Building a Specialized Model of Care for Youth at Risk of Sexual Exploitation in the Child Welfare System: A Systematic Review and Exploratory Program Evaluation

Sex trafficking is a global issue with the true prevalence of this crime being unknown. Youth are at heightened risk for sexual exploitation due to normative developmental vulnerabilities such as the desire for romantic relationships and their developing cognitive abilities. Child welfare samples indicate even higher prevalence rates, as traffickers target these youth related to their adverse childhood experiences. Despite the critical need, few programs exist to support youth who are at risk of sex trafficking. The present dissertation sought to identify components critical to a model of care for youth in the child welfare system, at risk of sexual exploitation. Chapter 1 introduces the issue of sex trafficking among youth in care, particularly in Canada, and provides a brief review of relevant literature and the critical need to support youth in this population through relevant programming. Chapter 2 (McDonald, Fisher, & Connolly, 2023, Child Abuse and Neglect) draws on multiple forms of evidence including a systematic literature review and interviews with experts-by-experience (i.e., survivors and child welfare personnel) to identify convergent and divergent evidence for best practices and components important for a model of care. Findings support a model comprised of two overarching components: 1) wraparound supports, and 2) trained caregivers and supported foster homes. Experts also uniformly expressed that an appropriate model of care would require child welfare agencies to take a preventative stance on the issue, such as conducting early coordinated risk assessments on all youth in care. Recommendations were provided to collaborating child welfare agencies. Chapter 3 (submitted to the Journal of Child and Family Social Work) is a multi-case qualitative evaluation of the exploratory START with the YOUTH (STAR-Y) program for three youth who were at risk of sex trafficking, and their families. Results indicated successful program implementation; a reduction in youth risk factors over time related to sexual exploitation including youth no longer engaging in concerning Internet behaviour. Wraparound supports and the foster parent-youth relationship appeared important in the decrease of risk over time. Chapter 4 concludes the dissertation through a review of the study findings, associated theoretical models, and future clinical and research directions. Overall this dissertation contributes to clinical research and practice through exploring ways in which we can support youth in the child welfare system at risk of and possibly engaged in sex trafficking.