Pulse
Reclaiming Girlhood
A program for runaway youths brings health care to sexually abused kids wherever they are.
Seven years ago, the doctors and nurse practitioners who work at the Midwest Children’s Resource Center (MCRC) in St. Paul were seeing a new phenomenon: girls as young as 11 years old who had been brutally sexually assaulted. Many had genital injuries and sexually transmitted diseases. All had been victimized by someone outside of their family. The situation was puzzling as well as disturbing. “I was seeing some of the worst sexual abuse I’d seen at a child abuse clinic,” says Laurel Edinburgh, a nurse practitioner who then had worked for three years at the MCRC, which specializes in child abuse and is located within Children’s Hospitals and Clinics of Minnesota.
With information from law enforcement, staff began to piece together what was happening. All of the girls were Hmong, and all of the perpetrators were adults or older teens, many of whom were members of Asian gangs. The girls might skip school and get picked up by a man who would take them to a party, where they would be raped and possibly introduced to drugs. Afterward, they were afraid to go home. Some started living on the streets or with a friend; others were prostituted.
The MCRC staff realized they were dealing with a group of girls who were falling through multiple cracks in the system. No police were assigned to search for runaways. The schools weren’t picking up on the truancy problem, or if they were, they weren’t reporting it to police. Child protection wouldn’t take up the girls’ cases because they hadn’t been abused by family members. Services for teens involved in prostitution were designed for girls 16 and older.
When the schools, law enforcement, social service agencies, and health care organizations became aware of the problem in 2004, they formed the Hmong Youth Task Force to address it. In addition, staff at the MCRC began to think of how they could better provide health care for these very young runaways, who were at high risk for pregnancy, sexually transmitted disease, substance abuse, and physical injury. By 2005, they were piloting an approach that has come to be known as the runaway intervention project.
Staffed by three nurse practitioners who function like a mobile special operations force, the grant-funded program is an intensive effort to ensure that girls’ lives are not defined by rape or prostitution they experienced as children. Its goal “is to help them be a normal kid in a family who will accept them,” says Carolyn Levitt, M.D., founding director of the MCRC. “This is what happened to them, but it’s not going to damage them for good.”
Intensive Intervention
Initially, a girl comes into the clinic, where one of the nurse practitioners evaluates her health and treats her for problems ranging from STDs to acne and interviews her about the sexual abuse. Then a nurse practitioner follows up with the girl once a week for the next three months and every other week for six months after that at her school, home, the juvenile detention center, shelter, or any other place the girl frequents. At these visits, the nurse practitioners do ongoing physical and mental health assessments and prescribe treatment, including Plan B and birth control, if needed. They also help the girls problem solve—What could they do if they’re taken to a party? Who could they call for help? Will they use birth control or be abstinent?
Seeing the girls in their environment enables the nurse practitioners to keep them connected to age-appropriate activities and supportive people. “If the orchestra teacher was the only person the kid talked to, but they got kicked out, [we find out] how we can get that kid back in orchestra,” Edinburgh says. “It’s sort of advocating for things that promote resiliency.”
In addition to visits with the nurse practitioners, the girls can attend weekly therapy groups during the year they spend in the program. A common topic of discussion, says Edinburgh, is defining sexual abuse. “A lot of kids will have these horrible things happen to them, but they will not identify them as abuse,” she says. “You’ll have a 13-year-old who thinks she’s having a relationship with a 30-year-old. She’ll say, ‘This is consensual, this is what I want to do.’ Then a peer will say, ‘That happened to me too, but that person didn’t really care about me at all.’” Edinburgh says the girls are willing to talk openly with health care providers when they know they’re not trying to get them in trouble.
Signs of Success
There are signs the program, which currently serves 75 girls of all ethnicities, is working. Edinburgh notes that the girls have a pregnancy rate below the average for teens in Minnesota. She attributes that to bringing health care to the girls rather than expecting them to go to a clinic. “Expecting a 13-year-old to see their provider and be given a prescription for birth control and think that they’re going to go back in three weeks or even know how to pick up a prescription in the pharmacy [is unrealistic],” she says. She also thinks it’s promising that the kids who initially have the lowest self-esteem, most serious depression, and fewest positive social connections seem to do the best in the program. She believes this is a sign that the MCRC has stumbled onto an approach for helping the most vulnerable of the vulnerable. “Most interventions work with kids who are already doing fairly well,” she says.
Levitt says another sign that the program is working is that on Thursdays, when the girls gather for their weekly therapy groups, they act like normal kids. “You see how resilient they are, that they’re good kids. Some are all-star students, some aren’t. It’s like a slumber party here on Thursday nights. It reminds me of when I was 13.”
—Carmen Peota