Between Protection and Coercion: Survivor and Stakeholder Perspectives on Court-Involved Therapy for Commercially Sexually Exploited Youth in Atlanta,Georgia

Literature Review

Sexual exploitation of children is a global phenomenon, but terminology, legal definitions, and institutional pathways into services vary substantially across jurisdictions (Arnull et al., 2025; United Nations Children’s Fund [UNICEF], 2020). In many international contexts, the acronym CSE is used to denote child sexual exploitation and is embedded within child-protection and safeguarding frameworks that focus on prevention, welfare-based intervention, and statutory duties toward children (Arnull et al., 2025; Lefevre et al., 2019; UNICEF, 2020). In contrast, U.S. responses to commercially sexually exploited youth, which we refer to as CSEY, often operate at the intersection of child welfare and juvenile justice systems, where court involvement may serve as a primary mechanism for identifying cases, coordinating services and care, or enforcing accountability (Barnert et al., 2016; Liles et al., 2016; Swaner et al., 2016). These differences reflect distinct legal traditions, institutional arrangements, and assumptions about responsibility, agency, and protection (Lefevre et al., 2019; Musto, 2016). In this context, therapeutic services linked to court processes represent one possible but context-specific pathway through which youth affected by CSEY may access care in the United States (Barnert et al., 2016; Heldman, 2025; Hetherington et al., 2022).

Recent international scholarship discusses how institutional responses to child sexual exploitation can unintentionally reproduce harm when systems fail to recognize vulnerability, prioritize control over care, or marginalize the perspectives of children and survivors. Drawing on UK-based evidence, Arnull and colleagues (2025) document persistent institutional failures to protect exploited youth, including patterns of disbelief, misidentification, and inadequate interagency coordination. Complementary survivor-centered research outside the United States notes how stigma, fear of consequences, and negative experiences with authorities shape disclosure, help-seeking, and engagement with services (Kavenagh & Maternowska, 2024; Palmer & Foley, 2017). Together, this literature denotes how the structure and framing of service pathways, particularly when linked to authority or enforcement, can shape survivors’ willingness and ability to engage in therapeutic and supportive care.

Across jurisdictions, scholars have identified a recurring ethical tension in responses to child sexual exploitation: Systems designed to protect may also coerce, and interventions intended as care may be experienced as surveillance or control. Lefevre et al. (2019) conceptualize this tension as a challenge of balancing protection with meaningful participation, including when statutory authority constrains young people’s choices. In the U.S. context, Musto (2016, 2022) similarly critiques forms of “carceral protection,” whereby anti-trafficking and protective interventions rely on legal leverage, monitoring, and compliance mechanisms that may reproduce the very dynamics of control they seek to disrupt. This tension is especially salient when access to services is linked to justice system involvement, which may facilitate coordination and resource allocation while simultaneously posing risks of coercion, net-widening, and retraumatization (Barnert et al., 2020; Flores & Barahona-Lopez, 2019).

Given this variation and ethical tension, clarity in terminology is important. The juvenile justice and child welfare literatures do not offer a single, standardized definition of therapeutic services linked to court processes for minors, reflecting variation in legal authority, service delivery models, and jurisdictional practice. Therapeutic services connected to court processes are described in the literature as court-ordered or court-involved treatment. While these terms do not uniformly denote coercive practice, they reflect legal frameworks in which participation is formally required and non-compliance may carry consequences, positioning treatment as a condition of court involvement rather than as a purely voluntary or collaboratively negotiated service (Barnert et al., 2016; Liles et al., 2016).

At the same time, research on survivor-centered and trauma-informed practice cautions that when treatment conditions are experienced as coercive, they may undermine trust, reduce engagement, and exacerbate harm, particularly for youth with extensive histories of trauma and system involvement (Barnert et al., 2020; Cattaneo & Goodman, 2015). This literature suggests that how mandates are structured, and how survivors experience them, matters as much as whether services are offered at all.

To clarify how these tensions operate in practice, we use the term court-involved therapy to refer to therapeutic services that are accessed, coordinated, or monitored through juvenile court processes (including judicial review hearings or specialty-court-style oversight), where engagement may be encouraged or required as a condition of case planning or service coordination. Consistent with stakeholder perspectives in our data, we distinguish between mandating attendance (presence in a therapeutic setting) and mandating participation (compelled disclosure), and we use court-involved therapy to emphasize the former rather than forced therapeutic disclosure.

Despite the growing use of court-involved and specialty court models for youth affected by CSEY in some U.S. jurisdictions, limited empirical work has examined how survivors and frontline stakeholders perceive these approaches, particularly with respect to autonomy, retraumatization, and family involvement. Existing evaluations have largely focused on program design or outcomes, with less attention to the lived experience of court involvement and the conditions under which such models may facilitate or hinder healing and engagement. Addressing this gap is critical for informing the development and implementation of court-involved therapeutic responses that align with trauma-informed, survivor-centered principles while navigating the ethical and institutional complexities inherent in justice system–based care.

Project Design

This article draws from a broader, multi-phase qualitative study that engaged key stakeholders to explore strategies for improving systems of care for youth experiencing CSE. Bringing together survivor and professional perspectives within a single study design reflects emerging calls for inclusive, multi-stakeholder approaches that center lived experience alongside practitioner expertise in shaping CSEY service design and implementation (Sahl et al., 2021; Sahl & Knoepke, 2018). The research involved pilot interviews to refine questions, mixed focus group discussions (FGDs) to explore interprofessional dynamics, and in-depth interviews (IDIs) with survivors to capture experiences that may not surface in group settings. An iterative approach was used, with feedback from each phase informing the next. Further methodological details regarding the parent study are reported in a companion paper (Lakshman et al., 2026).

Participants and Data Collection

The study was conducted in Atlanta, Georgia, a large Southeastern metropolitan area. At the time of data collection, no dedicated specialty court for commercially sexually exploited youth operated in the city, making the juvenile court system the primary institutional context through which survivors encountered court-involved services. This contextual detail is relevant to interpreting participant perspectives, as respondents discussed court-involved therapy as a prospective model rather than reflecting on an existing local program.

Qualitative data were collected from 31 individuals, including three in-depth interviewees and 28 focus group participants. In-depth interviewees were all adult survivors (over the age of 18) of CSEY. Focus group participants included the following groups of individuals: adult CSEY survivors, law enforcement, social workers, and clinicians. To be eligible for participation, stakeholders from the latter three groups had to have worked with survivors in their professional capacity and had to be over the age of 18 years. Participants were recruited through purposive and snowball sampling, where the researchers identified and reached out to individuals in each stakeholder group and participants provided the contact information of other eligible individuals. Survivors were recruited through the lead author’s relationships with local community-based organizations serving CSEY survivors. Participants were asked to refer other survivors/colleagues who had knowledge and experience with CSEY. All FGDs were held at the DeKalb County Juvenile Court private conference room, and the IDIs were held either over Zoom or in-person at a private conference room chosen by the participant.

FGDs were held during a 2-week period in the Fall of 2018, and IDIs were conducted in a month-long period in early 2019. FGDs were 2 hours long, and IDIs were between 30 and 45 minutes. A brief oral study summary of the risks and benefits of the study was provided to participants, and verbal informed consent for participation and digital recording was collected from all participants before FGDs and IDIs commenced.

The semi-structured interview guide was developed around the four previously mentioned domains aimed at strengthening survivor-centered care, shaped by early stakeholder input and existing literature. The guide included 14 questions related to service provision and stakeholder perceptions of the mental health needs of survivors, systems-level service gaps, and the four domains. Examples of questions included, “How might implementation of these four domains make the lives of survivors easier or more difficult?” and “What can be changed about existing court-involved therapy approaches that would make implementation more feasible?” This article focuses on one specific domain: court-involved therapy, or the use of tailored treatment options ordered by courts for survivors. Preliminary input from pilot participants helped refine the guide to ensure relevance across professional and lived-experience perspectives; however, these interviews were not formally coded and did not inform the results of the study.

Data Management and Analysis

The FGDs and IDIs were audio-recorded using a digital recording device, then transcribed verbatim. Data were stored on a password-protected computer, and backup copies of all recordings and transcripts were stored in secure, electronic files on the researchers’ computers. Identifying information was redacted from the transcripts, and all data were de-identified prior to commencing analysis. Data analysis followed a thematic content analysis approach using both deductive and inductive coding strategies (Braun & Clarke, 2006). Deductive themes were derived from FGD/IDI guide domains, and inductive themes emerged upon iterative reviews of the data, reflecting patterns not necessarily tied to specific questions asked (Morgan & Nica, 2020). The lead author conducted repeated close readings of all transcripts to generate initial codes. The emerging codebook was developed iteratively in close consultation with the faculty supervisor, with themes refined through ongoing discussion. Thematic codes were organized into a coding tree, given explicit definitions, and compiled into a codebook consisting of 13 main codes and 39 subcodes.

A unified coding framework was applied across both FGDs and IDIs; however, additional inductive codes emerged from survivor IDIs, reflecting the depth and individualized nature of one-on-one interviews relative to group discussion. To establish coding rigor, each transcript was independently coded by the lead author and a trained research assistant, and the coding team met iteratively after each transcript to discuss coding decisions and resolve any discrepancies through consensus (Lincoln & Guba, 1985). A second research assistant supported theme consolidation across transcripts, and the full research team subsequently convened to review the final codebook. Consensus was reached on all final themes with no outstanding disagreements. Research staff who facilitated focus groups also reviewed their field notes to ensure analytical completeness. An example of a deductive theme for this analysis was “factors that should be considered with court-involved therapy,” while inductive themes included “therapy for guardians” and “survivor involvement in training,” the latter of which emerged primarily from survivor IDIs. Thematic saturation was assessed across both data sources, with no new major themes emerging in the latter stages of data collection. All analyses were conducted using MaxQDA 12 (VERBI Software, 2016).

The Emory University Institutional Review Board (IRB) determined the study to be exempt from full review; however, best practices for informed consent and confidentiality were maintained throughout.

Survivor Involvement

Across the focus group discussions and in-depth interviews, participants discussed the importance of survivors being engaged in the court-involved processes. Two main aspects of this theme were (a) a proposed peer-mentor support network and (b) survivor-led training.

Survivors have a unique experience that is hard for others to understand, no matter how talented or compassionate a professional is:

I think there’s a tendency of some survivors to feel, still feel kind of like “Othered.” So, if she has another survivor that she can talk to, that can go a long way. It would be important to have a survivor mentor in the framework. (Survivor, IDI Participant)

Two survivors explained how survivor mentorship and peer support could help motivate other survivors to get the help they need. In addition, a prosecutor emphasized the importance of using feedback from survivors to continuously improve care design and delivery:

I would want to know, was this effective? . . . “Did you appreciate your court-mandated therapy or would you have liked to have come to that on your own? Were law enforcement professionals trained properly? Did they speak to you with respect?” (Prosecutor, FGD Participant)

With regards to training for professionals serving survivors, a survivor shared their view that people do not know how to treat survivors unless they are taught how to do so. They explained that these trainings must be survivor-led, as only survivors really know their experience:

There’s already so much training, but it needs to be survivor-led training because I’ve listened to people speak so much and I’ve read so many things and I’m just sitting here thinking, have you ever in your life experienced anything like this? So, you have to find those people in communities who are leading survivor groups, and you need to ask them “What do we need to do differently? We want to hear your side. Not your story. Your side.” (Survivor, IDI Participant)

Similarly, another survivor explained that law enforcement and social services need “survivors on hand that can actually be there. There should be more survivors who have actually gone into the line of work to help victims.” Other stakeholders agreed that doing so increases the odds of services being survivor-informed, and therefore actually helping survivors.

Considerations for Court-Involved Treatment Planning

Overall, participants endorsed court involvement in therapy for survivors but were concerned about the implications of mandating therapy. Many focus group participants were initially opposed to the idea of court-involved therapy for survivors. They expressed concern about encouraging a practice that could make a vulnerable group undergo forced treatment. They viewed this as a reproduction of the powerlessness they faced at the hands of their trafficker. To minimize this concern, a clinician suggested stakeholders have open conversations with survivors about therapy and present it as an option first, rather than as a requirement:

You should show [the youth] that they need to focus on their long-term mental health needs. Although it might not seem ideal in the moment, it will be beneficial to them in the long-term. You should make them think that treatment is an option. And if they still don’t want to do it, then I guess you get the courts involved. Because at the end of the day, they’re still a child. (Clinician, FGD Participant)

Stakeholders from law enforcement explained that mandating a survivor to therapy does not necessarily mean the alternative is jail. For systems-impacted youth or youth within the juvenile justice system, mandated attendance in therapy could be an alternative to a more intensive inpatient facility. Participants drew a distinction between mandating therapy and simply mandating attendance in therapy. The former, they suggested, might indicate forcing survivors to share even if they are not ready, which could take away their autonomy. The latter, however, might help them realize they deserve these resources prior to them turning 18 (after age 18, courts would no longer be able to easily enact mandates). A clinician gave some additional detail on how mandated attendance to therapy might work:

You’re not going to make [survivors] talk, you’re not going to force them to do anything other than be in a setting for half an hour or 45 minutes, and hopefully that relationship involves just being together, getting together with a good therapist who knows where to back off. You can just play music or look at the fish tank. Whatever they want. You’re just mandating them to be in a place. You’re not mandating that they talk to you. (Clinician, FGD Participant)

In alignment with the proposed domain, stakeholders recommended that psychologists and social workers should assess survivors’ mental health needs prior to bringing their cases to the court. Treatment would be determined individually for each case, and courts would then be able to create the treatment plan. A few clinicians underscored the importance of survivor-centered, trauma-informed care throughout the court-involvement and treatment process. A survivor described the need for court-involved attendance to be paired with more oversight by the courts, including general education development (GED) coursework:

Let’s say I was mandated, and I was told by a judge, “for your first three months, I want you to start trauma-informed therapy, GED classes and anger management. I want to see you again in three months.” Say I go back in three months, and I’ve started trauma-informed therapy but have not started GED classes nor anger management. I would have to go back and explain to the judge why I haven’t started these and they’d ask me, “You haven’t done this, why?” (Survivor, IDI Participant)

A social worker had a similar suggestion—the active involvement of the courts in survivors’ treatment programs was seen as facilitating accountability for survivor’s progress and healing. Judges and clinicians would work together to ensure survivors are following their treatment plan and that if there are obstacles to them doing so, these challenges would be addressed. Survivors additionally shared that demonstrated support from the courts could be empowering. Courts could set up a process where they would schedule periodic, brief meetings with survivors to check in on survivors’ therapy and recovery process.

Survivors expressed that court involvement would be a helpful resource for survivors because, “if the court mandates you to do something, you have to do it.” (Survivor, IDI Participant). They reflected that a survivor is still a minor, and it falls back on the family and then the state to take care of survivors and make sure they get help. Many CSE-affected youth might not have anyone that can hold them accountable, so court involvement in treatment planning was seen as helping to guarantee that survivors begin the process of receiving help before they turn 18. In the words of another survivor, “if the court’s going to mandate you to receive treatment, which they should, that’s only helping you” (Survivor, FGD Participant). As highlighted by stakeholders, mandated attendance in therapy ensures that survivors begin the process of getting treatment for their trauma while allowing them some control over the process.

Family Involvement

Family involvement in the therapeutic process included discussion of therapy for families and the benefits of familial involvement. Some stakeholders believed that affordable therapy should be mandated for all families of CSE-affected youth, while others thought having such services as an option would suffice. A social worker described how therapy could be recommended for caregivers of CSE-affected youth:

I think that maybe before the [survivor] is released from therapy, there should be some therapy with the caregiver or parent or foster parent, whoever it is for them. Even a support session to give them some ideas of how to best support the survivor and their rehabilitation from this lifestyle could help. (Social Worker, FGD Participant).

As explained by another social worker, “[Caregivers] also need support. They need to have a place to vent, too. They need to have a place to come to, talk about what their struggles, and get strategies from professionals” (Social Worker, FGD Participant). A stakeholder from law enforcement recommended that courts should mandate therapy for both survivors and their parents because survivors would see the process differently if their families were also involved and would be more willing to attend therapy sessions.

Participants explained that a large part of addressing mental health needs of survivors is ensuring their families are equipped to care for them. A clinician explained that court-involved attendance in therapy is more likely to be effective for the survivor if parents are also held accountable for following up. A survivor explained the rationale for such accountability in their interview:

I know my family would have been willing to attend therapy and hold me accountable if they were mandated to do so. This framework for court-mandated therapy is amazing because my mental health needs were not taken care of when I was in the system. My family wouldn’t listen to anybody except for the legal system. They kept just trying to get me to move on, but if the courts were involved, that would have really helped me. (Survivor, IDI Participant)

Family involvement in therapy was seen as increasing families’ confidence in their ability to support CSE-affected youth mentally and emotionally.

Survivor Involvement in Care Design and Delivery

Stakeholders contended that survivor voices must be central to designing and delivering care. Survivors expressed a desire to be treated not as passive recipients, but as active agents shaping the services intended to support them. This aligns with trauma-informed justice principles, which center empowerment, choice, and shared decision-making (Brantley, 2015; SAMHSA, 2014). Findings build on earlier work evaluating survivor-led initiatives such as the CSEY Community Intervention Project, which found that survivor-led training improved provider competence and attitudes toward CSEY (Ferguson et al., 2009). Survivor-defined accountability emerged as a core theme, with participants calling for education that not only amplifies lived experience but also highlights systemic failures and missed opportunities for early intervention (Ducak et al., 2022; Gavin & Thomson, 2017). These recommendations expand prior literature on survivor-led training by underscoring its value in reshaping how courts and service providers understand and respond to CSEY (Godoy et al., 2023). Survivors also endorsed peer mentorship as a strategy to enhance engagement and foster trust. Peer-led models were seen as uniquely capable of promoting motivation through relationship-building, aligning with trauma-informed practice and therapeutic jurisprudence (Buck et al., 2017; Ijadi-Maghsoodi et al., 2018). Taken together, these findings affirm that embedding survivor perspectives across education, policy, and service design is foundational to building effective and ethical therapeutic court responses.

Court-Involved Treatment Planning

Stakeholders described court-involved therapy as a potential pathway to ensure that youth affected by CSE receive timely access to care, including those who are aging out of eligibility or otherwise underserved. This rationale aligns with the emergence of specialty courts for CSE-affected youth, which aim to provide trauma-informed, non-punitive alternatives to traditional juvenile justice responses (Bounds et al., 2015; Heldman, 2025; Liles et al., 2016). While court involvement was seen by some survivors as offering consistency and accountability (especially when caregivers were absent or unsupportive), others expressed concern about mandates that could undermine autonomy and trust. Some participants differed on whether therapy should be mandated outright or offered as an option first, with many noting the importance of survivor agency and buy-in to avoid retraumatization and disengagement (Barnert et al., 2020; Cattaneo & Goodman, 2015).

Clinicians stressed a trauma-informed distinction between mandating attendance versus mandating participation, noting that simply being present in a safe setting can support trust-building without forcing disclosure (Cattaneo et al., 2021). Stakeholders also called for individualized treatment planning based on clinical assessments, consistent with developmental tailoring in juvenile court models. Survivors, too, noted the value of individualized, relationally grounded court involvement. One described being given clear expectations (attending therapy, completing anger management and GED coursework) and then reporting progress to the same judge. This made them feel seen and supported, rather than punished. Such survivor-informed models align with developmental tailoring in juvenile court models (Heldman, 2025). Still, concerns emerged that court mandates, if poorly implemented, could replicate coercive dynamics or expand system surveillance, including for marginalized youth. These findings resonate with critiques of “net-widening,” which warn that even therapeutic models can intensify control and inequity when procedural safeguards are lacking (Ducak et al., 2022; Flores & Barahona-Lopez, 2019; Musto, 2022; Roberts, 2014).

Family Involvement

Family dynamics emerged as another key factor in shaping therapeutic engagement. Stakeholders and survivors described how caregiver involvement could enhance trust, reinforce treatment goals, and provide emotional stability, including in cases where reunification was the goal. Courts were seen as potential facilitators of family-based services, including therapy or parent coaching. This finding contributes to and expands the CSEY literature by emphasizing the role of families, an area often overlooked in interventions that focus primarily on individual youth outcomes (Godoy et al., 2023), by pointing to family engagement as an underutilized but essential component of trauma-informed care. It also aligns with ecological models of trauma recovery, which position the family system as a central context for healing (Gurwitch & Warner-Metzger, 2022; Saxe et al., 2007). Survivors and stakeholders both noted that family readiness was often a precursor to youth readiness, and that neglecting this domain limited the effectiveness of even well-designed therapeutic interventions.

Limitations and Future Research

Limitations of the parent study have been described in the companion paper (Lakshman et al., 2026) and include limited representation of transgender and gender non-conforming (TGNC) individuals, as well as underrepresentation of racial and ethnic groups beyond Black/African American and White/Caucasian participants. In addition, there is potential for selection bias, as participants self-selected into the study, possibly based on interest in or prior experience with the topic. Furthermore, because all survivors interviewed were adults reflecting on past exploitation experiences, future research should engage youth participants directly to better understand their real-time perspectives on and responses to court-involved therapy.

The literature on treatment planning for CSEY would benefit from further research utilizing perspectives from multiple stakeholders, including survivors. More insight is needed on the experiences of each stakeholder group when coordinating treatment plans and, more specifically, concrete strategies on how these systems can be improved to better serve CSEY. Finally, further research should investigate ways in which CSEY and their families can receive mental health services and support without having to go through the carceral system.

Implications for Policy and Practice

This study underscores the importance of trauma-informed, survivor-centered approaches when designing therapeutic responses for youth affected by CSE regardless of jurisdictional context. While court-involved therapy represents one pathway through which survivors may access care in the United States, international evidence suggests that similar ethical tensions arise in welfare-based, child protection, and safeguarding systems globally when services are linked to authority, monitoring, or statutory mandates (Arnull et al., 2025; Lefevre et al., 2019).

Across contexts, findings emphasize that survivor autonomy, choice, and relational safety are foundational to engagement. Practitioners should prioritize models that distinguish between access-facilitating structure and coercive control, ensuring that therapeutic engagement does not replicate dynamics of surveillance or forced disclosure. Consistent with trauma-informed practice, survivors should retain control over the pace, content, and timing of disclosure, whether services are accessed voluntarily, through child welfare systems, or via court-involved mechanisms (Cattaneo & Goodman, 2015; SAMHSA, 2014).

Importantly, the distinction articulated by participants between mandated attendance and mandated participation has relevance beyond U.S. court systems. In international child-protection and safeguarding frameworks, service engagement is often compulsory in practice even when framed as supportive or preventive. This study highlights the need for practitioners to critically examine how “requirements” are experienced by youth and to implement safeguards that preserve dignity, choice, and psychological safety. Simply requiring presence in a therapeutic setting—without compelled disclosure—may offer a less-harmful entry point for youth with extensive trauma histories, particularly in systems where refusal may carry implicit consequences.

Findings also underscore the global relevance of survivor-led programming and peer mentorship. Survivor involvement in training, program design, and service delivery was viewed as essential for building trust and accountability across systems. These insights align with international survivor-centered research emphasizing that lived-experience expertise can counteract institutional blind spots, reduce stigma, and improve practitioner responsiveness (Kavenagh & Maternowska, 2024; Palmer & Foley, 2017). For practitioners working in diverse cultural and legal contexts, partnering with survivor-led organizations and community-based groups may offer a critical mechanism for ensuring services remain responsive to local realities and intersecting forms of marginalization.

Race, culture, and intersecting identities must be centered in the design and delivery of court-involved therapeutic services for CSEY. The literature consistently documents that youth of color, specifically Black girls, are disproportionately represented in CSE and in juvenile justice system contact. Yet these same youth are frequently underserved by systems that fail to account for the compounding effects of racism, poverty, and gender-based marginalization (Franchino-Olsen, 2021; Holley & VanVleet, 2006; Hurst, 2015). Court-involved models that do not explicitly attend to these dynamics risk reproducing the very inequities they aim to address, therefore subjecting already marginalized youth to increased surveillance, criminalization, and institutional harm under the guise of protection (Musto, 2022; Roberts, 2014). Culturally responsive practice requires more than demographic awareness; it demands that practitioners actively interrogate how race, class, gender identity, and immigration status shape survivors’ relationships to authority, their willingness to engage with court-linked services, and their experiences of safety within therapeutic settings. For jurisdictions developing or refining court-involved models, building in explicit mechanisms for cultural humility, community accountability, and survivor-defined measures of success is not optional but essential to equitable implementation.

Family involvement emerged as another underutilized but globally relevant strategy for improving outcomes in court-involved and community-based therapeutic responses. Despite strong theoretical grounding in ecological and trauma systems models positioning caregiver readiness as central to sustainable youth outcomes (Gurwitch & Warner-Metzger, 2022; Saxe et al., 2007), family engagement remains systematically underleveraged in CSEY interventions across jurisdictions. Services tend to prioritize individual youth treatment while neglecting the caregiving contexts that shape whether therapeutic gains endure. Practitioners should move beyond treating family involvement as supplementary and instead design services that explicitly address caregiver trauma, capacity, and relational repair alongside youth-facing treatment. Offering therapeutic support, psychoeducation, or coaching for caregivers can enhance engagement, build caregiver capacity to respond to trauma-related behaviors, and reduce pressure on youth to heal in isolation. This reorientation has implications not only for U.S. court-involved models but for child protection and safeguarding systems globally, where family-focused intervention remains an underdeveloped component of responses to child sexual exploitation.

Finally, this study cautions against overreliance on court-based models as default solutions to service access gaps. Expanding access to survivor-centered, community-based pathways to care outside of justice systems may reduce retraumatization, increase trust, and promote earlier engagement—particularly where system contact is associated with stigma or historical harm.