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

儿童性剥削和贩运的最大风险因素是功能失调的家庭 以暴力和父母使用药物为特征的环境。在肯塔基州，家庭性交易是 更常见的CSE/T。肯塔基州是全国性暴力（SV）发生率最高的州， 伴侣暴力，我们在阿片类药物过量死亡中排名第四。根据肯塔基州的需要，我们提出了一个 针对预防CSE/T的优先领域4，使用 旁观者知情的干预中学工作人员作为干预者。正如CDC所强调的那样， SV，旁观者编程显示有希望减少SV。我们的研究小组进行了一项为期5年的高中- 基于RCT，确定绿色点是减少多种形式SV的有效旁观者计划 包括性强迫和物质使用促进性行为两种形式与CSE/T风险密切相关。 鉴于绿色点在高中的有效性，我们提出了一个新的旁观者严格的评估- 知情看到它停止它（BiSiSi）计划旨在以电子方式交付给中学工作人员与 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 正在开展的州一级预防吸毒和儿童性虐待活动。32肯塔基州 县将被随机分配到BiSiSi干预或注意力控制条件;随机条件将 适用于县内招收的中学。鉴于阿片类药物使用与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率较高的人（包括在HEALing Communities中） RCT）。这一招募战略允许对两种可能互补的干预措施进行调查， 解决两个高度相关的公共卫生问题：CSE/T和阿片类药物使用。具体目标1：评估 BiSiSi培训改变中学工作人员的有效性：1a）CSE/T的知识，1b）对 CSE/T（耻辱），1c）干预的意愿和有效性，1d）使用“旁观者”行动来阻止CSE/T风险， （e）利用商业性剥削识别工具进行筛查、转介和报告。目的 2：评估BiSiSi培训在短期内增加CSE/T筛查和报告的有效性 (from 0-2年）和开始降低CSE/T率（3年）， 在学校和县一级实施，根据学校和县的“气候”进行调整。本RCT将 适当的权力（≥80%，在32个高中和低高中的县，64所中学各有约40名工作人员） 阿片类药物过量率）。一般估计方程（GEE）和结构方程模型将用于 前瞻性评估BiSiSi培训对中学教师CSE/T知识、态度、效能的影响 和干预行动，以减少CSAET（目标1）。线性混合模型和GEE将用于评估 BiSiSi改变CSE/T筛查和报告的有效性，在县一级进行衡量。预期 成果：确定补充性预防战略，以减少对儿童的性剥削和贩运。

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.