the response and treatment of prostituted juveniles, so all youths are viewed 

as victims and receive needed services to address their victimization. There are currently 18 states that 

have offer some form of a SH law in the United States. 

Screening Tools 

In an effort to better recognize trafficking victims, the Vera Institute recently published a report 

detailing its findings on an innovative Human Trafficking Identification Tool (Simich 2014). The tool is 

based on research that the Vera Institute conducted to develop reliable trafficking victim identification 

practices. The 30-topic questionnaire is statistically validated and designed to obtain evidence on 

trafficking victimization. A study was conducted to test the screening tool on 180 potential trafficking 

victims identified through service victim organizations in five states. The study found that the tool 

could differentiate between labor and sex trafficking victims and also distinguish trafficking victims 

from other crime victims. Out of the 180 participants, 53 percent were identified as human trafficking 

victims, with 40 percent reported as sex trafficked and 60 percent as labor trafficked (Simich 2014). 

However, the study had some limitations, including the fact that most interviewees were adults and 

most victims were foreign-born. Future evaluations using this tool could lead to improved ways of 

identifying child victims of CSEC and sex trafficking and providing these children with appropriate 

treatment. 

Prevention Programs 

The Stewards of Children program seeks to educate professionals working with children how to 

recognize and help child victims of sexual abuse. This prevention training program targets teachers, 

care providers, and other adults who work in a professional capacity with children. The program seeks 

to improve awareness on the prevalence, consequences, and circumstances that surround child sexual 

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abuse. Stewards of Children uses specific strategies to prevent child sexual abuse from occurring while 

also providing secondary training to identify if/when abuse occurred and how to appropriately 

respond to the child’s needs. The program’s goal is to keep children safe from future abuse while also 

preventing potential subsequent abuse-related problems. 

A study conducted by Rheingold and colleagues (2011) found positive, significant differences between 

those adults who received training in the Stewards of Children program on measures of child sexual 

abuse knowledge and self-reported prevention behaviors compared with those adults in the wait-list 

control condition. These positive differences remained between groups at the 3-month follow-up. 

Epstein and Edelman (2013) found that many professionals who work regularly with child populations, 

such as social workers, teachers, and state welfare advocates, have encountered trafficked children but 

did not recognize that the children had been trafficked. Programs such as Stewards of Children focus 

on training professionals that work directly with children to recognize and identify those who may be 

at risk for sexual abuse or victimization. 

Treatment Programs for Victims 

Victims of trafficking and CSEC often have serious and complicated mental health needs caused by 

their traumatic experiences. Often victims experience psychological issues such as posttraumatic stress 

disorder (PTSD). A Department of Health and Human Services report on evidence-based mental health 

treatment for victims of human trafficking found that some of the “most common presentations for 

victims of child sexual exploitation are substance-related disorders, dissociative disorders, impulse 

control, conduct disorder, attention-deficit/hyperactivity disorder, antisocial personality traits, and 

most or all of the Axis IV psychological and environment problems” (Williamson, Dutch, and Clawson 

2010, 8). 

Unfortunately, information is lacking about effective methods to treat youth because the identification 

of PTSD in children has only been recognized more recently compared with adults (Williamson, Dutch, 

and Clawson 2010). The Trauma-Focused Cognitive Behavioral Therapy (TF–CBT) program is one that 

has been shown to positively impact children who have experienced negative traumatic life events. The 

TF–CBT treatment intervention is designed to support children ages 3–18 and their parents in 

overcoming the negative effects of physical and/or sexual abuse. It targets serious emotional problems, 

including PTSD, stress, anxiety, fear, and depression, by teaching children new skills to process 

thoughts and emotions that result from the traumatic events. TF–CBT integrates cognitive and 

behavioral interventions with traditional child-abuse therapies. Its focus is to help children talk directly 

about their traumatic experiences in a supportive environment. 

Studies by Deblinger, Lippman, and Steer (1996), Cohen and Mannarino (1996), and Cohen -and 

colleagues (2004) found that children assigned to TF–CBT treatment scored significantly lower than 

control group children on scales measuring PTSD, depression, problem behaviors, sexualized 

behaviors, and externalizing behaviors. At the 2-year follow-up period, the Deblinger team (1996) 

found that improvements in externalizing behavior, depression, and PTSD for children were 

maintained. 

More information on the programs can be found at the following two sites: 

Stewards of Children 

Trauma-Focused Cognitive Behavioral Therapy (TF–CBT) 

Programs that target CSEC victims often have multiple limitations. For instance, most available 

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research on treating CSEC victims contains incomplete or inadequate information about the programs 

and their implementation. The studies usually have very small sample sizes, in part due to the difficulty 

in identifying and providing services to the population. Additionally, many programs are only funded 

for a short time, and are often forced to end because there are no additional financial resources to 

support or expand them (citation). 

Conclusions 

While national and international agencies have attempted to locate and punish those who seek to take 

advantage of vulnerable populations through commercial sexual exploitation of children and sex 

trafficking, much work is still needed in this area (President’s Interagency Taskforce to Monitor and 

Combat Trafficking in Persons 2014). Few evidence-based programs support CSEC victims or educate 

the public, sex buyers, and traffickers. Research suggests greater emphasis is needed on the prosecution 

of traffickers and sex abusers (Farrell et al. 2012), as well as increased opportunities for victims to be 

diverted into appropriate treatment programs rather than be prosecuted for selling sex (Cohen, Edberg, 

and Gies 2011). Additional research may provide the insight needed to effectively combat and finally 

end the occurrence of these crimes. 

References 

Adams, William, Colleen Owens, and Kevonne Small. 2010. Effects of Federal Legislation on the Commercial 

Exploitation of Children. Juvenile Justice Bulletin. Washington, D.C.: U.S. Department of Justice, 

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