Autonomy, power, and place: Ethical considerations at the intersections of substance use care, and the sex trade.

Substance use disorder (SUD) care among women in the sex trade poses multiple ethical challenges. We propose a framework with three lenses-autonomy, power, and place-that can inform and help improve more ethical clinical care for people who trade sex seeking SUD treatment. A relational perspective on autonomy, an analysis of power relations in the clinic, and a geographical analysis can inform how we create space for people with experience in the sex trade in substance use treatment facilities and beyond. We conclude with some practical applications of this framework, all while integrating a composite clinical vignette throughout our analysis. This analysis addresses a clinical and ethical gap in ways to provide better care for women in the sex trade, an understudied and chronically marginalized population deserving of care that meets them where they are.

Dermatology's role in the fight against human trafficking: A report from the AAD Ad Hoc Task Force and call to action.

While the majority of American Academy of Dermatology members have some broad awareness of human trafficking, most are not aware of it in their communities or of the skin signs that could prompt identification of those being exploited, and have requested educational resources to assist patients affected by trafficking. The American Academy of Dermatology Ad Hoc Task Force on Dermatologic Resources for the Intervention and Prevention of Human Trafficking has been working to develop relevant resources, including an online toolkit on the American Academy of Dermatology website: https://www.aad.org/member/clinical-quality/clinical-care/human-trafficking.

Uncharted Waters: Developing Mental Health Services for Survivors of Domestic Human Sex Trafficking.

In recent years, heightened attention has been paid to commercial sexual exploitation, including domestic human sex trafficking (HST), with mental health concerns named the most dominant health concern among survivors. Human sex trafficking is associated with significant and long-term mental health consequences. Research to date has emphasized ways to identify survivors in health care settings. Once identified, however, few specialized services are available to help survivors exit and recover. The current services infrastructure for HST has been compared to the disjointed social response to intimate partner violence before the women's movement helped develop a system of battered women's shelters. Although research has highlighted the need for a multidisciplinary and interagency response to HST, including mental health care, best practices have not yet been formulated. Furthermore, available services are fragmented across sectors. With psychology and psychiatry taking tentative steps to develop services for HST survivors, this article identifies six principles to help avoid a fragmented and potentially retraumatizing clinical and systemic response. The overarching goal is to design services that are flexible, accessible, trauma informed, survivor driven, responsive to stages of change, multidisciplinary, and enduring, especially given the centrality of healthy attachments and community in trauma recovery. Principles are derived from the limited available research on HST services and from examples of efficacious interventions for patient groups with similar characteristics. The discussion is also informed by composite clinical vignettes from a specialized clinic for adult survivors of HST, housed in a major teaching hospital. Finally, practice recommendations and strategies for building interdisciplinary collaborations are discussed.

Engaging Survivors of Human Trafficking: Complex Health Care Needs and Scarce Resources.

Human trafficking, also known as modern-day slavery, is an egregious human rights violation associated with wide-ranging medical and mental health consequences. Because of the extensive health problems related to trafficking, health care providers play a critical role in identifying survivors and engaging them in ongoing care. Although guidelines for recognizing affected patients and a framework for developing response protocols in health care settings have been described, survivors' ongoing engagement in health care services is very challenging. High rates of disengagement, lost contact, premature termination, and attrition are common outcomes. For interventions to be effective in this marginalized population, challenges in engaging survivors in long-term therapeutic primary and mental health care must be better understood and overcome. This article uses the socioecological model of public health to identify barriers to engagement; offers evidence- and practice-based recommendations for overcoming these barriers; and proposes an interdisciplinary call to action for developing more flexible, adaptable models of care.

"Sexting" among U.S. adolescents: psychological and legal perspectives.

This article will discuss the phenomenon of "sexting" (i.e., the exchange of sexually explicit images between adolescents via cell phone) in the United States, with a particular focus on clinical and legal implications. Although sexting is frequently discussed in the popular press, there is virtually no scientific literature available on this topic. In contrast, the legal literature has discussed sexting more comprehensively due to the implications of child pornography statutes for the social response to involved youth. This article will consider sexting from a clinical and legal perspective, and recommend ways to understand and address this practice clinically with adolescent patients.

Recognizing and responding to early psychosis: a qualitative analysis of individual narratives.

OBJECTIVE: The ways in which individuals recognize and respond to emerging psychotic illness remain poorly understood. This retrospective study explored when and how individuals recognized changes in themselves and responded to these changes. METHODS: This study used qualitative methods to explore when and how 15 individuals recognized changes and identified how they responded. Standardized information on the onset of psychosis was also collected. RESULTS: Themes relating to recognizing and responding to emerging psychosis were identified through qualitative analysis of interview transcripts. Themes included normalization, explanatory models, withdrawal, avoiding help, and coming to terms with psychosis. CONCLUSIONS: Participants recognized changes in themselves but tended not to understand the observed changes as part of a mental illness. Individuals avoided professional help because of stigma concerns and identified domains of recovery beyond the management of symptoms and medication. Qualitative methods offer a promising strategy for understanding subjective illness experience and suggesting psychosocial treatment approaches.

Evaluating the effects of eating disorder memoirs on readers' eating attitudes and behaviors.

OBJECTIVE: More than 50 individuals have published eating disorder (ED) memoirs. The current study was the first to test whether memoirs affect readers' eating attitudes and behaviors, and whether they normalize and/or glamorize EDs. METHOD: Fifty female undergraduates read an ED or control memoir. Before and afterward, participants completed the 26-item Eating Attitudes Test (EAT-26), the Eating Disorders Inventory (EDI) Drive for Thinness subscale, a measure of perceived ED symptom prevalence, and an Implicit Association Test (IAT) measuring associations between anorexia and glamour/danger. RESULTS: Participants in the ED condition did not demonstrate significant changes in the EAT-26, the EDI Drive for Thinness subscale, perceived symptom prevalence, or IAT associations compared with controls. Before reading, the EAT-26 and EDI Drive for Thinness subscale correlated positively with perceived symptom prevalence and strength of the IAT association between anorexia and glamour. CONCLUSION: ED memoirs appear to have little effect on undergraduates' eating attitudes and behaviors. Future research should investigate whether memoirs affect individuals with preexisting eating pathology, who may normalize and glamorize ED symptoms.