“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.”
Traumatic events are a universal human experience. Each of us has experienced trauma in one form or another. However, repeated trauma can lead to severe negative outcomes. In addition to the trauma experienced during exploitation, victims/ survivors of Commercial Sexual Exploitation of Children (CSEC) often endure trauma prior to their exploitation. For example, 70% to 90% of CSEC survivors have experienced sexual abuse prior to being trafficked (Lloyd & Orman, 2007). These traumatic experiences affect the biological, psychological, social, and spiritual health of a person. In order to foster positive outcomes, providers must acknowledge how trauma adversely affects a survivor’s response to the environment, stress, and daily activities. Although research on trauma-informed mentoring is limited, trauma-informed care is used frequently in therapy practices, residential treatment centers, foster homes, and child welfare systems (Brown, McCauley, Navalta, & Saxe, 2013; Hodgdon, Kinniburgh, Gabowitz, Blaustein, & Spinnazzola, 2013; Johnson & Pryce, 2013). Trauma-informed care can be easily applied to the mentoring relationship and is particularly important when working with mentees who have been involved in human trafficking.
- A basic understanding of the impact of trauma is a key ingredient to a successful implementation of trauma-informed care.
- Trauma, as defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), is exposure to “death, threatened death, actual or threatened serious injury, actual or threatened sexual violence.” Trauma can be experienced directly (i.e. traumatic experience happens to you), indirectly (learning a friend experienced trauma), by witnessing a traumatic experience, or through repeated exposure to details of something traumatic.
- Trauma can be a one-time event (acute trauma) or can be prolonged (chronic trauma) (Bath, 2008).
- Most survivors of trafficking experience chronic trauma.
- Trauma has physical ramifications. For example, survivors of trafficking often experience headaches, stomach pain, memory problems, back pain, poor appetite, exhaustion, dizzy spells, pelvic pain, and gynecological infections due to the physical and psychological trauma they have faced (Oram et al., 2012a; Oram et al., 2012b; Zimmerman, et al., 2008).
- Trauma changes how your body responds to stress. In order to survive repeated trauma, the body, brain, and even nervous system learn to adapt (Child Welfare Information Gateway, 2014). The resulting survival mechanisms are often mislabeled as problem behaviors such as aggression, not following rules, dissociation, acting out, distrust, etc. Exposure to a traumatic experience can result in Post-Traumatic Stress Disorder (PTSD). PTSD occurs if a person is consistently, for more than one month, re-experiencing the traumatic event, shows avoidance and numbing response to stimuli related to the trauma, experiences negative changes in mood or behavior (lack of interest in significant activities, alimentation, self-blame, persistent trauma-related emotions, etc.), displays changes in arousal or reactivity (DSM-IV).
- High levels of PTSD, anxiety, and depression have been found in survivors of trafficking (Oram et al., 2012b).
- Many people who have experienced something traumatic become fixated on safety. They may become alarmed just thinking about the traumatic event. The resulting actions are rooted in their aroused state, even though they are no longer in immediate harm (Perry, 1999).
- Trauma-informed care aims to address the unique needs of those who have experienced trauma. Services are offered in a manner that acknowledges the impact of past trauma and is tailored to meet the specific vulnerabilities of those who have experienced trauma (Harris & Fallot, 2001; Clawson, Salomon, & Grace, 2008).
- Trauma-informed care should influence all levels of an agency/organization. Every interaction, from check-in at the front desk to actual service delivery, should be offered with the unique needs of trauma survivors in mind (Clawson, Salomon, & Grace, 2008; Harris & Fallot, 2001).
- Chronic trauma (i.e. repeated or prolonged exposure to traumatic events, like human trafficking) will require a lengthy recovery process (Bath, 2008). Service providers must recognize and prepare for this process before engaging in work with survivors.
- Trauma is so pervasive it changes how our bodies respond and cope. Healing from trauma must be holistic (bio-psych-social-spiritual).
- Many of the negative behaviors displayed by survivors of trafficking are actually skills which helped them survive exploitation. It takes time for the body to relearn how to cope and respond when trauma is absent. Service providers should work with survivors on identifying how to change and adapt past coping skills to more effectively serve them in recovery.
- Trauma is “highly personal and the impact of a traumatic event is specific to the individual” (Buse, Burker, & Bernacchio, 2013, p. 15).
- Trauma-informed services take into account the impact of trauma. Services are designed to meet the unique needs of survivors and avoid re-traumatization (Harris & Fallot, 2001; Clawson, Salomon, & Grace, 2008).
General Practice Implications
- Those that will be connecting with survivors should receive training on the impact of trauma as well as trauma-informed care.
- All those intentionally engaging with survivors should be held accountable for ensuring that a trauma-informed environment is created.
- Survivors of trafficking have likely dealt with some form of childhood abuse or traumatic experience before they were exploited. Service providers will need to attend to trauma associated with both trafficking and early childhood experiences.
- Trauma-informed care is not just about client interactions, but rather, how organizations incorporate the concepts of trauma-informed care into all aspects of daily operations. Organizations should assess their policies and procedures through a trauma-informed lens and adjust as necessary to better serve those who have experienced trauma.
- Advocate for trauma-informed care to be implemented across social service agencies.
Mentoring Practice Implications
- It is vital that mentors receive training on the impact of trauma and trauma-informed care. Such training can greatly impact how they interact with mentees.
- For many survivors of trafficking, trauma occurred in the context of relationships. With the right support and training, healing can occur in a healthy mentor relationship ( Johnson & Pryce, 2013). Service Providers
- Encourage mentors to see their mentee’s behavior through a trauma-informed lens (“what happened to you” vs “what is wrong with you”) and assist them in developing trauma-informed responses.
- Ensure that mentors receive continual training on trauma. Failure to provide training on trauma leads to poorer outcomes in the mentee ( Johnson & Pryce, 2013).
- Provide regular and ongoing support to mentors so that they know that they are not alone in supporting the survivor.
- Advocate for more trauma-informed communities which aim to address community and individual level trauma through community engagement and participation (Annie E. Casey Foundation, 2015)
- Organizational Trauma-Informed Assessment
- Creating Trauma-informed Care Environments
- Trauma Training Toolkit
- Tips and Strategies for Trauma-Informed Mentoring
- Childhood Trauma Changing Minds
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5. Washington, DC: American Psychiatric Association.
- Annie E. Cassey Foundation. (2015). A model move: Trauma informed community building. Retrieved from: http://www.aecf.org/blog/a-model-move-trauma-informed-community-buildin…
- Bath, H. (2008). The three pillars of trauma-informed care. Reclaiming Children and Youth, 17(3), 17-21.
- Brown, A., McCauley, K., Navalta, C., & Saxe, G. (2013). Trauma systems therapy in residential settings: Improving emotion regulation and the social environment of traumatized children and youth in congregate care. Journal of Family Violence, 28, 693-703.
- Buse, N., Burker, E., & Bernacchio, C. (2013). Cultural variation in resilience as a response to traumatic experience. Journal of Rehabilitation, 79(2), 15-23.
- Clawson, H. J., Solomon, A., & Grace, L. G. (2008). 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.
- Child Welfare Information Gateway. (2014). Parenting a child who has experience trauma. Washington, DC: U.S. Department of Health and Human Services, Children’s Bureau.
- Fallot, R., & Harris, M. (2009). Creating cultures of trauma-informed care: A self-assessment and planning protocol. (Community Connections. Washington, D.C.) retrieved from http://www.theannainstitute.org/CCTICSELFASSPP.pdf
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- Keesler, J. (2014). A call for the integration of trauma-informed care among intellectual and developmental disability organizations. Journal of Policy and Practice in Intellectual Disabilities, 11(1), 34-42.
- Johnson, S. & Pryce, J. (2013). Therapeutic mentoring: Reducing the impact of trauma for foster youth. Child Welfare, 92(3), 9-25.
- Perry, B. (1999). Helping traumatized children: A brief overview for caregivers. Child Trauma Academy Press, 1(5), 1-17.
- Zimmerman, C., Hossain, M., Yun, K., Gajdadziev, V., Tchomarova, M., Ciarrocchi, R., . . . 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.
- Oram, S., Ostrovschi, N., Gorceag, V., Hotineanu, M., Gorceag, L., Tribug, C., & Abas, M. (2012a). Physically health symptoms reported by trafficked women receiving post-trafficking support in Moldova: Prevalence, severity, and associated factors. BioMed Central Women’s Health, 12(20), 1-9.
- Oram, S., Stockl, H., Busza, J., Howard, L., & Zimmerman, C. (2012b). Prevalence and risk of violence and the physical, mental, and sexual health problems associated with human trafficking: Systematic review. PLoS Medicine, 9(5), 1-13.