Familial Child Sexual Exploitation in the U.S. 

Joy Lo, MD 

Introduction 

Every child should have the opportunity to grow up feeling safe and loved.  Ideally, this occurs within the environment of family.  When a child is victimized, the impact to their well-being can be deep, pervasive, and long-lasting; when a child is victimized by the very people who are supposed to care for them, even greater harm may result. Of the many types of victimizations a child can experience, sexual abuse in the context of material gain to the abuser is one that creates extreme trauma and consequences, especially when the abuser is a family member.  The purpose of this paper is to explore the literature on familial child sexual exploitation in the United States: to gather what we know, identify gaps, and determine directions in which to move forward. 

Defining the problem 

The Office of Juvenile Justice and Delinquency Prevention states the “commercial sexual exploitation of children (CSEC) refers to a range of crimes of a sexual nature committed against children and adolescents,” including prostitution, survival sex, child sexual abuse material, and performing in sexual venues (Confronting Commercial Sexual Exploitation and Sex Trafficking of Minors in the United States, 2014).  

All CSEC is child sexual abuse (CSA).  Not only is CSEC a subset of CSA, but the two are often interrelated.  Research has shown that early abuse, especially sexual abuse, is a significant risk factor for future sexual exploitation (Brandt et al., 2021; Cole et al., 2016; Fedina et al., 2019).  Furthermore, Estes and Weiner (2002) emphasize the related nature of CSA, child sexual assault, and child sexual exploitation as a “continuum of abuse” (p. 15).  In the last 20 years, research – and myths – about human trafficking have proliferated.  Much of the literature on sex trafficking in minors has focused, with good reason, on runaway/homeless youth with histories of multiple adversities who are trafficked by non-family members or engaging in survival sex.  Additionally, online child sexual abuse material (CSAM) are increasingly in the news.  These are all important.  In this paper, I discuss a lesser-known subgroup of CSEC – CSEC that is facilitated or committed by a family member of the victimized child. 

Familial CSEC has distinct characteristics, which lead to specific implications.  Familial CSEC is child sexual abuse in which a family member or caregiver profits or benefits in a manner beyond sexual acts with a child (Reid et al., 2015).  It is also CSEC that is facilitated by a family member or caregiver and when the family member or caregiver exploits the child sexually for something of value (Allert, 2022; Brandt et al., 2018; Raphael, 2020; Reid et al., 2015; Smith et al., 2009).  

Where do the data come from? 

The research on familial CSEC come from a variety of sources. Many studies include data from social service cases and interviews with social service providers (Brandt et al., 2018; Cole et al., 2016; Cole & Sprang, 2015; Edwards et al., 2022; Reid et al., 2015; Sprang and Cole, 2018).  Some include records, surveys, and in-depth interviews of law enforcement (Allert, 2022; Estes & Weiner, 2002; Mitchell et al., 2010).  Nichols et al. (2022) conducted surveys with social, healthcare, and legal professionals working with human trafficking survivors.  Other studies derive information from survivors themselves (Perkins & Ruiz, 2017; Raphael, 2020; Reed et al., 2019).  These studies, while mostly local, come from several regions of the country.  Allert (2022), Estes and Weiner, (2002) and Mitchell et al. (2010) conducted studies with data from across the U.S..  Unfortunately, no reliable national data summarizing prevalence or other details of CSEC exists; however, there are three national databases that contain useful information. They are the FBI’s National Incident-Based Reporting System (NIBRS) (Finkelhor & Ormrod, 2004), the National Human Trafficking Hotline (Polaris Project, 2016), and the National Child Abuse and Neglect Data System, run by the U.S. Department of Health and Human Services (Child Maltreatment 2019, 2021). 

Findings 

According to several studies, familial CSEC ranges from 12%-82% of CSEC cases (Allert, 2022; Child Maltreatment 2019, 2021; Cole & Sprang, 2014; Edwards et al., 2022; Finkelhor & Ormrod 2004; Mitchell et al., 2010; Nichols et al., 2022; Perkins & Ruiz, 2017; Polaris 2016; Reed et al., 2019; Reid et al., 2015; Sprang & Cole, 2018).  While this range is wide, it demonstrates that familial CSEC can comprise a significant portion of children and youth who experience sexual exploitation.  According to justice professionals interviewed by Allert (2022), the rate of familial CSEC (26% in her study) is likely erroneously low due to insufficient disclosure, lack of evidence, and plea bargaining.  

Mothers were the most common traffickers, ranging from 63-64.5% (Reid et al., 2015; Sprang & Cole, 2019).  At times, the mother would act with another trafficker, often the mother’s paramour (Allert, 2022; Raphael, 2019) or another relative (Sprang & Cole, 2018).  If the mothers were not the trafficker, they were often aware of their children’s victimization (Reed et al., 2019; Reid, 2015; Sprang & Cole, 2018).  Reid et al. (2015) state that the mother-daughter dyad was the most common perpetrator-victim dyad of familial CSEC in their study.  This finding is significant.  Traditionally, mothers are thought to be nurturing and loving.  If mothers are involved in domestic violence, they are often assumed to be the victims and not the perpetrators.  Also, “pimps” are most commonly pictured as men.  We may have an implicit bias against a reality of a mother as her child’s trafficker. Other common familial traffickers are fathers, cousins, uncles, and other caregivers (Raphael, 2019; Reid, 2015; Sprang & Cole, 2018). 

Geographically, the studies showed more familial trafficking in rural than urban areas, which is opposite of data seen in youth involved with non-familial traffickers or with no trafficker (Cole & Sprang; 2014; Edwards et al., 2022; Nichols et al., 2022; Perkins & Ruiz, 2017; Sprang & Cole, 2018).  Perkins and Ruiz (2017) found in their study that of the youth that had a trafficker, the rural victims were more often trafficked by family members, contrasting with the urban victims, who were more often trafficked by non-family members. Sprang and Cole (2018) found that rural professionals had less training on human trafficking; for that reason, as well as fewer resources in rural areas, they posited that familial trafficking was allowed to continue undetected in rural regions, compared with urban regions.  

Child sexual abuse material (CSAM) may also be perpetrated by family members (Finkelhor & Ormrod, 2004; Mitchell et al., 2005; Seto et al., 2018; Smith, 2009; Sprang & Cole, 2018).  The NIBRS reflects that 25% of victims of CSAM with identifiable offenders were exploited by family members (Finkelhor & Ormrod, 2004).  Mitchell et al. (2005) found in their study of 796 cases of juvenile prostitution that 44% of CSAM were disseminated by family members.  Using data from the National Center for Missing and Exploited Children regarding CSAM, Seto et al. (2018) found that “while most cases involved male offenders who were unrelated to the child, cases involving female offenders, younger children, or more egregious content were more likely to involve familial offenders” (p. 3). 

The main characteristic that distinguishes CSEC from other forms of CSA is that someone is profiting materially, above the sexual act alone.  In familial CSEC the most common motivation was found to be money, a close second being drugs (Allert, 2022; Mitchell et al., 2010; Raphael, 2019; Reed et al., 2019; Reid et al., 2015; Smith et al., 2009; Sprang & Cole, 2018).  Other motivations included housing and supporting the family (Raphael, 2019; Reed et al., 2019; Smith et al., 2009). 

Edwards et al.’s study (2022), which included 698 victims of child trafficking in the Kentucky welfare system, documented that family-controlled child trafficking was more often reported by the victim’s relatives or non-relative community members than by professionals. Contrarily, Sprang & Cole (2018) found that minors sexually exploited by their families were more often identified by professionals: 51.6% of their cases were identified in a hospital emergency room, and 45.1% of the cases were discovered during a police investigation, often an investigation of the trafficker’s drug related activity.  Interestingly, Sprang and Cole (2018) found that about 1/5 of their victims had been to emergency rooms multiple times with no identification or suspicion of abuse raised.  These details reflect the difficulty in identifying familial trafficking as well as the crucial role professionals play in identification, and also reflects the need for training of such professionals. The familial trafficking cases in Edwards et al.’s study were more likely to be unsubstantiated or unfounded compared to trafficking cases without family members. Sprang and Cole (2018) found that of findings, neglect was the most common maltreatment identified – in their study 93.5% had a primary finding of neglect, whereas 9.7% had a finding of sexual abuse.  This misidentification is relevant, as it does not fully express what the child has experienced and has implications for victim services, prosecution of the perpetrator, and data accuracy.  

Compared to CSEC victims with non-familial or no trafficker, familial CSEC victims were more likely to be younger and reflect a wider range of ages (Edwards et al., 2022; Mitchell et al., 2010; Nichols et al., 2022; Raphael, 2019; Reid et al., 2015; Sprang & Cole, 2018).  Reid et al. (2015) found the age of initial exploitation in familial CSEC was 4-17, whereas those trafficked by non-family members were 11-17 years old at initiation.  In Sprang and Cole’s (2018) sample, familial CSEC victims’ ages ranged from 6 to 17 years old at time of identification. Familial CSEC victims have a higher rate of poly-victimization (Cole et al., 2016; Reid et al., 2015).  They are less likely to be using drugs and alcohol and less likely to be runaways (Reid et al., 2015; Sprang & Cole, 2018), which can be partially due to their younger ages – these factors, if higher, could increase opportunities to be detected.  They were more likely to have witnessed domestic violence (Reid et al., 2015).  They were more likely to be involved with child welfare, while being less likely to be involved with the juvenile justice system (Allert, 2022; Reid et al., 2015; Sprang & Cole, 2018).  They frequently moved residences (Estes & Weiner, 2006), which could make detection of cases more difficult.  They were more likely to have family members involved in commercial sex.  Sex work is sometimes intergenerational (Allert, 2022; Fedina et al., 2019; Mitchell et al., 2010; Puigvert et al., 2019; Reed et al., 2019).  As such, sex work may be normalized, even expected, and intergenerational trauma is perpetuated (Nichols et al., 2022; Raphael, 2019; Reed et al., 2019).  Fedina et al. (2019) cited 35% of their child trafficking victims had family members in sex work.  Additionally, victims of familial CSEC had high truancy rates.  According to Sprang and Cole (2018), 86.4% of their cases showed “extreme” absenteeism from school. 

Outcomes 

As familial CSEC research is in its infancy, outcomes specific to this population are not well-defined.  We can draw some inferences from research on victims of CSEC, who frequently suffer from developmental, physical, mental, relational, and social consequences, some of which may be severe and long-term (Brandt, 2021; Cole et al., 2016; Cole & Sprang, 2014; Hopper, 2017; Raphael, 2019; Reed et al., 2019; Reid et al., 2015; Sprang & Cole, 2018).  These outcomes include complex developmental trauma, PTSD, depression, anxiety, attachment disorders, difficulty with relationships, and higher rates of future interpersonal violence and revictimization.  Despite having lower drug usage when identified, they are at high risk for substance use later in life (Cole et al., 2016).  Self-harm, suicidal ideation, and suicide attempts are not uncommon sequelae (Allert, 2022; Reid et al., 2015; Sprang & Cole, 2018).  Sprang & Cole (2018) found that almost ½ of their familial CSEC victims reported at least one suicide attempt.  And over 80% of them were diagnosed with PTSD.  Additionally, CSEC victims often suffer reproductive impacts, including multiple sexually transmitted infections and multiple pregnancies.  Many of them suffered physical violence (Brandt et al., 2021; Cole et al., 2016; Hopper, 2017; Reid et al., 2015; Sprang & Cole 2018).   

We can also draw inferences from research on children who have experienced CSA.  Cole et al. (2016) compared a group of CSA survivors without history of CSEC to a group of CSEC survivors.  They found that both groups suffered severe trauma exposure, mostly in the caregiving environment, and that both groups experienced multiple types of trauma – an average of over 5 types.  Both suffered from separation, loss, bereavement, and complex trauma.  As a group, CSEC survivors fared worse on functional impairments and risky behaviors, and had greater levels of trauma symptoms.  They scored higher on sexualized behaviors compared to youth with a history of child sexual abuse without CSEC (60.9% vs. 29.2%).  Additionally, sexually exploited youth have higher scores on dissociation than women who enter the sex trade as adults (Cole et al., 2016).  Given these results, one can reasonably speculate that experiencing familial CSEC highly predisposes a child to severe and negative sequelae. 

Despite being abused and exploited, children may fear the loss of not only parental figures, but the whole family (Allert, 2022; Reid et al., 2015; Sprang & Cole, 2018).  They are exploited at an age when they do not understand they are being harmed (Cole & Sprang, 2014; Reid et al., 2015).  Furthermore, pain and abuse from the very people upon whom they are dependent and with whom they have bonded causes confusion, attachment problems, and dysregulation (Cole et al., 2016; Cole & Sprang, 2015, Sprang & Cole, 2018).  Victims may internalize the blame for the abuse, creating shame and worthlessness (Reid et al., 2015).  Because the fear of loss of family can be strong, they may protect their abuser.  Additionally, other family members may be uncooperative with investigation of the abuse (Allert, 2022).  Sprang and Cole (2018) found that even after trafficking was identified, 60% of victims stayed in touch with their familial trafficker, complicating the healing process. 

Children who experience sexual exploitation by their own families have an increased risk of sexual exploitation as adults (Sprang & Cole, 2018).  They also have a high risk of revictimization, especially sexual revictimization (Hopper, 2017; Sprang & Cole, 2018).  “Exploited youth who were previously sexually abused by exploitative adults become confused about what constitutes kindness, intimacy, and safety, which may result in greater vulnerability to subsequent exploitation by adults (e.g., pimps) who initially seem kind, protective, and safes” (Cole et al., 2016, p. 135).  They are also likely to be involved with many systems: social, legal, medical, mental health (Brandt, 2021).   

What Can Be Done? 

Applying the socio-ecological model allows for a holistic approach to the problem of familial CSEC.  On the individual level, all children should receive developmentally appropriate education with evidence-based sexual abuse prevention programs (Nichols et al, 2022). Such education should occur in multiple settings and occur multiple times throughout a child’s lifetime.  Also on the individual level, trauma-focused, evidence-based treatments that address the multiple traumas that each individual child has experienced are crucial.   

On the relational level, because substance use is a risk factor for many aspects of child maltreatment, screening parents for substance use and offering services serves as prevention.  Treating substance and alcohol use can mitigate the direct effects of substances on the adult, which affects parenting, while also indirectly eliminating the motivation to exploit one’s child to obtain illicit substances.  Additionally, as children receive preventative sexual abuse education, so should their caregivers.  Long-term support and trauma-informed education to non-offending caregivers is also crucial, as their ability to understand and appropriately respond to their traumatized child’s behaviors may greatly enhance the child’s healing. 

The community aspect of the socioecological model encompasses a wide variety of peoples and groups.  Prevention efforts include awareness campaigns and bystander mobilization education for community members (Mitchell et al., 2010; Nichols et al., 2022).  Cole et al. (2016) posit that abused youth in traditional community settings may be more difficult to identify – awareness and empowerment to community members may combat this. Training and education for multiple layers of the community should be considered, for example, the workplace and faith-based organizations.  Organizations that work with children and foster care systems should continue to update their trainings to reflect the evidence. Trainings for social services, healthcare providers, law enforcement, mental health providers, and teachers, must include information on CSEC and the fact that it can be familial (Edwards et al., 2022). Filling in the gaps of knowledge are important – such as ensuring training for professionals in areas that have had little, for example rural areas (Cole & Sprang, 2015; Nichols et al., 2022; Reid et al., 2015; Sprang & Cole, 2018).  Furthermore, screening children and youth for trauma histories as secondary prevention in well-child appointments may help to identify families at risk or children who are victimized (Cole & Sprang, 2014). 

In regard to the societal/policy level of the socioecological model, multidisciplinary collaboration, including social services, medical, mental health, justice professionals, and community members should be standard, in order to holistically address this population’s various short- and long-term needs.  Hopper (2017) recommends creating “trauma-informed systems” for “working with complexly traumatized youth and their caregivers” (p. 170).  Adding questions addressing familial CSEC in relevant professional screening tools can also increase identification of familial CSEC (Brandt et al., 2021; Cole & Sprang, 2015).  

Properly identifying familial sexual exploitation is important to offering appropriate services to each victim of familial CSEC.  As mentioned earlier, Sprang and Cole (2018) found a majority of cases in their study were classified as neglect, which leads to more behaviorally focused and case management services.  Proper classification would generate more relevant trauma-based therapy that is more common for victims with findings of physical or sexual abuse. Properly identifying familial CSEC also prompts appropriate prosecution of perpetrators and more accurate tracking of data (Edwards et al., 2022).  Allert’s (2022) study involving justice professionals asserts that women often receive lighter sentences for the same crime than men.  Often familial child trafficking is prosecuted as other offenses, such as neglect, maltreatment, or endangerment (Allert, 2022). 

Lastly, more research is needed. The studies that exist, while helpful, are limited in scope and have small sample sizes.  Many are geographically-based and are not generalizable.  That said, as CSEC experiences are varied and nuanced, the value of these studies is strong.  Weitzer (2014) discusses how problematic macro level research has been in the field of human trafficking, and argues for micro level research to better describe the nuances of lived experiences of individuals who experience trafficking. Familial CSEC is difficult to identify; underreporting is likely. Further research to understand the sources of familial CSEC can identify targets for prevention (Nichols et al., 2022).  A national database documenting CSEC (Cole & Sprang, 2015), longitudinal data, and combining disciplines can further flesh out our understanding of all CSEC.  

Conclusion 

While we do not know exactly how many children experience familial CSEC, we do know that no child deserves to have such an experience.  We also know that research shows devastating impacts to most of these children. While we continue to learn more about familial CSEC, we must also do what is in our power, at present, to prevent, identify, and empower victims to thrive. 

References 

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