Health and Risk Outcomes Among Commercially Sexually Exploited Youth throughout a Year of Intervention

Background and purpose: Commercially sexually exploited youth (CSEY) are at a high risk for experiencing various health adversities, but little is known about interventions that can improve their health outcomes. This study presents the quantitative evaluation of an Israeli program serving cisgender male, female, and transgender youth victims of commercial-sexual exploitation. Our perpuse was to explore changes in physical and mental health outcomes (health behavior, physical and mental health, drug use, risky sexual behavior) in the first year of treatment of participants in a comprehensive multi-module program for CSEY in Israel and to identify various trajectories of change.

Methods: We conducted a longitudinal observational study on 122 youth (ages 15-26) who received service from the program. Monthly data was collected during 2016-2017 using questionnaires which were filled out by the youth's case managers over a period of a year. Data included socio-demographic and background information until time of program entry and monthly information on the treatment received and health and risky behavior status of the youth. A three-part analytic strategy assessed changes in repeated measures over time, and their contributors. Latent class analysis facilitated the identification of differential trajectories of change over time among groups of participating youth.

Results: Findings showed that CSEY suffer from various health disparities. They exhibited different trajectories of change during the first year of intervention that were associated with various background and treatment-level factors. Significant improvement was observed mostly in health behaviors and risky sexual behaviors. In all health disparities assessed, a significant, positive health change over the one-year intervention was found among participants who displayed lower levels of health-risk factors and behavior at program entry. A better relationship with the program staff was associated with better health behaviors and better mental health. Youth who struggled with high levels of mental health disparities were mostly transgender females, previously hospitalized in psychiatric facilities, more intensively engaged in CSE, and serviced by other programs.

Conclusion and Implications: Findings of the current study showed that a one-year holistic, multi-module intervention for CSEY significantly improved health outcomes among most of the youth involved. Specifically, findings showed significant improvement mostly in health behaviors and risky sexual behaviors, while mental health difficulties and drug use posited a bigger challenge for improvement of health outcomes over the course of a one-year intervention duration. Given the cyclic manner of CSE involvement, longer studies are needed in order to assess whether these results are steady, as well as to continue to assess changes over time, specifically in medium and long term outcomes. In addition, studies should further explore which interventions are most effective to CSEY from different backgrounds.