106 CONSEJO NACIONAL DE TELEVISIÓN

Some survivors will not want to talk about their experience of CSE while others will have already had to talk about their experiences with the police, social workers, lawyers and others.168 _{One coping strategy}

may therefore be to simply try and forget what has happened to them.

Survivors during the field research mentioned a variety of ways that they coped with their experiences. Many survivors talked about how they ‘kept busy’ and service providers echoed this believing that ‘distractions’ helped children forget about their experiences.

“…among friends. We will joke and we have fun and we forget about it”.

(A boy in Thailand)

“… if you’re busy and happy, then you can forget”. (A girl in the Philippines)

One theme that strongly emerged, particularly in respondents from Thailand, was around survivors focussing on their future rather than on their past. Survivors shared a number of ‘mottos’ such as:

y

y “…Just move forward”. ( A young woman in Thailand)

y

y “What is past is past. Like the wind, it’s past. I move forward. Can learn from experience”. (A

young man in Thailand) y

y “No need to be afraid with the past. Past is past, it’s already gone. Look for the future”. (A girl in

Thailand)

Service providers also talked about how they felt that survivors should “not concentrate too much on

past, but on present and what next” (A government social worker from Thailand).

Although not all respondents who talked about this approach to recovery were Buddhist, this approach aligns with the Buddhist tradition which emphasises the importance of acceptance and moving forward.169 _{Although this may be helpful for some and help provide a sense of hope for the future, for}

others this may mask underlying problems which may surface at a later date.

168 Stanley, N., Oram, S., Jakobowitz, S., Westwood, J., Borschmann, R., Zimmerman, C., Howard, L. (2016), “The health needs and healthcare experiences of young people trafficked into the UK,” Child Abuse & Neglect, 59, 100–110. 169 Devine, S. (2009), “Psychosocial and mental health service provision for survivors of trafficking: Baseline research in

Therapies

During the research, various forms of therapeutic approaches were mentioned by service providers as being helpful to survivors. This included:

y

y Trauma-focused cognitive behavioural therapy (TF-CBT), y

y Eye movement desensitisation and reprocessing (EMDR), y

y Play therapy, y

y Narrative therapy, y

y Nature therapy, and y

y Adventure therapy.

It was not however, clear how common or effective these forms of therapy were or when, how or by whom they were administered.

There is a strong evidence base for cognitive behavioural therapy and EDMR in effectively addressing symptoms of PTSD, however such approaches require that there are skilled, trained professionals available.170 _{TF-CBT has been recommended for use with individuals affected by trafficking}171 _{and it has}

been designed for use with survivors of CSE in some low/middle-income settings.172 _{However, some}

professionals in these contexts argue for the need for a less structured, more holistic and culturally acceptable approach to intervention.173

170 Aberdein, C. and Zimmerman, C. (2015), “Access to mental health and psychosocial services in Cambodia by survivors of trafficking and exploitation: a qualitative study,” International Journal of Mental Health Systems, 9:16

171 Macy, R. and Johns, N. (2010), “Aftercare services for international sex trafficking survivors: Informing U.S. service and program development in an emerging practice area,” Trauma, Violence and Abuse, Vol. 12 (2), 87-98.

172 Bass, J; Bearup, L, Bolton P, Murray L, Skavenski, S. (2011), “Implementing trauma focused cognitive behavioural

therapy among formerly trafficked sexually exploited and sexually abused girls in Cambodia: A feasibility study,” Johns

Hopkins Bloomberg School of Public Health, World Vision International.

173 Aberdein, C. and Zimmerman, C. (2015), “Access to mental health and psychosocial services in Cambodia by survivors of trafficking and exploitation: a qualitative study,” International Journal of Mental Health Systems, 9:16.

Summary

All children have a right to access the highest attainable standard of health. Children affected by CSE may have a number of physical, mental, sexual and reproductive health issues that need to be assessed and addressed. Through the field research and literature review, it is apparent that there are many reasons why children affected by CSE may be unable or unwilling to access health care services. This may be due to discrimination that they face; the fact that they don’t have the right documentation to access care; because they are afraid of finding out that something is wrong with them; because they may not trust that information about their health status will be kept confidential; because services do not exist; or because they cannot cover the cost of them.

Service providers therefore have a role to play in helping children access services and accompanying them to appointments. Service providers must also advocate for confidential, consistent, child-friendly and sensitive health service provision for the children they are supporting. Children affected by CSE want confidential services and they want to develop relationships with non-judgemental medical professionals.

Children affected by CSE have a right to be supported by professionals who have received appropriate training. The field research highlights that in reality this does not happen due to the lack of trained professionals and lack of mental health and drug, alcohol and substance misuse services in the region. The challenges in accessing appropriate support calls for more creative solutions to address these gaps. In the short-term, this may involve working with children to help them strengthen their own coping mechanisms.