“This project was supported by Grant #2017-MC-FX-K051 awarded by the Office of Juvenile Justice and Delinquency Prevention, Office of Justice Programs, U.S. Department of Justice. The opinions, findings, and conclusions or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect those of the Department of Justice.”
Human Trafficking is perhaps one of the greatest social injustices of our time, and in the last several decades, has received increased attention. While many assume human trafficking only impacts third world countries, in actuality, it touches communities across the world - urban and rural, rich and poor, foreign and domestic. While human trafficking has been occurring for centuries, it did not appear on the agenda of the United Nations General Assembly, the Commission on Human Rights, and the World Conference until the 1990s (Gozdiziak & Collet, 2005). Therefore, our policy, advocacy, and direct service response to this issue are relatively new.
- As defined by the Trafficking Victims Protection Act of 2000, human trafficking occurs when “a commercial sex act is induced by force, fraud, or coercion, or in which the person induced to perform such act has not attained 18 years of age; or the recruitment, harboring, transportation, provision, or obtaining of a person for labor or services, through the use of force, fraud, or coercion for the purpose of subjection to involuntary servitude, peonage, debt bondage, or slavery” (US Department of State, 2000).
- Human trafficking is best conceptualized as an overarching term which can be further broken down into: — Labor trafficking which typically involves forced hard labor, usually in agriculture or textile sweatshops, or domestic labor, usually working as a nanny or house servant (Green, 2016).
- Sex trafficking involves the exchange of a sex act for something of value such as money, shelter, or food. It is the commercial aspect which separates sex trafficking from other crimes such as sexual assault or domestic violence.
- We can further break this term down by considering location of the crime:
- International trafficking is the force, fraud, and/or coercion of foreign nationals, both adult and juveniles, to engage in trafficking (sex or labor) across borders outside their native country.
- Domestic trafficking is when a person engages in trafficking (sex or labor) within their native country.
- Unfortunately, due to the hidden nature of the crime, exact statistics regarding the prevalence of victims are difficult to obtain and influenced by questionable research methods employed to assess the number of victims, misidentification, and underreporting (Clawson & Dutch, 2009; Rafferty, 2013; Smith et al., 2009). Statistics provided are, at best, estimates.
- Across the world, anywhere between 12 to 27 million people are thought to be victims of human trafficking (US Department of State).
- The International Labor Organization estimates that forced labor and human trafficking is a $150 billion industry worldwide.
- It is estimated that 100,000 to 300,000 youth are at risk for sexual exploitation each year in the United States alone (Estes & Weiner, 2001; Smith et al., 2009).
- Individuals are exploited in a variety of ways (Richards, 2014). Note, this list is not exhaustive.
- Individuals may be sold by family members in order to pay off a debt or for general financial gain (Hodge & Lietz, 2007; Richards, 2014; Zimmerman et al., 2006).
- Alternatively, families or individuals may be tricked into believing a potential educational or employment opportunity exists in a foreign country, only to have their personal documents (passports and visas) confiscated once they arrive at their destination (Richards, 2014). — Additionally, victims may turn to trafficking as a means of survival or be manipulated through a relationship with a trafficker/pimp. • While anyone can become a victim, certain characteristics can increase an individual’s risk.
- Pre-teen and adolescent girls; children who have a history of physical and/or sexual abuse; those living in extreme poverty; individuals with a history of parental or personal drug or alcohol abuse; those who are runaway or homeless; or have lost a parent due to death, divorce, or abandonment are more likely to become victims of human trafficking (Clawson & Dutch, 2009; Countryman-Roswurm, 2012; Logan et al., 2009; Rafferty, 2013; Smith et al., 2009; Tyler & Johnson, 2006).
- Because of their age and inexperience, youth are particularly susceptible to the advances of a trafficker (Banks & Kyskelhahn, 2011; Clawson, Dutch, Solomon, & Goldblett, 2009a; Smith et al., 2009).
- Human trafficking is a human rights issue with potentially devastating health consequences (Countryman-Roswurm, 2015; Richards, 2014).
- Survivors must endure physiological, physical, sexual, social, and spiritual abuse which results in severe physiological trauma (Countryman-Roswurm, 2015).
- Virtually every body system is affected by the trauma associated with human trafficking (Richards, 2014; Zimmerman et al., 2008).
- Victims/survivors of human trafficking suffer from anxiety, depression, suicidal ideation, insomnia, dissociative disorders, low self-esteem, self-mutilation, mood swings, eating disorders, and drug and alcohol dependency (Abas et al., 2013; American Psychiatric Association, 2000; Bremner & Vermetten, 2001; Farley, et al. 2003; Herman, 2003; Hossain et al., 2010).
- The most common issue survivors deal with is post-traumatic stress disorder (PTSD) (Bremner & Vermetten, 2001; Choi et al., 2009; Farley, 2003a).
- Victims will require long-term aftercare services which ensure their mental and physical health needs are met while also addressing re-integration needs (job skills, education, money management, basic life skills, etc.) (Clawson, Solomon, & Grace, 2009).
- The needs of victims are vast; no one entity can meet them all. The complexity and scope of human trafficking requires a multi-disciplinary approach (Clawson & Dutch, 2008; Smith et al, 2009; Countryman-Roswurm, 2012).
- Communities which have been able to successfully implement programs that allow for collaboration across professions and disciplines are better able to meet the needs of Domestic Minor Sex Trafficking victims (Countryman-Roswurm, 2012.)
General Practice Implications - Individuals
- It is important for direct service providers to be trained on trauma-informed methods in order to effectively address the complex mental health needs of human trafficking victims (Clawson, Solomon, & Grace, 2009; Hardy et al., 2013; Orme & Ross-Sheriff, 2015).
- Trauma-focused cognitive–behavioral therapy (TF-CBT), dialectical behavioral therapy (DBT), and eye movement desensitization and reprocessing (EMDR) have been found useful for addressing PTSD symptoms in survivors of trafficking (Clawson, Solomon, & Grace, 2009; Fong & Cardoso, 2010; Kotrla, 2010; Orme & Ross-Sheriff, 2015). Courtois (2008) advised that these methods should be implemented in a manner that avoids retraumatizing the client.
- Group therapy may also be helpful for building interpersonal skills, working on affect regulation, and establishing connections (Clawson, Solomon, & Grace, 2009).
- In addition to more traditional modes of therapy, it may be helpful to offer alternative therapeutic supports such as yoga, art therapy, journaling, and mindfulness (Clawson, Solomon, & Grace, 2009; Polaris Project, 2015). Such services offer survivors another strategy for dealing with the effects of trauma.
- Being tolerant of a victim’s possible distrust of the system and remaining supportive over a long period of time can assist in the healing process (Orme & Ross-Sheriff, 2015).
General Practice Implications - Service Providers
- Organize training sessions for direct service staff as well as those in other systems of care that may come in contact with victims/survivors (Clawson, Solomon, & Grace, 2009; Hodge & Lietz, 2007).
- Since identifying victims is the first step to ensuring they receive appropriate services, it is critical for agencies to integrate a human trafficking protocol that includes specialized assessment/screenings and coordination of services (Hardy et al., 2013).
- Additionally, agencies should review current program policies and procedures to ensure they will not cause undue stress or re-traumatize victims/survivors (Clawson, Solomon, & Grace, 2009).
- If your community does not already have one, consider organizing a multidisciplinary team to address the multifaceted challenges associated with human trafficking (Hodge & Lietz, 2007).
- Multidisciplinary teams can help victims/survivors coordinate services across agencies and improve communication to develop a more effective system response to human trafficking.
General Practice Implications - Community
- Raise awareness regarding human trafficking through prevention and educational outreach programs (Orme & Ross-Sheriff, 2015).
- Advocate for effective local, state, national, and international policies regarding human trafficking (Hodge & Lietz, 2007; Linhorst, 2002).
- Educate the community on what to do if they encounter a victim of trafficking. Ensure they are aware of community resources that can assist in an emergency.
Mentoring Practice Implications - Individual
- Youth with a history of human trafficking will face a number of unique challenges because of the trauma they have endured (Dubois & Felner, 2016). Educate yourself on the impact of trauma to best serve your mentee.
- Mentors can help youth stay accountable and prevent backsliding to old behaviors (Dubois & Felner, 2016). Seek to connect mentees to services and program that can be helpful in their healing. Encourage them to stay committed to programming in which they are already engaged. Help them identify and address issues that are holding them back from full recovery.
- Be patient. Youth who have a history of human trafficking can greatly benefit from a caring relationship with a positive adult mentor. However, there will be a number of ups and downs in the relationship and building trust will take time (Dubois & Fulner, 2016).
Mentoring Practice Implications - Service Providers
- Provide mentors with comprehensive training on human trafficking.
- Include mentor training on the impacts of trauma, and how to use a trauma-informed approach in their interactions with their mentee.
- Provide support for mentors who are matched with youth who have a history of human trafficking. Work with them to set appropriate boundaries and expectations with their mentee.
Mentoring Practice Implications - Community
- Advocate for support of mentoring programs in the community.
- Educate others on the benefits of mentoring for youth with a history of trafficking.
- Office of Trafficking in Persons
- US Department of State Trafficking in Persons Report
- National Human Trafficking Hotline
- National Institute of Justice: Human Trafficking
- Abas, M., Ostrovschi, N., Prince, M., Gorceag, V., Trigub, C., Oram, S. (2013). Risk factors for mental disorder in women survivors of human trafficking: A historical cohort study. BioMed Central Psychiatry, 13, 1-11.
- American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders. Arlington, VA: American Psychiatric Association.
- Countryman-Roswurm (2015). It’s more than just my body that got hurt: The psychophysiological consequences of sex trafficking. Journal of Trafficking, Organized Crime and Society, 1(1), 1-8.
- Banks, D., & Kyckelhahn, T. (2011). Characteristics of suspected human trafficking incidents, 2008-2010. US Department of Justice, Office of Justice Programs, Bureau of Justice Statistics.
- Bremner, J.D., Vythilingam, M., Vermetten, E., Adil, J., Khan, S., Nazeer, A.,…Charney, D.S. (2003). Cortisol response to a cognitive stress challenge in posttraumatic stress disorder (PTSD) related to child abuse. Psychoneuroendocrinology, 28, 733-750.
- Choi, H., Klein, C., Shin, M., Lee, H. (2009). Post-traumatic stress disorder (PTSD) and disorders of extreme stress (DESNOS) symptoms following prostitution and childhood abuse. Violence Against Women, 15, 933-951.
- Clawson, H., & Dutch, N. (2009). Addressing the needs of human trafficking victims: Challenges, barriers and promising practices. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation.
- Clawson, H. J., Solomon, A., & Grace, L. G. (2009). Treating the hidden wounds: Trauma treatment and mental health recovery for victims of human trafficking. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation.
- Clawson, H., Dutch, N., Solomon, A., & Goldblatt, G. (2009). Human trafficking into and within the United States: A review of the literature. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation.
- Courtois, C. A. (2008). Complex trauma, complex reactions: Assessment and treatment.
- Psychological trauma: Theory, research, practice, and policy, S(1), 86–100.
- DuBois, D., Felner, J. (2016). Mentoring for youth with backgrounds of involvement in commercial sex activity. National Mentoring Resource Center. Retrieved from http://www.nationalmentoringresourcecenter.org/index.php/ component/k2/item/125-mentoring-for-youth-with-backgrounds-of-involvement-in-commercial-sex-activity.html
- Estes, R., & Weiner, N. (2001). The commercial sexual exploitation of children in the U.S., Canada and Mexico. Philadelphia: University of Pennsylvania, School of Social Work, Center for the Study of Youth Policy.
- Gozdziak, E. M., & Collett, E. A. (2005). Research on human trafficking in North America: A review of literature. International Migration, 43(1/2), 99-128. doi:10.1111/j.0020-7985.2005.00314.x
- Green, C. (2016). Human trafficking: Preparing for a unique patient population. American Nurse Today, 11(1), 9-12
- Farley, M., Cotton, A., Lynne, J., Zumbeck, S., Spiwak, F., Reyes, M., et al. (2003). Prostitution and trafficking in nine countries: An update on violence and post-traumatic stress disorder. In M. Farley (Ed.), Prostitution, trafficking, and traumatic Stress (pp. 33-74). Binghamton, New York: The Haworth Press.
- Farley, M. (2003a). Prostitution and the invisibility of harm. Women and Therapy, 26, 247-280.
- Fong, R., & Berger Cardoso, J. (2010). Child human trafficking victims: Challenges for the child welfare system. Evaluation and Program Planning, 33(Child Welfare and the Challenge of the New Americans), 311-316. doi:10.1016/j.evalprogplan.2009.06.018
- Hardy, V. L., Compton, K. D., & McPhatter, V. S. (2013). Domestic minor sex trafficking: Practice implications for mental health professionals. Journal of Women & Social Work, 28(1), 8-18. doi:10.1177/0886109912475172
- Herman, J.L. (2003). Hidden in plain sight: Clinical observations on prostitution. In M. Farley (Ed.), Prostitution, trafficking, and traumatic stress (pp. 1-13). Binghamton, New York: The Haworth Press.
- Hodge, D., & Lietz, C. (2007). The international sexual trafficking of women and children - A review of the literature. Journal of Women and Social Work, 22(2), 163-174.
- Hossain, M., Zimmerman, C., Abas, M., Light, M., and Watts, C. (2010). The relationship of trauma to mental disorders among trafficked and sexually exploited girls and women. American Journal of Public Health, 100, 2442- 2249.
- Hyland, K.E. (2001). The impact of the Protocol to Prevent, Suppress and Punish Trafficking in Persons, Especially Women and Children. Human Rights Brief, 8(2), 30-38.
- International Labour Organization. (2012) ILO global estimate of forced labour: results and methodology. ILO: Geneva.
- Johnson, A. L. (2012). A perfect storm: The U.S. antitrafficking regime's failure to stop the sex trafficking of American Indian women and girls. Columbia Human Rights Law Review, 43(2), 617-710.
- Kotrla, K. (2010). Domestic minor sex trafficking in the United States. Social Work, 55:2, 181-187.
- Linhorst, D. M. (2002). Federalism and social justice: Implications for social work. Social Work, (3), 201.
- Logan, T., Walker, R.., & Hunt, G. (2009). Understanding human trafficking in the United States. Trauma, Violence, and Abuse, 10(1), 3-30.
- Mohsen, R. (2016). The emerging epidemiology of human trafficking and modern slavery. Middle East Journal of Business, 11(3), 32-36.
- Orme, J., & Ross-Sheriff, F. (2015). Sex trafficking: Policies, programs, and services. Social Work, 60(4), 287-294. doi:10.1093/sw/swv031
- Rafferty, Y. (2013). Child trafficking and commercial sexual exploitation: A review of promising prevention policies and programs. American Journal of Orthopsychiatry, 83(4), 550-575.
- Richards, T. A. (2014). Clinical practice: Health implications of human trafficking. Nursing for Women’s Health, 18155-162. doi:10.1111/1751-486X.12112
- Smith, L., Vardaman, S., & Snow, M. (2009). The national report on domestic minor sex trafficking: America’s prostituted children. Vancouver, WA: Shared Hope International.
- Trafficking Victims Protection Act (TVPA) of 2000. Public Law 106-386, 114 Stat. 1464, 106th Cong. (2000).
- Tyler, K. A., & Johnson, K. A. (2006). Trading sex: Voluntary or coerced? The experiences of homeless youth. Journal of Sex Research, 43(3), 208-216.
- US. Department of State. (2000). Victims of Trafficking and Violence Protection Act of 2000, Pub. L. No. 106-386, 114 Stat. 1464.
- Zimmerman, C., Hossain, M., Yun, K., Roche, B., Morison, L., & Watts, C. (2006). Stolen smiles: The physical and psychological health consequences of women and adolescents trafficked in Europe. London: London School of Hygiene.
- Zimmerman, C., Hossain, M., Yun, K., Gajdadziev, V., Guzun, N., Tchomarova, M., … Watts, C. (2008). The health of trafficked women: A survey of women entering posttrafficking services in Europe. American Journal of Public Health, 98(1), 55–59.