RCT to evaluate Bystander-informed See it Stop it (BiSiSi) to Prevent Child Sex Trafficking in Kentucky Middle Schools

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The strongest risk factor for child sexual exploitation and trafficking (CSE/T) is a dysfunctional family environment characterized by violence and parental substance use. In Kentucky, familial sex trafficking is the more common form of CSE/T. Kentucky leads the nation with the highest rates of sexual violence (SV) and partner violence and we rank 4th in opioid overdose deaths. Based on Kentucky’s need, we propose a clustered randomized controlled trial (RCT), in response to Priority area 4 preventing CSE/T, using a bystander-informed intervention among middle school staff as interventionists. As highlighted by CDC’s STOP- SV, bystander programming shows promise to reduce SV. Our research team conducted a 5-year high school- based RCT that identified Green Dot as an effective bystander program to reduce multiple forms of SV including two forms, sexual coercion and substance use facilitated sex, strongly correlated with CSE/T risk. Given the effectiveness of Green Dot in high schools, we propose a rigorous evaluation of a novel Bystander- informed See it Stop it (BiSiSi) program designed to be electronically delivered to middle school staff with the goal of reducing CSE/T risk in children. Our multi-disciplinary research team has the opportunity to leverage ongoing county-level activities addressing substance use and child sexual abuse prevention. 32 Kentucky counties will be randomized to BiSiSi intervention or attention control conditions; the randomized condition will be applied to recruited middle schools within counties. Given the strong links between opioid use and CSE/T risk, county selection will reflect those with higher opioid overdose rates (included in HEALing Communities RCT). This recruitment strategy allows an investigation of two, potentially complimentary, interventions to address two highly correlated public health problems: CSE/T and opioid use. Specific Aim 1: To evaluate the effectiveness of BiSiSi training to change middle school staff 1a) knowledge of CSE/T, 1b) attitudes towards CSE/T (stigma), 1c) willingness and efficacy to intervene, 1d) use of ‘bystander’ actions to thwart CSE/T risk, and 1e) use commercial sexual exploitation –identification tool (CSE-IT) screening, referral and reporting. Aim 2: To evaluate the effectiveness of BiSiSi training to increase CSE/T screening and reporting in the short term (from Years 0-2) and begin to reduce CSE/T rates in the longer term (Year 3) by condition, with BiSiSi implementation, at the school & county level, adjusting for school and county ‘climate’. This RCT will be appropriately powered (≥80% with ~40 staff in each of 64 middle schools, in 32 counties with high and lower opioid overdose rates). General estimating equation (GEE) and structural equation modeling will be used to prospectively evaluate how BiSiSi training affects middle school staff’s CSE/T knowledge, attitudes, efficacy and intervention actions to reduce CSAET (Aim 1). Linear mixed models and GEE will be used to evaluate the effectiveness of BiSiSi to change CSE/T screening and reports, measured at the county level. Anticipated results: Identification of complementary prevention strategies to reduce child sexual exploitation and trafficking.