The intersection of family-controlled sex trafficking, organized sexual abuse and child sexual abuse materials (CSAM) has been minimally explored. This is despite statistics indicating the prevalence of young children depicted in CSAM and the growing body of knowledge reflecting the frequency with which these forms of abuse are co-occurring. The US Department of Justice produced a factsheet in 2021 which states “Notably, governments and anti-trafficking stakeholders overlook familial trafficking…”. According to Polaris 42% of adult survivors of sexual exploitation report that their trafficking began with a parent or caregiver. Content analysis of CSAM shows a growing trend of younger victims and more severe abuse with a pattern of younger victims and boys experiencing the most severe forms of abuse. A 2018 report from Interpol states that 60% of children depicted in CSAM are prepubescent pointing to possible caregiver involvement (ECPAT and Interpol, 2018). 85% of the analyzed sample of images or videos contained explicit erotic posing, explicit sexual activity, assault, gross assault, sadism or other problem paraphilias. One must ask the question of how an offender is able to abuse a young child so severely without a caregiver being aware. Often occurring alongside family-controlled trafficking, organized sexual abuse is defined as sexual abuse by multiple perpetrators acting in concert. In clinical settings up to 20% of sexually abused women and children disclose organized sexual abuse when asked (Salter/Richters, 2012). Children who are being abused by an organized group demonstrate a more significant mental health impact due to the earlier onset of abuse, quick progression to serious abuse, high intensity and prolonged duration. Children exploited by a parent or caregiver are trapped in a way that is very different compared to extra-familial abuse. FC-CSEC often begins very young resulting in attachment trauma and complex post-traumatic stress symptoms. Caregivers with unfettered access to their victim have the opportunity to carry out more heinous and injurious forms of abuse and still avoid detection. Caregivers control the narrative that explains any identified concerns with the child. Caregivers can withhold medical care or keep a child out of school to avoid detection. However, service provision, research efforts, legal/law enforcement responses, clinical and public health conversations strongly emphasize a more traditional understanding of CSEC leaving the discourse around FC-CSEC lacking substance and depth. It is critically important for survivor serving organizations to be prepared to identify children and adults trapped in these often-overlapping forms of egregious abuse. This presentation will be co-led by a survivor of family controlled, organized child sexual exploitation (FC-CSEC) and a clinical social worker. The foundation of this presentation is current research as well as specific real-life examples.