8


The Education Sector

Five days a week, most of the nation’s school-aged youth spend 6 to 8 hours at school (U.S. Department of Education, 2012). While some of the most vulnerable youth may no longer participate regularly in school, many continue to attend. As a result, schools are a potentially promising environment for a variety of prevention and intervention activities for the young people in their care.

School settings provide educators and school personnel with a unique window into and opportunity to influence the health and development of their students. For example, school personnel are uniquely positioned to recognize changes in behavior and appearance among the youth with whom they interact each day, changes that may be indicative of underlying problems (e.g., food insecurity, abuse and/or neglect, substance abuse). In addition, problems at school, such as numerous unexplained absences, academic decline, or disciplinary issues, may be signs of other problems. With appropriate training and established protocols, school personnel are well positioned to identify and intervene early with vulnerable youth.

This role for school personnel is reflected in how schools traditionally have supported the health and wellness of their student populations. In addition to educating young people in the traditional sense, schools promote and support their healthy physical and emotional development. School-based health education initiatives have been used, among other purposes, to promote physical activity (Franks et al., 2007), to reduce tobacco use (Franks et al., 2007), to promote healthy sexual behaviors (Coyle et al., 2004, 2006; Tortolero et al., 2010), to prevent adolescent dating violence (Foshee et al., 2004; Miller et al., 2012; Wolfe et al., 2009), and to reduce



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8 The Education Sector Five days a week, most of the nation’s school-aged youth spend 6 to 8 hours at school (U.S. Department of Education, 2012). While some of the most vulnerable youth may no longer participate regularly in school, many continue to attend. As a result, schools are a potentially promising environment for a variety of prevention and intervention activities for the young people in their care. School settings provide educators and school personnel with a unique window into and opportunity to influence the health and development of their students. For example, school personnel are uniquely positioned to recognize changes in behavior and appearance among the youth with whom they interact each day, changes that may be indicative of underly- ing problems (e.g., food insecurity, abuse and/or neglect, substance abuse). In addition, problems at school, such as numerous unexplained absences, academic decline, or disciplinary issues, may be signs of other problems. With appropriate training and established protocols, school personnel are well positioned to identify and intervene early with vulnerable youth. This role for school personnel is reflected in how schools traditionally have supported the health and wellness of their student populations. In ad- dition to educating young people in the traditional sense, schools promote and support their healthy physical and emotional development. School- based health education initiatives have been used, among other purposes, to promote physical activity (Franks et al., 2007), to reduce tobacco use (Franks et al., 2007), to promote healthy sexual behaviors (Coyle et al., 2004, 2006; Tortolero et al., 2010), to prevent adolescent dating violence (Foshee et al., 2004; Miller et al., 2012; Wolfe et al., 2009), and to reduce 297

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298 Commercial Sexual Exploitation and Sex Trafficking of Minors alcohol-impaired driving (Elder et al., 2005). Support for such activities is well founded. Based on a recent systematic and rigorous review, for ex- ample, the Community Preventive Services Task Force recommended com- prehensive risk reduction interventions delivered in school settings, finding these interventions to be effective in promoting behaviors that prevent or reduce the risk of pregnancy, HIV, and other sexually transmitted infections (Chin et al., 2012). Schools also may serve as the primary source of health care for many of their students. School-based health centers, for example, provide a range of primary care services (e.g., comprehensive health assess- ments, vision and hearing screenings, immunizations, treatment of acute illness) for children and adolescents who may lack a usual and consistent source of health care (Allison et al., 2007; Soleimanpour et al., 2010). While commercial sexual exploitation and sex trafficking of minors cur- rently are not addressed broadly by the education sector, schools are begin- ning to recognize these problems—and the potential risk they pose—within their school communities. This chapter provides an overview of the roles of schools and the education sector more generally in preventing, identifying, and responding to child maltreatment and interpersonal violence (e.g., adolescent dating violence and bullying), problems that, as discussed in earlier chapters, share related and overlapping aspects with the problems of commercial sexual exploitation and sex trafficking of minors. It then describes the roles of schools and the education sector in preventing and addressing commercial sexual exploitation and sex trafficking of minors. Next, the chapter de- scribes a number of noteworthy efforts on the part of educators, schools, and the education sector to address commercial sexual exploitation and sex trafficking of minors. Because this is an emerging area of research and prac- tice, the committee used its public workshops, site visits, and key informant interviews to learn about such efforts at the federal, state, and local levels. The descriptions of these efforts in this chapter are meant to complement and supplement the limited published research. It should be noted that these activities have not been empirically evaluated. Thus, while the commit- tee does not intend to imply that it is endorsing these approaches, it does endorse additional examination of their effectiveness. These examples are included to illustrate ways in which the education community can capital- ize upon its expertise, resources, and daily interaction with school-aged children and adolescents to prevent, identify, and respond to exploitation on their campuses and within their communities. Following the description of these efforts is a discussion of challenges and opportunities for schools and the education sector in responding to commercial sexual exploita- tion and sex trafficking of minors. The final section presents findings and conclusions.

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The Education Sector 299 roles of schools and the education sector in preventing and addressing violence and abuse To be effective in promoting student success, schools must create and maintain safe and supportive environments that are conducive to teaching and learning. Doing so includes supporting the physical, mental, and emo- tional well-being of all members of the school community (e.g., educators and other school personnel, students, and families). This is a complex and demanding responsibility that requires strong leadership, preparation, and engagement that extends beyond the boundaries of the school day and the schoolyard. One aspect of this responsibility, and an especially important role for the education sector, is ensuring the physical safety of students and the school community. Examples of laws, policies, and programs to support student safety abound. The following sections describe the roles of schools and the education sector in preventing and responding to child maltreat- ment and interpersonal violence. Lessons from research and practice in these areas can inform the education sector’s role in preventing and re- sponding to commercial sexual exploitation and sex trafficking of minors. Child Maltreatment Teachers and other school personnel are among the groups of individu- als who are required to report suspected child abuse or neglect in virtually every state (HHS, 2011). In 2010, education personnel were among the most common reporting sources for child maltreatment (HHS, 2011). Re- sults from the National Survey of Children’s Exposure to Violence revealed that “school authorities are more likely to find out about victimizations experienced by children and adolescents than other authorities” (Finkelhor et al., 2011, p. 14). To comply with mandatory reporting requirements, school districts have developed specific protocols and policies for school personnel to fol- low when child maltreatment is suspected or disclosed. These protocols and policies, which build on state statutes, ensure that school personnel understand their responsibilities and know how to make a report to child protective services or other authorities. Many schools and school districts also provide special training to help their employees recognize signs and report instances of child maltreatment. In addition to reporting child maltreatment that has already occurred, many schools engage in a variety of prevention strategies to address both child maltreatment and interpersonal violence (e.g., bullying and adolescent dating violence) in their school communities (Henry et al., 2012; Vreeman and Carroll, 2007; Wolfe et al., 2009). These programs take many forms,

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300 Commercial Sexual Exploitation and Sex Trafficking of Minors and while some have shown great promise, only a fraction have been rigor- ously evaluated. Strong evidence indicates that school-based interventions are a success- ful primary prevention strategy in a variety of domains. Based on a recent systematic and rigorous review, for example, the Community Preventive Services Task Force found strong evidence that universal school-based pro- grams are effective for the prevention of violent and aggressive behavior (Hahn et al., 2007). Evidence regarding the effectiveness of prevention pro- grams for child maltreatment is less conclusive. A 2009 systematic review of reviews of child maltreatment prevention interventions found that school- based prevention programs for child sexual abuse are effective in increasing knowledge and disclosure of child sexual abuse among both students and teachers (Mikton and Butchart, 2009). Despite these encouraging find- ings, however, evidence is insufficient to determine whether school-based programs designed to prevent child maltreatment reduce or prevent abuse. Interpersonal Violence Because school-based interpersonal violence and commercial sexual exploitation and sex trafficking of minors share related and overlapping as- pects (e.g., violence and victimization, social isolation), examining how the education sector has sought to address interpersonal violence through pre- vention and intervention efforts can be informative. The following sections provide a brief overview of the nature and extent of bullying and adolescent dating violence among students in the United States, and of strategies used by the education sector to prevent and respond to these problems. Bullying Public concern about bullying behavior and bullying victimization has been growing, in part as a result of highly publicized cases of bullying that have led to extreme violence and suicide. These events have heightened awareness and galvanized support for school-based bullying prevention efforts. Bullying includes aggressive and unwanted verbal, social, and/or physi- cal behavior (typically among school-aged children and adolescents) that involves a real or perceived imbalance of power. Recent research suggests that bullying is a common experience for many children and adolescents. In one study, for example, 28 percent of students aged 12-18 reported having been bullied at school during the 2009-2010 school year, and 23 percent of public schools reported that bullying had occurred among students on a daily or weekly basis during that same period (Robers et al., 2012). An- other recent study, using data collected by the National Survey of Children’s

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The Education Sector 301 Exposure to Violence, found that physical bullying had been experienced by 13 percent of the sample in the previous year and that teasing and emo- tional bullying had been experienced by nearly 20 percent of the sample in that same period (Finkelhor et al., 2009). Regardless of how pervasive physical and emotional bullying behaviors may be, research suggests that they are far from benign. Recent research has found that bullying “has serious implications for victims of bullying and for those who perpetrate the bullying” (Swearer et al., 2010, p. 38). For exam- ple, one recent study of a nationally representative sample of U.S. students in grades 6-10 (n = 15,686) found that, instead of being a benign aspect of youth development, bullying was strongly and consistently associated with future more serious violent behaviors among its perpetrators, including carrying weapons, frequently fighting, and sustaining injuries related to fighting (Nansel et al., 2003). Similar research has found the perpetration of school bullying to be a predictor of the perpetration of adult intimate partner violence (Falb et al., 2011). Finally, other research suggests that be- ing victimized by bullying is associated with depression (Brunstein Klomek et al., 2007; Gini and Pozzoli, 2009) and suicidal ideation (Cleary, 2000; Kim et al., 2005). Given the serious implications of both the perpetration of and victimization by bullying for current and future health outcomes, a compelling health and safety case can be made for developing and imple- menting bullying prevention and intervention efforts. Because the majority of bullying occurs at schools and among students, the education sector can play a significant role in such efforts. Schools have used a number of strategies to prevent and respond to bullying. Examples include • increasing awareness about bullying among students, families, and school personnel (e.g., teachers, coaches, guidance counselors, others); • increasing understanding among students, families, and school personnel that bullying is a form of youth violence with serious consequences for victims, perpetrators, and the school community; • training school personnel to recognize settings (e.g., lunch, recess, after-school programs) and individuals that may be vulnerable to bullying; • increasing adult supervision in areas where bullying takes place; • establishing school-wide policies that include clear and consistent consequences for bullying; • enlisting students as partners in responding to bullying behaviors; and • promoting communication among school personnel and between schools and the families and communities they serve.

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302 Commercial Sexual Exploitation and Sex Trafficking of Minors Despite the widespread implementation of bullying prevention and intervention efforts in the nation’s schools, few such efforts have been rigor- ously evaluated. Yet while research on preventing and addressing bullying is still emerging, findings from two recent systematic reviews of school-based interventions to prevent and reduce bullying offer insight into the effective- ness of various strategies. In a review of 26 rigorously evaluated international school-based inter- ventions, Vreeman and Carroll (2007) found considerable variation in effec- tiveness. Overall, interventions that employed a “whole-school approach” to bullying prevention—an approach aimed at changing the school climate with respect to violence by engaging all members of the school commu- nity and by addressing school policies and practices—more often reduced victimization by bullying than interventions consisting of classroom-based curriculum or targeted social skills training (Vreeman and Carroll, 2007). The degree to which school-wide interventions were found to be effective depended largely on the fidelity of implementation and participation of school personnel. The authors conclude that the evidence suggests that “children’s bullying behavior can be significantly reduced by well-planned interventions” (Vreeman and Carroll, 2007, p. 87). In a separate systematic review and meta-analysis of 44 school-based bullying prevention programs, Ttofi and Farrington (2011) found that such programs were often effective. They identified specific program elements associated with a decrease in bullying and victimization, including meet- ings with parents, firm disciplinary methods, and increased supervision on school playgrounds (Ttofi and Farrington, 2011). Based on their review, the authors conclude that bullying prevention efforts should extend beyond the school setting to include families and communities. The committee believes that examples of effective bullying interventions that employ systematic and comprehensive approaches can be particularly instructive for the develop- ment of strategies for preventing and responding to other threats to student safety and well-being. Adolescent Dating Violence Adolescent dating violence (also known as teen dating violence) is a form of physical, sexual, or emotional violence that occurs in the context of an adolescent dating relationship (CDC, 2013). Adolescent dating violence, like other forms of intimate partner violence, is a preventable public health problem that, left unaddressed, can have considerable short- and long-term consequences for both victims and perpetrators. Evidence suggests that adolescent dating violence is not an uncommon experience among the nation’s youth. For example, findings from the 2011 Youth Risk Behavior Survey (YRBS), a national school-based health surveil-

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The Education Sector 303 lance survey, indicate that 9.4 percent of students had experienced dating violence (e.g., were hit, slapped, or physically hurt on purpose by their boy- friend or girlfriend) during the previous year (CDC, 2012). (See Chapter 2 for a more detailed description of the YRBS.) In addition, 8 percent of stu- dents reported having “been physically forced to have sexual intercourse” against their will (CDC, 2012, p. 66). Another survey of 14- to 17-year-olds found that 5.6 percent had experienced dating violence in the previous year, and 8.8 percent had ever experienced such violence (Finkelhor et al., 2009). Researchers who rely on survey data to estimate adolescent dating violence and other forms of youth violence and victimization are quick to note potential limitations of their findings due to methodological issues (e.g., recall bias, selection bias, survey design). Finkelhor and colleagues (2009), for example, note that not all surveys of children and adolescents include a broad spectrum of victimization experiences. In particular, dating violence is an “important and common” form of victimization that is frequently omitted from questionnaires (Finkelhor et al., 2009, p. 1,417). As a result, the prevalence of adolescent dating violence is likely to be underestimated. Despite the inherent challenges entailed in estimating the occurrence of adolescent dating violence, substantial and growing evidence suggests the serious and long-term consequences associated with this form of violence. For example, a recent longitudinal study of a nationally representative sample of U.S. students aged 12-18 (n = 5,681) found that victimization by adolescent dating violence was associated with “adverse health outcomes in young adulthood” (Exner-Cortens et al., 2013, p. 75). Specifically, the authors found that 5 years after their victimization, females who had experienced adolescent dating violence reported heavy episodic drinking, depressive symptoms, suicidal ideation, smoking, and victimization by adult interpersonal violence; 5 years after their victimization by adolescent dating violence, males reported increased antisocial behavior, suicidal ideation, marijuana use, and victimization by adult interpersonal violence (Exner- Cortens et al., 2013). These findings are supported by those of previous research examining specific health risks associated with victimization by dating violence (physical and sexual violence) among female adolescents. One study, for example, examined data from two consecutive representa- tive state-level surveys of female students in grades 9-12 (n = 1,977 and n = 2,186). Data from both surveys indicated that 18 to 20 percent of respondents had experienced adolescent dating violence (Silverman et al., 2001). Further, the authors found an association between female respon- dents who had experienced adolescent dating violence and an increased risk of substance use, unhealthy weight control behaviors, sexual risk behaviors, pregnancy, and attempted suicide (Silverman et al., 2001). Given the range of adverse health consequences associated with per- petration of and victimization by adolescent dating violence, programs to

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304 Commercial Sexual Exploitation and Sex Trafficking of Minors prevent and address this form of violence are clearly needed. Because ado- lescent dating violence affects youth from middle school to high school, and many early dating experiences develop at school and among classmates, the education sector can play an important role in preventing and responding to adolescent dating violence and supporting the understanding and develop- ment of healthy relationships. While research on adolescent dating violence has steadily increased over the last 20 years, recognition and understanding of this form of vio- lence as a significant student health problem remains unclear. One recent study, for example, surveyed a national sample of school guidance coun- selors to determine whether they perceived adolescent dating violence to be a serious problem (Khubchandani et al., 2012). Of the 523 respondents, approximately one-fourth (28 percent; n = 85) considered adolescent dat- ing violence to be a minor issue compared with other student health issues. Fully 81.3 percent of respondents reported that their school lacked policies and procedures to follow when adolescent dating violence was reported (Khubchandani et al., 2012). On the other hand, there are numerous ex- amples of efforts within the education sector—at the individual school level, and in some instances, district-wide and/or statewide—to prevent and address adolescent dating violence in schools. In addition, a number of federal agencies, including the Centers for Disease Control and Prevention and the Office of Adolescent Health at the U.S. Department of Health and Human Services, have acknowledged the significance of adolescent dating violence and healthy relationships by supporting efforts to prevent and ad- dress this form of violence (CDC, 2006, 2012, 2013; Office of Adolescent Health, 2013). Findings from a growing number of school-based interventions de- signed to prevent and reduce dating violence demonstrate the education sector’s increasing engagement and offer insight into the effectiveness of various strategies (Foshee et al., 2004; Miller et al., 2012; Wolfe et al., 2009). One study, for example, examined the long-term effects of a school- based intervention aimed at preventing and reducing adolescent dating violence (Foshee et al., 2004). This randomized controlled trial included baseline data on 957 8th graders from 10 public schools and follow-up data on 460 of the original study participants 4 years postintervention. (Because of the number of participants lost to attrition, the authors conducted an attrition analysis. They determined that “the amount of attrition did not differ for treatment and control groups” [Foshee et al., 2004, p. 20].) These investigators found that adolescents who received the intervention reported 56 to 92 percent less victimization by and perpetration of dating violence (e.g., physical, serious physical, and sexual violence) compared with mem- bers of the control group 4 years postintervention. Another recent study examined the effectiveness of a school-based

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The Education Sector 305 intervention designed to reduce adolescent dating violence and increase intentions to intervene, targeting coaches and male athletes (Miller et al., 2012). This cluster randomized controlled trial included 16 randomly as- signed high schools, 1,798 male athletes, and their coaches. The authors found that the program participants were more likely than members of the control group to intervene in instances of dating violence (estimated inter- vention effect = 0.12; 95 percent; confidence interval: 0.003-0.24) (Miller et al., 2012). School-based programs focused on promoting healthy relationships and preventing adolescent dating violence give educators and school personnel an opportunity to discuss and educate about commercial sexual exploi- tation and sex trafficking of minors as another form of violence against adolescents that requires the attention and response of all members of the school community. roles of schools and the education sector in preventing and addressing Commercial Sexual Exploitation and Sex Trafficking of Minors As work on commercial sexual exploitation and sex trafficking of minors progresses in a variety of sectors and as public awareness of these problems increases, the roles of the education sector and school personnel are coming into sharper focus. Currently, most school districts lack an or- ganized response to commercial sexual exploitation and sex trafficking of minors. However, schools can be important actors in addressing these prob- lems for a number of reasons. First and foremost, as stressed throughout this report, commercial sexual exploitation and sex trafficking of minors are forms of child abuse. Because schools are responsible for the health and safety of the students in their care, school personnel need to be prepared to help prevent, recognize, and respond to suspected or confirmed com- mercial sexual exploitation and/or sex trafficking of students. In addition, schools may serve as recruitment sites for commercial sexual exploitation and sex trafficking of minors. For example, the defendant in a 2012 federal case involving sex trafficking of children and adolescents pleaded guilty to operating a prostitution ring that recruited underage girls directly from their high schools in suburban Virginia.1 Similar allegations are emerging in sex trafficking cases in other parts of the country. Therefore, schools have a responsibility to recognize commercial sexual exploitation and sex trafficking of minors and to make appropriate referrals to address the needs of these youth. 1  .S. U District Court, Eastern District of Virginia, Alexandria Division. Affidavit in Support of a Criminal Complaint and Arrest Warrants. Case No. 1:12mj 172. March 26, 2012.

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306 Commercial Sexual Exploitation and Sex Trafficking of Minors Schools and school districts need to develop specific protocols and poli- cies for school personnel to follow when commercial sexual exploitation and sex trafficking of minors are suspected or disclosed. Fortunately, poli- cies and protocols developed to address other forms of child maltreatment can help inform such policies and protocols. In addition, schools have the opportunity to raise awareness of these issues and engage in prevention activities. These efforts can be informed by evidence-based school-based prevention programs. Similar to work in other health domains, a comprehensive school-based prevention strategy might include primary, secondary, and tertiary prevention approaches for all mem- bers of the school community. For example, primary prevention strategies would include raising awareness of commercial sexual exploitation and sex trafficking of minors among all members of the school community to ensure that they recognize students at heightened risk of being victimized by these crimes. Secondary prevention efforts would include training school personnel and student peer groups to recognize and respond to exploited students. Finally, tertiary prevention strategies would include creating spe- cific policies and protocols for identifying and responding to commercial sexual exploitation and sex trafficking of minors and linking victims and families to services. Box 8-1 gives examples of primary, secondary, and tertiary prevention programs for commercial sexual exploitation and sex trafficking of minors. A variety of members of the school community can be engaged in efforts to prevent, identify, and address commercial sexual exploitation and sex trafficking of minors. The necessary training can be provided to teachers, school nurses, school-based health centers, guidance counselors, physical education teachers, attendance personnel, school safety officers, staff of after-school and enrichment activities, and other school personnel who regularly interact with students. Like all such programs, school-based interventions and prevention programs for commercial sexual exploitation and sex trafficking of minors, such as those described in the next section, will need to be evaluated to assess their effectiveness. Future studies on these programs will need to include strong research designs and adequate sample sizes to enable conclu- sions about their overall effectiveness to be drawn. Finally, none of these efforts will be maximally effective if they are undertaken in isolation. Chapters 10 and 11 describe the education sector’s integral role in multisector efforts to prevent and respond to commercial sexual exploitation and sex trafficking of minors.

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The Education Sector 307 BOX 8-1 Examples of Primary, Secondary, and Tertiary Prevention Programs for Commercial Sexual Exploitation and Sex Trafficking of Minors •  rimary prevention programs are directed at the general population in P an effort to prevent or reduce the risk of an event or a condition before it occurs.  xample: A public awareness campaign that provides information on how E to recognize risk and protective factors for commercial sexual exploitation and sex trafficking of minors. •  econdary prevention programs target high-risk or vulnerable individuals S among whom an event or condition is more likely to occur.  Example: Education programs, located in high schools, for individuals who have one or more risk factors associated with commercial sexual exploitation and sex trafficking of minors, such as poverty, substance abuse, or mental or developmental health concerns. •  ertiary prevention programs are directed at families in which an event(s) T has already occurred or a condition(s) already exists.  Example: Availability of short- and long-term mental health services for children affected by commercial sexual exploitation and sex trafficking of minors to improve functioning. SOURCE: Adapted from Framework for Prevention of Child Maltreatment (HHS Administration for Children and Families, 2012). Efforts of schools and the education sector to Address Commercial Sexual Exploitation and Sex Trafficking of Minors Through its public workshops, site visits, and key informant interviews, the committee learned about several noteworthy efforts to address com- mercial sexual exploitation and sex trafficking of minors by schools and the education sector. These efforts include developing district-wide policies and partnerships, leveraging established school and community resources, and raising awareness among members of the school community. Developing District-Wide Policies and Partnerships Grossmont Union High School District (GUHSD) serves more than 24,000 students in grades 9-12 in California’s East San Diego County. The arrest of a high school student for prostitution—for a second time—

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312 Commercial Sexual Exploitation and Sex Trafficking of Minors Federal Education Records Protection Act and the confidentiality of juvenile court, family court, and medical records, may inhibit the sharing of per- sonally identifiable information about students. (See Chapter 4 for a more detailed discussion of laws that regulate the sharing of student records/ information.) While such protections are generally beneficial to students and their families, the information whose sharing they prevent may be critical, increasing the likelihood that an individual will fall through the cracks. Therefore, schools will need to have relationships and, potentially, special information-sharing arrangements with agencies outside the school community (e.g., law enforcement, child welfare, probation) to overcome communication barriers and coordinate services (Littrell, 2012). Finally, current efforts of the education sector are directed almost ex- clusively at the high school level. As noted in Chapter 3, however, evidence suggests that risk and protective factors for commercial sexual exploita- tion and sex trafficking of minors emerge well before high school age and that some youth become involved in these crimes before or during middle school. Thus, the education sector has an opportunity to address com- mercial sexual exploitation and sex trafficking of minors earlier and with a life-course approach (i.e., using developmentally appropriate strategies, which change over time). Opportunities Despite the above challenges, schools and the education sector are well positioned to play a pivotal role in preventing, identifying, and addressing commercial sexual exploitation and sex trafficking of minors. The commit- tee identified a number of opportunities in a range of settings for a variety of members of the school community. The committee recognizes that nu- merous and varied demands are placed on schools to promote the health and safety of the students in their care (e.g., promoting healthy eating and physical activity, addressing substance abuse and mental health). Therefore, the opportunities described below are meant to enhance and expand upon existing efforts. These opportunities include enhancing training for educa- tors, taking advantage of school nurses, utilizing alternative schools and programs, and engaging students as partners (Tharp et al., 2012). Enhancing Training for Educators Most states require current and prospective teachers to receive some form of training in identifying and reporting child maltreatment. The fre- quency (e.g., annually, one-time training at the start of employment, at the discretion of school administrators), content (e.g., identification, in- tervention, prevention, laws, mandatory reporting), and audience (e.g.,

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The Education Sector 313 instructional personnel, student services staff, administrators, others) vary considerably by state and school district. In some instances, required train- ing is linked to initial teacher certification, licensure, and license renewal. The State of Virginia, for example, requires that all individuals seeking initial teacher licensure/certification and teacher license renewal complete a course on child abuse recognition and intervention (Virginia Department of Education, 2011). The Virginia Department of Education does not require any additional training or professional development in the area of child abuse and neglect beyond initial teacher certification and teacher license renewal. However, individual schools and school districts may elect to provide additional training for school personnel. Information on commercial sexual exploitation and sex trafficking of minors could be integrated into existing child maltreatment training for educators. Locating this subject within broader child maltreatment train- ing for educators could reinforce that commercial sexual exploitation and sex trafficking of minors are forms of child abuse. For example, the State of Florida’s Child Abuse Source Book for Florida School Personnel was updated to include “child trafficking” as a category of abuse with which its school personnel should be familiar (Florida Department of Education, 2011). Opportunities exist to provide training in commercial sexual exploita- tion and sex trafficking of minors at a number of levels, including under- graduate and graduate education, internships, postgraduate training, or as part of continuing education and professional development. Educators well prepared to identify and address commercial sexual exploitation and sex trafficking of minors could enhance the education sector’s overall response and function as an integral part of multisector approaches. Taking Advantage of School Nurses As on-site providers of health care and preventive services in schools (AAP, 2008), school nurses are an important resource within the education sector who can help prevent, identify, and address the commercial sex- ual exploitation and sex trafficking of minors. Understanding commercial sexual exploitation and sex trafficking of minors as forms of child abuse can help school nurses recognize their critical role in recognizing risk and providing assistance to students in need. This role is well within the scope and standards of practice of school nurses (ANA and NASN, 2011; NASN, 2003). According to the position statement of the National Association of School Nurses on child maltreatment, for example, school nurses should be able to recognize signs and symptoms of child maltreatment, support victims, connect victims and their families to support services, educate other school personnel regarding the signs and symptoms of child maltreatment,

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314 Commercial Sexual Exploitation and Sex Trafficking of Minors and work with others to raise awareness and reduce the incidence of child maltreatment (Gibbons et al., 2012). Broadening the understanding of child maltreatment to include commercial sexual exploitation and sex trafficking of minors is an important first step in engaging school personnel, including school nurses, in dealing with these problems. Numerous opportunities exist to capitalize on the expertise and experi- ence of school nurses in preventing, identifying, and addressing commercial sexual exploitation and sex trafficking of minors. Indeed, with appropriate training, school nurses can play a leadership role in the school’s overall response to these problems. Such training exists in Massachusetts, where the Massachusetts Department of Public Health and the Northeastern Uni- versity School Health Institute provide continuing education—specifically designed for school nurses—on the commercial sexual exploitation and sex trafficking of minors (Goldblatt et al., 2012). This type of preparation can, in turn, help school nurses teach other school personnel to recognize risk for exploitation and refer students who may be in need of assistance. In addition, school nurses can use their experience in developing individual- ized health care plans and emergency care plans for students (NASN, 2003) in their response to student victims of commercial sexual exploitation and sex trafficking. This strategy is similar to the case management elements of the model used by the Oakland High School Wellness Center, described previously. Utilizing Alternative Schools and Programs Alternative schools and programs (also referred to as alternative educa- tion programs) are designed to address student needs that typically cannot be met in the traditional school environment. Students enrolled in these programs are referred for special services by school personnel (e.g., teach- ers, administrators, school counselors), by student or parental request, as a result of behavioral assessment, or by the criminal justice system, among others. These students are considered to be at risk of educational failure for such reasons as poor academic achievement, disciplinary issues (e.g., disruptive behavior, chronic truancy, continual academic failure), criminal activity (e.g., arrest or involvement with the criminal justice system), or physical and mental health needs (e.g., pregnancy/teen parenthood, mental health issues) (Carver and Lewis, 2010). A national survey of 1,806 public school districts for the 2007-2008 school year (the most recent year for which data are available) identified 10,300 district-administered alternative schools and programs serving an estimated 646,500 youth in grades K-12 (Carver and Lewis, 2010). In addition to being at risk of educational failure, children and ado- lescents who attend alternative schools and programs often have or are at

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The Education Sector 315 risk for acute and chronic health problems (Escobar-Chaves et al., 2002; Grunbaum et al., 2001; Johnson and Taliaferro, 2012; Tortolero et al., 2008). A comparison of national survey data on health risk behaviors found that students in alternative high schools and programs were at significantly greater risk for violence-related injuries, suicide, HIV infection or other sexually transmitted infections, and pregnancy than their traditional high school counterparts (Grunbaum et al., 2001). Because many of these risk factors and reasons for placement overlap with risk factors for and reasons for involvement in commercial sexual exploitation and sex trafficking, al- ternative education programs may be in an ideal position to help identify and address individuals at risk and victims/survivors of commercial sexual exploitation and sex trafficking in these settings. Finally, because these students are still attending school, they may be more receptive to preven- tion and intervention efforts—or at the very least be easier to reach—than individuals who no longer attend school. Alternative education programs, then, can play an important role in preventing, identifying, and addressing commercial sexual exploitation and sex trafficking of minors. Although the composition of these programs var- ies greatly, several common characteristics make them especially well suited to recognizing and responding to suspected and/or disclosed exploitation, including • a student-centered, strengths-based approach; • small teacher-to-student ratios; • personal development activities; • special teacher training; and • high levels of collaboration. In particular, the extent to which alternative schools and programs col- laborate with various community agencies to provide services for enrolled students is noteworthy. In a national survey of public school districts with district-administered alternative schools or programs, for example, 77 per- cent worked with child protective services, 78 percent with community mental health services, and 80 percent with the criminal justice system (Carver and Lewis, 2010). The same survey revealed that 60 percent of the alternative schools and programs worked with drug and/or alcohol clinics, 46 percent with community organizations (e.g., Boys and Girls Clubs of America and United Way), and 46 percent with job placement centers. As noted earlier in this chapter, an established body of research sup- ports school-based health education and prevention initiatives in traditional school settings. However, similar research within alternative education programs is scarce. Findings from a handful of recent studies provide some support for interventions in these settings (Carswell et al., 2012; Coyle

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316 Commercial Sexual Exploitation and Sex Trafficking of Minors et al., 2006; Tortolero et al., 2008). For example, researchers have adapted Safer Choices—a rigorously evaluated school-based prevention intervention targeting HIV, other sexually transmitted infections, and pregnancy—for alternative schools (Tortolero et al., 2005). Safer Choices 2 has collected baseline data that demonstrate the need for such interventions for students attending alternative schools (Tortolero et al., 2008). Implementing and evaluating interventions in alternative school settings is not without considerable challenges. Tortolero and colleagues (2008, p. 70) note that, “while alternative schools provide a point of access to high-risk adolescents, they also give the researcher several challenges in designing and evaluating health promotion programs using a randomized trial design” (e.g., significant loss to follow-up and selection bias). Yet de- spite the apparent challenges, the committee considers alternative schools and programs to be important and underutilized settings. There is a real opportunity to draw lessons from school-based interventions and the bur- geoning research on alternative schools and programs to provide programs that can help decrease the prevalence of risk-taking behaviors associated with commercial sexual exploitation and sex trafficking of minors and train school personnel to recognize and respond to these problems. Engaging Students as Partners As noted throughout this report, each sector that is or should be engaged in preventing, identifying, and responding to commercial sexual exploitation and sex trafficking of minors has inherent resources and ca- pabilities that can be leveraged to help address these problems. While leadership in the education sector and school personnel are essential to these efforts, students can be valuable partners. Peer- and student-led in- terventions (including peer mentoring and peer education) have been found to be effective in other health domains, such as reproductive health care (Brindis et al., 2005) and smoking prevention in adolescence (Campbell et al., 2008). In addition, evidence suggests the value of having the population affected by an issue (e.g., adolescents, young adults) engaged in addressing it (Miller et al., 2012). The violence prevention and intervention program for male athletes described earlier in this chapter is a good example of how engaging peers can be an effective strategy for addressing a school-based problem (Miller et al., 2012). Thus the education sector has an opportunity to capitalize on the interest of students in working to prevent and address commercial sexual exploitation and sex trafficking of minors.

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The Education Sector 317 Findings and Conclusions The committee’s review of the literature and its careful consideration of expert testimony revealed several themes related to the role of the educa- tion sector in preventing, identifying, and responding to commercial sexual exploitation and sex trafficking of minors in the United States. This chapter has highlighted a range of noteworthy and emerging efforts and drawn les- sons from school-based approaches to related and overlapping problems. The chapter has also described a number of opportunities that exist within current education settings and through emerging practices. However, the committee reminds readers that the need to evaluate these and future efforts is crucial. In addition, the committee formulated the following findings and conclusions: 8-1 School personnel have a unique opportunity to prevent, identify, and respond to commercial sexual exploitation and sex traffick- ing of minors. 8-2 Schools can build upon current policies, programs, and resources that promote student health and well-being, many of which have proven efficacy, to develop effective, evidence-based programs to prevent, identify, and address commercial sexual exploitation and sex trafficking of minors. 8-3 Current and future efforts in the education sector will require additional examination to determine their effectiveness. 8-4 Collaboration with other sectors may often be important in as- sisting victims of commercial sexual exploitation and sex traf- ficking of minors. 8-5 An essential step is training school personnel to recognize com- mercial sexual exploitation and sex trafficking of minors and to make appropriate referrals to address the needs of these youth. 8-6 Senior education officials, such as U.S. Department of Education administrators and school superintendents, need to acknowledge the role of the education sector in addressing commercial sexual exploitation and sex trafficking of minors and provide leader- ship and support for meaningful responses within schools.

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