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A few years ago, the Wilbanks Child Endangerment and Sexual Exploitation (CEASE) Clinic at the University of Georgia School of Law represented Anna (the client’s name has been changed to protect the client’s identity and confidentiality), a 16-year-old girl in foster care and a survivor of commercial sexual exploitation of a child (CSEC). Since infancy, Anna had experienced abuse and neglect at home. At the age of 8, she was sexually abused by a family member. By age 11, she was court-involved and on probation for an incident that involved taking a classmate’s phone and yelling at the classmate (reported as “terroristic threats”). Anna was described as an “11 yr old single black female” with a “sassy attitude.” At age 12, she first used marijuana and began drinking alcohol, and after cutting herself to dull the emotional pain of her trauma, she was hospitalized for suicidal ideations for the first, but not last, time. By age 13, Anna was a victim of CSEC and dual-involved in both the juvenile justice and child welfare systems.
While in care, Anna changed placements 15 times, eloped from placement on at least 4 occasions, was hospitalized at least 3 times for suicidal ideation, was detained twice for runaway status offenses, and experienced further CSEC victimization. Despite having disclosed engaging in survival sex, defined as “exchanging one’s body for basic subsistence needs, including clothing, food, and shelter,” Anna was arrested and placed in a youth detention center for runaway status offenses. She received no medical or therapeutic care, was not referred to a child advocacy center for a forensic interview, and none of the men who exploited her were ever arrested or even investigated. On one occasion, Anna ran away with a group of girls from her placement, a congregate care setting for survivors of CSEC. One of the girls who ran with her reported that Anna coerced her into having sex with an adult man in exchange for food and a place to stay. Even though Anna’s coercive actions were acts of survival so that she did not have to be the one to perform sexual acts with the man, Anna was now labeled a “perpetrator” by the system and was no longer eligible for services for victims of CSEC.
By age 17, Anna had yet to complete the ninth grade. The court returned her home to her mother after the state declared that “there was nothing else we could do to help her.” According to the paperwork that followed Anna throughout her years of involvement in the juvenile justice and child welfare systems, Anna was “defiant,” “impulsive,” “engaged in dangerous and risky behaviors,” “sought the attention of older men,” “had an older boyfriend,” made “poor choices,” was having “unprotected sex,” was “noncompliant with therapy and medication management,” and “refused to take responsibility for her behaviors.” A behavioral checklist completed at a “therapeutic” placement indicated that she was a liar, refused offers of affection, blamed others for her own mistakes, and engaged in dangerous behaviors. With no support or actual knowledge, placement staff completing the checklist also marked “maybe” for stealing, withdrawal, cursing, using pornographic materials, engaging in “seductive moves or sexual advances,” reporting foster parents for physical/sexual abuse, having temper tantrums in private, masturbating in private, acting out in church, and refusing to participate in group activities.
The records, checklists, evaluations, assessments, and reports about Anna were first and foremost inaccurate and missed the core of the problem. Underneath the behaviors and allegedly delinquent acts was a child who had experienced a variety of complex traumas and who was responding the same way any child would under the same circumstances. The court, service providers, and other stakeholders involved in Anna’s case adultified her, seeing her not as a child but as a grown woman responsible for the maltreatment inflicted on her by others. The system labeled her a “perpetrator” and a “prostitute.” However, survival sex is not prostitution, and “there is no such thing as a ‘child prostitute’—there are only victims and survivors of child rape.”
Anna’s victimization was not isolated to those who abused and exploited her: her parents, extended family, and traffickers. She was also traumatized by multiple system stakeholders who, despite having the opportunity to identify her victimization and provide her with trauma-informed and culturally responsive care, criminalized Anna’s behavioral responses to her maltreatment. So Anna fought and hurt herself and behaved the only way she knew how, to survive and to get away from the system that continued to harm her. The continuous retraumatization sustained the constant rush of cortisol through her brain and body, affecting her social and emotional development, as well as her ability to control her survival responses.
Anna’s case is not an outlier. Too often, we fail to see victims of CSEC as children whose behaviors are natural and normal responses to complex trauma. Instead, we punish them for what we would all do under the same circumstances: run away, have emotional outbursts, act defiantly toward authority figures who make us feel unsafe, fight, and simply survive. Systems-involved children with a history of sexual abuse, particularly Black girls, are more likely to be placed in group home or congregate care facilities, which increases the risk of further victimization, leading children “to develop coping strategies that increase their risk of justice involvement. . . .” And when we criminalize the behavioral results of trauma, we set in motion a cycle of abuse and imprisonment that has harmful consequences for child victims.
Herein lies the core of the CEASE Clinic’s mission: to provide free, quality legal representation to all survivors of child sexual abuse, exploitation, and trafficking, in whatever form justice can be found. CEASE opened its doors in January 2016 as a civil litigation clinic prompted by a two-year retroactive window allowing survivors of child sexual abuse to file civil claims against their abusers despite the passing of the statute of limitations. However, once the window closed on June 30, 2017, and survivors had only until the age of 23 to file civil claims in Georgia, CEASE recognized the need to expand legal services in order to pursue justice for all child survivors, wherever they may find themselves within the justice system. Today, CEASE continues to represent survivors in civil claims, but it also provides interdisciplinary legal and social work services to survivors in vacatur and record restriction cases for convictions related to trafficking victimization and in juvenile court dependency proceedings, where CEASE represents survivors of CSEC as the child’s client-directed attorney. The expansion of CEASE’s work ensures that survivors of child sexual abuse and trafficking in Georgia have access to specialized representation across the sexual-abuse-to-prison pipeline.
Over the last seven years, the CEASE Clinic has been chasing the idea of being “trauma-informed,” what it means for our clients, and whether a trauma-informed approach improves outcomes and reduces retraumatization for clients. Multiple frameworks exist describing what it means to be “trauma-informed,” but CEASE strives to be more than just trauma-informed. We want to be trauma-responsive. We have to ask ourselves, have we taken what we have learned at that conference or webinar and actually applied it to child representation? Are we amplifying our clients’ voices, or are we stifling them? Do we see clients as children, or are we letting implicit bias and racism get in the way of remembering that we are working with children who are not culpable for the results of their victimization? Can we put a stop to the sexual-abuse-to-prison pipeline?
Enter the CEASE Clinic’s most recent exploration and implementation of Trust-Based Relational Intervention, or TBRI. TBRI is an attachment-based, trauma-informed intervention designed to meet the needs of children with complex trauma who have experienced early adversity, toxic stress, relational trauma, or a combination of these. TBRI is grounded in evidence-based and trauma-responsive practices, neuroscience, child development research, and behavioral science, and is an innovative approach that can be adapted to meet the needs of children in a variety of settings, from schools to congregate care settings to juvenile courts. TBRI’s Caregiver Package is rated by both the California Evidence-Based Clearinghouse and the Title IV-E Prevention Services Clearinghouse as “promising” research evidence. Although TBRI began as an intervention for parents adopting children internationally, the model has been adapted for professionals, organizations, and systems serving children, showing promise in the juvenile justice and child welfare legal systems. For example, results of a TBRI implementation study with therapists providing family preservation services not only showed significant improvements for both children and parents but also demonstrated that professional staff investment in TBRI predicted positive outcomes for children. Results from a study of TBRI implementation across several child welfare agencies suggested that stakeholders across organizations showed more favorable attitudes regarding trauma-informed care after implementing TBRI. TBRI is also cost-effective and equips professionals and caregivers with tangible strategies and tools that provide healing from the impacts of trauma.
Results of TBRI implementation studies demonstrate the possibility of enhancing quality legal representation for children in dependency proceedings, especially for older youth and children who are victims of CSEC. TBRI allows us to recognize when a client’s behavior is not criminal or willfully disobedient, but rather a trauma or survival response. Through the CEASE Clinic’s implementation of TBRI, we have begun to focus on connecting principles, creating trusting relationships, and ensuring “felt-safety” with clients, allowing us to more effectively conduct case investigations and client interviews. In turn, we can more effectively represent our clients while preventing further retraumatization and combatting systemic responses that funnel our clients along the sexual-abuse-to-prison pipeline.
Common factors that heighten the risk of victimization include a history of sexual and physical abuse, community and family instability, poverty, running away, experiencing homelessness, and foster care placement. Older youth in foster care are at a heightened risk for CSEC victimization. One study of girls ages 12–18 who were adjudicated delinquent and were victims of CSEC reported that 35 percent had been in foster care. Estimates based on national data are that “72.1 percent of victims of sex trafficking are in the age range of 14–17 and 22.7 percent are in the age range of 9–13. Among all victims of sex trafficking, 64.6 percent are females in the age range of 14–17.” Although there is no standard typology of victims of CSEC, youth who have run away, experience homelessness, identify as LGBTQ+, and are Black or African American are disproportionately victimized and subsequently criminalized.
The CEASE Clinic not only provides legal representation to survivors but also serves as a teaching, training, and resource center for law and social work students, attorneys, and other advocates working with or on behalf of survivors. In accordance with best practices in implementation of evidence-based approaches, CEASE is partnering with the University of Georgia’s School of Social Work to evaluate whether the clinic currently provides trauma-informed representation and whether the implementation of TBRI as part of a quality legal representation model in dependency proceedings improves outcomes for survivors.
The initial evaluation included interviews with law and social work interns, as well as staff. All interviews were conducted by a doctoral student at the School of Social Work and provided insight into the CEASE Clinic staff members’ and interns’ understanding of trauma-informed legal practice and perceptions about the impact of working with survivors of CSEC on providers. The findings of the initial evaluation indicate the benefits of the CEASE Clinic’s comprehensive and ongoing training on trauma-informed practices for legal and social work interns. In particular, the interviews highlighted CEASE’s heightened awareness and understanding of the benefits of a trauma-informed approach. However, the initial results also indicated the presence of symptoms of secondary trauma associated with reviewing case materials and working directly with survivors of CSEC, compounded by frustration related to engaging with multidisciplinary stakeholder partners who may not have as strong of an understanding of and training in trauma-informed practices. These findings support the use of TBRI as the foundational approach for the CEASE Clinic because a key component of TBRI is recognizing and addressing dysregulation not only in clients and oneself but also in other professionals.
The program self-evaluation and reflection that CEASE and the School of Social Work are undertaking is an ongoing process and can be daunting when faced with the possibility of gaps in services or approaches that call for change. But grounding practice in an evidence-based approach, paired with ongoing and objective evaluations, allows for consistency of services to clients, increases the ability to assess outcomes, and provides structure to confirm fidelity to evidence-based practices. Importantly, program evaluation and a willingness to evolve with research findings benefit clients and can improve outcomes for some of the most vulnerable populations who are often seen as the most challenging to assist. Although CEASE is in a unique position to partner with the School of Social Work and make use of the knowledge of social work faculty, staff, and students, attorneys representing survivors of CSEC and other court-involved youth can collaborate with multidisciplinary stakeholders to implement trauma-responsive programs and monitor their practices to ensure continued success.
The bottom line is that, despite progress toward breaking the sexual-abuse-to-prison pipeline, what we’re doing isn’t enough and we can’t say that we are trauma-informed lawyers until we can determine whether what we are doing works and has evidence to support the continuation of current or new practices. As the CEASE Clinic enters its eighth year, we hope to demonstrate not just that we have a strong foundational understanding of trauma-informed practices but that we are trauma-responsive, open to receiving objective feedback on our practices, and willing to transform how we operate at both the organizational and individual levels to ensure that CEASE achieves its stated mission of providing trauma-informed, quality legal representation to survivors of CSEC.
Emma Hetherington is a clinical associate professor and the director of the Wilbanks Child Endangerment and Sexual Exploitation Clinic at the University of Georgia School of Law in Athens, Georgia.
Copelenn McMahon is a third-year law student at the University of Georgia School of Law and a legal intern with the Wilbanks CEASE Clinic in Athens, Georgia.
Allison Dunnigan is an assistant professor and the Title IV-E program director at the University of Georgia School of Social Work in Athens, Georgia.
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