The protection prong of the 4P approach focuses on identifying victims and appropriate services, referring survivors to services, providing services and supporting survivors in the short and long terms.
Trauma-Informed Service Delivery
It is important to acknowledge the impact that trauma has on survivors as they engage with victim services. Using a trauma-informed approach can help make interventions more effective and result in better outcomes for survivors. The Substance Abuse and Mental Health Services Administration highlights six principles to trauma-informed service delivery:
- Trustworthiness and transparency
- Peer support
- Collaboration and mutuality
- Empowerment, voice and choice
- Cultural, historical and gender issues
Project REACH, part of the Trauma Center at Justice Resource Institute, is a program that addresses the mental health needs of trafficking survivors through consultation and short term direct services. In addition to those services, Project REACH also provides training and informational resources to trafficking service providers. One resource, “Utilizing Trauma-Informed Approaches to Trafficking-related Work,” provides a look at the various ways trauma impacts survivors and offers insight into how providers can deliver services with those consequences in mind.
Services to Survivors
The importance of addressing the emergency needs of trafficking survivors—such as food, shelter and clothing— can be an important component of providing services. Several surveyed survivors have identified the promise of receiving basic necessities as a reason for entering a trafficking situation. Ensuring these basics needs are met can build trust and a relationship between the service provider and the survivor, leading to further cooperation and participation in services.
The basic necessities are many, and include providing:
(1) an interpreter or translator to make the survivor feel more comfortable and understood; (2) crisis intervention and safety planning to ensure that the impact of the recent trauma is addressed and there is a plan to keep the survivor safe through the duration of the reintegration period; (3) health care, including immediate medical attention, sexual assault evaluations, substance abuse counseling, and other health care to ensure the survivor is well; (4) emergency housing; and (5) food and clothing.
From the immediate physical and emotional health care concerns, to the longer-term mental health and substance use treatment needs, trafficking survivors require access to a complex array of health care services.
Several studies have found that trafficking survivors need access to health services for various reasons, including sexually transmitted infections, physical injuries, burns, anxiety, post-traumatic stress disorder, suicidal ideation, substance abuse, HIV/AIDS, depression, sexual violence, malnutrition, skin conditions, gastrointestinal disorders, dental injuries and diseases, and tuberculosis. In addition to these physical manifestations, mental health is an important medical concern for survivors of human trafficking. Mental health and trauma therapy has been found to be helpful to survivors, all of whom have experienced some form of trauma.
Estimates show that between 30 percent to 88 percent of trafficking victims access health services during their exploitation. A University of Kansas project demonstrates how local partnerships can come together to identify and support trafficking survivors. After participating in an Anti-Slavery and Human Trafficking Initiative, the University of Kansas School of Law’s Medical-Legal Partnership Clinic began providing legal services to trafficking survivors and training medical providers how to recognize trafficking and connect victims to services. This work has developed into a partnership with the University of Kansas hospital and physician clinics, which led to further training and partnerships to develop a screening and assessment tool for medical professionals to identify victims and connect them to services.
Survivors of sex and labor trafficking face complex legal issues that often require expertise in many areas of the law, including criminal, civil, immigration and more. Survivors may need legal assistance in the following areas:
Civil Claims and Restitution. Civil litigation against the trafficker is one way survivors can seek redress and receive financial remedy, including restoration of earnings in labor trafficking situations and elimination of trafficking-related debts. Financial compensation also can be a powerful tool in helping survivors move toward more economic stability. The Trafficking Victims Protection Act provides federal and civil remedies for trafficking survivors. In addition 34 states provide guidance on the civil suits survivors can bring against traffickers, including where the suit can be filed, what damages can be recovered and the statute of limitations on such claims. Those states are Alabama, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Indiana, Kansas, Kentucky, Louisiana, Maine, Massachusetts, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Utah, Vermont, Washington, West Virginia and Wisconsin.
In addition, traffickers convicted of their crimes can be required to pay restitution to their victims, with the goal of addressing the financial harm done. At least 29 states provide restitution for trafficking survivors, particularly labor trafficking survivors. This restitution may contribute to the payment of medical and psychological services, housing, child care, property loss, repatriation and, as often is the case, cost of labor provided. Those states include Alabama, Colorado, Connecticut, Delaware, Hawaii, Idaho, Illinois, Indiana, Iowa, Kentucky, Louisiana, Maryland, Michigan, Mississippi, Missouri, Nevada, New Hampshire, New Jersey, New Mexico, North Carolina, North Dakota, Oklahoma, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Vermont and Wyoming.
Vacating and Expunging Criminal Records. Survivors often have criminal records resulting from crimes committed as part of or in furtherance of the trafficking activity, including theft, drug possession or sales, loitering and prostitution, among others. At least 37 states have created procedures for survivors to expunge, vacate or seal criminal records related to being trafficked. Those states are Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Hawaii, Idaho, Illinois, Kansas, Kentucky, Louisiana, Maryland, Michigan, Mississippi, Montana, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, South Carolina, Texas, Utah, Vermont, Washington, West Virginia, Wisconsin and Wyoming. Clearing a survivor’s criminal record removes barriers to obtaining housing, gaining employment, pursuing education and restoring certain civic rights, all of which are critical to the survivor’s ability to recover and re-enter society.
Family Law. The intersection between domestic violence and human trafficking is complicated and comes in several forms. First, domestic violence victims may be particularly vulnerable to human trafficking as they are trying to escape a dangerous situation. Second, human trafficking victims may be particularly susceptible to domestic violence for some of the same reasons. Third, trafficking victims may be trafficked by their intimate partner, a form of domestic violence in and of itself.
Survivors of trafficking may be fleeing complex personal situations when they come in contact with service providers. These situations—which may include protection orders, child custody, child support and the potential termination of parental rights of the abuser/ trafficker—are critical to keep in mind when providing or planning service delivery.
Victim/Witness Advocacy. The court process can be intimidating, particularly for human trafficking survivors. They could be asked to recount their experience and often are required to be in the same courtroom as their trafficker. Victim/witness advocacy can prepare survivors for the emotionally charged process that lies ahead, and help them navigate the legal system while protecting their rights and safety.
Identity Theft. Identity theft is a huge issue for survivors of human trafficking. Often, a victim’s personal identification may be stolen as a form of capture and to ensure their compliance. This identification is sometimes sold by the trafficker, further placing the victim at risk. The ramifications of this are widespread, from credit issues to criminal records. Assistance often involves reversing the damaging effects of identity theft, or just helping survivors get proper identification.
Immigration. The legal status of many victims may be used by traffickers to maintain compliance with the trafficking activity.
The immigration services available to trafficking survivors include special visas known as T or U visas, which are intended to protect victims of human trafficking by allowing them to stay in the United States to assist in the investigation and prosecution of their traffickers.
A T visa, or T nonimmigrant status, allows a victim of trafficking to remain in the U.S. for up to four years. To do so, victims must comply with reasonable requests from law enforcement agencies for assistance with investigating or prosecuting a human trafficking crime and demonstrate that, if removed from the U.S., they would suffer extreme hardship. A T visa also allows survivors to work and obtain lawful permanent resident status.
A U visa, or U nonimmigrant status, is very similar to a T visa. However, it is only available to victims of human trafficking who suffered substantial physical or mental abuse resulting from trafficking.
Many challenges persist with securing survivors of all forms of trafficking with safe, affordable, and appropriate housing. The United States Advisory Council on Human Trafficking’s 2016 report noted that “the housing needs of survivors of human trafficking are immense.” Another report on the needs of sex trafficking survivors who are minors noted that nearly 75 percent of them identified housing—either emergency, transitional or long term—as an area of need. Resources available may vary depending on the survivor’s immigration status, gender, age, or form of trafficking, in addition to the immediate and long-term nature of housing needs.
Some survivors need only emergency or transitional housing. Domestic violence and other types of shelters can temporarily house human trafficking survivors, but available housing options do not always meet victims’ needs and may be harder to access for certain victims. For example, a labor trafficking survivor may need different services than a domestic violence survivor needs. Youth shelters may have open beds but may have age limits that may preclude some survivors from seeking temporary shelter there.
Also, some domestic violence shelters may be unwilling to extend their services to trafficking victims due to safety concerns or because the specific needs of trafficking victims might not be addressed by their programs. Lack of available beds is a persistent challenge for service providers. Ohio’s Human Trafficking Task Force released a report in January 2017 called Sheltering Minor Victims of Human Trafficking, which provides guidance to programs looking to shelter these minors. The document also provides examples and an analysis of the nuanced needs of minor survivors of human trafficking and how housing and shelter services can respond.
A 2012 report from the U.S. Department of Health and Human Services (HHS), Services Available to Victims of Human Trafficking, states that some trafficking survivors, depending on legal and immigration status, are eligible for housing services from the U.S. Department of Housing and Urban Development (HUD). These include the public housing program and tenant-based vouchers. Providing long-term housing assistance can be difficult, but innovative methods are emerging. For example, in July 2016, the Chicago Housing Authority Board of Commissioners approved a housing pilot program for survivors of human trafficking. The first-of-its-kind pilot provides 60 tenant-based vouchers over a three-year period, providing access to permanent housing for survivors of labor and sex trafficking. This program is the result of a public-private collaboration between HHS, HUD, the Chicago Housing Authority Board of Commissioners, and nonprofit service providers Heartland Alliance and Salvation Army.
In addition to direct services provided to trafficking survivors, other system-based services are available, such as child welfare and public assistance benefits. However, youth in one evaluation said they did not want to engage with other systems for fear of being referred to child welfare or juvenile justice systems. This common hurdle for service providers likely leads to fewer victims coming forward and accessing support services.
Child Welfare. Several surveys and reports indicate that the intersection between human trafficking and child welfare involvement is common. In 2012, a survey from the Los Angeles Probation Department found that 59 percent of the 174 minors arrested on prostitution-related charges were in foster care, often being recruited from group homes. A California Child Welfare Council report found that 50 percent to 80 percent of the victims of commercial sexual exploitation in the state are or were formally involved with child welfare. On the other side of the country, Connecticut’s Department of Children and Families found that 86 out of 88 children identified as sex trafficking victims had been involved with child welfare services.
This vulnerability faced by children and youth involved in the child welfare system uniquely positions the child welfare workforce to identify, prevent and protect youth who may be targeted for human trafficking. The Colorado Human Trafficking Council compiled several human trafficking screening tools currently being used by county child welfare agencies and created a statewide screening tool that will be validated and made available for use in all 62 Colorado counties.
So how does a minor human trafficking survivor access child welfare services? The Trafficking Victims Protection Act of 2015 requires states to include human trafficking in their definition of child abuse. This allows reports to be made directly to the child protection agency, and services to be provided to the child and his/her family. As of April 2016, according to the Child Welfare Information Gateway, 21 states include the term “sex trafficking” in their civil definition of child abuse. Those states are Alaska, Arkansas, California, Colorado, Connecticut, Florida, Hawaii, Illinois, Indiana, Iowa, Kansas, Louisiana, Maine, Maryland, Massachusetts, Minnesota, North Carolina, North Dakota, Oklahoma, Texas and Vermont.
Child welfare services may include reunification and family counseling, foster care placement and other trauma-informed therapeutic services, with the goal of finding a safe, permanent placement for the minor.
Public Benefits. Because of the financial toll that trafficking can have on survivors, access to public benefits and assistance can help some survivors meet basic needs and move toward stability. In 2012, the U.S. Department of Health and Human Services indicated that both child and adult survivors of human trafficking may be eligible for Temporary Assistance for Needy Families (TANF), Medicaid, the Children’s Health Insurance Program (CHIP), as well as programs administered by the Health Resources and Services Administration (HRSA) and the Substance Abuse and Mental Health Services Administration (SAMHSA), in addition to several refugee assistance programs.
Given the diversity of human trafficking survivors, public assistance that benefits adults and children are important to distinguish. For example, housing and other benefit programs are restricted to adults, which causes youth to not engage with them.
In addition to the services outlined above, human trafficking survivors may also require other services, including case management, education assistance, employment, and vocational assistance, transportation and crime victim compensation. For more on comprehensive victim services, visit the Human Trafficking Task Force e-Guide published by the Office for Victims of Crime Training and Technical Assistance Center (OVC-TTAC).