Minnesota NP leads effort to care for teen runaways
January 11, 2013 -- Today Minnesota Public Radio (MPR) aired a report by Laura Yuen about sexual abuse of runaway girls that featured St. Paul nurse practitioner Laurel Edinburgh (right), who helped start an intervention program for the girls. And the MPR website also offers a substantial interview with Edinburgh about her work. Broadcast as part of National Public Radio's All Things Considered program, the main report describes efforts by police, prosecutors, advocates, and nurses to address the problem of sexual exploitation of runaway girls, with a focus on the police who search for missing children. The report spends significant time with Edinburgh, explaining that the nurse practitioner "helped create the beginnings" of the Ramsey County Runaway Intervention Program a decade ago, that her research has shown that the program improves outcomes, and that advocates hope the program can serve as a model for the rest of the state. The piece also notes that Edinburgh devised a set of questions that St. Paul police use to screen runaways for signs of physical and sexual abuse. The interview allows Edinburgh to provide more detail about the runaway problem, how the Program started, and how it might be expanded. We thank Laura Yuen and Minnesota Public Radio for this report, which presents Edinburgh as an innovative and expert health care leader.
The nurses step in
Yuen's main report is headlined "Runaway girls focus of Minn. fight to curb sex trafficking." Mostly it discusses what various Ramsey County professionals are saying and doing about the "troubling link between teens who run away from home and the child-sex trade," noting that research shows Minnesota girls who run away are more likely to be sold for sex, raped, or otherwise sexually abused. Yuen spends time with two St. Paul police officers who work to "track down runaways before the pimps and other criminals reach them"; many runaways are fleeing "rancorous households, alcoholic parents, or abuse by a family member." And even when the exploiters are caught, the piece suggests, criminal sentences can be remarkably light. The report also describes interactions with a couple of the victims, including a teen who called 911 to report that she was being held captive at a hotel and forced to engage in prostitution.
The article notes that law enforcement and schools "identify the most vulnerable runaways," and "then the nurses step in to help the girls rebuild their lives." Later, the piece expands on the nursing role with a substantial discussion of Edinburgh's work. It notes in passing that her office at the Midwest Children's Resource Center at Children's Hospitals and Clinics of Minnesota "looks like a regular doctor's office," which seems an odd thing to say. Is that notable because she's just a nurse? Because her runaway work would seem to call for something unconventional?
Anyway, the report goes on to say that when "the nurse practitioner helped create the beginnings of the Runaway Intervention Program 10 years ago, she largely treated Hmong girls as young as 12 who were slipping through traditional safety nets of school and law enforcement." Surprised that there were no services for the "most severely traumatized" kids, she developed "10 questions for St. Paul police to screen runaways for physical and sexual abuse." One of the officers who now uses the questions notes that the first one--"Why did you leave home?"--often leads to others that may point to abuse in the home. The County Attorney's office reviews the reports about runaways and the "highest-risk girls are given the option to meet with nurses like Edinburgh for a health assessment." In her program, almost a third of the girls have undergone "the most extreme forms of sexual assault or exploitation, including gang rape, prostitution, and survival sex" (trading sex for food and shelter). And "most of the girls said they've tried to kill themselves and use drugs or alcohol." Edinburgh explains that the girls are often duped because they are so young and can be lured with promises of a visit to an amusement park or a hotel pool. As she notes, "as an adult, as soon as I start hearing that, I'm like, 'People just don't invite you to a hotel.'" But, the report says, girls in the program receive treatment for substance abuse, group counseling, and home visits by nurses. Over time, most of them report becoming more connected to their families and schools and show fewer signs of destructive behavior. Edinburgh's research shows that after about a year of services, the girls report lower rates of suicide attempts and substance abuse than when they started the program.
Youth advocates hope the program can serve as a roadmap for the whole state. The piece notes that two years ago, Minnesota passed a Safe Harbor Law to protect at-risk kids "with the Runaway Intervention Program in mind, but it won't be fully implemented until the Legislature funds a system to help sexually exploited children and teens," which will apparently require that they find $13 million by June 2014, some of it for more housing services. If they do, the report suggests, Minnesota would have the first comprehensive system in the nation to help sex-trafficked youth.
This is a brief but really good look at the work of a nursing leader, particularly in conveying the effectiveness of Edinburgh's program and its potential broader impact. The notes about the questions she created to help the police screen for abused kids are also great, showing that nurses think holistically and innovatively about how to help patients; indeed, about how to identify who needs to be a patient in the first place, which is clearly not obvious. The report also includes several quotes from Edinburgh, specifically about the need she initially saw for the program and the innocence of the runaways. The piece might have benefited from more explanation of how the program was created, what role Edinburgh played, and how the nurses interact with the runaways today. But on the whole, it presents her as an effective, innovative health leader.
I see middle schoolers
Yuen's interview with Edinburgh provides more detail about "her thoughts on the link between runaways and child prostitution -- and what other communities across the state can learn from it." Most of Yuen's questions focus on what runaways go through. Edinburgh explains that about 9 percent of Minnesota girls have run away at least once ("it's not a small problem") and that 20 percent of runaway girls experience abuse, mostly after they've run away, although in most cases the girls are relatively safe since they have gone to a relative or friend's house. She says that "hopefully" the public schools or the police will notice that the kids have run away, and if the kids return, school police liaisons or missing-persons officers can ask questions directed at learning why they ran away and what happened after they did, in a non-judgmental way.
Edinburgh explains that a relatively small number of the runaway girls end up being sexually abused. But she effectively illustrates how that can happen:
I see middle schoolers. The average age in our program is 14 years old. They've run away from home. They go to one house that may be relatively safe, but then someone at that house says, "Do you want to go to a party?" Without now having the protection of their family and a place to stay, they're in a situation where they're sexually assaulted. Then they go back home. Not surprisingly, the parents are really mad at them because they left. The [kids] are in trouble. The parents don't know this has happened. I really believe that the majority of parents, if they knew what happened, they would not have the response of, "You're in trouble." It would be, "Let me figure out how to help you." And now the teen is probably also in trouble at school because they haven't been handing in their homework. The social supports that should be there are failing them. The teen may start using alcohol. They might start cutting. And then the teen gets sexually abused again, or sexually exploited.
Yuen asks what might make the children of immigrants especially vulnerable, and Edinburgh explains that with "a foot in both cultures," those children may struggle with who to go to for help when "something horrible happens to them" because there may be a stigma.
The interview also includes additional information about Edinburgh's Runaway Intervention Program. Edinburgh says it started after she was referred a number of sexually exploited girls and realized there were no services for them. Half were no longer in school and had not been reported missing by their parents: "I felt that these were girls that were slipping through the cracks." She goes on to explain why the Program could be useful statewide:
It's a public-health model, and there are public-health nursing services probably in almost every county in Minnesota. You have nurses who are experienced going into homes and working with teams of people. [And] we have child-advocacy centers that for years have been working on child sexual abuse. And probably every school has a response to truancy. If you took the missing-persons department in police stations, paired them with truancy departments in schools, and share information on kids they're worried about, they could be referred to a child-advocacy center so they could be evaluated by a healthcare professional. That's where it starts. Then you need to have avenues for treatment.
The interview is not too long, but it gives Edinburgh a chance to explain in greater detail the nature of the problem and the Program's response. She does so in an articulate but down-to-earth way, a great example of a nurse educating the public about a key public health issue. As with the main report, there is no suggestion that Edinburgh works for a physician or needs to ask one what to do. And although it would have been good to hear more about how the program was formed and exactly what it does now, we do get at least a glimpse of a nurse leader connecting health and social systems to devise a holistic way to address to a complex problem.
We thank Laura Yuen and Minnesota Public Radio for this helpful reporting. You can send the reporter notes of thanks and encouragement at firstname.lastname@example.org.
See the article by Laura Yuen "Runaway girls focus of Minn. fight to curb sex trafficking" and/or listen to it, and see the sidebar "How one St. Paul nurse is helping runaways heal," posted on the Minnesota Public Radio website on January 11, 2013.