Abstract
Understanding the experiences of those who experienced commercial sexual exploitation (CSE) at early life stages (i.e., below age 11) is critical to gaining a comprehensive understanding of human trafficking. Yet, CSE-impacted groups are rarely integrated into research processes. Further, researchers have not widely documented the benefits of this approach from the perspectives of these community members. Following involvement in a community advisory board and a qualitative study, we asked adults with CSE histories to talk about their experiences in human trafficking research. Using a community-engaged framework and narrative approach, we conducted two to three interviews with 10 participants between September and November 2023. Participants were ages 27-55, identified as cis women or nonbinary, and were Black, white, or multiracial. Through reflexive thematic analysis and in collaboration with participants, three overarching themes were identified: (1) adverse experiences with human trafficking research; (2) perspectives on community-engaged research; and (3) rigorous research can foster healing. Participants felt largely excluded from research, often believing that available human trafficking research misrepresented their experiences. When they were included, they reported that studies frequently lacked trauma-informed and community-engaged approaches. Without such support, research was viewed as emotionally laborious and mentally challenging. Still, there was great excitement, feelings of empowerment, and overall gratitude for their involvement in research studies that did take their needs into account. Participants had high aspirations for how research could benefit their communities over time. Insights gained from these participants underscore the critical need for researchers to prioritize trauma-informed, person-centered, and community-engaged research approaches.
Keywords
Introduction
Commercial sexual exploitation (CSE) is a largely hidden crime that disproportionately impacts the most vulnerable of children. Indeed, CSE affects those with minoritized racial/ethnic identities, with disabilities and developmental disruptions, who identify as lesbian, gay, bisexual, transgender, queer, or two-spirit (LGBTQ+), facing poverty, and experiencing homelessness (Franchino-Olsen, 2021; Hogan & Roe-Sepowitz, 2023; Laird et al., 2020). Their vulnerabilities are heighted by the continuum of adverse childhood experiences, poly-victimization, and resultant complex trauma that frequently begins in early childhood and lasts throughout the exploitation (Cole et al., 2016; Franchino-Olsen, 2021; Godoy et al., 2020; Macias-Konstantopoulos & Bar-Halpern, 2016). While it is critical that we center the lived experiences of CSE-impacted populations in research, there is little guidance available on how to engage such a structurally vulnerable group.
The CSE of children can be defined as sexual activities (e.g., transactional sex, the production of sexually explicit images and videos) involving a minor less than age 18 in which anything of value is exchanged (OJJDP, n.d.). No community is immune from CSE. Globally, it is estimated that at least 6.3 million people experience CSE each day (International Labour Organization et al., 2022). In the United States (U.S.), the clandestine nature of the crime, among other factors, make it difficult to gain an accurate estimate of the prevalence or scope of CSE (Franchino-Olsen et al., 2022). Still, it is well-documented that children, including infants, preadolescents, and adolescents, are at risk of being commercially sexually exploited by family members, caregivers, romantic partners, friends, peers, acquaintances, and strangers (Baird & Connolly, 2023; Godoy et al., 2024; Roe-Sepowitz & Jabola-Carolus, 2022; Sprang & Cole, 2018). The contexts in which these children are exploited along with myriad factors outside of their control, such as power and control dynamics, threats of bodily harm, unmet basic needs, and trauma-responses often work together to reduce their ability to exit the exploitation (Godoy et al., 2024; Reid, 2016; Twis et al., 2022).
CSE-impacted children are known to suffer months or years of exploitation before receiving any type of intervention (Corbett, 2018; Hopper, 2017; Landers et al., 2017). Their under-identification is partly due to lack of systematic protocols in place to screen for CSE (Armstrong et al., 2020). Additionally, these children often lack healthy, trusting relationships with adults and experience issues related to power, control, fear, manipulation, and torture among other factors that consequently develop distrust and avoidance of adults (Franchino-Olsen et al., 2022; Macias-Konstantopoulos & Bar-Halpern, 2016). These dynamics contribute to barriers to conducting research with this population and point to critical considerations for researchers in how to gain access to and engage with CSE-impacted groups.
Background
Challenges in Identification and Access for Research
Children who have been exploited constitute a group placed at increased vulnerability as a result of distinct life circumstances. Prior to and during the exploitation, children often endure a multitude of physically, emotionally, and sexually abusive and violent acts, such as being beaten, raped, attacked with a weapon, and threatened (De Vries & Goggin, 2020; Le et al., 2018; Wilson & Butler, 2014). The consequences of cumulative trauma include elevated rates of psychological issues, such as depression, dissociation, posttraumatic stress disorder, suicidality, and problematic substance use (Bath et al., 2020; Crisp & Bellatorre, 2024; Le et al., 2018; Meza et al., 2023; Wilson & Butler, 2014). These vulnerabilities also increase the risk of re-traumatization and complicate our ability to not only identify the exploitation but to gain access to CSE-impacted groups.
It is difficult to identify individuals experiencing exploitation. Exploiters are known to use entrapment and enmeshment tactics, such as developing romantic relationships or friendships to gain trust, isolation, control, blackmail, and violence/aggression, that result in trauma bonding, fear, shame, and a reluctance or inability to seek help (Baird & Connolly, 2023; Henderson & Rhodes, 2022; Lavoie et al., 2019; Sanchez et al., 2019; Wilson & Butler, 2014). Children who are trafficked by their families are often very young (i.e., below age 11), inherently loyal to the family unit, and less likely to be identified by frontline professionals, such as school personnel and medical professionals (Baird & Connolly, 2023; Edwards et al., 2022; Reid, 2016; Sprang & Cole, 2018). These children are often dependent on their exploiters to fulfill their basic needs, trained to remain silent, and risk deprivation or violence if they are not compliant (Baird & Connolly, 2023; Henderson & Rhodes, 2022).
In addition, individuals who identify as boys, those in the LGBTQ + community, and youth who run away from care or face homelessness may be induced into CSE as a means of survival, to obtain substances, and/or for other material goods (Hogan & Roe-Sepowitz, 2023; McCann & Brown, 2019; Wilson & Butler, 2014). For many, commercial sexual activity becomes normalized and accepted within various contexts (e.g., amidst homelessness) and cultures (e.g., in family networks with intergenerational CSE; high-control religious groups) which work together to deter self-disclosure and hinder identification (Crisp & Bellatorre, 2024; Greenbaum, 2020; Reid, 2016; Wilson & Butler, 2014).
CSE-impacted populations are often under-identified and difficult for researchers to access, as providers overlook their unique challenges and fail to engage with community members to tailor strategies and address barriers. Moreover, there is a longstanding history of criminalizing exploited persons. Many countries continue to arrest, detain, and deport individuals affected by human trafficking, rather than provide supportive services (Schloenhardt & Markey-Towler, 2016). For example, adolescents in the U.S. are often arrested on prostitution-related charges and routed to a punitive legal system that is largely not trained to identify or support the needs of CSE-impacted individuals (Abrams et al., 2021; Choi, 2015; Godoy et al., 2023; Hammond et al., 2020; Hoefinger et al., 2019). To that end, CSE-impacted individuals are often distrustful, and avoidant of authority figures and the very systems charged with keeping them safe (Barnert et al., 2017; Godoy et al., 2020; Macias-Konstantopoulos & Bar-Halpern, 2016; Sahl et al., 2021). Early CSE research contributed to this distrust by failing to acknowledge the totality of these individuals’ identities and perpetuating a conceptualization of them that was rooted in a criminal-victim dichotomy. Human trafficking research commonly used disparaging language that criminalized and re-victimized children affected by CSE, including terms like child prostitution and juvenile prostitute, rather than strength-based or person-centered approaches (Choi, 2015). In summary, the vulnerabilities faced by these individuals, the hard-to-reach nature of CSE, and a long history of distrust of researchers and service providers create distinct challenges to conducting research with the focal population.
Traditional Research Approaches
Scientific inquiry has traditionally focused on observing, understanding, and describing phenomena with less attention paid to how researchers’ belief systems, biases, and assumptions influence their chosen research methods or their interpretation of findings (Mahmood, 2011; Morse, 2007). Although scientific inquiry is socially and geographically situated, and constrained by structure and ideology, the ways white supremacy, western perspectives, and related notions of power and control manifest in studies remains largely uninterrogated (Faria & Mollett, 2016; Goar, 2008; Mahmood, 2011). Additionally, the exclusion of community members in traditional research efforts means that captured experiences risk being misunderstood and misrepresented, and researchers rarely consider how research could directly benefit or harm communities (Bishop, 1998; Mahmood, 2011). Traditional research thereby benefits researchers by advancing their ideologies and agendas, while simultaneously denying communities agency over their authentic narratives and negating their sociocultural realities (Bishop, 1998; Wilson & Neville, 2009). This may be particularly problematic when investigating the experiences of highly vulnerable and structurally disempowered groups who historically lacked agency and bodily autonomy.
Community-Engaged Research
Participatory research approaches aim to conduct research with communities. These approaches have been used with CSE-impacted groups and include collaborative processes where community members perspectives are centered and valued, their agency over research decisions is promoted, and traditional power imbalances are addressed (Carranza et al., 2013; Cornwall & Jewkes, 1995; Godoy et al., 2022; Lockyer & Koenig, 2020). Community-based participatory research centers the knowledge, expertise, and lived experiences of community members with the research enterprise (Duke, 2020). By ensuring that participants’ perspectives are elicited, incorporated, and valued in research, a participatory approach coupled with trauma-informed strategies can serve to restore individual feelings of dignity and autonomy (Carranza et al., 2013; Godoy et al., 2022; Lockyer & Koenig, 2020; Teti et al., 2012).
While there is little consensus on what threshold of community engagement is necessary in community based participatory research, this approach frequently involves developing and sustaining a community advisory board to co-lead research activities (Duke, 2020; Hacker, 2013). Community advisory boards have high utility in CSE research, including keeping researchers accountable to community priorities and cultural sensitivity. Collaboration between researchers, community members, and key partners and collaborators strengthens a researcher’s ability to understand the full range and impact of the phenomenon of interest. By working closely with community members, researchers are able to tap into their prior knowledge of and relationships with networks, scholars, and others with substantive expertise. Prior human trafficking studies have exclusively relied on key partners and collaborators, such as agency directors across systems and in the community to refer potential participants and as research sites (e.g., Barnert et al., 2020; Pasko & Chesney-Lind, 2016). Yet, this approach alone may be insufficient to fully understand a community’s needs in a research context and to access populations that may be inaccessible without established connections. Thus, there is high value in integrating community-engaged approaches, including community advisory boards made up of individuals with lived experience, to investigate CSE.
Trauma-Informed, Strength-Based, and Person-Centered Approaches
Being trauma-informed means understanding how traumatic experiences, such as violence and human trafficking, may impact individuals, and using that understanding to tailor services and systems to support those who have experienced trauma (Butler et al., 2011; Day, 2018; Harris & Fallot, 2001). Research indicates that individuals who experience human trafficking require policies and services that integrate trauma-informed approaches (Hemmings et al., 2016; Scott et al., 2019). For instance, service providers may use open-ended questions, avoid asking irrelevant questions, and ensure that individuals do not feel pressured to repeatedly recount details of their exploitation to reduce risk of re-traumatization (Hemmings et al., 2016).
A strength-based approach calls service providers to view individuals “in the light of their capacities, talents, competencies, possibilities, visions, values, and hopes, however dashed and distorted these may have become through circumstance, oppression, and trauma” (Saleebey, 1996, p. 297). Individuals impacted by human trafficking benefit from a strength-based approach because the focus is not on trauma or deficits, but on identifying and emphasizing resources, personal strengths, and resilience (Crisp & Johnson, 2024; Saleebey, 1996). Similarly, person-centered care refers to eliciting and integrating one’s values and preferences in their treatment, and often involves upholding respect and value, choice, dignity, self-determination (Counsell, 2016; Washburn & Grossman, 2017). It involves a dynamic collaboration between individuals, those who support them, and providers, guiding decisions based on the individual desires (Counsell, 2016). In research, a person-centered approach can be defined as focusing on the person and their characteristics, rather than situational factors, and their individual, subjective experiences (Woo et al., 2018). Taken together, human trafficking research can integrate trauma-informed, strength-based, and person-centered practices to support and empower research participants who have experienced CSE.
Current Study
This study used a community-based participatory research approach and integrated trauma-informed, strength-based, and person-centered strategies to investigate how adults with histories of CSE initiated at early life stages (i.e., prior to age 11) perceived their involvement in research. The overarching research questions were: (1) What do participants’ stories reveal about their experiences with human trafficking research? (2) How do they see themselves and others with lived experience in research? and (3) What are their perspectives on using community-engaged approaches in research? Findings from this study can inform the development of person-centered, human trafficking research that engages community members with lived experiences and be used to advance scientific inquiry with this or similarly vulnerable populations.
Methods
This study was part of a larger qualitative study that used a community-based participatory research approach to explore CSE initiated at early life stages. The formation of the community advisory board formation and study procedures, which were guided by the board, were approved by the University of North Carolina at Chapel Hill Institutional Review Board (IRB # 23-1252).
Positionality and Reflexivity
This article was co-authored by a cadre of academic researchers and lived experience experts, including community advisory board members and research participants. We are a group of racially/ethnically diverse cis women and nonbinary individuals. The academic researchers have experience conducting research studies that used community-engaged approaches with structurally vulnerable populations, including CSE-impacted adolescents and adults as well as immigrants and adolescents who identify as Latine, respectively. Additionally, the co-authors have nearly 70 years of cumulative experience in the anti-human trafficking field. Given prior research experiences and after reviewing available peer-reviewed literature and engaging in conversations about the potential harms and unintended consequences of excluding community members in research, the decision was made to use a community-engaged approach for the current study.
In preparation, the principal investigator shared relevant articles related to participatory research and presented key components of the community-based participatory research approach that would be integrated into the present study with the community advisory board. We engaged in ongoing conversations about the community-engaged approach. Thus, we are critically reflexive about how our positionalities, social identities, and lived experiences affected research processes, including design, implementation, analyses, and dissemination. From this perspective, we believe that it was the diversity of our experiences and perspectives that helped us co-create an enriching and safe research environment for all collaborators and participants. This article reflects our collective desire for more equitable research that incorporates and values the perspectives of lived experience experts.
Research Design
We conducted this study within a constructivism paradigm, which is grounded in the relativist ontological assumption that multiple realities are socially and experientially constructed with various ways to access these realities (Guba & Lincoln, 1989, 1994). From a transactional epistemology, we recognize the interactive connection between researchers and participants; consequently, research findings were co-created throughout the study (Guba & Lincoln, 1994). Transactional epistemology aligns well with a community-based participatory research approach given its emphasis on collaboration, co-creation of knowledge, mutual influence, empowerment and agency, and the iterative and adaptive nature of research processes (Guba & Lincoln, 1994; Israel et al., 1998; Wallerstein & Duran, 2010).
To explore participants’ perspectives on community-engaged research, we employed a narrative approach. This approach places value on participant’s subjective experiences and recognizes that their interpretations and these meanings are critical to knowledge creation (Riessman, 2008). Further, a narrative approach has the power to validate participants’ experiences and give them agency in research processes which aligns closely with the tenets of community-based participatory research (Israel et al., 1998; Padgett, 2017).
Integrating a Community Advisory Board
Developing the Board
Community advisory boards formalize a partnership between the academy and community by providing community members representation in research (Newman et al., 2011). A community advisory board was developed with support and guidance from a lived experience expert, who is knowledgeable about community processes, well-connected and respected in the CSE community, and has experience collaborating with researchers. The lived experience expert invited potential community advisory board members by engaging widely across their network and various social media platforms, where CSE-impacted adults participate, to capture diverse representation. The lived experience expert was provided a stipend in appreciation for their time and support.
Together, the principal investigator and lived experience expert held two information sessions to identify potential advisory board members. Of the initial 11 individuals who participated in the information sessions, seven individuals (including the lived experience expert) indicated their interest in being part of the board. Each potential member met individually with the principal investigator via Zoom to assess their emotional capacity and availability (see Godoy et al., 2022). Importantly, the principal investigator recognized that research can result in unintended and harmful consequences to those who experience CSE, such as re-traumatization. To mitigate those risks for community advisory board members, a trauma-informed approach was integrated into the board formation. Individuals were asked about their access to mental health treatment, their history of involvement in the anti-trafficking field, and their perceptions on how mentally and emotionally prepared they were to engage in a sensitive research topic that may remind them of their past experiences. During these private conversations, two of the potential community advisory board members agreed that their participation in research was not conducive to their recovery process at that point in time.
Board Members and Meetings
The final community advisory board was composed of five lived experience experts from southwestern, midwestern, and northeastern regions of the U.S. These advisory board members ranged in age from mid-20s to mid-50s, four identified as cis females, and one identified as nonbinary. The community advisory board and principal investigator met between 2-3 times each month during the initial research design and planning phase (January-July 2023). At least two board members participated in each meeting, and those who were unavailable provided their feedback via email and shared documents. By April 2023, one board member was unable to continue with the advisory board due to availability. During the implementation, analysis, and dissemination phases, the board convened on an as-needed basis, rather than at regularly scheduled intervals. Each meeting was 60-minutes in length and took place via Zoom. Each board member was provided a stipend for their contributions to the study which was distributed at two time points. The stipends were provided when the board was initially formed and mid-way through the design and planning phase.
Role and Responsibilities
Overview of the Community Advisory Board’s Responsibilities in the Current Study.
The interview guides were co-developed and refined with the community advisory board. For instance, interviews began with participants deciding on verbal or visual signals that would indicate that they wanted to: (a) skip a question; and (b) take a break or stop the interview. Examples include participants saying “pass” or “skip” to move past a question, and raising their hand or putting a finger up to indicate they needed a break. We built in check-in points to ensure that the onus was not on the participants to decide if they needed a break after a potentially sensitive conversation. Instead all participants were provided a scheduled 5-minute break at two timepoints throughout the interview. Additionally, we included an opportunity to debrief at the end of each interview, which was not audio/video recorded or analyzed as data. These debriefs allowed participants to engage in reflection and the researcher to encourage participants to access their social support systems and create a plan to care for themselves in the hours and days after the interview.
Interactions with Research Participants
Participants were made aware that the study used a community-based participatory research approach, including a community advisory board. However, during the study period, participants were unaware of the specific contributions of the community advisory board, aside from study recruitment. The only formal interactions board members had with participants were during the recruitment and dissemination phases, including as co-authors and co-presenters. Community advisory board members contributions to participant recruitment, procedures, and data analysis are discussed below.
Recruitment Strategies and Sample
Purposive sampling strategies, including criterion and snowball sampling, and convenience sampling were used to invite potential participants (Gray, 2018; Padgett, 2017). Criterion sampling ensured that potential participants had a history of CSE initiated in early childhood (Gray, 2018). Snowball sampling allowed eligible participants to refer others with CSE histories within their networks to the study (Padgett, 2017). Lastly, convenience sampling helped mitigate challenges in identifying populations affected by CSE. Members of the community advisory board distributed electronic flyers and study information to individuals, agencies, and networks in the anti-human trafficking field (Gray, 2018; Johnston & Sabin, 2010). All five community advisory board members were invited to complete the eligibility screener to determine if they met inclusion criteria. Four board members chose to complete the screener, were deemed eligible, and participated in interviews.
Participants were included if they met the following inclusion criteria: (a) age 18 or older; (b) English speaking; (c) had the capacity to provide consent; (d) experienced CSE prior to age 11; (e) had not experienced any form of exploitation for a minimum of 4 years; (f) currently had a support system and/or therapeutic services available; and (g) had not made a plan or attempted to seriously harm themself in the prior 12 months. Eligibility screeners were self-administered electronically via Qualtrics. All potential participants who completed the eligibility screener received email communication from the principal investigator. Those who were deemed ineligible were thanked for their interest in the current study, informed why they were ineligible, and asked if they would like to be contacted for future studies. Potential participants who were eligible for the study were asked to schedule an interview using an online booking service via Microsoft Outlook. In total, 67 individuals were screened, 21 met inclusion criteria, and 11 scheduled an interview; however, one potential participant did not move forward with the interview. Ten participants were interviewed between September and November 2023. Padgett (2017) notes that a sample size of 10 is considered appropriate for a narrative approach, which is effective for studying one or a few individuals.
Participant Characteristics (N = 10).
Study Materials and Procedures
Before data collection, eligible participants underwent the informed consent process. During which the consent form was reviewed, questions were addressed, and individuals provided their consent both electronically and verbally. Once consent was obtained, participants completed a brief questionnaire to capture demographic characteristics via Qualtrics. Semi-structured, individual interviews were conducted using interview guides that were co-developed and piloted with community advisory board members in an iterative way. The first interview focused on capturing life histories and stories embedded in participant’s narratives. The second interview included questions about participants’ perspectives on human trafficking research and the interview process. For example, participants were asked, “What did you think the interview would be like?” and “What, if anything, was meaningful to you about participating?” Each interview was scheduled approximately two to six weeks apart to provide sufficient time for preliminary data analysis but not too much time that participants were lost to follow up. Given the possibility of re-traumatization, an adverse event protocol was developed. The protocol included documenting the adverse event, determining the level of intensity (ranging from asymptomatic to severe), and consultation with faculty mentors who maintain clinical licensure.
Interviews lasted 90 minutes on average and took place via a secure, teleconferencing software (i.e., Zoom). Interviews were audio/video recorded and transcribed using Zoom software, and checked for accuracy by the principal investigator. Field notes were recorded to capture relevant contextual details and insights regarding inflections, tone changes, and emotional nuances which supported interpretation of these data. Participants were compensated $50 with a gift card or electronic payment for each interview and received a resource guide with no-cost, nationally available behavioral health and anti-human trafficking services.
Data Analysis
Reflexive thematic analysis was employed to identify themes, which are interpreted as patterns that share meaning across narratives (Braun & Clarke, 2019). This analytical strategy aligns with a constructivist paradigm and a narrative approach that emphasizes meaning-making and storytelling (Braun & Clarke, 2006; 2019, p.7). The meanings derived from these data were viewed as context-dependent, situated, and anchored in specific times and places (Braun & Clarke, 2019). Field notes were part of the coding process and provided nonverbal information (e.g., gesture, tone) and insight into changes in tone and inflection (Mayring, 2021).
Reflexive thematic analysis followed a six-phase process (Braun & Clarke, 2006, 2019). In phase one, the principal investigator became familiar with these data by reading interview transcripts. In phase two, open coding was conducted and a codebook was created in an iterative manner. In phase three, codes were combined and sorted into preliminary themes. In phase four, the principal investigator reviewed these themes against the data, including transcripts and field notes. The principal investigator met with co-authors, including community advisory board members and participants, to gather feedback that was then integrated into the analysis. Personally identifiable information was not shared with community advisory board members or participants, rather data were presented with pseudonyms and in a narrative format. In phase five, identified themes were named and defined. Lastly, identified themes were finalized and findings were iteratively written and revised. Data were analyzed in Atlas.ti (version 8).
Credibility
Crystallization and member reflections were used to enhance the rigor and trustworthiness of this study (Braun & Clarke, 2023; Tracy, 2010). While data triangulation is typically aligned with a realist/positivist paradigm (Braun & Clarke, 2023; Padgett, 2017; Tobin & Begley, 2004), the use of multiple data sources is deemed valuable by researchers using various research paradigms (Tracy, 2010). In this study, crystallization, or the use of multiple perspectives to interpret and analyze data, involved using interviews and field notes which captured contextual information and insights from inflections, affect, and changes in tone. Field notes helped make meaning of data by providing a more complex, in-depth understanding of participants’ stories (Tracy, 2010). Preliminary findings were reflected back to participants through member reflections.
Member reflections, similar to member checking, provided participants an opportunity to correct and reflect on the information collected during interviews, ultimately offering new insights or elaboration and generating further data (Braun & Clarke, 2023; Padgett, 2017; Tracy, 2010). The principal investigator presented preliminary findings to the community advisory board in a team meeting and to participants individually. In these meetings, engaging in member reflections was not about verification of findings, but rather reflecting on contradictions and differences in understanding and exploring potential gaps in understanding (Braun & Clarke, 2023; Tracy, 2010). Elicited feedback was integrated into data analysis and the written report. This strategy complemented our community-based participatory research approach and analytic strategy by providing opportunity for ongoing collaboration (Braun & Clarke, 2023; Tracy, 2010).
Results
Overarching Themes, Subthemes, and Representative Quotes.
Note. Quotes are presented with self-selected pseudonyms.
Theme 1: Adverse Experiences with Human Trafficking Research
Participants reported similar negative experiences with human trafficking research that varied from being deemed ineligible for certain studies to engaging in studies that felt disorganized and even harmful. We generated three subthemes that captured their adverse experiences with human trafficking research which ultimately point to the need for more inclusive and trauma-informed practices. These subthemes were: (a) excluded and misrepresented; (b) lacking trauma-informed and community-engaged approaches; and (c) emotionally laborious and mentally challenging.
Excluded and Misrepresented
These participants were frequently denied the opportunity to take part in research altogether, despite study materials suggesting that anyone who had experienced human trafficking was eligible. As a result, participants felt that certain groups affected by CSE receive more attention in research and anti-human trafficking discourse, specifically adolescents and young adults exploited by romantic partners as well as those who are lured or run away from their households, leaving no room for their own stories. For Lucy and others who were exploited during early childhood, being excluded from research opportunities felt like a form of rejection that invalidated their life experiences and resulted in feeling like their “trauma [history] was too severe or too bad or it was too much” to explore. Ultimately, participants were disheartened when they were excluded from research. They were particularly upset when studies claimed to represent all types of sex trafficking but did not reflect their own experiences, meaning those exploited at early life stages (i.e., prior to age 11), including individuals currently in middle-to-late adulthood, as well as those who experienced CSE due to family members or acquaintances known to their family. Indeed, participants recognized that cis boys/men, LGBTQ + individuals, people with disabilities, Indigenous populations, immigrants, and exploitation that occurs in rural populations are rarely centered in research. This pattern of exclusion not only highlights gaps in available research but reveals deeper issues of representation and understanding.
Even when these participants were technically included in studies, they often felt excluded from research processes and like their exploitation histories were misunderstood. It was noted that interview and survey questions frequently failed to align with or fully capture the complexities of their CSE. For instance, Lucy described her involvement in a research study: I remember this question about, ‘Did you love your perpetrator?’ Like? Obviously, they’re talking about a pimp. But that’s a very complicated question when you’re talking about like a family member who was a trafficker, you know.
This lack of nuance further alienated participants by overlooking the intricate complexities of their realities and emphasized research priorities that often focused on certain types of exploitation. Taken together, participants believed that these exclusionary practices hinder the advancement of prevention efforts, as well as treatment and services for children with varied pathways into CSE.
Lacking Trauma-Informed and Community-Engaged Approaches
Participants reported having been part of studies that were generally respectful, mindful, and thoughtful. Still, they largely felt that these studies did not grant a high level of agency to participants or consider the holistic needs of the population. It was noted that these studies failed to incorporate survivor-led or community-engaged approaches and mostly lacked trauma-informed practices. In their experiences, even when lived experience experts were part of research studies as collaborators, their input was rarely elicited or integrated.
Participants generally viewed research as data-driven and goal-oriented, rather than person-centered. Chanel described seeing studies take place that felt “robotic” where researchers were “reading things off of a list and getting the information.” The perception that research is “transactional” and that researchers “always seemed to have an end goal or motive,” as Priceless described, or were predominantly focused on reaching a specific sample size created impersonal environments and fostered distrust among participants. Indeed, it was believed that researchers prioritized extracting information from participants over building meaningful, reciprocal relationships. Axel described it in this way, “A lot of times… as soon as the study is done, it feels like the researcher just washes their hands of at least me as a participant....”
The lack of ongoing engagement with participants was evident in the rarity of engagement after data collection. These participants received little to no feedback about how their stories were interpreted or where findings were disseminated. Axel explained: … As a professional in this field, I actually come across a lot of the studies that I have been a research participant in. And, sometimes it creates feelings of ickiness, sometimes it makes me feel sad, sometimes it makes me go, ‘there was more you could’ve done but that you didn’t do.’ But it also makes me feel like, once again, someone is washing their hands, they have done the deed and are moving on.
This participant likened their prior research experiences to sexual exploitation, pointing to the potential for researchers to perpetuate harm.
Participants recounted involvement in studies that they perceived to be chaotic, harmful, and even unethical. From their perspectives, researchers unintentionally perpetuated harmful practices that afforded little agency to CSE-impacted individuals and risked re-traumatization. This harm encompassed the type of information collected, such as, “Tell me about the hardest or most violent interaction you had with a [sex] buyer.” Even in these contexts, studies rarely provided space to debrief or resources to help process heavy conversations.
The issues also extended to how data were collected and by whom. For instance, one participant described a study in which a lived experience expert was hired to interview survivors only 6 months after they exited their own exploitation, without any mental health support. The lived experience expert received no formal research training which led to unprofessional behavior, such as failing to introduce themselves before asking questions and abruptly ending interviews by saying, “That’s it. Bye.” The participant recalled the principal investigator acknowledging this problematic behavior by saying, “I didn’t think I needed to train her, but I did need to train her.” These issues not only caused re-traumatization for participants but put the lived experience expert at risk of relapse into CSE. In short, participants felt that researchers lacked adequate training in trauma-informed practices, as few studies seemed to prioritize the overall wellbeing of participants or consider the potential for re-traumatization.
Researchers’ presentation, including their affect and tone, influenced how these participants responded. Participants described interacting with researchers who had a flat affect and seemed disinterested. At times, researchers appeared anxious and nervous during data collection. This led participants to feel responsible for managing the researchers’ emotions and hindered their ability to delve deeply into their experiences. While participants wanted to share some intimate details about their exploitation, concerns about the researchers’ capacity to handle these difficult stories often held them back. There was a strong desire for researchers to demonstrate competence in diverse forms of sex trafficking and an ability to engage with these challenging narratives in a trauma-informed manner.
Emotionally Laborious and Mentally Challenging
Research participation was understood as a form of emotional labor that was often mentally challenging and physically draining, even in trauma-informed contexts. Recounting traumatic life events was difficult. Nicole recalled that in this study, “I remember walking away from the first one [first interview] feeling like ‘Whoa, this is really hard.’” Sharing their narratives was further complicated when it required these participants to regulate their trauma responses and resist dissociation, especially if the study did not feel like there were trauma-informed or strength-based approaches. Dylan shared that in any research study, “There’s an emotional labor piece… it’s not easy at all mentally, psychologically to go to those places.” On the contrary, some participants experienced a different dynamic after their interviews for this study. Chanel described how her involvement in this study was the first time in a research setting where she “didn’t feel drained and empty when I walked away from that interview.” She continued: I feel like a release and sometimes, like I've done interviews…it is draining. And that’s a good feeling, because 9 times out of 10, when I walk away from a conversation about my life, I walk away exhausted.
The emotional labor associated with human trafficking research is complex and multifaceted and can be experienced differently based on context and the nature of the engagement. This duality highlights the nuanced experiences of participants, who are simultaneously navigating retelling their trauma and finding empowerment.
Participants acknowledged that their histories of complex trauma often made it difficult to recall certain memories or details of particular experiences. Amanda described that following the first interview of this study she thought: “Oh, my gosh! There are things that I wanted to say that I just like forgot to, or just it didn’t come to mind.” Therefore, as Amanda explained, some questions were “hard to answer” because of how memories had been compartmentalized, “and so it takes some time or like a little bit of digging to access it.” Engaging in multiple interviews was viewed as valuable, because it provided participants the opportunity to share new details or stories that they felt were important.
Given that retelling stories from their past was often experienced as laborious and challenging, some participants chose to reschedule interviews until they had the emotional capacity or declined participation in other research studies altogether. One participant described needing to reschedule an interview for this study because they were not in a good “mental space to do the interview. It would cause more emotional harm than good to participate.” This participant’s decision to reschedule the interview was influenced by challenges in their personal life which would have felt exacerbated given the sensitive nature of the topic. Participants also described declining research involvement in other studies because the emotional labor required outweighed potential incentives. Priceless explained, “I said, ‘no,’ because I was like, I’m not just going to carry the emotional labor of like contributing to your study, and there’s no compensation.” Though receiving monetary compensation could not fully offset the emotional burden, it was perceived as a necessary and thoughtful incentive for research participation. Isabella Blue, explained, “I perceive payment for my time and energy to be respectful of my choice to contribute to an academic outcome that will not benefit me directly once completed.” Taken together, these participants emphasized the need for community-engaged processes that centered the perspectives of lived experience experts in how to care for participants during the interview process, as well as fair compensation for those who choose to participate in the study.
Theme 2: Perspectives on Community-Engaged Research
Participants’ prior research experiences shaped their expectations of what a community-engaged research study would entail. Their expectations varied widely, from no particular expectation to high expectations for contribution and involvement. Two subthemes reflecting participant’s perspectives on community-engaged research were generated: (a) excited, empowered, and grateful; and (b) aspirations for future research and its outcomes.
Excited, Empowered, and Grateful
Regardless of preconceived notions, there was a sense of excitement and gratitude about being included in the study. Overall, these participants were eager to contribute to science and willingly set aside the time needed to do so. Research participation was viewed as a learning opportunity and process. At times, participants expressed how their involvement in community-engaged research studies positively affected their own understanding of knowledge creation and how they could contribute to future studies. Participants described seeing a shift from traditional power dynamics that felt “very unique” for Dylan and others in this study which made their contributions feel valued and the research process feel equitable.
The four community advisory board members, who were also research participants in this study, described feeling excited and empowered to offer suggestions from inception to dissemination. They believed their feedback was valued because “we partnered together, we listened to each other, and decided this was something we were going to do” as Lucy shared. Lucy continued by describing how other efforts in the anti-trafficking field: ... talk about including people with lived experience, but that isn’t always the case when it comes to actually being able to make decisions or have some agency in a project. Often times, it is giving your check mark on things. But, in this case, we truly had folks that joined together and were able to, through conversation and talking about different dynamics we see in this type of exploitation and even our own life experiences shape the questions.
These advisory board members recognized their presence as a vital contribution that enriched the study and addressed the community’s priority needs, rather than a formality. Isabella Blue described feeling “excited to come back” because the board’s “contributions were so important.” She continued by saying, “This was our opportunity to create a research project that would increase a participants ability to participate fully.”
The community advisory board felt no sense of judgment, or the need to censor themselves because there was a “deep respect” for each other. Instead, they expressed knowing that it was okay to disagree with others in the group, including the researcher, and believed that discord enabled people to “dig in and find a middle ground” as Isabella Blue described. She continued by explaining: Each time someone pushed back on language [for an interview question], we arrived somewhere better in the research process. We didn’t ever abandon the process. We may have ‘parked’ the topic for our next meeting to give ourselves time to reflect on it, but we always found the better language and concept for better [interview] questions. I think we all felt it was imperative to deeply listen to each other in this process.
Importantly, when disagreements arose, community advisory board members still felt respected and listened to, and considered the decision-making process fair.
Participants in this study took part in two to three interviews which provided them the opportunity to reflect on their stories, stay engaged in the research process, and correct any details as needed. Amanda expressed her gratitude for being part of two interviews in this study by stating, “I am thankful to have had this follow up.” The ongoing interactions were valued because it ensured they could provide additional information, clarify their stories, and aid in data interpretation—an approach not previously experienced by these participants.
Aspirations for Future Research and Its Outcomes
Participants shared aspirations that stemmed from their research involvement. They emphasized the importance of including lived experience experts in human trafficking research and noted that community advisory boards are “very unique and important in this process.” Dylan and others believed that community engagement could “change the trajectory of research.” Priceless explained that while she was “eager to be a part of something that seemed to encompass my experience,” she “didn’t expect the level of ownership, autonomy and even opportunity for ongoing engagement.” Across narratives, participants wanted to stay connected to on-going research that derived from the current study saying, “we’ve just put so much thought and time into trying to create something that is ethical and gentle.” These perspectives underscore the value of collaboration and thoughtful engagement in research.
Theme 3: Rigorous Research Can Foster Healing
These participants emphasized that the community-engaged process, including contributions of the community advisory board, was vital for creating a safe, validating environment. Moreover, having a safe space to discuss their experiences made them feel believed and seen. This approach felt transformational, rather than transactional, and like a remedy or source of healing. Priceless explained, “The benefit of the research being done in this way, for me, is that rather than leading to further traumatization or exploitation, in a way it opened up the door for further healing.” For Priceless and other participants, it felt meaningful for “participants to truly be the owners and narrators of our own story.”
Integrating a community advisory board to inform research, such as when to take breaks and specific diction for interview questions, increased participants’ sense of safety, provided autonomy over what stories they shared and how information was disseminated, and helped avoid re-traumatization. Through this approach participants felt empowered to share parts of their exploitation previously withheld from other researchers. For Axel, the community-engaged approach paired with trauma-informed and strength-based practices created “greater permission, an invitation to go deeper and to feel safer to go deeper. And so then that creates the ability to have more data.” Indeed, being part of a research study that handled their life histories with care not only created a sense of empowerment but increased their trust that researchers had good intentions. Kathleen shared, “I think it’s empowering to feel like you can share your story and it’s going to be used for a good purpose. Be helpful.” Similarly Priceless said, “There… hasn’t seemed to be an intention to glorify the stories, have our stories told in a way to produce further shock or engage in trauma porn.” Incorporating lived experience experts’ perspectives was deemed crucial for developing ethical research practices that empowered these participants and enabled researchers to gain deeper insights into their experiences.
These participants were clear that how they perceive the researcher and the research process matter. Participants expressed needing to understand and wanting to feel like the researcher was adequately trained in and comfortable with the substantive area. Additionally, it was viewed as imperative that there was ample time allotted for interviews, so that participants would not feel rushed or pressured by time constraints. Lucy shared that as a community advisory board member she felt comfortable sharing details of her exploitation because she had a relationship with the principal investigator. She said it is “harder when you’re telling a stranger.” Lucy continued by saying that in contrast to other studies: I know you [the principal investigator] have the skills necessary to do whatever you need to do to take care of yourself when you hear something that’s tough.
The relationships cultivated with the researcher made the interview more comfortable and built trust that the researcher would not unintentionally perpetuate harm and confidence in their skills and ability to hold space for participants.
Across narratives, participants described a sense of connection with the research and a connection with other members of the study which together increased their sense of belonging. This was especially true after the study principal investigator reengaged participants to share preliminary findings. Participants also described how being invited to the study by community advisory board members and other participants (as part of snowball sampling) increased their sense of safety and trust in the researcher, and ultimately influenced their belief that this study would be trauma-informed. Jenna explained: …because I heard that you are trauma-informed, and that you have a way that you interact with this process that’s positive, and so I was expecting that. And it has been like that, and I really appreciate it.
These engagement strategies also mitigated fears related to uncertainty about the research process and weariness about the researcher’s intentions. Very importantly, these participants emphasized that what made a difference in the research process was that a community-engaged approach helps research focus on the whole person and not just the most egregious aspects of their CSE histories.
Participants believed that their participation in research could raise greater awareness and support for others with similar stories. Their enthusiasm about the real-world impact of this research was coupled with a strong hope that research findings could inform prevention strategies, facilitate early intervention, and improve service provision for children initiated into CSE at young ages. Lastly, there was a strong desire for research to drive change in policies and practices that support CSE-affected populations.
Discussion
This work builds upon a growing body of literature that underscores the significant benefits of using community-engaged research approaches with structurally vulnerable groups, including those impacted by CSE (Carranza et al., 2013; Gerassi et al., 2017; Godoy et al., 2022; Heaney et al., 2011; Lockyer & Koenig, 2020). Our findings highlight the complex and nuanced experiences of these participants with research. Their narratives not only revealed adverse experiences with human trafficking research but their perspectives on community-engaged research and ways it can foster healing while maintaining rigor. Insights gained from these participants have several implications and underscore the critical need for researchers to prioritize trauma-informed, strength-based, and community-engaged research approaches.
Enhancing CSE Research through Community Engagement
Our findings align with extant literature suggesting that research on sensitive and risky topics with socially disadvantaged and vulnerable groups poses the potential for substantial threats, including emotional harm, reactivating distress, and intensifying stigma (De Haene et al., 2010; Farrimond, 2012; Lee & Renzetti, 1990; Morse, 2007). Literature suggests that ethical issues in research may be more pronounced for CSE-impacted populations, given their ranging degrees of experienced trauma, coercion, and exploitation (Duong, 2015; Gerassi et al., 2017). Participants’ stories emphasized the critical need for researchers to consider how to design studies that center their stories while prioritizing their protection from harm. We propose that in an effort to keep participants safe, it is imperative that researchers are mindful of their eligibility criteria and include a robust adverse event protocol. The eligibility criteria were mindfully co-developed by the community advisory board to ensure the criteria was inclusive while ensuring that participants were not in active crisis or without social support. Adverse event protocols may include gauging the level of severity of the event, determining if the participant requires access to immediate emergency services, and engaging in a conversation about if the participant has the emotional capacity to remain in the study. Participants’ beliefs aligned with prior research suggesting that community-engaged strategies can increase participants’ sense of safety and agency (Gerassi et al., 2017; Godoy et al., 2022; Heaney et al., 2011). Involving lived experience experts in CSE research has been shown to be productive and beneficial for community members.
Our findings advance prior literature that found that research can create spaces for healing and build community among groups with histories of sexual violence and sex trading (Gerassi et al., 2017, 2019; Ragavan et al., 2020; Ratcliff et al., 2018). Community engagement can improve self-competence and self-esteem, and support self-reflection on how personal abilities and strengths contribute to resilience (Carranza et al., 2013; Lockyer & Koenig, 2020). Further, participants in this study disclosed feeling a sense of validation because their stories were believed and feeling like they were not alone. Lastly, we believe that it was the intentionality of the community-engaged approach coupled with trauma-informed, strength-based, and person-centered practices that not only avoid re-traumatization but empowered participants and even contributed to their healing process.
Participants’ accounts of feeling seen and understood aligns which literature suggesting that community-based participatory research can promote an epistemological version of validity that is culturally safe (Wilson & Neville, 2009). Participant stories showed that a community-based participatory research approach positions the power and agency of what is acceptable research and literature within the focal population itself (Bishop, 1998). This study also contributes to establishing research norms based in the reciprocity and ongoing engagement of community members which can enhance the quality of research (Godoy et al., 2022). As seen in these findings, community engagement can guard against the misinterpretation of findings and misrepresentation of these communities (Bishop, 1998), ultimately improving rigor and trustworthiness of findings. The benefits of participatory research described in this analysis provides evidence that integrating a community-based participatory research approach does enhance human trafficking research.
Importance of a Community Advisory Board
Our findings build on literature suggesting that community advisory boards can support the integration of trauma-informed, resilience-oriented, and strength-based frameworks into the research process, and provide critical oversight to ensure community expectations are met (Duke, 2020; Hacker, 2013). The community advisory board helped reduce risk of re-traumatization by co-developing study materials that accounted for potential participants emotional capacity and integrated safety measures, like dedicated check-in points and opportunities to debrief. Community advisory board members and participants alike agreed that integrating lived experience experts in research improved study rigor and trustworthiness of findings. For instance, through this approach researchers integrated member reflections in the study design, which enabled participants to clarify parts of stories shared and enhanced researcher’s understanding and interpretation of data (Braun & Clarke, 2023; Tracy, 2010).
Our integration of a community advisory board opened the possibility that researchers’ own beliefs could be transformed while conducting research with groups different than ourselves (Mahmood, 2011). Ongoing meetings with the board provided a safe space for the principal investigator to enhance their own understanding of the substantive area, including stories about early onset CSE that are frequently absent from the literature. Importantly, community advisory board meetings afforded the principal investigator an opportunity to debrief and reflect when participants’ stories were particularly difficult to digest.
Some research is available on how vicarious trauma, defined as the psychological consequences of trauma exposure through one’s work, affects researchers (AbiNader et al., 2023; McCann & Pearlman, 1990). Less remains known about how community-engaged strategies can serve as a protective factor. Despite the principal investigator's more than decade experience in the anti-human trafficking field, vicarious trauma was experienced during data collection which resulted in nightmares and intrusive thoughts. In addition to a robust support team, which included a therapist, family/friends, and mentors, the community advisory board played an important role in working through the vicarious trauma. The principal investigator was not only able to engage in honest conversations about the difficulty of hearing egregious stories of sexual victimization against very young children (i.e., birth through preadolescence) but was provided a sense of hope. Indeed, working with lived experience experts in this study highlighted these individuals’ survival skills, resiliency, and ability to make meaningful contributions to prevent and stop future exploitation.
Details Matter
Findings indicate that the ways in which the researcher presents, including their affect and tone, their consistency or lack thereof, how questions are asked, and other aspects of the research process are incredibly important for the following reasons. Participants in this study perceived that in prior studies researchers were not well-trained or emotionally capable of handling their life stories which resulted in several negative consequences. First, it hindered participants’ ability to go in-depth, making them feel like their stories were “too much.” Second, it increased participant’s emotional labor during the research process. Third, it increased apprehensions and feelings of distrust against researchers and discouraged future participation in research. Taken together, these issues diminish the anti-human trafficking field’s ability to comprehensively understand CSE and increases the limitations of available literature. Therefore, we believe that it is imperative that researchers are mindful of their readiness to engage these populations and take the steps necessary to ensure they are cultivating a safe and comfortable environment for participants.
Exclusion and Misrepresentation
Participants’ stories indicate that exclusion from research and misrepresentation of findings are significant issues that can perpetuate harm and marginalization in structurally vulnerable populations, particularly among CSE-impacted groups. Our findings indicate that when certain groups are systematically excluded from studies, whether due to social identity (e.g., age, gender, sexual identity) or type of exploitation (e.g., familial sex trafficking, circumstantial need) and despite claims of inclusivity, it raises serious ethical concerns and undermines the credibility of the research. Moreover, when studies assert that they represent “all survivors,” as our participants’ perceived, while excluding specific voices, such as those who were initiated into exploitation as toddlers and preadolescents compared to adolescents, it misrepresents the diversity of experiences within the human trafficking community. Further, our findings highlight that these exclusionary practices, while likely unintentional, invalidate the lived realities of those who are omitted. This disconnect can create a sense of disillusionment and mistrust toward researchers and institutions.
We believe that the consequences of this exclusion and misrepresentation are profound. It can lead to policies and interventions that do not address the needs of all CSE-impacted groups. Importantly, these policy gaps may result in insufficient support and resources for highly structurally vulnerable groups, such as those initiated into CSE during early childhood, those who identify as LGBTQ+, immigrants, Indigenous populations, and individuals with disabilities. Furthermore, the failure to accurately represent the full spectrum of CSE experiences can perpetuate stereotypes and reinforce existing power imbalances, ultimately marginalizing the very voices that research aims to illuminate.
Implications for Research
Our findings call attention to the critical need for researchers to integrate trauma-informed, person-centered practices when interacting with structurally vulnerable populations, including those affected by human trafficking. At times, participants described wanting to share their experiences, but felt afraid researchers were unable to handle it. Simultaneously, researchers sometimes asked for too much detail or for them to be too graphic which reduced their agency in what aspects of their CSE histories they shared. To this end, integrating the perspectives of lived experience experts in research can help to gauge boundaries of what is and is not acceptable. Providing trauma-informed practices, including frequent breaks, checking-in with participants at multiple timepoints to assess their capacity, and ensuring fair remuneration, can help offset the unavoidable emotional labor required while increasing agency and autonomy in research processes.
These findings have important implications for research designs and Human Subjects Review Committees, also known as Institutional Review Boards, which perform ethical reviews of research approvals with human subjects. Participants agreed that interviews will likely require more time and/or multiple interviews which may not be a researcher’s standard practice. Additionally, we believe that it was partly due to engaging in multiple interviews and member reflections that increased the researchers’ depth of understanding and enabled participants to feel, for the first time, truly seen in research. Human Subjects Review Committees often consider the length of the interview to be an indication of response burden. However, because the content related to extensive trauma is highly charged and may be affected by participant recall issues (Coughlin, 1990), more time and multiple interactions will likely be required and should be scheduled from the outset and approved by Human Subjects Review Committees. Lastly, our findings indicate that it is critical that Human Subjects Review Committees place high value on community-engaged research which can create a more ethical, inclusive, and impactful research landscape.
Conclusion
There is a high need for researchers to intentionally realign power and control over research decisions and center the perspectives of lived experience experts in research. Moreover, addressing the exclusion of certain CSE-impacted groups, such as those initiated into CSE during early childhood, and issues related to misrepresentation requires a commitment to inclusive, trauma-informed, and community-engaged research practices that prioritize the voices of all survivors. It is critical that all stories contribute to research so that we may have a more comprehensive and accurate understanding of human trafficking. Only then can research fulfill its potential to inform effective and equitable solutions.
Footnotes
Consent to participate
Participants provided written and verbal consent before starting interviews.
Acknowledgements
Thank you to those who participated in this study for their thoughtful insights.
Ethical Statement
Funding
The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by Philanthropic Education Organization (P.E.O.) Foundation; The Melissa Institute; Royster Society of Fellows at UNC Chapel Hill
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.