11


Overall Conclusions and
Recommendations

The committee’s ultimate goals in this report are to identify what is known about commercial sexual exploitation and sex trafficking of minors and to define strategies for improving prevention and identification of and interventions for victims and survivors of these crimes. As noted in Chapter 1, the committee was guided in its work by three principles:

1.    Commercial sexual exploitation and sex trafficking of minors should be understood as acts of abuse and violence against children and adolescents.

2.    Minors who are commercially sexually exploited or trafficked for sexual purposes should not be considered criminals.

3.    Identification of victims and survivors and any intervention, above all, should do no further harm to any child or adolescent.

The committee faced a number of challenges in addressing the above goals, the most difficult of which was the lack of a well-established, peer-reviewed evidence base for virtually every aspect of the subject of this study. In response, the committee drew upon the existing literature, governmental and nongovernmental reports, research from related fields of practice and study, key informant interviews, and testimony presented during the com-



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11 Overall Conclusions and Recommendations The committee’s ultimate goals in this report are to identify what is known about commercial sexual exploitation and sex trafficking of minors and to define strategies for improving prevention and identification of and interventions for victims and survivors of these crimes. As noted in Chapter 1, the committee was guided in its work by three principles: 1. Commercial sexual exploitation and sex trafficking of minors should be understood as acts of abuse and violence against children and adolescents. 2. Minors who are commercially sexually exploited or trafficked for sexual purposes should not be considered criminals. 3. Identification of victims and survivors and any intervention, above all, should do no further harm to any child or adolescent. The committee faced a number of challenges in addressing the above goals, the most difficult of which was the lack of a well-established, peer- reviewed evidence base for virtually every aspect of the subject of this study. In response, the committee drew upon the existing literature, governmental and nongovernmental reports, research from related fields of practice and study, key informant interviews, and testimony presented during the com- 371

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372 Commercial Sexual Exploitation and Sex Trafficking of Minors mittee’s workshops and site visits1 to formulate a number of key findings and conclusions that are highlighted in the preceding chapters. In this final chapter, those findings and conclusions are consolidated into five overall conclusions. Those conclusions in turn serve as the foundation for the committee’s recommendations for a coordinated, multisector response to commercial sexual exploitation and sex trafficking of minors in the United States. The committee’s recommendations include strategies for increasing awareness and understanding among professionals and the public, includ- ing children and adolescents; for strengthening the law’s response, as well as research, interventions, and collaboration among essential partners; for evaluating current and future programs; and for creating a digital informa- tion-sharing platform to promote communication and coordination among providers, professionals, and the public. Also provided is guidance on key implementation strategies for the committee’s recommendations by an array of individuals and entities. overall conclusions As this report demonstrates, the United States is in the very early stages of recognizing, understanding, and developing solutions for commercial sexual exploitation and sex trafficking of minors. After reviewing the evi- dence, the committee came to the following overall conclusions: • There is substantial and compelling evidence that commercial sexual exploitation and sex trafficking of minors in the United States are serious problems with immediate and long-term adverse consequences for children and adolescents, as well as for families, communities, and society as a whole. • Efforts to prevent the commercial sexual exploitation and sex trafficking of minors in the United States are essential but largely absent. • Efforts to identify and respond to the commercial sexual exploita- tion and sex trafficking of minors in the United States are emerging, with some noteworthy examples, but efforts to date are largely undersupported, insufficient, uncoordinated, and unevaluated. 1  he committee acknowledges that this report cannot include all noteworthy activities T currently under way to prevent, identify, and respond to commercial sexual exploitation and sex trafficking of minors in the United States. However, the committee made every attempt to learn about and document a broad array of strategies, programs, policies, and laws for this study. Any exclusions or omissions should not be viewed as intentional, but as a function of the time and resources available for this study and/or the visibility of various activities across the nation.

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Overall Conclusions and Recommendations 373 • Efforts to prevent, identify, and respond to commercial sexual ex- ploitation and sex trafficking of minors in the United States require collaborative approaches that build upon the core capabilities of people and entities from a range of sectors. • Efforts to address commercial sexual exploitation and sex traffick- ing of minors in the United States need to confront demand and the individuals who commit and benefit from these crimes. The above conclusions reflect the need for action. The evidence, al- though limited, identifies a serious and largely unaddressed issue that re- quires a national response. This report calls for nothing short of a paradigm shift from treating victims and survivors of commercial sexual exploitation and sex trafficking of minors as criminals to understanding and recogniz- ing commercial sexual exploitation and sex trafficking of minors as forms of child abuse. Realizing such a profound change will require significant and sustained efforts among numerous partners. The committee views this study—and this moment—as a critical turning point in the nation’s ap- proach to commercial sexual exploitation and sex trafficking of minors in the United States. Recommendations The committee arrived at a set of six recommendations based on the best evidence currently available. (See Box 11-1 for supporting evidence for each of the committee’s recommendation.) These recommendations provide practical strategies for increasing awareness; advancing understanding; and supporting efforts to prevent, identify, and respond to commercial sexual exploitation and sex trafficking of minors in the United States. They call for multiple and diverse efforts at a variety of levels by a wide range of in- dividuals and governmental and nongovernmental entities. (Box 11-2 pro- vides suggested actions that can be taken by a range of actors to support the implementation of the committee’s recommendations.) If acted upon in a coordinated and comprehensive manner, the committee’s recommendations have the potential to advance and strengthen the nation’s emerging efforts to address commercial sexual exploitation and sex trafficking of minors in the United States. The result would be a significant step forward in improv- ing the prevention and identification of and responses to these crimes. Before proceeding, the committee wishes to stress that it recognizes the numerous challenges entailed in engaging in new work and commit- ting additional resources in a time of serious fiscal constraints. However, choosing austerity over action is not in the best interest of victims and survivors of commercial sexual exploitation and sex trafficking of minors who are subjected to chronic sexual exploitation or of vulnerable children

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374 Commercial Sexual Exploitation and Sex Trafficking of Minors and adolescents whose exploitation could be prevented. Therefore, the committee highlights strategies for leveraging existing resources whenever possible, and urges strong and immediate action to prevent, identify, and address these crimes. Increase Awareness and Understanding The committee found that a lack of training among professionals who interact with children and adolescents—especially those who are vulnerable—inhibits timely and appropriate action on behalf of victims and survivors of and minors at risk of commercial sexual exploitation and sex trafficking. For example, the committee repeatedly heard from speak- ers and read in the literature that people were dismayed to learn that they had missed opportunities to help these youth, and wanted to know more about how to identify and assist these victims. As noted in Chapters 5-10, training and public awareness campaigns addressing commercial sexual exploitation and sex trafficking of minors are two strategies already in use in some areas and sectors. Similar efforts have been shown to be effective in other public health and public safety domains, such as dating violence, bullying, and substance abuse. Therefore, the committee makes the follow- ing recommendation: Recommendation 1: The Department of Justice, the Department of Health and Human Services, and the Department of Education, work- ing with other partners, should increase awareness of commercial sexual exploitation and sex trafficking of minors by supporting the development, implementation, and evaluation of •  national, regional, state, and local evidence-informed training for professionals and other individuals who routinely interact with children and adolescents; •  ational, regional, state, and local public awareness campaigns; n and •  pecific strategies for raising awareness among children and s adolescents. All training activities and public awareness campaigns should be carefully designed to engage the public and service providers to act on the behalf of victims and survivors without doing further harm.

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Overall Conclusions and Recommendations 375 Training Based on its review of the evidence, the committee determined that training needs to target and reach a range of audiences in a variety of set- tings (e.g., urban and rural; tribal lands, territories, and states). Specific audiences include, but are not limited to, • parents and caregivers, • teachers and other school personnel, • students, • physicians and other health care providers, • child welfare professionals, • community- and faith-based organizations, • law enforcement personnel, • attorneys in juvenile and criminal courts, • judges in juvenile and criminal courts, • mental health professionals, and • social workers. In addition, as noted in Chapter 10, training activities need to be on- going to ensure that training levels are sustained among professionals in fields that experience high rates of turnover and/or transfers. Based on its overall conclusion that efforts to address the commercial sexual exploita- tion and sex trafficking of minors should build on the core capacities of various individuals and entities, the committee encourages the Office of Juvenile Justice and Delinquency Prevention (OJJDP), in partnership with the Departments of Education and Health and Human Services, to engage relevant sectors in developing, implementing, and evaluating training ac- tivities that use evidence-based methods to promote adult learning (NRC, 1999). Broad engagement will help ensure that the necessary training is available, accessible, and acceptable for multiple audiences. Further, each sector should be consulted to determine the best methods for providing the training, recognizing that needs may vary, for example, between focused task forces and rural providers and between law enforcement personnel and health care providers. Likewise, the training needs of general health care providers (e.g., primary care providers) likely will differ from those of health care providers who routinely interact with and examine victims of abuse (e.g., forensic nurses). Therefore, while it is necessary to increase awareness of commercial sexual exploitation and sex trafficking of minors among all health care providers, training activities will need to be developed for different specific audiences (e.g., both general awareness training and highly specialized training). Strategies might include leveraging existing programs and expanding

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376 Commercial Sexual Exploitation and Sex Trafficking of Minors current efforts within the Departments of Justice, Education, and Health and Human Services to provide a range of training opportunities to an array of professionals. One such strategy is to make use of the online Di- rectory of Technical Assistance for Anti-Human Trafficking Task Forces and Service Providers, recently launched by the Department of Justice’s Office for Victims of Crimes and Bureau of Justice Assistance (BJA and OVC, 2012). Other opportunities exist through the Health Resources and Services Administration’s Area Health Education Centers, a program that provides community-based training and continuing education to health care providers who serve vulnerable and underserved populations (HRSA, 2013). Finally, the Department of Education’s Office of Safe and Healthy Students’ Technical Assistance Centers could develop training for education professionals and students (Office of Safe and Healthy Students, 2013). Public Awareness Campaigns The committee found that a lack of public awareness about all aspects of commercial sexual exploitation and sex trafficking of minors in the United States is a significant barrier to preventing, identifying, and respond- ing to these crimes. Public awareness campaigns addressing these problems need to be developed. The structures and functions of existing efforts and programs could be enhanced and expanded to encompass commercial sexual exploitation and sex trafficking of minors in the United States. As noted in Chapter 8, for example, schools could build upon current poli- cies, programs, and resources that promote student health and well-being, many of which have proven efficacy, to develop effective, evidence-based programs for preventing, identifying, and addressing commercial sexual exploitation and sex trafficking of minors. Further, the committee found that child and adolescent victims and survivors of commercial sexual exploitation and sex trafficking may not view themselves as victims. In addition, children and adolescents who are at risk for this kind of exploitation may not recognize their individual risk. Therefore, special efforts are needed to increase the awareness of children and adolescents to help them avoid becoming victims and to help victims and survivors obtain needed assistance. As noted in Chapter 8, for example, school-based programs focused on promoting healthy relation- ships and preventing adolescent dating violence provide educators and school personnel with an opportunity to discuss and educate students on commercial sexual exploitation and sex trafficking of minors as another form of violence against adolescents. In addition, peer- and student-led interventions (including peer mentoring and peer education) that have been found to be effective in other health domains, such as reproductive health care (Brindis et al., 2005) and smoking prevention in adolescence

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Overall Conclusions and Recommendations 377 (Campbell et al., 2008), may be suitable strategies for raising awareness about commercial sexual exploitation and sex trafficking among children and adolescents. In keeping with its belief that a variety of sectors and stakeholders should be engaged in addressing the commercial sexual exploitation and sex trafficking of minors in the United States, the committee urges the OJJDP and the Departments of Education and Health and Human Services to part- ner with the commercial sector, foundations, nongovernmental organiza- tions, and journalists and media that reach the public to leverage resources so as to reach the broadest possible audience. Strengthen the Law’s Response Through its review of the evidence, the committee found that national, state, local, tribal, and territorial laws and policies addressing commercial sexual exploitation and sex trafficking of minors in the United States vary significantly. Understanding the need for a consistent and appropriate legal response to victims and survivors of commercial sexual exploitation and sex trafficking, the committee makes the following recommendation: Recommendation 2: All national, state, local, tribal, and territorial ju- risdictions should develop laws and policies that redirect young victims and survivors of commercial sexual exploitation and sex trafficking from arrest and prosecution as criminals or adjudication as delinquents to systems, agencies, and services that are equipped to meet their needs. Such laws should apply to all children and adolescents under age 18. Drawing on its analysis of federal, state, tribal, and local laws and their application (as described in Chapters 4 and 5), as well as new un- derstandings of adolescent development (as described in Chapter 3), the committee concluded that current laws are inadequate to prevent, identify, and respond to commercial sexual exploitation and sex trafficking of mi- nors. Therefore, the committee urges states and local, tribal, and territorial jurisdictions to develop laws that, at a minimum, • prevent commercially sexually exploited children and adolescents from being arrested or prosecuted for prostitution; • provide victims and survivors of commercial sexual exploitation and sex trafficking of minors with needed support services; and • apply to children and adolescents at least up to age 18. These laws will need to be evaluated over time to determine best prac- tices. Further, laws and practices that divert victims from the criminal or

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378 Commercial Sexual Exploitation and Sex Trafficking of Minors juvenile justice system to the child welfare system to receive supportive services could include older adolescents (over age 18) who have been vic- tims of commercial sexual exploitation or sex trafficking since childhood. The committee believes a number of other recent legislative initiatives may also merit further consideration, with care being taken to avoid adverse consequences for victims and survivors while maintaining strong penalties for exploiters. These initiatives include decriminalization of prostitution for minors in recognition that they are victims, not criminals. As noted in Chapter 4, Illinois currently is the only state to have fully decriminalized prostitution for minors. In addition, the committee’s review of the evidence revealed that, de- spite laws in every state that enable the prosecution of individuals who purchase sex with a minor, function as exploiters/traffickers, or otherwise sexually exploit children and adolescents, and despite the hard work of prosecutors and law enforcement in many jurisdictions, individuals who sexually exploit children and adolescents have largely escaped accountabil- ity. Understanding the need for a strong legal response to perpetrators of commercial sexual exploitation and sex trafficking, the committee makes the following recommendation: Recommendation 3: All national, state, local, tribal, and territorial jurisdictions should review, strengthen, and implement laws that hold exploiters, traffickers, and solicitors accountable for their role in com- mercial sexual exploitation and sex trafficking of minors. These laws should include a particular emphasis on deterring demand. As described in Chapter 5, commercial sexual exploitation and sex trafficking of minors are crimes driven, to a large extent, by profit and demand. Legal efforts to prevent and respond to these crimes need to be enhanced. The committee learned about a number of laws and emerging law enforcement strategies designed to address commercial sexual exploita- tion and sex trafficking of minors, as reviewed in Chapters 4 and 5. For ex- ample, the Illinois Safe Children Act has provisions that enhance detection and investigation of commercial sexual exploitation and sex trafficking of minors using tools such as wiretapping. The committee also learned about strategies for ensuring that prosecutors have the necessary tools to create victim-driven, not victim-built, cases. In Cook County, Illinois, for example, prosecutors pursue a range of offenses related to the exploitation and/or trafficking of a child or adolescent to maximize the likelihood of conviction and substantial sentencing. As noted in Chapter 5, prosecutors can employ additional “creative” strategies to help prove these cases, depending on applicable law and resources in their jurisdictions. Examples include the

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Overall Conclusions and Recommendations 379 following (Clawson et al., 2008; Gentile Long and Garvey, 2012; Greene, 2012; Knowles-Wirsing, 2012; Koch, 2012; Nasser, 2012; Walker, 2012): • Seek to admit evidence of the victim’s prior testimony or out- of-court statements in lieu of having the victim testify at trial by establishing that “forfeiture by wrongdoing” applies, i.e., that the defendant’s actions to intimidate the victim are the reason the victim is unable or unwilling to testify, so that the defendant has forfeited the constitutional right to confront the victim at trial. • Introduce any available evidence that shows overt or subtle in- timidation employed by the defendant to explain why the victim is absent from the trial, is unwilling to testify, or is testifying on behalf of the defendant. • Introduce expert testimony to explain victim behavior and the dynamics involved in cases of commercial sexual exploitation and sex trafficking of minors that might otherwise be misunderstood by jurors or interpreted as damaging the victim’s credibility. • Use technology and the private sector to assist in gathering and presenting evidence of money laundering, to “mine” cell phone data, and/or to identify a “financial footprint” that corroborates the victim’s testimony or indicates suspicious or criminal behavior. • Seek forfeiture of assets (e.g., money, houses, cars, other property) gained by the offender as a result of engaging in commercial sexual exploitation or sex trafficking of minors. • Pursue restitution orders to make offenders pay for victim services. Other tools that may enhance prosecution of commercial sexual exploita- tion and sex trafficking cases include permitting prosecution of solicitors/ purchasers regardless of whether they knew or should have known the victim’s age—so-called strict liability laws—and imposing stricter penalties for facilitators of these crimes, such as taxi and limousine drivers. In addition to reviewing, strengthening, and implementing laws that respond to victims/survivors and exploiters after crimes have occurred, the committee urges state, local, tribal, and territorial jurisdictions to consider how laws can be used to help prevent commercial sexual exploitation and sex trafficking of minors. Finally, in keeping with its guiding principle that any intervention should do no further harm to any child or adolescent, the committee urges that all efforts to strengthen laws include provisions to protect young people from possible retaliation by exploiters and traffickers. The committee emphasizes that all of the strategies discussed above will require evaluation to develop best practices and enhance the national response to commercial sexual exploitation and sex trafficking of minors.

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380 Commercial Sexual Exploitation and Sex Trafficking of Minors Strengthen Research to Advance Understanding and Support the Development of Prevention and Intervention Strategies As noted throughout this report, the committee’s review of commercial sexual exploitation and sex trafficking of minors in the United States was constrained by the extremely limited evidence base related to these crimes. In addition, the committee found considerable variability in the quality of current research in these areas. Therefore, the committee makes the follow- ing recommendation: Recommendation 4: The Department of Justice, the Department of Health and Human Services, and the Department of Education should collaborate and partner with others to implement a national research agenda focused on •  dvancing knowledge and understanding of commercial sexual a exploitation and sex trafficking of minors in the United States; •  eveloping effective, child- and adolescent-centered, multisector d interventions designed to prevent children and adolescents from becoming victims or exploiters and to assist those who have been exploited; and •  eveloping strategies and methodologies for evaluating the effective- d ness of prevention and intervention laws, policies, and programs. A Shift from Counting Generally to Counting Specifically The committee found that the data currently available, as detailed in Chapter 2, are sufficient to demonstrate that commercial sexual exploita- tion and sex trafficking of minors who are U.S. citizens and legal permanent U.S. residents are pressing problems that require attention. Based on dif- ficulties entailed in measuring crime in general and in measuring commer- cial sexual exploitation and sex trafficking of minors specifically, however, the committee concluded that it would not be useful to devote substantial resources to refining estimates of the problems’ overall prevalence. At the same time, the committee concluded that more needs to be known about the prevalence of these crimes among and the associated needs of certain vulnerable and difficult-to-reach populations, including but not limited to boys; lesbian, gay, bisexual, and transgender (LGBT) youth; homeless youth; rural youth; systems-involved youth; and racial and ethnic minority populations, including Native Americans. As described in Chapter 3, many of these children and adolescents have specific risk factors and needs that have not yet been adequately recognized or examined.

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Overall Conclusions and Recommendations 381 Priority Areas for Research In addition to emphasizing the importance of addressing the needs of vulnerable youth, the committee identified the following priority areas for immediate examination: • development of evidence-based prevention strategies; • identification of risk and protective factors; • development and evaluation of short- and long-term intervention needs and strategies; • gender- and ethnic-responsive delivery of services (including physi- cal health, mental health, legal, housing, and education) and sup- port to difficult-to-reach populations; • comprehensive, multisector approaches; and • demand and its reduction. As described in Chapters 1 and 3, researchers and practitioners must consider all of the environments and factors that have an impact on mi- nors at risk for and those who are victims/survivors of commercial sexual exploitation and sex trafficking. The social-ecological approach (described in detail in Chapter 3) provides a framework for considering opportunities for prevention and intervention at every level (e.g., individual, relationship, community, societal). In addition, research will need to be especially sensi- tive to issues of gender and ethnicity since minors at risk for and affected by commercial sexual exploitation and sex trafficking include both girls and boys and come from a wide array of backgrounds. The committee recommends that particular attention be paid to under- standing and developing interventions to address known risk factors, such as child abuse, sexual abuse, and separation of the child or adolescent from the home, including homelessness, that are associated with victimization through commercial sexual exploitation and sex trafficking. As described in Chapter 3, the Adverse Childhood Experiences Study found that child sexual abuse affects 25 percent of women and 16 percent of men. Being a victim of child sexual abuse appears to be a risk factor for many forms of future health and social problems, including suicide attempts, depression, poor self-esteem, posttraumatic stress disorder, and marital problems. Child sexual abuse also is a powerful risk factor for commercial sexual exploita- tion and sex trafficking of minors. Any effort to decrease the occurrence of these crimes must therefore target child sexual abuse as a primary risk factor for being exploited or trafficked. Broad attempts to prevent sexual abuse of both boys and girls and to punish those who engage in this form of abuse will yield benefits not only in reducing commercial sexual exploi- tation and sex trafficking of minors but also in decreasing future health

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388 Commercial Sexual Exploitation and Sex Trafficking of Minors BOX 11-1 Continued harbor harbor laws and principles furtherfurther consideration federal, state, laws and principles merit merit consideration in all in all federal, and local jurisdictions. local jurisdictions. state, and 4-16 Civil lawsuits merit further exploration as a strategy for creating effec- tive remedies for commercial sexual exploitation and sex trafficking of minors. Efforts to identify and remove barriers faced by child and adolescent victims in bringing such claims against the traffickers and other exploiters who have victimized them are warranted. 4-17  is critical to ensure that, once adopted, laws are implemented fully It and that legislatures take steps to appropriate funding that has been authorized for survivor services under existing law. 5-2 Many law enforcement personnel and agencies continue to arrest and charge minors with prostitution. 5-7 P  ursuing cases that are “victim-driven, not victim-built” can reduce the need for the legal system to depend on cooperation by victims and survivors of commercial sexual exploitation and sex trafficking. 5-9 Diversion programs need to be established so that youth identified as victims of commercial sexual exploitation and sex trafficking can re- ceive treatment as part of their rehabilitation or in lieu of punishment. 5-10  The judiciary, juvenile justice agency personnel, and prosecutors should all have the opportunity to use their discretion to refer youth identified as victims of commercial sexual exploitation and sex traf- ficking to appropriate treatment services. Recommendation 3: All national, state, local, tribal, and territorial jurisdictions should review, strengthen, and implement laws that hold exploiters, traffickers, and solicitors accountable for their role in commercial sexual exploitation and sex trafficking of minors. These laws should include a particular emphasis on deter- ring demand. Supporting Evidence 4-5 Despite laws in every state that enable the prosecution of individuals who purchase sex with a minor, function as pimps, operate brothels engaged in the sale of sex with young females and males, or other- wise sexually exploit children and adolescents, and despite the hard work of prosecutors and law enforcement personnel in many jurisdic- tions, individuals who sexually exploit children and adolescents have largely escaped accountability. 4-8 Monitoring and evaluation of the implementation of laws, policies, and implementation of laws, polices, programs that have been promulgated at the federal and state levels or supported through federal and state law has been sparse and inadequate, and at times completely absent.

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Overall Conclusions and Recommendations 389 4-10 Further research is needed on an ongoing basis to identify gaps and weaknesses in federal and state laws (including the implementation of these laws) and in understanding of how and the extent to which they address, or fail to address, the needs of minors who are victims of commercial sexual exploitation or sex trafficking. 4-15 Further research is needed to identify and address any obstacles in law or its enforcement that inhibit the prosecution of customers, traf- fickers, and other exploiters of children. 4-17  is critical to ensure that, once adopted, laws are implemented fully It and that legislatures take steps to appropriate funding that has been authorized for survivor services under existing law. 5-11  he Trafficking Victims Protection Act and new state laws have pro- T vided prosecutors and judges with additional tools for investigating, prosecuting, and sentencing exploiters, traffickers, purchasers, and solicitors in cases of commercial sexual exploitation and sex traffick- ing of minors. In addition, prosecutors can use a range of existing laws to pursue convictions and more substantial sentences. Recommendation 4: The Department of Justice, the Department of Health and Human Services, and the Department of Education should collaborate and partner with others to implement a national research agenda focused on •  dvancing knowledge and understanding of commercial sexual exploita- a tion and sex trafficking of minors in the United States; •  eveloping effective, child- and adolescent-centered, multisector interven- d tions designed to prevent children and adolescents from becoming victims or exploiters and to assist those who have been exploited; and •  eveloping strategies and methodologies for evaluating the effectiveness d of prevention and intervention laws, policies, and programs. Supporting Evidence 2-1  reliable national estimate exists of the incidence or prevalence No of commercial sexual exploitation and sex trafficking of minors in the United States. 2-6 Specific data fields related to commercial sexual exploitation and sex trafficking of minors have been added to existing crime measurement efforts (e.g., UCR/SRS and NIBRS) to enhance estimates of these crimes; similar changes could be made to existing non-criminal justice measurement efforts (e.g., YRBS and Add Health) to enhance esti- mates of commercial sexual exploitation and sex trafficking of minors that may not involve law enforcement (e.g., instances in which police are not notified or the crime is not recognized). 3-1  3-1 There is a lack of peer-reviewed evidence focused onon the causes is a lack of peer-reviewed evidence focused the causes of of commercial sexual exploitation and sex trafficking of minors and commercial sexual exploitation and sex trafficking of minors and continued

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390 Commercial Sexual Exploitation and Sex Trafficking of Minors BOX 11-1 Continued consequences for victims, particularly boys. Also scarce is evidence on factors that protect against exploitation and revictimization. 3-8 The multiple systems that engage youth (e.g., health care, education, juvenile justice) have few models for intervening with youth at risk of commercial sexual exploitation and sex trafficking of minors. 3-9  general, an integrated public institutional response to commercial In sexual exploitation and sex trafficking of minors is lacking. 4-11 Further research is needed to examine whether child welfare agen- cies have the necessary resources and are adequately prepared to meet the needs of minors who are victims and survivors of commer- cial sexual exploitation or sex trafficking in states that have adopted, or are considering adoption of, a requirement for universal or wide- spread reporting of cases of commercial sexual exploitation or sex trafficking of minors under child abuse reporting laws. 4-12 Further attention is needed to the intersection of laws and the educa- tion, housing, and employment needs of both children and adoles- cents who are vulnerable to and those who have been victimized by commercial sexual exploitation and sex trafficking to ensure that their needs are met. 4-16 Civil lawsuits merit further exploration as a strategy for creating effec- tive remedies for commercial sexual exploitation and sex trafficking of minors. Efforts to identify and remove barriers faced by child and adolescent victims in bringing such claims against the traffickers and other exploiters who have victimized them are warranted. 4-17  is critical to ensure that, once adopted, laws are implemented fully It and that legislatures take steps to appropriate funding that has been authorized for survivor services under existing law. 5-5 Task forces are one approach used by the legal system to identify and respond to commercial sexual exploitation and sex trafficking of minors. Additional research is needed to identify specific task force strategies and components that can increase the reach and effective- ness of this approach. 5-12  Research on the effectiveness of the overall response of the crimi- nal justice system to exploiters and traffickers and to solicitors and purchasers is limited. Therefore, additional research is needed to determine effective punishments for both exploiters and traffickers and solicitors and purchasers who engage in the commercial sexual exploitation and sex trafficking of minors. 6-3 Given the growing support for and implementation of trauma-informed care, trauma-specific treatment, and trauma-focused services for vic- tims and survivors of commercial sexual exploitation and sex traf-

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Overall Conclusions and Recommendations 391 ficking, a more thorough evaluation of the effectiveness of these approaches is warranted. 6-9 Research on victim and support services can help build a much- needed evidence base for promising and best practices for victims and survivors of commercial sexual exploitation and sex trafficking of minors in the United States to inform future work. Broad dissemina- tion of the findings of this research through publication in the peer-re- viewed literature is needed so that this evidence base will be critically reviewed. 6-10 With few exceptions, current victim and support services for victims and survivors of commercial sexual exploitation and sex trafficking of minors lack plans and mechanisms for evaluation and outcome measurement. 6-11  Additional research is needed to determine the range of services needed to assist and support victims and survivors of commercial sexual exploitation and sex trafficking of minors and to evaluate the delivery of services to populations in need. 7-1 Future research needs to focus on the roles of the health sector and health care providers in both prevention of and treatment for victims of commercial sexual exploitation and sex trafficking of minors. 7-2 Education and training programs for health care providers need to be evidence-based and have outcome data to support their effectiveness. 7-3 Assessment and screening tools and intervention programs for use by health care providers in identifying and assisting victims of com- mercial sexual exploitation and sex trafficking of minors in the United States need to be developed and evaluated. 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 traffick- ing of minors. 8-3 Current and future efforts in the education sector will require addi- tional examination to determine their effectiveness. 9-5 Further research is needed to evaluate the effectiveness of existing commercial-sector initiatives aimed at supporting efforts to prevent, identify, and respond to commercial sexual exploitation and sex traf- ficking of minors, with a view to developing models or best practices for commercial-sector entities seeking to address these crimes. Recommendation 5: The Coordinating Council on Juvenile Justice and Delin- quency Prevention, in collaboration and partnership with national, state, local, tribal, and territorial governmental and nongovernmental entities, should develop continued

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392 Commercial Sexual Exploitation and Sex Trafficking of Minors BOX 11-1 Continued guidelines on and provide technical assistance to support multisector collaboration and information sharing. Supporting Evidence 3-8 The multiple systems that engage youth (e.g., health care, education, juvenile justice) have few models for intervening with youth at risk of commercial sexual exploitation and sex trafficking of minors. 3-9  general, an integrated public institutional response to commercial In sexual exploitation and sex trafficking of minors is lacking. 5-3 Few law enforcement agencies have specific protocols to follow when commercial sexual exploitation and sex trafficking of minors are sus- pected or disclosed. 5-5 Task forces are one approach used by the legal system to identify and respond to commercial sexual exploitation and sex trafficking of minors. Additional research is needed to identify specific task force strategies and components that can increase the reach and effective- ness of this approach. 10-1  Multisector and interagency collaboration is necessary to respond adequately to the multifaceted nature of commercial sexual exploita- tion and sex trafficking of minors. 10-6  Broad-based multisector and interagency collaborative approaches that are victim centered and tailored to the unique needs and circum- stances of victims/survivors and their communities appear to hold the most promise for positively impacting commercial sexual exploitation and sex trafficking of minors in the United States. Recommendation 6: The Office of Juvenile Justice and Delinquency Prevention should create and maintain a digital information-sharing platform to deliver reli-

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Overall Conclusions and Recommendations 393 able, real time information on how to prevent, identify, and respond to commercial sexual exploitation and sex trafficking of minors in the United States. Supporting Evidence 3-8 The multiple systems that engage youth (e.g., health care, education, juvenile justice) have few models for intervening with youth at risk of commercial sexual exploitation and sex trafficking of minors. 3-9  general, an integrated public institutional response to commercial In sexual exploitation and sex trafficking of minors is lacking. 4-4 The absence of a comprehensive source of information identifying the services for victims and survivors established or funded by federal and state law presents obstacles for children and adolescents seeking to access services after experiencing the trauma of sex trafficking or sexual exploitation and for professionals and caregivers who try to help them. 4-12 Further attention is needed to the intersection of laws and the educa- tion, housing, and employment needs of both children and adoles- cents who are vulnerable to and those who have been victimized by commercial sexual exploitation and sex trafficking to ensure that their needs are met. 6-5 Broad consensus exists among professionals in each sector that serves victims/survivors of commercial sexual exploitation and sex trafficking that there are too few services available to meet current needs, and that services that do exist are unevenly distributed geo- graphically, lack adequate resources, and vary in their ability to pro- vide specialized care to victims/survivors of these crimes. NOTE: The supporting evidence in this box consists of the findings and conclusions presented in Chapters 2-10, which bear the numbers shown in the box.

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394 Commercial Sexual Exploitation and Sex Trafficking of Minors BOX 11-2 Summary of Key Implementation Strategies for the Committee’s Recommendations Congress •  uthorize and appropriate funds for demonstration and pilot projects A designed to cultivate sustainable multisector collaboration to prevent, identify, and respond to commercial sexual exploitation and sex trafficking of minors in the United States. Require demonstration and pilot projects to include work with particularly vulnerable populations, such as lesbian, gay, bisexual, and transgender (LGBT) children and adolescents; racial and ethnic minority populations (including Native Americans); homeless/ runaway children and adolescents; rural children and adolescents; and multisystem-involved children and adolescents. (Recommendation 4) •  equire the implementation, enforcement, and evaluation of laws, poli- R cies, and practices designed to prevent, identify, and respond to commer- cial sexual exploitation and sex trafficking of minors in the United States through federal legislation. (Recommendations 2 and 3) State Legislatures •  irect states to conduct needs assessments to inform appropriate plan- D ning, implementation, evaluation, and resource allocation for strategies designed to prevent, identify, and respond to commercial sexual exploi- tation and sex trafficking of minors in the United States. (Recommenda- tion 4) •  irect states to review and amend, as appropriate, state laws addressing D commercial sexual exploitation and sex trafficking of minors in the United States to ensure that exploited and trafficked children and adolescents are treated as victims/survivors, not criminals, and to promote reduction of demand. (Recommendations 2 and 3) Administration for Children and Families •  evelop and disseminate an annual Domestic Trafficking in Persons D report. Require states to submit reports annually on specific prevention, protection, prosecution, and partnership activities for inclusion in this report. (Recommendations 1 and 6) National Institute of Mental Health and National Institute of Child Health and Human Development •  upport research on the root causes and prevention of commercial sexual S exploitation and sex trafficking of minors in the United States, includ- ing commercial sexual exploitation and sex trafficking of boys, risk and protective factors for all children and adolescents, short- and long-term intervention needs and strategies, and the delivery of services and sup- port to difficult-to-reach populations. (Recommendation 4)

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Overall Conclusions and Recommendations 395 National Institute of Justice •  upport research on laws, policies, and practices that reduce demand for S commercial sexual exploitation and sex trafficking of minors in the United States and on the individuals who commit and benefit from these crimes. (Recommendation 4) Office of Safe and Healthy Schools and Institute of Education Sciences •  rovide technical assistance to school districts for conducting school P needs assessments on the prevention and identification of and response to commercial sexual exploitation and sex trafficking of minors within the school district, at individual schools, and in the immediate community. Produce and disseminate needs assessment reports that serve as bench- marks against which future gains can be measured. •  upport research to evaluate implementation strategies for meeting S needs identified in these school assessments. (Recommendation 4) National, State, and Local Bar Associations •  xamine and report on the impact of existing and emerging federal, E state, and local laws addressing commercial sexual exploitation and sex trafficking of minors in the United States. Particular attention needs to be focused on new laws that redirect young victims and survivors of com- mercial sexual exploitation and sex trafficking from arrest and prosecution as criminals or adjudication as delinquents to systems, agencies, and services equipped to meet their needs. (Recommendations 2 and 3) •  upport laws, policies, and practices that reduce demand for commercial S sexual exploitation and sex trafficking of minors in the United States, and punish the individuals who commit and benefit from these crimes. (Rec- ommendation 4) •  onduct reviews of laws, policies, and practices in consultation with other C law-related professional organizations, including associations of prosecu- tors and law enforcement, and publish the results of these reviews every 3 years to support the development and refinement of laws and policies. (Recommendations 2 and 3) Academic and Research Institutions •  stablish formal relationships with victim and support service providers, E especially nongovernmental organizations, to develop studies, to collect data, and to evaluate the effectiveness of prevention and intervention activities. (Recommendation 4) •  rovide guidance and technical assistance to the Office of Juvenile Jus- P tice and Delinquency Prevention on the delivery of reliable, real-time information about how to prevent, identify, and respond to commercial sexual exploitation and sex trafficking of minors in the United States. (Recommendation 5) continued

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396 Commercial Sexual Exploitation and Sex Trafficking of Minors BOX 11-2 Continued Foundations and Nongovernmental Organizations •  upport and disseminate national, regional, state, and local public aware- S ness campaigns, including specific strategies for raising awareness among children and adolescents. (Recommendation 1) •  evelop, support, and evaluate effective prevention and victim and sup- D port service strategies for underage victims and survivors of commercial sexual exploitation and sex trafficking. (Recommendation 4) •  upport the development and maintenance of a digital information-shar- S ing platform that can deliver reliable, timely information about how to prevent, identify, and respond to commercial sexual exploitation and sex trafficking of minors in the United States. (Recommendation 5) Commercial Sector •  rovide technical expertise to the Office of Juvenile Justice and Delin- P quency Prevention on the development and maintenance of a digital information-sharing platform that can deliver reliable, real-time informa- tion about how to prevent, identify, and respond to commercial sexual exploitation and sex trafficking of minors in the United States. (Recom- mendation 5) •  everage core capacities (e.g., big data, new media) to create and dis- L seminate national, regional, state, and local public awareness campaigns, including specific strategies for raising awareness among children and adolescents. (Recommendation 1) •  everage core capacities to support prevention, identification, and re- L sponse efforts of law enforcement, social services, and other governmen- tal and nongovernmental organizations working to address commercial sexual exploitation and sex trafficking of minors in the United States. (Recommendation 1)

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