Table 3.

Perceived benefits and challenges to SDM implementation.

Perceived Benefits to Applying the SDM Model to Youth who have experienced CSEC
Encourage Empowerment & Self-worth
Well I like this because you’re giving that client, that youth, a choice. And you’re letting them have a voice. And maybe they don’t make the final decision, because sometimes we don’t make always great decisions when we’re young but at least they feel like they participated in their own life. I think that’s important for self-esteem and learning value for themselves. (Participant 16, Survivor of CSEC*)
I think helping give them self-esteem. I think that trafficked youth have often lost their own personal sense of identity and to do anything that helps them regain that, decreases their risk for future trafficking. You’re giving them autonomy, which is what, again, most youth are looking for. (Participant 15, Medical Provider)
Develop Youth Decision-Making Skills
Well, I think it’s ideal that the kids are making their own decisions or having input on their decisions. I mean, a lot of times they’re making decisions that are self-destructive. So, if we help them make some decisions that are constructive and those pan out, like I said those small victories, then we can work up to bigger things…(Participant 6, Social Services Provider)
When we make decisions for them, it takes that power or control away. Empowering them to be human, to make good decisions. If you’re always making a choice for someone, they don’t know if they can make good choices…that skill set never develops. (Participant 5, Social Services Provider)
Rapport & Relationship Building
Regardless of what type of trauma a child has been through, what they want to feel is inclusion… And it also gives them a sense of trusting, being able to trust someone, because they feel as though, oh hey, this person cares about my opinion… which allows them to feel as though they matter. (Participant 12, Survivor of CSEC)
Restore Power & Control Taken by the Trafficker
I think the biggest thing about being trauma-informed is not pushing something that somebody’s not ready for and trusting that they know themselves and giving them that agency. Because, I mean, trauma happens when people lose control–that’s a big part of it–and giving them that control and agency back is really important. (Participant 8, Social Services)
Then, of course, giving youth power in their lives, because traffickers take away power. So the more that we can give them power, it just means that they’re more likely to have a sustainable outcome or a longer-term positive outcome than if we force them to do an option that may not be the best option for them. (Participant 16, Other)
Restore Power & Control Taken by Service Systems
That lack of control is how they’re driven into their trafficker. It gives them skin in the game. If somebody is always telling me what to do, it’s not on me if it doesn’t work out. This seems to be a little more collaborative, so decisions are only being made for the child if it’s like a safety issue. (Participant 5, Social Services)
I really like that this is giving them all the choices. It’s giving them all the positives and the negatives. And essentially it hopefully makes it so that a case manager or person in a position of power couldn’t make them or unintentionally or intentionally kind of coerce them into a specific choice. (Participant 16, Other)
Perceived Challenges to Applying the SDM Model to Youth who have experienced CSEC
Trauma-bonds
The problem being, if we are still in that stage that I talked about of “I’m attached and in love with their trafficker,” they’re going to choose that option that takes them back to that trafficker…. And you got to remember that initially, their decisions aren’t their decisions. They’re still their trafficker’s decisions, whether they are there or not. They’re inside their head, making decisions for them. So, there’s a period of time that I think we need to be really cautious about, and then I think we can really work on empowering them by allowing them to be a bigger part of process. (Participant 4, Social Services)
They’re still either in love with the person who trafficked them or believe that they’re in love with the person who trafficked them. Or think that this is all stupid, and we’re just a bunch of squares getting in the way of what they want to do. (Participant 11, Social Services)
Distrust in the System
Kids who have been in that life for a while, they are really very savvy and manipulative sometimes. I think they sometimes just tell you what you want to know. I don’t know. It’s hard, because they’re so used to just trying to survive. It requires their buy-in on this, because we want your input on what’s going to happen with you, but they really have to be bought into their recovery or their treatment for them to really make real input. (Participant 6, Social Services)
Time & Policy Constraints
“It may affect DCFS and the child welfare agencies in that when they’re rushing to prepare a case, they’re just trying to comply with the law - “I must find a placement for this child within so much time that meets these legal criteria and I really don’t care what you want and what you think.” I just need to get it done, so their caseloads and their work burdens really don’t provide them the opportunity to discuss with the youth what their wants and needs are. (Participant 1, Legal)
I think the barrier to this process is the time aspect. The time for professionals to engage with the youth in this way and then it’s a question of who is the appropriate professional to engage in this way and when is it appropriate to engage this way? For example, in the middle of a court hearing, this maybe really inappropriate because this could take forever - not forever - but it could take a really long time to sit down and say “these are your options. Let’s talk about pros and cons, let’s write down a little decision tree” or something. That would take a really long time and I think judges would get really impatient. I think District Attorneys and attorneys would get impatient. (Participant 2, Legal)
Lack of Available Options to Choose from
I think if it’s done properly, and kids are actually able to participate in the decision making because there’s enough resources for them to choose, honestly… I mean, if there isn’t more than one option, what kind of decisions can they make? It’s either yes or no, but it would be better if they had more options. That would be great, but how often is that really the case? I mean, in a perfect world this is how it should be, but in everyday life it’s not always possible. (Participant 6, Social Services)
It’s time-consuming. We don’t currently have a lot of options, so it’s difficult to conceive of “here are three placement options for you,” when we’re scrambling to find one placement option. There’s a tendency to, when you’ve got the trafficked youth, to try to do everything you can right there and then because you fear you won’t see them again. (Participant 15, Medical)
Buy-in & Fidelity Monitoring
So saying they implement it, and not actually doing it. I see that being a huge barrier. Buy-in and actually whether a service provider would follow it. (Participant 5, Social Services)
I think it’s possible. I think it would be hard. I mean, there’s a lot of people who their role is to be like an authority, and so I think it will be really hard to make the child equal players… you know, like there are a lot of people who are used to their role being to decide what’s best. So it’s not that they don’t listen to children, but it could be challenging to give some of the reigns over. (Participant 8, Social Services)