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

儿童性剥削和贩运(CSE/T)的最大风险因素是一个不健全的家庭 以暴力和父母物质使用为特征的环境。在肯塔基州，家族性交易是 更常见的CSE/T形式肯塔基州以最高的性暴力发生率(SV)和 伴侣暴力，我们在阿片类药物过量死亡人数中排名第四。基于肯塔基州的需求，我们提出了一个 群集化随机对照试验(RCT)，针对优先领域4预防CSE/T，使用 作为干预者的中学教职员工中的旁观者知情干预。正如疾控中心停止行动所强调的那样- SV，旁观者编程展示了降低SV的承诺。我们的研究团队进行了一项为期5年的高中- 基于RCT，确定Green Dot为减少多种形式SV的有效旁观者计划 包括性胁迫和物质使用促进性行为两种形式，与CSE/T风险密切相关。 鉴于绿点在高中的有效性，我们建议对一位新奇的旁观者进行严格的评估- INFORMATED SEE Stop It(BiSiSi)计划旨在通过电子方式向中学教职员工提供 降低儿童CSE/T风险的目标。我们的多学科研究团队有机会利用 正在进行的县级活动涉及药物使用和防止儿童性虐待。肯塔基州32号 县将被随机分配到BiSiSi干预或注意力控制条件；随机条件将 适用于县域内招生中学。鉴于阿片类药物的使用与CSE/T之间的密切联系 风险，县选择将反映那些阿片类药物过量比率较高的人(包括在治疗社区中 RCT)。这一招聘战略允许调查两种可能相辅相成的干预措施 解决两个高度相关的公共卫生问题：CSE/T和阿片类药物的使用。具体目标1：评估 BiSiSi培训对改变中学教职员工的有效性1a)CSE/T知识，1b)态度 CSE/T(耻辱)，1c)干预的意愿和有效性，1d)使用“旁观者”行动来挫败CSE/T风险， 和1e)使用商业性剥削识别工具(CSE-IT)进行筛查、转介和报告。目标 2：评估BiSiSi培训在短期内增加CSE/T筛查和报告的有效性 (从第0年到第2年)，并开始根据情况在较长期(第3年)降低CSE/T费率，使用BiSiSi 在学校和县一级实施，根据学校和县的“气候”进行调整。这项RCT将是 适当的支持(≥80%，每所中学有~40名教职员工，分布在32个县和县 阿片类药物过量比率)。将使用通用估计方程(GEE)和结构方程建模来 前瞻性评估BiSiSi培训对中学教师CSE/T知识、态度、效能的影响 以及减少CSAET的干预行动(目标1)。将使用线性混合模型和GEE来评估 BiSiSi在改变CSE/T筛查和报告方面的有效性，在县级进行测量。预期的 结果：确定了减少儿童性剥削和贩运的补充预防战略。

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.