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Supporting Young Women Survivors of Commercial Sexual Exploitation: Long Term 

Solutions to an Age Old Problem

BACKGROUND

Commercial sexual exploitation of children (CSEC) in the United States, including domestic trafficking, 

is receiving considerable attention as an issue that warrants urgent response. While some have 

approached domestic sex trafficking as a new phenomenon, at the National Crittenton Foundation we 

know that this issue has been around for a very long time. For more than 129 years, Crittenton 

agencies have supported survivors of trafficking and commercial sexual exploitation reclaim their lives 

and their futures. While many who recognize the Crittenton name associate it with single mothers, in 

truth we were founded to support women seeking to leave lives of “ill repute” or violent situations. 

Today, our network of 27 agencies provides services in 31 states and the District of Columbia to girls 

and young women living in rural, suburban, urban and tribal communities who have experienced 

violence, abuse and persistent neglect. From intensive residential treatment and transitional programs, 

to after school and wrap around community-based programs to in-home supports, services are 

provided using a social justice framework that demands a dual focus on symptoms and root causes.

The harsh reality is that when it comes to the epidemic of violence against girls in our country we 

look away.

• One out of every three girls in this country experiences violence and abuse as a child.

• Nearly 25 percent of all females raped here at home are 12 years old or younger and 61 percent 

are under the age of 18. 

No question–we have a problem. But to be clear, CSE is a symptom of a much larger societal problem 

that continues to go unaddressed, namely violence and abuse against girls and young women. This 

violence is rooted in the way in which society views girls and women. Violence and the vulnerability, 

isolation and instability it causes are the reason girls enter the foster care and juvenile justice systems. 

It is why they run away, escape through drugs and alcohol, get pregnant and fall prey to traffickers.

Regardless of the negative circumstances in which girls find themselves it is most often these 

conditions beyond their control that propel them into a life marked by self destructive cycles.

As of late we are often asked about the services provided, observations and thoughts on CSEC. This 

document is a compilation of ideas, thoughts and practices based on the experiences of Crittenton 

agencies.
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CRITTENTON AND CSEC

During the past 24-36 months Crittenton agencies have experienced a significant increase in the 

number of young women who are under the age of 18 and are referred by child welfare and juvenile 

justice for services because the have been identified as being involved in domestic commercial sexual 

exploitation. This includes being trafficked for sex. While these formal referrals have increased, our 

experience suggests that CSEC is a symptom of the root causes (noted above) exacerbated by many 

larger challenges facing system-involved girls. As such, throughout the years many girls have come to 

Crittenton agencies with histories of exchanging sex for shelter, food, safety, etc. It is important to keep 

in mind that most of the needs of girls who are trafficked are similar to the needs of all girls and young 

women who are survivors of sexual abuse and/or other forms of violence. In fact, they are the same 

girls. 

Girls who are vulnerable to commercial sexual exploitation include those in the juvenile justice or foster 

care systems who move around frequently and do not have stable family environments. Some have 

been kicked out of their homes or run away because of inter-familial violence. Many have had multiple 

placements throughout their young lives. The absence of unconditional love in their lives and the abuse 

and betrayal they experience heightens their vulnerability to the manipulations and false promises of 

pimps involved in the commercial sex trade. Given their unstable histories, many do not want to “leave 

the life” and don’t realize that they are being exploited until it is far, far too late. Few have the 

knowledge of resources that can help them escape. They see the life they are living as better than and 

even “glamorous” compared to the living conditions they had before. While it is difficult to understand

how girls can glamorize the abuse and exploitation they experience, it is essential to be sensitive to this 

perspective in order to create effective programs and services to address their needs and “get out” of 

the life.

Much progress has been made recently to highlight the importance of addressing childhood trauma. 

Yet there is much work to be done to identify trauma early on and to ensure that girls who have 

experienced sexual, physical and emotional abuse get the help they need before commercial sexual 

exploitation can take hold. Unaddressed trauma often causes girls to undervalue themselves and their 

worth, crave attention and material goods, and believe that the abuse and violence are a part of who 

they are. By the time they are referred to our agencies, it is a complex and long term process to help 

them build self- esteem, value themselves and their bodies, and believe that they have a future beyond 

their current exploitation. 

TREATMENT

Many are searching for standards of care for supporting the needs, recovery and potential of girls who 

are survivors of CSE but there are none. Unfortunately, there are no uniform standards of care for 

supporting the needs girls who are survivors of violence and abuse in any system of care, let alone the 

specific population of girls who are victims of CSE. Gender and culturally responsive, trauma informed 

and specific, age appropriate, strength-based approaches essential to the healing and progress of 

system involved girls should be the norm but sadly is still the exception. Furthermore, current trends 

across the child serving systems make it difficult to provide girls and young women with the 

comprehensive services they need. Many child welfare and juvenile justice systems strive to achieve a 

reduction in residential treatment beds, shorter-term stays, and community and family based 

placements. These trends may be good for some children, but do not reflect what is needed for girls 

who have experienced complex trauma such as CSE. At least initially, these young women need 

individualized service and supports, a safe and protected environment (often away from the 

communities in which they were exploited) and longer term treatment to deal with complex trauma. 
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Additionally, many older teens (15 and up) do not participate in services on a voluntary basis, thus the 

need for requiring mandated services that some courts are reluctant to order. 

Beyond Screening and Assessment to Trauma Focused/Specific Interventions

Despite these hurdles, we are heartened by the increased focus on this population, particularly the 

movement to treat girls who have experienced commercial sexual exploitation as victims rather than 

criminals. In several of our communities, partnerships between law enforcement, child protection, 

juvenile justice and the courts have yielded promising results to ensure that police, prosecutors, public 

defenders, child protection workers, and probation officers can identify girls who are being sexually 

exploited and refer them to shelters and residential treatment facilities where they can be safe.

CSEC as an issue appears to be hitting a tipping point with wide spread involvement and coverage. 

Our concern is that much of the attention is focused on “the rescue” and not on longer term 

needs. Unfortunately, we know too well that recognizing girls as victims and referring them to safe 

havens are only short-term solutions to a long-term process. We must follow suit with a framework for 

intervention that can help these young women heal and lead productive lives. This would include:

• Providing the trauma focused and gender responsive services that they should have received 

prior to their involvement in commercial sexual exploitation,

• Recognizing that recovery from sexual exploitation is a long term process that will likely involve 

relapse, and 

• Providing meaningful educational and job opportunities for young women so that the rewards 

they perceive they are getting while “in the life” (food, clothes, jewelry, cell phones, etc.) are not 

more attractive than a life in persistent poverty.

The Approach from the Crittenton Family of Agencies

In an effort to share what we have learned over the years in supporting the needs and potential of CSE 

survivors– as well as the broader population of “girls at the margin” – below is a brief summary of the 

services and supports that have worked to help young women transition to adulthood with the freedom, 

hope, strength, confidence, and resilience needed to succeed outside of “the life.” While Crittenton 

agencies use gender and culturally responsive, trauma informed and specific, age appropriate, 

strength-based approaches it is important to emphasize that despite a common philosophical approach 

to our work, there is no one ideal screening tool, one ideal curriculum, or one ideal program. Rather, 

each youth presents with their own complex history and issues. We have found that building a culture 

of high expectations, caring, nurturing, and understanding helps young people establish healthy youthadult relationships they can trust, which in-turn creates the foundation for healing. Finally, by 

delivering and reinforcing the message that, “their future is not determined by their past”, we

can support the capacity of girls to empower themselves. We emphasize their worth, the 

importance of self-advocacy and finding and using their voice.

Screening 

Girls who have experienced CSE may show up in any system, including CPS, foster care, juvenile 

justice, runaway and homeless youth, and law enforcement. All systems must be prepared to screen 

for CSE: to know what to look for, understand how to build trust, and ensure safety. Building trust with 

young women who are being sexually exploited must be handled discreetly, as previous trauma has 

taught them to trust no one, particularly adults in authority. Training on screening practices is a must for 

all professionals who may come into contact with girls who have experienced CSE. Educating the 
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broader community about the importance of treating girls and young women as victims and not as “bad 

girls” is key so we do not re-traumatize young women whose self-esteems are already very low.

On a broader level, we believe that childhood sex abuse is too often unidentified and unaddressed in 

general, irrespective of CSE involvement. Efforts to more systematically screen for and provide 

services to victims of child sex abuse are critical to future efforts to prevent vulnerability to CSEC. 

Toward that end, we promote broader use of the Adverse Childhood Experiences (ACE) survey in a 

wide range of health, mental health, public health and other settings to identify sex abuse at an earlier 

age.

Assessment 

Assessment for young women who come to Crittenton agencies, whether commercially exploited or 

not, is geared toward understanding the root causes of their situations. We use a wide range of 

evidence based assessment tools, including but not limited to:

• Casey Life Skills Assessment

• Adverse Childhood Experience Trauma Indicator Scale

• Child and Adolescent Needs and Strengths

• Child Welfare Trauma Referral Tool

• Social History Assessment

• Mental Status Assessment

• PTSD checklist

• Mental Health/Substance Abuse Functional Assessment

• Addiction Severity Index

• Substance Abuse Subtle Screening Inventory-A2

These and other assessment tools are critical to our ability to create plans that address the issues that 

are unique to each girl who comes through our door. They allow us to put in place clinical interventions 

that treat the whole child and her experiences, not just the child who has been exploited for sex. It is 

important to note that many girls and young women have normalized the violence, abuse and 

dysfunction in their lives so deeply that even the most comprehensive screening and 

assessment will not reveal the true depth of the trauma they have experienced. As such, 

flexibility and re-assessment are also essential to creating a plan for services and supports that work.

Safety 

Increasingly, we find that our mechanisms for guaranteeing safety of the girls served in our agencies 

are insufficient for the population of girls who are at risk of or have been commercially sexually 

exploited. This is largely due to the determination of the exploiters, namely their pimps (who they might 

identify as “boyfriends.”). Security in group home facilities is particularly difficult to guarantee as most 

state contractual agreements prohibit agencies from locking doors and young people are encouraged 

to partake in community and school activities. Given the increasing prevalence of recruitment from 

within group home facilities, however, agencies are training all staff in what to look for as it relates to 

possible CSE activities. Training and education for the community in general is also critical to prevent 

future CSEC.

Whether we learn that they have experienced CSE before they came to us or identify the problem after 

they have been with us for some time, we can develop individualized safety plans and put mechanisms 
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in place to guarantee campus security. Depending upon the prevalence of CSE in the individual 

agencies, they may have numerous cameras in the facility to monitor unauthorized visits.

Finally, agencies that serve a high volume of CSE girls have created policies that allow girls to return to 

the facility if they run away and/or return to the life. If they run away, we believe it is critically important 

that girls receive a message that they have made a bad choice, not that they are bad people. 

Services

Services provided to young women who have experienced CSE must begin with an 

acknowledgement of the underlying trauma that caused them to become vulnerable in the first 

place. Again, these services are geared toward treating the whole individual and her experiences and 

are not unique for girls with CSEC involvement. These services generally have the following 

components:

• Trauma focused mental health and rehabilitative services – for CSEC girls this includes an indepth and personal examination of how their childhood trauma led to sexual exploitation

• Survivor mentorship, drawing on the resilience of survivors to motivate girls currently 

experiencing CSE

• Motivational interviewing

• Trauma focused cognitive behavioral therapy, dialectical behavioral therapy and structural 

family therapy, depending upon each individual assessment

• Addiction counseling

• Art and other approaches that use creativity as an approach to therapy 

• Exercise that makes a connection between mind, body and spirit, i.e. Yoga

• Healthy relationships and building trust

• Visioning oneself outside of the life – goal setting and action plans

• Building a support system

Transitions into the Community

Girls who transition back into the community face an uphill journey of survival out of the life. They must 

use new skills they have learned in treatment and put them to use in the real world, while also

understanding that relapse is common. As they prepare to leave the protected environment of the 

agencies, it is critical that they understand where to turn if they need community resources and how 

they can get help if lured back into a life of sexual exploitation that is more familiar to them than the life 

of a “normal” adolescent. Depending on the age and circumstances of each individual, transition 

services may include:

• Community based mental health trauma treatment 

• Family therapy, if appropriate

• Peer support, if appropriate

• Mentorship, particularly by other survivors of CSE

• Meaningful educational opportunities, typically in alternative schools where their experience is 

understand and in some cases, shared

• Opportunities for education and living wage employment

• Sexual reproductive health services

• Stable placement or housing

• Community-based programs that continue to emphasize healthy choices, healthy relationships, 

physical health and self-esteem
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Collaboration

Crittenton agencies have facilitated the development or been involved in the creation of local 

collaborations/coalitions on human trafficking designed to increase awareness and the coordination of 

services to survivors of human trafficking. Members should include the District Attorney’s office; County 

Sheriff’s Office; local Police Department; the City; US Attorney General’s Office; FBI; ICE; child welfare, 

juvenile justice, homeless and runaway public agencies and nonprofit service providers; non 

governmental agencies and other interested organizations and individuals in the local community. The 

relationships developed through a community-wide approach will facilitate training, funding and service 

provision.

CONCLUSION

As Rachel Lloyd, Founder and CEO of Girls Education and Mentoring Services (GEMS) and a survivor 

of CSEC stated in her TED speech on trafficking, the issue has hit a tipping point. People are rallying to 

take action, express their outrage and support survivors. This is all well and good but much of the focus 

is on rescuing girls and young women from their exploiters. While this is important, one thing we know 

for sure is that rescue is not enough. As outlined above, girls and young women who are survivors of 

CSE experienced trauma before entering “the life” as well as while in it. Rescue alone does not trigger 

the healing that is necessary for them to build healthy lives. If we are truly committed to eradicating 

CSEC then we must care equally about addressing sexism and racism and waging war on the 

epidemic of violence against girls. This begins by eliminating the sexualization of girls and eliminating 

the double standard of “bad girls” and “boys will be boys” in our society.

The National Crittenton Foundation and the family of agencies will continue to refine our knowledge 

base, services and supports for girls, young women and women who are survivors of commercial 

sexual exploitation and trafficking. Yet we will also continue to address and raise broader awareness 

about the epidemic of violence and the millions of survivors of violence that are not commercially 

sexually exploited. Through the development and replication of our own assessments, service models, 

sharing experiences and working as partners with survivors we will add knowledge to the field(s) as 

well as blaze some new trails.

We believe that if girls involved in the juvenile justice, child welfare, and runaway and homeless youth 

systems were properly assessed and treated for childhood trauma at the front door, commercial sexual 

exploitation would be significantly diminished. Until then, girls who have experienced commercial 

sexual exploitation need to be treated as victims not criminals. Their complex trauma must be identified 

early and supports for healing provided over the long haul. We must convey to them that their future is 

not determined by their past and that they are courageous, women warriors with the power to change 

their lives and the world.