Purpose

We sought to understand the perspectives of commercially sexually exploited (CSE) young women regarding their health care needs, access, and use patterns.

Methods

Twenty-one CSE young women participated in this mixed methods study. Data collection included brief surveys measuring health care use, followed by in-depth, semistructured interviews to gain insight into CSE young women's health care needs, barriers and facilitators to health care, use patterns, and recommendations for improving care. Data analysis techniques included descriptive statistics for the quantitative survey data and thematic analysis for the qualitative interviews.

Results

Survey data demonstrated relatively high health care use across health care types, especially for reproductive and mental health treatment services. Barriers to care included being "on the run," fear of bad diagnoses, and trafficker control. The fierce autonomy conceptual model emerged from the analyses to describe participants' strong desire for self-determination in their health care decision making, including when to access care. Recommendations for improving care for CSE young women include preserving autonomy in health care decisions while meeting their basic needs, such as safety and shelter.

Conclusions

Overall, the CSE young women expressed high health care needs. Despite experiencing significant barriers to accessing care, study participants frequently sought care in a variety of settings. Furthermore, they shared insights about how to improve engagement in health care among CSE young women. Improving CSE young women's engagement in care requires health professionals and health systems that foster a sense of safety, trust, and autonomy over health care decisions-a need intertwined with CSE young women's experiences of abuse, survival, and sexual exploitation.

This study assessed the psychometric properties of a parent-reported tic severity measure, the Parent Tic Questionnaire (PTQ), and used the scale to establish guidelines for delineating clinically significant tic treatment response. Participants were 126 children ages 9 to 17 who participated in a randomized controlled trial of Comprehensive Behavioral Intervention for Tics (CBIT). Tic severity was assessed using the Yale Global Tic Severity Scale (YGTSS), Hopkins Motor/Vocal Tic Scale (HMVTS) and PTQ; positive treatment response was defined by a score of 1 (very much improved) or 2 (much improved) on the Clinical Global Impressions - Improvement (CGI-I) scale. Cronbach's alpha and intraclass correlations (ICC) assessed internal consistency and test-retest reliability, with correlations evaluating validity. Receiver- and Quality-Receiver Operating Characteristic analyses assessed the efficiency of percent and raw-reduction cutoffs associated with positive treatment response. The PTQ demonstrated good internal consistency (α = 0.80 to 0.86), excellent test-retest reliability (ICC = .84 to .89), good convergent validity with the YGTSS and HM/VTS, and good discriminant validity from hyperactive, obsessive-compulsive, and externalizing (i.e., aggression and rule-breaking) symptoms. A 55% reduction and 10-point decrease in PTQ Total score were optimal for defining positive treatment response. Findings help standardize tic assessment and provide clinicians with greater clarity in determining clinically meaningful tic symptom change during treatment.