Abstract
Children, youth, and adults of both genders are sex trafficked into and throughout the United States every day. Regrettably, little attention has been given to how human service providers might identify the sex-trafficking victims they are likely to encounter. To address this knowledge gap, the authors review 20 documents with the aim of detecting and synthesizing service identification recommendations in the scientific literature, government reports, and documents produced by organizations working with sex-trafficking victims. The review shows consensus regarding identification recommendations, including (a) trafficking indicators, (b) victim interaction strategies, (c) immediate response strategies, and (d) child-specific information. The review also shows consensus regarding screening questions that are important for service providers to use in identifying sex-trafficking victims. These questions relate to the victims’ safety, employment, living environment, and travel and immigration status in addition to specific questions used with children and youth. The review results offer human service providers a preliminary set of screening strategies and questions that can be used to identify sex-trafficking victims in the context of human services. Building on the review findings, the authors offer policy and research recommendations.
Children, men, and women are sex trafficked into and throughout the United States every day. Regrettably, research has shown that sex-trafficking victims are infrequently identified by service providers who may have contact with these victims (Clawson, Dutch, Salomon, & Grace, 2009; U.S. Department of State [USDS], 2010). This under identification means that many victims are not able to access services and escape the horrors of trafficking.
Currently, no uniform system of data collection exists for tracking either the numbers of trafficking victims identified or the various efforts of law enforcement agencies targeted toward trafficking (Logan, Walker, & Hunt, 2009; USDS, 2010). Thus, the incidence and prevalence of sex trafficking in the United States remains largely unknown. The USDS’s current conservative estimates of human trafficking for any reason (e.g., forced labor, prostitution) suggest between 14,500 and 17,500 individuals are trafficked annually into the United States (Clawson et al., 2009). However, even less is known about domestic sex trafficking (i.e., the trafficking of U.S. citizens within the country). Although the scope of sex trafficking is unclear, there is consensus that the trafficking of persons into and throughout the United States may be more prevalent than suggested by these initial findings (Caliber, 2007; Clawson et al., 2009).
This review adopted the USDS’s (2010, p. 8) definition of sex trafficking: “sex trafficking in which a commercial sex act is induced by force, fraud, or coercion, or in which the person induced to perform such an act has not attained 18 years of age.” Consistent with the USDS (2010), we note that prostitution by willing adults is not considered human trafficking. However, adults who are “coerced, forced, or deceived into prostitution” are considered trafficking victims (USDS, 2010, p. 9). Likewise, adults who are “maintained in prostitution through coercion” are also considered trafficking victims (USDS, 2010, p. 9), regardless of whether they initially entered into prostitution willingly.
Research has shown that human service providers in a variety of settings were likely to encounter sex-trafficking victims (Clawson et al., 2009; Logan et al., 2009). Beyond service settings such as sexual assault agencies in which encountering sex-trafficking victims might be anticipated, service providers are likely to encounter trafficking victims among clients of agencies that provide services related to child advocacy, child protection and welfare, criminal justice, domestic violence, health care, homelessness outreach and shelter, juvenile justice, and victim advocacy. Providers in any of these service settings might encounter sex-trafficking victims while delivering usual services. For example, adult or youth trafficking victims might be able to escape perpetrators and seek help at a domestic violence or homeless shelter. Child protection workers may be called to respond to sexual abuse cases that are actually sex-trafficking situations. Providers in community clinics may encounter trafficking victims who are receiving treatment for sexually transmitted infections, and mistakenly identify trafficking victims as victims of partner violence based on the type or history of physical injuries.
To avoid such misidentification and to help victims once they are identified, an emerging body of literature has focused on developing best practices for the delivery of aftercare services to trafficking victims (e.g., Busch-Armendariz, Nsonwu, & Cook, 2011; Clawson & Dutch, 2008a; Fong & Cardoso, 2010; Macy & Johns, 2011). In addition, the literature has given some attention to the development of community and organizational aftercare services (Boxill & Richardson, 2007). Unfortunately, less attention has been given to developing protocols or guidelines to assist service providers in identifying sex-trafficking victims among their clients. sex-trafficking victims could appear for services in any of the above mentioned service settings without ever explicitly describing their situations or identifying themselves as trafficking victims (Clawson & Dutch, 2008b). Victims might not report their situations to providers because they are unaware of their rights or the fact that there are protections for trafficking victims (Logan et al., 2009). In addition, victims might not self-identify because of fear or intimidation from traffickers. In the absence of full description or self-identification, service providers are likely to go about service delivery in the usual manner, without tailoring their services to the needs of this especially vulnerable group. In light of this serious knowledge gap, providers need a set of practice protocols and screening questions to help identify sex-trafficking victims, regardless of where and when they appear in the human services system.
However, efforts to develop screening questions to help identify sex-trafficking victims have been hindered by the dearth of empirical research on sex trafficking (Kaufman & Crawford, 2011; Macy & Johns, 2011). To date, little empirical research has been conducted on best practices for identifying sex-trafficking victims in the context of human services. Thus, a comprehensive and systematic literature review is a needed first step toward developing an evidence-base of strategies for identifying sex-trafficking victims during the provision of human services. Accordingly, this study sought to detect and synthesize all service identification recommendations in the scientific literature, government reports, and documents prepared by organizations working with victims and survivors of sex trafficking in the United States.
Method
The review was organized using a three-prong strategy to compile literature relevant to the identification of sex-trafficking victims in the United States. First, we completed a systematic review of computerized journal databases, including PsycINFO, PubMed, Web of Science, Social Work Abstracts, Social Services Abstracts, Sociological Abstracts, and Public Affairs Information Service (PAIS) International. The following search strings were used in the initial searches: sex trafficking, sex trafficking and identification, sex trafficking and assessment, sex trafficking and screening, slavery and assessment, slavery and identification, slavery and screening, prostitution and assessment, prostitution and identification, prostitution and screening, sexual violence and assessment, sexual violence and identification, and sexual violence and screening. Six of the search strings were eliminated from subsequent searches because these strings yielded only articles irrelevant to the narrow focus of our review (i.e., sexual violence and assessment, sexual violence and identification, sexual violence and screening, prostitution and assessment, prostitution and identification, and prostitution and screening). Each search was systematically tracked in a spreadsheet, which enabled compilation of data on the total articles yielded by each search and the number of articles identified (based solely on their abstracts) as potentially relevant to this literature review (i.e., identification of sex-trafficking victims in the United States by human service providers). These searches yielded 102 potentially relevant journal articles for review.
The research team outlined specific article inclusion criteria to focus the review toward gathering information most pertinent to the identification of sex-trafficking victims encountered in the context of human service delivery. The three inclusion criteria were (a) the article’s primary focus was the identification of sex-trafficking victims, including both domestically or internationally trafficked victims; (b) the article provided explicit practice recommendations for identifying victims of sex-trafficking that could be used by human service workers in the United States; and (c) the article was written in English. Only two of the 102 peer-reviewed journal articles satisfied these inclusion criteria and were selected for the review (Barrows & Finger, 2008; Dovydaitis, 2010).
Given the low number of relevant peer-reviewed articles, we expanded the systematic search to include documents available on the Internet. Using the Google search engine, the research team used the broad search term sex trafficking to conduct an extensive search and identify relevant literature. This strategy provided 28 potential sources of information, including reports and reference guides from government entities (e.g., USDS, Department of Health and Human Services [DHHS], U.S. Department of Justice [DOJ]), nongovernmental organizations (NGOs) and nonprofit organizations (e.g., Polaris Project, Advocates for Human Rights, Grace Haven House). Each document identified was evaluated using the inclusion criteria given above. Of the 28 Internet sources, 11 documents met the inclusion criteria, and were included for further review (A21 Campaign, n.d.; Bortel, Ellingen, Ellison, Phillips, & Thomas, 2008; Grace Haven House, 2009; Office to Monitor and Combat Trafficking in Persons, n.d.; Polaris Project, 2006, 2009, 2010; U.S. DHHS, 2008a, 2008b, 2008c, 2008d).
The research team’s third strategy was to conduct a backward literature search by reviewing the references of the articles and documents already selected for review. This backward search yielded an additional 15 articles and reports. Of these, seven documents were retained for further review based on the inclusion criteria (Anti-Slavery International, 2005; Clawson & Dutch, 2008b; Florida Coalition Against Domestic Violence [FCADV], 2004; Hughes, 2003; R.I.P.P.L.E., 2007; U.S. Department of Education [ED], 2009; Zimmerman & Watts, 2003).
In all, 20 documents were assembled for review. The research team first developed a standardized review form, and then a research team member systematically reviewed each document using that form. The review form enabled the research team to systematically scrutinize each document for (a) strategies used to identify sex-trafficking victims and (b) specific screening questions for victim identification, while focusing on recommended practices for human service providers in U.S. practice settings.
Results
Document Characteristics
The 20 documents selected for review came from various sources, including NGOs, nonprofits, governmental agencies, and academic researchers. Findings from all 20 documents are presented in Table 1 . Of the 20 documents, only 12 provided a publication date, with a range between 2003 and 2010. Eight documents addressed both domestic and international sex trafficking (Bortel et al., 2008; Clawson & Dutch, 2008b; Dovydaitis, 2010; FCADV, 2004; Hughes, 2003; Polaris Project, 2010; R.I.P.P.L.E., 2007; U.S. ED, 2007). In contrast, 10 documents did not specify a focus on domestic or international sex trafficking (A21 Campaign, n.d.; Barrows & Finger, 2008; Office to Monitor and Combat Trafficking in Persons, n.d.; Polaris Project, 2006, 2009; U.S. DHHS, 2008a, 2008b, 2008c, 2008d; Zimmerman & Watts, 2003). One document focused exclusively on domestic sex trafficking of minors (Grace Haven House, 2009). Although one document focused on sex trafficking in European nations (Anti-Slavery International, 2005), we retained this document in our review because the information addressed victim identification, which we evaluated as relevant to the human service context in the United States.
Review Findings: Sex-Trafficking Indicators, Interaction, Response Strategies, and Child- or Youth-Specific Information
Only one document included in the review provided recommendations based on primary data collection (Bortel et al., 2008). These researchers gathered data through qualitative interviews with community members such as law enforcement officers, judges, service providers, health care providers, and attorneys.
An additional 16 documents provided practice recommendations typically based on the organizations’ experience working directly with trafficking victims (A21 Campaign, n.d.; Anti-Slavery International, 2005; Clawson & Dutch, 2008b; FCADV, 2004; Hughes, 2003; Office to Monitor and Combat Trafficking in Persons, n.d.; Polaris Project, 2006, 2009, 2010; R.I.P.P.L.E., 2007; U.S. DHHS, 2008a, 2008b, 2008c, 2008d; U.S. ED, 2007; Zimmerman & Watts, 2003). Another three documents were identified as “think pieces” (i.e., articles intended to be thought-provoking that provide background information) because these authors reviewed and cited existing research (Barrows & Finger, 2008; Dovydaitis, 2010; Grace Haven House, 2009).
Strategies for Identifying Sex-Trafficking Victims
Overall, the literature regarding recommended strategies for service providers to use in the identifying sex-trafficking victims consistently discussed several salient issues, including trafficking indicators, victim interaction, immediate response, and child-specific information.
Trafficking indicators
Of the documents reviewed, 12 noted indicators of sex trafficking, and overwhelmingly agreed on typical indicators (A21 Campaign, n.d.; Anti-Slavery International, 2005; Barrows & Finger, 2008; Clawson & Dutch, 2008b; Dovydaitis, 2010; Hughes, 2003; Office to Monitor and Combat Trafficking in Persons, n.d.; Polaris Project, 2009, 2010; U.S. DHHS, 2008a; Zimmerman & Watts, 2003). Several documents cited a list of trafficking indicators originally put forth by U.S. DHHS (2008a), including (a) signs the person is being controlled (e.g., under control of the person accompanying him or her); (b) signs the person does not have the freedom to exit a job or move; (c) signs of physical abuse (e.g., bruises, injuries, scars); (d) signs indicating the person is fearful or depressed. In addition, the DHHS list included indicators of international trafficking such as the potential victim is not an English speaker; the potential victim is a recent arrival to the United States from India, Asia, Latin America, Eastern Europe, Canada, or Africa; and the potential victim does not have identification, immigration documents, or a passport. The second column in Table 1 lists all sex-trafficking indicators discussed in these documents.
Victim interaction strategies
Specific strategies for service providers to use in their interactions with possible trafficking victims were included in 16 documents (A21 Campaign, n.d.; Anti-Slavery International, 2005; Barrows & Finger, 2008; Bortel et al., 2008; Clawson & Dutch, 2008b; DOJ, 2007; FCADV, 2004; Hughes, 2003; Polaris Project, 2006, 2010; U.S. DHHS, 2008a, 2008b, 2008c, 2008d; U.S. ED, 2007; Zimmerman & Watts, 2003). The discussion around these strategies included a range of topics such as (a) building trust and rapport with potential victims; (b) procedural issues in conducting interviews; and (c) messages that service providers should convey to potential victims. The following set of strategies was mentioned in multiple documents: (a) question a potential victim when he or she is alone; (b) use indirect rather than direct questions, excluding words such as “coercion,” “force,” and “trafficking”(e.g., I would be interested to hear … or Can you tell me…); (c) clearly explain the service provider role to potential victims; (d) clearly explain confidentiality policies and how the information the victim provides will be used; (e) focus on the potential victim’s safety and needs; and (f) conduct interviews and provide services with cultural and linguistic competence. The third column of Table 1 provides a listing of all of the victim interaction strategies discussed in these 15 documents.
Immediate response strategies
Among the literature selected for review, 14 documents suggested strategies for interactions with potential victims in situations that might require an immediate response (A21 Campaign, n.d.; Anti-Slavery International, 2005; Barrows & Finger, 2008; DOJ, 2007; Dovydaitis, 2010; FCADV, 2004; Grace Haven House; 2009; Office to Monitor and Combat Trafficking in Persons, n.d.; Polaris Project, 2009; U.S. DHHS, 2008a, 2008b, 2008c, 2008d; U.S. ED, 2007). These documents consistently recommended that service providers should immediately contact the National Human Trafficking Resource Center’s (NHTRC) hotline to obtain further information or to report suspected cases of trafficking. Further, a minority of documents also suggested that providers call local law enforcement, especially if the victim’s situation posed immediate danger. Other suggested strategies proposed that providers should work with victims in making decisions about contacting local authorities or trafficking organizations. A few documents noted the importance of providers developing a safety plan in conjunction with victims. The third column of Table 1 provides a listing of recommended strategies for providing immediate victim assistance.
Child-specific information and strategies
Arguably, children and youth are the most vulnerable of all trafficking victims. As with adult victims, service providers may encounter these trafficking victims in a variety of settings. In addition, the literature review findings show that special indicators and strategies may be needed to identify that a child or youth has been trafficked. Of the documents included in our review, 10 noted at least one indicator of sex-trafficking victimization specific to child or youth victims, or at least one strategy for interacting with children or youth who are potential sex-trafficking victims (A21 Campaign, n.d.; Bortel et al., 2008; Dovydaitis, 2010; Grace Haven House, 2009; Hughes, 2003; Office to Monitor and Combat Trafficking in Persons, n.d.; Polaris Project, 2009, 2010; U.S. DHHS, 2008a; U.S. ED, 2007). Four documents discussed prostitution as a definite indicator of sex-trafficking victimization among persons younger than 18 years old. Other documents described indicators of prostitution as indicators of trafficking, including a child or youth who has hotel room keys, has a much older “boyfriend,” and/or is familiar with prostitution phrases or terms. In offering strategies for service providers to use in interactions with minors who may be trafficking victims, several documents noted that service providers are required to report such trafficking victims to child protective services. The fourth column in Table 1 shows the recommendations for child- and youth-specific sex-trafficking indicators and screening strategies for minor trafficking victims.
Review of Sex-Trafficking Screening Questions
Many of the reviewed documents provided screening questions that human service providers could use to help identify if a client was a victim of trafficking. In particular, eight articles were selected for further scrutiny because the authors provided exemplar screening questions (A21 Campaign, n.d.; Bortel et al., 2008; DOJ, 2007; FCADV, 2004; Polaris Project, 2006, 2009, 2010; U.S. DHHS, 2008c). These screening questions were considered exemplary because the questions were comprehensive and addressed key trafficking indicators. In addition, the documents offered specific recommendations that could be readily implemented in practice. Overall, the screening questions addressed five categories of information: victim’s safety, victim’s employment, victim’s living environment, victim’s travel or immigration, and child- and youth-specific questions. A list of all screening questions by category is provided in Table 2 . We note that some reviewed documents listed the same list of screening questions originally recommended by U.S. DHHS (2008c). To avoid repetition of questions in the table, we did not include documents in Table 2 that only restated the original U.S. DHHS (2008c) questions. However, to indicate that these questions have been recommended by multiple sources, we have placed an asterisk (*) next to them in Table 2.
Screening Questions for Identifying Sex-Trafficking Victims
Note.
*Questions originally developed by U.S. Department of Health and Human Services. Cited by multiple reviewed articles (e.g., A21 Campaign, n.d.; Barrows & Finger, 2008; Clawson & Dutch, 2008b; Office to Monitor and Combat Trafficking in Persons, n.d.).
Discussion
Our goal was to detect and synthesize all available service recommendations for identifying sex-trafficking victims during the provision of human services. To the best of our knowledge, this research is one of the first efforts to conduct a comprehensive, systematic literature review on this topic. Thus, this research takes an important step toward developing promising practices for identifying sex-trafficking victims in the context of human service provision. Taken together, the findings of this review offer human service providers a preliminary set of screening strategies and questions that can be used to identify sex-trafficking victims in the context of human services. The trafficking indicators discussed in this review can also inform future trafficking research.
Although the problem of human trafficking is likely as old as human history (Logan et al., 2009), it is notable that most of the documents identified for this review were produced only recently. Using the earliest of these documents as a starting point, we estimate that 2.5 documents addressing identification of sex-trafficking victims have been produced annually since 2003. Nearly all of these reviewed documents were either “think pieces” or were developed based on practical field experience. Despite increased general awareness, relatively little attention has been focused on helping service providers identifying sex-trafficking victims in routine practice settings. This knowledge gap is further underscored by the fact that only one of the relevant documents was informed by original data collection and research. Nonetheless, the rate of document production on this topic has increased substantially over the past 5 years, which may indicate growing attention to the issue of sex-trafficking victim identification.
Even though the review findings showed consensus on many recommended strategies for victim identification, the results also showed areas of uncertainty. Many documents did not clearly distinguish whether the recommendations were intended to be used with victims of domestic trafficking, international trafficking, or both. Thus, it remains unclear if one set of screening strategies and questions will be useful in the identification of both domestic and international victims. Given the differences between domestic and international trafficking victims’ circumstances, characteristics, and needs, it is likely that distinct screening strategies and questions are needed (Clawson et al., 2009). We encourage advocates and researchers who focus on the issue of sex trafficking to distinguish between the needs and concerns of domestic and international sex-trafficking victims in future efforts.
Second, a few of the documents proposed that service providers use the recommended screening strategies with potential victims in the context of ongoing service delivery, but only after providers have established trusting relationships with potential victims. This recommendation is well reasoned because victims might be unlikely to disclose details about their situation to service providers who they do not know and trust. On the other hand, service providers may have only one contact, and thus one opportunity, to identify victims. For example, trafficked youths could appear at a homeless service center once—never to appear again. In addition, service providers may not know from one encounter to the next whether a potential victim will return for services. Indeed, one trafficking indicator noted in the reviewed research emphasized that perpetrators of trafficking frequently move victims from one geographic location to another. Thus, a victim might encounter a human service provider in one community 1 month only to see a new service provider in another community the next month. Currently, the recommended identification practices do not provide guidance on ways in which service providers can conduct screenings safely and sensitively in the context of one-time encounters. This lack of guidance is a limitation of the current literature given the realities and hidden nature of sex trafficking (Clawson & Dutch, 2008b). Again, we encourage advocates and researchers to address this issue in future efforts.
Third, the literature lacks clarity regarding a recommended immediate response by service providers once a sex-trafficking victim is identified. Almost all of the reviewed documents recommended contacting the NHTRC’s hotline or local law enforcement. Few documents recommended that providers consult with adult victims before taking such actions. However, the recommendation to consult with victims before taking action underscores an important question for providers: Is it possible that by contacting the national hotline or law enforcement, providers could do more harm than good for victims (Kaufman & Crawford, 2011)? Is a victim at heightened risk of danger and violence if a provider makes such a call without first establishing immediate safety for the victim? Likewise, if providers make such calls without consulting adult victims or despite adult victims’ preferences, what are the implications for victims’ agency and empowerment? Moreover, and a further complication, many of the reviewed documents noted that often trafficking victims are not only unaware that human trafficking is unacceptable and illegal but also unaware that help and resources to escape trafficking are available (Logan et al., 2009). In such cases, victims might never receive help unless human service providers actively intercede. These complex, interrelated issues deserve careful attention and consideration. We encourage advocates and researchers to address these important issues by conducting research with survivors of sex trafficking about their preferences regarding interactions with human service providers.
The fourth issue raised by this review centers on what actions human service providers should take if their community lacks aftercare services to which they can refer victims. As noted earlier, there is a nascent literature regarding aftercare services for trafficking victims. Unfortunately, such services are not universally available throughout the United States. To help address this service gap, we encourage human service providers to collaborate with other providers to develop aftercare organizations, policies, and protocols in their communities. We refer readers who are interested in such community organizational efforts to Boxill and Richardson’s (2007) discussion of how their community worked to develop an aftercare service organization for victims of domestic sex trafficking. We also call on policy makers to attend to the various aspects of human trafficking, including its identification and the provision of services for victims. Community-based service providers are necessary for the development of an aftercare services infrastructure. However, there are many demands on these providers’ time and resources, and their capacity to develop such services is limited. Consequently, the provision of aftercare services will remain inconsistent and uneven as long as society relies on community-based service providers to take the sole lead in developing such a service system. The United States needs consistent and widespread policy development and funding attention to this atrocious problem.
However, even without aftercare services available in the community, the findings from this review suggest that it is important for human service providers to identify victims whenever possible. If nothing more, providers should adapt their usual services to victims’ unique and vulnerable circumstances. Nonetheless, we urge providers to seek out possible referrals and resources for victims before they implement the recommended screening strategies and questions presented here. Human service providers should be able to find some services in their community to help trafficking victims, even if those services are not dedicated to trafficking victims.
Limitations and Future Research
As readers consider the review findings, we encourage them to be mindful of this study’s limitations. For example, we might not have discovered and included all pertinent documents in this research. However, from the outset of this research, we worked to address this limitation by using wide-ranging, multiple search strategies to locate as many relevant documents as possible. In addition, two researchers worked independently to choose articles for review based on clearly defined inclusion criteria. It is also possible that we missed or misunderstood information presented in the reviewed documents. Again, we worked to address this limitation by reviewing each of the 20 documents carefully and completely with a standardized review form. Our goal for this research was to synthesize all service recommendations for identifying sex-trafficking victims during the provision of human services. Nevertheless, the recommended identification strategies and screening questions cannot be considered promising practices without thorough empirical testing. Accordingly, we urge human service providers concerned with sex trafficking to collaborate with researchers to test these identification strategies and screening questions.
Based on current practice protocols, it may be that human service providers are often offering typical services to sex-trafficking victims without identifying these highly vulnerable clients. Such service delivery practices are unfortunate. At best, service delivery encounters in which victims are not identified are missed opportunities to help victims escape the horrors of trafficking. At worst, human service providers could do harm to sex-trafficking victims by delivering services as usual without accounting for these victims’ vulnerable circumstances. Our aim and hope is to help human service providers in their everyday practice by offering a preliminary set of screening strategies and questions to identify sex-trafficking victims in the context of human services. We also hope this review encourages others to test the recommended practices so that evidence-based screening strategies and questions will become available to all human service providers.
Identifying Domestic and International Sex-Trafficking Victims During Human Service Provision: Critical Findings
Identifying Domestic and International Sex-Trafficking Victims During Human Service Provision: Practice, Policy and Research Implications
Footnotes
Acknowledgment
The authors acknowledge Diane Wyant for her comments on an earlier draft of this manuscript.
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
The author(s) received no financial support for the research, authorship, and/or publication of this article.