The role of healthcare in combating online child sexual exploitation

Healthcare professionals, mental health professionals, and social workers understand the impact of child sexual abuse on their patients.

In today’s technology-dependent world, the children and teens in your care face an increasing and insidious threat from predators who use technology to access and exploit children online. Online threats to the safety and well-being of your patients pose unique challenges for healthcare providers who want to prevent patients from becoming victims of online sexual exploitation and abuse (CSEA).

Here’s what healthcare professionals need to know about online child sexual exploitation and abuse, as well as their role in identifying, reporting and treating it in a healthcare setting.

What is online child sexual exploitation and abuse?

The U.S. Department of Homeland Security (DHS), whose mission is to investigate and combat crimes of exploitation, defines online CSEA as a heinous crime that targets some of the most vulnerable people in our communities: our children and teens. Online CSEA covers a wide range of criminal acts that involve the victimization of a minor for sexual gratification or other personal or financial gain.

Online CSEA, also known as technology-enhanced child sexual abuse, is a term that describes the use of technology in sexual abuse.

Online CSEA includes a range of abusive and harmful practices, such as:

• Production, possession or sharing of child sexual abuse (CSAM) material, including ‘self-produced’ sexual content involving minors.
• Live streaming of sexual content or sexual abuse involving minors.
• Presenting pornographic or sexually explicit material to minors.

How widespread is online CSEA?

Over the past decade, online CSEA has increased exponentially. Because this crime takes place online, it occurs all over the world and is a global epidemic.

The National Center for Missing and Exploited Children received 1 million reports of online CSAM in 2014. That number increased to 36 million reports in 2023.

The number of incoming reports to DHS has increased by more than 20% over the past three years. The number of urgent, threatening reports involving a child at risk of imminent harm has increased by more than 140% in the same period; almost 64,000 such reports were received last year alone. The plague is affecting the world, from India to Pakistan, from the Philippines to Australia, Europe and here in the United States.

Increased technology use among children and teens has allowed these tech-enabled crimes to flourish.

Children and teenagers are spending more and more time online. More than half of American teens spend an average of 7 hours and 22 minutes on screen time every day. Many report using some social media platforms, such as YouTube and Instagram, “almost constantly.”

A 2024 report on child well-being in a digital world of internet business found that two-thirds (67%) of children reported harmful experiences online, including a 5% increase in the number of strangers trying to contact them or send them messages.

This increase is even stronger for girls aged 15 and 16; 48% reported contacting strangers online this year, compared to 29% last year.

How AI influences online CSEA

The rise of new artificial intelligence (AI) technology has created exponentially more ways for predators to generate and distribute child sexual abuse material. Perpetrators can use AI to take a photo of a child and manipulate it so that the child appears naked or is involved in a sexual act. AI can also be used to create chatbots that simulate human conversations and are programmed to prepare children to be sexually exploited and abused.

Online CSEA images created by AI are illegal and just as harmful to victims as live images. AI-generated CSEA or “deepfakes” can victimize children and cause severe mental suffering through cyberbullying and extortion. As AI technology rapidly improves, the risk of deepfakes increases.

The impact of technology-enabled child sexual exploitation and abuse

Research on the impact of technology-enabled online CSEA is still in its infancy. However, there is evidence that the harmful effects of CSEA are equivalent to contact abuse.

Young people who experience online grooming that leads to child sexual abuse (online or offline) experience psychological problems in the aftermath, including:

• Depression
• Aggression
• Self-harm
• Victimization again
• Negative reactions from peers, family members and schools
• Self-blame
• PTSD

Children and teens who have been abused through CSAM production appear to experience additional problems than those associated with contact abuse.

The main psychological consequences of online sexual abuse include:

• Concerns about whether the victim can be seen as a willing participant in the abuse
• Fear of being recognized if someone they knew saw the image
• Guilt and shame and a constant feeling of vulnerability

Which young people are at risk of online CSEA?

Online CSEA can happen to anyone. However, studies have identified some characteristics of youth at risk for online CSEA and online grooming.

• Research has shown that the risk of online sexual solicitation by adults is greater for adolescents aged 13 to 17 than for children under 12.
• Girls are about three times more likely than boys to receive sexual requests online.
• The risk of unwanted sexual contact online is greater for adolescents who question their sexuality, experience psychological problems (depression) and experience other problems offline, such as parental conflict.
• Low parental involvement or supervision, poor communication between parents and children, involvement in risky online behavior and greater internet use have also been associated with an increased risk of online sexual grooming.

Some research also suggests that young people not typically considered vulnerable to offline child sexual abuse may be vulnerable to online grooming, abuse or exploitation, including sextortion, a trend that disproportionately affects boys aged 14 to 17 .

The role of healthcare professionals in online CSEA

Healthcare professionals are often the first line of defense when it comes to contact abuse in children. However, identifying and treating online CSEA is very different from contact abuse.

Research has found that healthcare professionals (HCPs) believe that talking about young people’s online activities and their impact on mental health is important, yet they have varying levels of confidence in their ability to identify and respond to issues of online CSEA to respond.

Identifying online CSEA in a healthcare environment

Assessments can help healthcare providers identify potential cases of online CSEA in a healthcare setting. A routine set of questions on technology use, associated risks, and technology-assisted/online CSEA experience in the assessment of clinical intake of children and adolescents can systematically evaluate the potential involvement of technology or online activities in cases where online CSEA is suspected.

Young people often feel judged or misunderstood when they talk about their online activities. This may deter them from disclosing problems online for fear of judgement. HCPs can help promote openness by approaching online CSEA assessments with curiosity and an understanding of how technology and online activities can be used to facilitate abuse or exploitation.

How healthcare professionals can report CSEA online

DHS Homeland Security Investigations Know2Protect initiative is a national awareness campaign that educates and empowers youth and trusted adults with online CSEA education, prevention and intervention strategies.

Know2Protect offers the following methods for reporting suspected online CSEA:

• Contact your local, state, or tribal law enforcement officials directly. Call 911 in an emergency.
• Call the Know2Protect tip line at 833-591-KNOW (5669). All information received through the Tipline will be reviewed by appropriate personnel and referred to the Homeland Security Investigations field offices for possible investigation.
• File a CyberTipline report with the National Center for Missing and Exploited Children.

Report suspected online CSEA

Healthcare professionals are often mandated reporters. If you are required to report suspected child sexual abuse (online or offline) in your state, you may have additional reporting requirements if you suspect a patient is a victim of online CSEA.

Mandatory reporter training for medical professionals can help you learn more about your reporting requirements and the signs of online CSEA.

Treatment and recovery from online CSEA

The treatment and recovery of youth exposed to online CSEA is an emerging area with implications for healthcare providers, social workers, and other mental health professionals.

Victims of online CSEA are typically exposed to more than one form of abuse, such as some form of sexual abuse and the resulting digital material. Exposure to more than one form of abuse can cause problems for victims; it increases the risk of negative long-term effects into adulthood. The digital component can increase feelings of powerlessness and helplessness among victims, as online material can be recirculated and lead to re-victimization.

Learn more about online child sexual abuse and exploitation

It is critical for healthcare professionals, mental health professionals and social workers to understand that the threat of child sexual abuse through technology has never been greater. Learn about the threats and dangers children and teens face online and find resources to help you become a trusted professional working with children at Know2Protect.