Validation of the Commercial Sexual Exploitation-Identification Tool

Background and Purpose:  Commercial sexual exploitation (CSE) of children in the U.S. is recognized as a child welfare, mental health, and public health crisis. Despite growing awareness of the problem, it is poorly understood and difficult to recognize. This problem remains hidden for several reasons: 1) 75% of trafficked youth do not recognize their own exploitation and so do not seek help; 2) professionals lack the tools and training to recognize the signs of exploitation; and 3) agencies lack consistent data collection protocols. As a result, 75% of young people who experience CSE endure multiple years of abuse before anyone intervenes (Basson, Rosenblatt and Haley, 2012). The primary purpose of this study is to validate the Commercial Sexual Exploitation-Identification Tool (CSE-IT) to address the need for early identification and determine prevalence.

Methods: We analyzed screening data for youth in a large statewide sample (n=5,537) in child welfare and juvenile justice settings and community based organizations that provide services to vulnerable youth. We provide construct validity evidence for the CSE-IT, including criterion, concurrent, and content validity. We compared the CSE-IT to data collected concurrently using the Crisis Assessment Tool (CAT) among a population of children and youth experiencing interpersonal trauma. The CAT, a lengthy instrument with licensure requirements to use it, has an indicator for exploitation and other mental health, risk behavior, and life functioning needs of youth. We calculated the sensitivity and specificity for the CSE-IT to evaluate the ability of the tool to correctly identify cases of exploitation, as measured by the CAT. We also examined the psychometric properties of the CSE-IT using Exploratory Factor Analysis. To ensure the tool is usable and has content validity, we conducted expert review with stakeholders, including service providers, survivors of exploitation, and advocates.

Results: Analyses revealed a high correlation between the CSE-IT and the CAT. We present sensitivity and specificity statistics at different cutoff scores for the CSE-IT. The reliability statistics and factor analysis show the factors on the CSE-IT provide coherent subscales. As we expected, the factors on the CSE-IT are correlated with each other, reflecting the complex nature of the phenomenon and the lack of any single indicator that points exclusively to exploitation. The content validity efforts revealed ambiguous or missing items. The factor analysis results also showed some items were not useful in predicting exploitation and therefore resulted in removal of a few items, ultimately enabling us to shorten the final instrument.

Conclusions: The pilot and validation effort showed that systematically screening for CSE among vulnerable populations is feasible. Several large, complex public systems were able to implement the CSE-IT screening tool and to institute data collection procedures that would allow them to measure prevalence within their own jurisdictions. The analysis also revealed that the CSE-IT provides valid and reliable evidence on whether a young person is experiencing this form of abuse, enabling the children’s system of care to identify this abuse more quickly and provide young people with the care and protection they deserve.