Applying a Universal Precautions Approach to Residential Programs for Girls

Published in Children’s Voice, Volume 30, Number 1

Applying a Universal Precautions Approach to Residential Programs for Girls: The My Life My Choice Prevention Solution Model
by Lisa Goldblatt Grace

Girls in communities across the United States, growing up in a variety of life circumstances, are at risk of being commercially sexually exploited. This vulnerability most frequently comes at the crossroads of racism, sexism, and classism. Often, transnegativity or heterosexism play a major role, as well. Though there are many differences in each young person’s story, their vulnerabilities often are quite uniform: The majority of young survivors who we see in our Survivor Empowerment Program at My Life My Choice, based in Boston, are in the care and custody of the child welfare system, meaning they have experienced prior abuse or neglect and have lived in foster care or a congregate care facility. Exploiters systematically target adolescent girls who have experienced trauma and are living in these facilities.

There is a tremendous amount of dialogue in the antitrafficking field about the need for specialized housing for girls who are commercially sexually exploited (Groton & Gomory, 2021). Service providers have posited that these girls, due to their specific type of trauma, can benefit from a specific type of program. A program in which all girls have experienced the commercial sexual exploitation of children (CSEC) would decrease stigma and shame, thus creating a stronger environment in which to heal, grow, and take on leadership roles. Something profound can happen when youth who have been exploited support each other in the context of a warm, compassionate, and normalizing residential program. Specialized housing programs serve an important purpose; My Life My Choice’s Survivor Empowerment service model has shown that when survivors help survivors, a powerful model for recovery is created.

At My Life My Choice, we feel strongly about supporting the development of these programs nationwide. However, there is simply not enough funding to create all of the specialized beds that are needed. Further, and perhaps most important, we would never reach every girl who needs it. The process of parsing out those who have been exploited from those who are so very close to this happening is important but may not be necessary to get the services and supports needed to all of those vulnerable. Within our program, 67% of the youth referred to My Life My Choice as “high risk” or for “suspected history of exploitation” (those who have not yet been confirmed as being exploited) disclose that they were indeed exploited once they establish a relationship with their survivor mentor (My Life My Choice, 2019). Given the secrecy and subversiveness inherent in commercial sexual exploitation, there are inherent challenges in trying to identify every girl in need of specialized housing in advance of the establishment of a relationship.

Those in the public health field will remember the enormous national shift that came with the adoption of Universal Precautions guidelines in the mid-1980s—particularly around blood spills and the risk of HIV transmission (Broussard & Khawaji, 2020). Rather than examining each blood spill to determine its likelihood of carrying HIV, health care workers adopted a process by which they assumed that all blood spills were infectious and treated them accordingly. This assured that health care workers and others were safe: Each situation was met with the care that it deserved. Similarly, what if we assumed that every girl who has entered into a residential program is vulnerable to being exploited? Could we create programs that expertly wrap specialized care around all girls, ensuring that no youth who has been exploited or is high-risk slips through the cracks? This is the ethos of the My Life My Choice Prevention Solution Model.

The model is survivor-led, survivor-informed, and survivor-delivered, and takes a public health approach to prevention. It provides a blueprint for service providers working with youth who are vulnerable or exploited in an effort to prevent commercial sexual exploitation and re-victimization. The model is predicated on three primary means of creating systemic and systematic prevention within congregate care facilities:

Our first goal is to shift behavior among those who are at highest risk. We feel strongly that it is not the responsibility of girls who are vulnerable to prevent their own exploitation. That responsibility lies within the greater community, and targeted efforts need to focus on raising young men who don’t sell or buy human beings. However, research conducted on our model supports the efficacy of a comprehensive psychoeducational program that pushes girls to examine their own vulnerabilities while shifting attitudes, knowledge, and skills. This type of prevention education works: A recent National Institute of Justice study (Rothman et al., 2019) found that the My Life My Choice Exploitation Prevention Curriculum decreases incidence of sexual exploitation by 50 percent. Participants reported experiencing two times less incidents of dating violence. This was shown to be true with girls who had never been exploited as well as with those who had. A universal precautions approach in which all participants are in essence inoculated against the threat of exploitation is a key facet of a comprehensive prevention plan for either a specialized or general congregate care facility.

Our second goal is to shift practice and policy within the congregate care facility to be able to most effectively reduce the risk of primary victimization or re-victimization. The objectives here are to ensure that every child is served by trained adults who are expert in at minimum the following:

• how to execute and run prevention plans;
• how to support youth after they have been missing from care; and
• how to spot and respond to recruitment on site.

To do this, programs need to develop appropriate, thoughtful policies that both support this specialized approach and dovetail effectively with federal, state, and local statutes. They need to connect with community-based agencies—ideally those that are survivor-led—to bring expert services onsite. This kind of practice and policy shift weaves an effective safety net for those most vulnerable.

Our third goal is sustained, program-wide change. To accomplish this, facilities should partner with local antitrafficking experts—again, ideally, survivor-led programs— that can support them in their ongoing work. Most effectively, these residential treatment centers and group homes become connected to each other for practice support and would be buttressed by their larger state child welfare system. Specialized services are critical for youth who are exploited. However, as a field we must step up to ensure that all girls about whom we are concerned—and all girls with disproportionate vulnerabilities whose lives hang in the balance between high-risk and confirmed exploited— are offered the best possible safety net. Just like shifting our thinking about blood spills and HIV, we can make lasting, systemic change on behalf of the most marginalized through a universal precautions approach.

Lisa Goldblatt Grace is the co-founder and executive director of My Life My Choice, a program of JRI. Founded in 2002, My Life My Choice is a groundbreaking, nationally recognized leader in the fight to end the commercial sexual exploitation of children. My Life My Choice offers a unique continuum of evidence-informed, survivor-led services spanning service provider training, exploitation prevention programming for adolescent girls at disproportionate risk, survivor mentoring to young survivors of commercial sexual exploitation, and advocacy and leadership development.

References
Broussard, I.M., & Kahwaji, C.I. (2020). Universal precautions. StatPearls. StatPearls Publishing.

Groton, D. B., & Gomory, T. (2021). Improving housing services for youth survivors of sexual exploitation: An exploratory study. National Youth-At-Risk Journal, 4(2).

My Life My Choice. (2019). Impact report. Author.

Rothman, E.F., Farrell, A., Paruk, J., Bright, K.T., Bair-Merritt, M., & Preis, S.R. (2019). Evaluation of a of a multi-session group designed to prevent commercial sexual exploitation of minors: The “My Life My Choice” curriculum. Journal of Interpersonal Violence, 36(19-20), 9143-9166.