Background
Adolescent females with histories of commercial sexual exploitation (CSE) have high mental health and substance use treatment needs, yet little is known about their perspectives regarding behavioral health and behavioral health treatment.

Objective
We sought to understand the attitudes of adolescent females with histories of CSE regarding behavioral health to identify factors influencing “buy-in” to behavioral healthcare.

Participants and setting
Participants included 21 adolescent females, affiliated with our partner organizations (two group homes, a service agency, and a juvenile specialty court), who reported having exchanged sex for something of value.

Methods
In-depth qualitative interviews explored participants’ perspectives towards behavioral health. We conducted thematic analysis to identify themes concerning behavioral health.

Results
Participants provided insightful definitions of “mental health” that included positive and negative aspects of emotional and cognitive states (e.g. “being happy with yourself” and “not thinking suicidal”), indicating intensified mental health challenges and resilience. Substance use was viewed as a coping mechanism for childhood trauma and their exploitation. Trusted relationships with providers and navigable health systems that encourage autonomy were key to promoting “buy-in” and thus engagement in behavioral health treatment. A conceptual model emerged illustrating factors leading to treatment engagement.

Conclusion
Adolescent females with histories of CSE constitute a vulnerable population with high levels of trauma as well as unmet mental health and addiction treatment needs. The delivery of trauma-focused, behavioral healthcare centered on patient-provider trust and shared-decision making that encourages client autonomy should be prioritized.