The Institute of Medicine (IOM): The Board of Children, Youth, and Families of the IOM will establish a Forum on Promoting Children's Cognitive, Affective, and Behavioral Health (C-CAB Health Forum). This Forum will engage in dialogue and discussion to connect the prevention, treatment, and implementation sciences with settings where children are seen and cared for, including primary health care, schools, preschools and child care, social service and child welfare, juvenile justice, family court, military, and community based organizations, and to create systems that are effective and affordable in addressing children's needs. A major goal of the Forum is to highlight and address gaps in the science of implementing programs and practices in the service of informing research, policy, and practice. One necessary component of addressing implementation science is knowledge utilization of the end user or decision maker, which can be at the local, state, or federal level. The Forum will address gaps in the science of implementation by convening a multi-sectorial group of representatives from academia, federal agencies, professional organizations, and philanthropy in an ongoing way, over three years. This group of Forum members will decide on two workshop topics per year and work with the Academies staff to design the agendas and invite speakers and guests to participate. Workshops can be designed to engage the users of research from state and local agencies as well as intermediaries who translate research for legislators and service providers. Psychologist Kimber Bogard is the staff director for the IOM Board. Those colleagues familiar with the philosophy behind President Obama's Patient Protection and Affordable Care Act (ACA) will quickly recognize how this IOM initiative nicely parallels the legislation.
Earlier in the year, the Board issued an insightful report Confronting Commercial Sexual Exploration and Sex Trafficking of Minors in the United States, with psychologist Sharon Lambert serving as a committee member. Every day in our nation children and adolescents are victims of commercial sexual exploitation and sex trafficking. The report concluded that efforts to prevent, identify, and respond to this national tragedy are largely under supported, inefficient, uncoordinated, and unevaluated. They require better collaborative approaches that build upon the capabilities of people and entities from a range of sectors. In addition, such efforts will need to both confront demand and the individuals who commit and benefit from these crimes. Supported by the Department of Justice, the report focused primarily on trafficking for purposes of prostitution, exploiting a minor through prostitution and survival sex – which is the exchange of sex or sexual acts for money or something of value. The Committee based its deliberations on three fundamental principles: * These crimes should be understood as acts of abuse and violence against children and adolescents; * Minors who are commercially sexually exploited or trafficked for sexual purposes should not be considered criminals; and, * Identification of victims and survivors as well as any interventions should do no further harm to these unfortunate victims.
Numerous factors contribute to the general societal lack of understanding and awareness. These crimes may be simply overlooked, as they often occur at the margins of society and behind closed doors. Victims may not come forward. And, those who routinely interact with victims and survivors may lack awareness or tools to properly identify and assist victims. Accordingly, there is no reliable estimate of the incidence or prevalence of these crimes and many victims go without help.
The Committee proffered three fundamental recommendations and urged that those are involved and who genuinely care seek to leverage existing resources towards these objectives. 1.) Increasing Awareness – Many professionals and individuals who interact with youth -- such as teachers, health care providers, child welfare professionals, and law enforcement officials – are unaware that these crimes occur and often are ill-equipped in knowledge about how to respond to victims, survivors, and those at risk. Developing, implementing, and evaluating relevant training activities on how to identify and assist these young victims is necessary. Public awareness campaigns are needed, with a special focus on increasing awareness among children and adolescents to help them avoid becoming victims. 2.) Strengthening Laws, Improving Understanding, and Prevention -- Minors who are the victims can still be arrested, detained, and given permanent records as offenders. Instead, they should be redirected from criminal or juvenile justice systems to child welfare systems or other appropriate agencies. Sadly, individuals guilty of taking advantage of these children have largely escaped accountability. There is an extremely limited evidence base related to these crimes, particularly related to areas of prevention and intervention, with much variability in quality. Accordingly, the Committee called for implementing a national research agenda in order to: * Advance knowledge and understanding of commercial sexual exploitation and sex trafficking of minors in the United States. * Develop effective, youth-centered, multi-sector interventions designed to prevent minors from becoming victims and to assist victims. And, * Form strategies and methodologies for evaluating the effectiveness of prevention and intervention laws, policies, and programs. 3.) Collaboration and an Information Sharing Platform is essential – No one sector, discipline, or area of practice can fully understand or respond effectively to the complex problems surrounding commercial sexual exploitation and sex trafficking of minors. Therefore cooperation is essential.
IOM -- A nation that is unaware of these problems or disengaged from solutions unwittingly contributes to the ongoing abuse of minors. If acted upon in a coordinated and comprehensive manner, those involved can strengthen the nation's emerging efforts to prevent, identify, and respond to commercial sexual exploitation and sex trafficking of minors. Myth – Help is readily available for victims and survivors. Fact – There are far too few services to meet the current needs. The services that do exist are unevenly distributed geographically, lack adequate resources, and vary in their ability to provide specialized care.
Efforts at the State Level: "In the Spring of 2012, in response to a request from the Governor's wife, the Anchorage-based Cook Inlet Tribal Council (CITC) President & CEO Gloria O'Neill dedicated staff time to work with service providers from various fields to develop recommendations for state action to address sex trafficking in Alaska. As a former Congressional staffer and policy analyst for CITC, I was tasked to guide the group. Federal and local law enforcement and state juvenile justice officials provided technical assistance. Sex trafficking is an overwhelmingly complex issue that requires multi-sector awareness and response. According to the literature, vulnerability, often caused by trauma, particularly child abuse and neglect, is a significant risk factor. Alaska has very high rates of trauma in the general population. Six trafficking cases have been prosecuted in Alaska; however, concrete action towards prevention, victims' services, and demand reduction have been stymied by the paucity of data and research. Our group found there was sufficient national and international research and examples of action from other states to guide the development of a basic framework for action in Alaska. The legislature, which had just strengthened the trafficking statutes and created a temporary task force on the topic, was ripe for input. Our final product included a background report, a plan of action, and recommended statutory changes. More than half of our group's recommendations were included in the State Task Force's report to the legislature, and some, such as a comprehensive approach to demand, and new funding for prevention and services were left out. However, our work effectively framed the issue for policy makers and service providers in Alaska. Recognizing our work and its impact, FBI staff has nominated CITC for the FBI Director's Community Leadership Award [Lisa Moreno, MSW]."
Because It Was the Right Thing To Do: Reflections – "I don't remember much about the salary – in the mid-'70s we almost had psychologists paid on the same state schedule as physicians. I believe the Director of the Department of Health did not really know the difference between psychologists and psychiatrists. I also recall that his daughter was a psychologist. At one point he ordered the state hospital to close one of the wards for patients for security. The hospital did not want to do that. I later called him to personally say 'thank you' since we were having trouble with the patients sent from the prisons and courts. Apparently he was very grateful for the support and when the position came open as head of Mental Health he thought of me. It went fairly well for almost two years when the hospital called me and told me not to renew the contract for one of the psychiatrists. He was foreign trained and was messing up the medication orders. So much so that another psychiatrist had to follow him to correct his orders. I did not recommend the renewal. A few days later the Director called me in and told me we had to renew the contract. I told him the problem and explained we couldn't afford to do it. I found out later that his family had given $20,000 to the Governor's election. In any case, I told the Director again that the records were clear and my answer was 'no' and that just in case someone tried to change the records, I had taken a copy home with me. I then walked out of the office and said to myself, 'I think I just resigned.' I was right and the next week he appointed a psychiatrist to the position. I was tempted, but never did ask my successor what he did about it. I assume he renewed the contract. Jobs like that are too closely related to politics for me. I went back to my old job until '95 [Joe Blaylock, first psychologist to be appointed as the head of the Mental Health Division of the State of Hawaii]." Aloha,
Pat DeLeon, former APA President – Hawaii Psychological Association – December, 2013
