Stakeholder perspectives on the implementation of shared decision making to empower youth who have experienced commercial sexual exploitation.

OBJECTIVE: Shared decision making (SDM) has been proposed as a method to improve treatment adherence, placement stability, and other youth-centric outcomes for children who have been victims of commercial sexual exploitation (CSEC). This project seeks to characterize service providers' perspectives on the adoption and implementation of SDM into treatment and placement planning decisions. METHOD: Sixteen key stakeholders who provide services for youth who have experienced CSEC in a Southern city, as well as adults who survived exploitation as children, were individually interviewed. These interviews focused on stakeholders' perspective on the appropriateness and contextual considerations regarding implementing this model to engage youth in decision-making conversations. Interview transcripts were qualitatively analyzed using group-based inductive content analysis. RESULT: While all participants acknowledged the philosophical importance of including youth in decision-making, perspectives varied on how this philosophy could be operationalized. Trauma-bonds to offenders, distrust in service systems, and policy and time constraints were discussed as potential barriers to implementation. Perceived benefits to applying this model included encouraging youth empowerment, helping youth develop decision-making skills, and strengthening relationships between youth and providers. Implementation considerations mirrored those seen in other medical and behavioral health settings, including extensive training, fidelity monitoring, enforcement through policy and legislation, and ultimately resetting the culture of services to be maximally youth inclusive. CONCLUSION: Participants supported the use of SDM to standardize the inclusion of youth in treatment and placement planning decisions. However, there exist challenges in defining exactly how to adopt this approach, and how to implement broad-scale cultural change within the service-providing community.

Using Shared Decision Making to Empower Sexually Exploited Youth.

Commercial sexual exploitation of children (CSEC) is a pervasive public health crisis that affects children across the United States. After receiving public attention in recent years, several approaches have been developed to aid in identifying and intervening with trafficked youth to prevent further exploitation. Despite these developments, intervention efforts are plagued by client dropout, treatment nonadherence, and failures in placement, partially due to the failure of service systems to recognize the child's voice and preferences in decision-making conversations. We propose a new approach to addressing CSEC by applying shared decision making, a model developed in other areas of medicine, to working with high-risk and trafficked juveniles to increase youth voice and participation in care and to prevent revictimization.