Diversity Supplement-Michael Brienzo: RCT to Evaluate Bystander-informed See it Stop it (BiSiSi) to Prevent Child Sex Trafficking in Kentucky Middle Schools

The strongest risk factor for child sexual abuse, exploitation and trafficking (CSAET) is a dysfunctional family environment characterized by violence and parental substance use. In Kentucky, familial sex trafficking is the more common form of CST/E. Kentucky leads the nation with the highest rates of sexual violence (SV) and partner violence and we rank 5th in opioid overdose deaths. Based on Kentucky’s need, we propose a clustered randomized controlled trial (RCT), in response to Priority area 4 preventing CSAET, 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 CSAET 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 CSAET risk in children. Our multi-disciplinary research team has the opportunity to leverage ongoing county and school-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 CSAET risk, county selection will reflect those with higher opioid overdose rate (NIH HEAL RCT). This recruitment strategy allows an investigation of two, potentially complimentary, interventions to address two highly correlated public health problems: child sexual violence and opioid use. Specific Aim 1: To evaluate the effectiveness of BiSiSi training to change middle school staff 1a) knowledge of CSAET, 1b) attitudes towards CSAET (stigma), 1c) willingness and efficacy to intervene, 1d) use of ‘bystander’ actions to thwart CSAET 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 CSAET screening and reporting in the short term (from Years 0-2) and begin to reduce CSAET rates in the longer term (Year 3) by condition, with BiSiSi implementation, at the school & county level, adjusting for school and county l ‘climate’. This RCT will be appropriately powered (≥80% with ~40 staff in each of 60 middle schools, in 32 counties with high and lower opioid overdose rates). Structural equation models 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, individual level analyses). Linear mixed models and general estimating equations will be used to estimate the effectiveness of BiSiSi on CSAET reports, measured at the school and county levels. Anticipated results: Identification of complementary prevention strategies to reduce child sexual exploitation and trafficking.