whAt YoU need to Know

SeX trAfficKinG And SeXUAL eXPLoitAtion

A trAininG tooL for

mentAL heALth ProviderS

Human Trafficking and terms like

modern day slavery usually conjure
images of young girls being sold to sex
tourists in faraway countries. Movies and
documentaries often feature
scenes of tourists being
kidnapped and forced into
sexual servitude.

young people for the purpose of supplying

the demand (Harris, 2012).
Although there is limited data to quantify
the exact number of human trafficking

Human Trafficking is a real

problem all over the world,
including here in the United
States. It defies stereotypes
and experts continue to
build new knowledge about
the issue.

SEX TRAFFICKING OF
MINORS IS A FORM OF
CHILD ABUSE.
According to the National
Coalition to Prevent Child
Abuse and Exploitation, the
sex trafficking of minors
is a severe form of child
abuse with lasting effects
on the health and wellbeing
of individuals, family and
society (National Plan 2012).

The sex trafficking market is

driven by the laws of supply
and demand. As long as
there remains a demand for
a commercial sex industry,
there will remain a supply of
individuals willing to profit
from its sale.

In 2013, multiple cases of human

tracking were reported all 50
states and Washington, D.C.
(Polaris Project, 2013).

Sex trafficking is a high profit,

low risk business where the
commodity, a human body,
can be sold repeatedly, unlike
drugs or weapons, where
the product can only be sold
once.
Consequently, those looking to profit will
continue to recruit, abduct, and exploit
if YoU SUSPect
hUmAn trAfficKinG,
cALL the nAtionAL
hUmAn trAfficKinG
hotLine At

1-888-3737-888

often co-occurring with sex trafficking

victimization include domestic violence,
child abuse and neglect, HIV and
other Sexually Transmitted Infections,
unwanted pregnancies, unmet
preventative
healthcare
needs, drug and alcohol abuse
and addiction (Williamson et
al 2009).

incidences, we know that the sex trafficking

of minors happens and has devastating
physical and mental health consequences
on victimized youth. It can be difficult
to detect unless people who interact with
victims are trained to recognize the signs.
Sex Trafficking is now being treated as a
public health crisis, and has become the
source of research and debate across all
sectors. Common public health concerns

Young people can be

commercially
sexually
exploited through prostitution,
pornography, stripping, erotic entertainment
or other sex acts. The commercial aspect
of the sexual exploitation is critical to
separating the crime of trafficking from
sexual assault, molestation or rape (Shared
Hope, 2014).
Worldwide, forced sex trafficking
generates over $30 billion a year in profit
annually (Belser, 2012).

In a recent study of Emergency

medicine residents,
ED attendings, ED nurses,
and hospital social workers,
only 4.8% felt some degree
of condence in their ability
to identify and 7.7% to treat
a trafcked patient (ChisolmStraker, 2012).

You can
begin to ask
the right
questions
and help
your clients
avoid further
exploitation
and abuse.

THE MAJORITY OF MENTAL HEALTH

PROVIDERS HAVE A LIMITED
UNDERSTANDING OF THE ISSUE OF
SEX TRAFFICKING AND HOW IT MAY
PRESENT WITH THEIR CLIENTS.
MISSED OPPORTUNITIES
With increased knowledge about the topic,
and new screening tools and intervention
strategies, you can begin to ask the right
questions and help your clients avoid further
exploitation and abuse.

DESPITE CHANCES FOR

INTERVENTION, MENTAL
HEALTH PROVIDERS CAN
EASILY FAIL TO IDENTIFY
VICTIMIZED YOUTH.
Vulnerable youth can be lured into
prostitution and other forms of sexual
exploitation using promises, psychological
manipulations, provision of drugs and
alcohol, and violence. The traffickers main
purpose is financial gain and will make every
effort to establish trust and allegiance by
wooing the victim in what feels like a loving
and caring relationship.

TARGETED

Pimps shop for their

victims online, in shopping malls, bus stops,
at schools, at after school programs, foster
homes and other places where teens gather.

TRICKED

Pimps invest a lot of time

and effort in forming a bond with their
victim. They often buy gifts, provide
a place to stay, and give affection
before revealing their true intent to
sexually exploit them. Traffickers
use a powerful technique pioneered
by religious cults knows as love
bombing in which a girl is
showered with affection as a
means of manipulating her
(Dorais & Corriveau, 2009).

TRAUMATIZED The pimps

use of psychological manipulation,
physical violence and rape can make
the victim feel trapped and powerless.
The trauma bond is very difficult to
break and may require intensive long

term treatment and counseling (National

Center for Missing and Exploited Youth, 2014).

WHO ARE THE VICTIMS?

While there is no commonly accepted profile
for victims of minor sex trafficking, certain
populations are more vulnerable than others.

HOMELESS, RUNAWAY
THROWAWAY, AND FOSTER
CHILDREN ARE THE MOST
VULNERABLE POPULATION
OF YOUTH AT RISK FOR SEX
TRAFFICKING
(ECPAT USA, 2013).
Pimps/traffickers
target
runaway
or
throwaway teens or those who are having
trouble at home. Runaway and homeless
youth are at increased risk for predators
as they have few resources, may not be old
enough to legally get a job, and are often
running away from difficult situations.
It is common for these adolescents to trade
sex to meet their basic survival needs of food,
clothing or shelter. According to a recent
survey of homeless youth in New York, of
those engaged in commercial sex, they said
they did it for shelter because they needed
someplace to stay (Bigelsen, 2013).
How do individuals become victims of
trafficking?
Recruitment by Romeo/boyfriend
pimps who convince them that they
love and care for them
Kidnapped by guerilla pimp and
forced into the life
Gang related prostitution
A parent or family member pimps their
child for drugs or money
Running away and living on the streets
and are force to exchange sex for
survival

If you suspect Human Trafficking, call the National Human Trafficking Hotline at 1-888-3737-888

THERE IS NO SUCH THING

AS A WILLING CHILD PROSTITUTE

The Federal Trafficking Victims Protection Act (TVPA) defines the crime of trafficking as the recruitment, harboring, transportation, provision,
or obtaining of a person for the purpose of a commercial sex act where such an 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. The most important thing to understand from the federal definition is
that anyone under the age of 18 who is induced to perform a commercial sex act is automatically a trafficking victim.
Across all mental health care settings, from the
school counselor to the child welfare agency
caseworker, mental health professionals have
a unique opportunity to identify, report and
assist victims of sexual exploitation and abuse.
Victims are often reluctant to come forward
because they have been taught by their
victimizer that if they attempt to seek help, no
one will believe them, and they will be treated
like a criminal and a prostitute (Bigelsen, 2013).

A lot of victims of trafficking do

not identify themselves as being a
victim. Some may feel that they got
themselves in this situation and its their
responsibility to get out.
Jane, a survivor
It is helpful to understand that there are many
similarities in victimization between domestic

violence and sex trafficking. Victims of sex

trafficking and domestic violence tend to hide
their situations and both victim groups are
hesitant to disclose their victimization in medical
or clinical settings (Roe-Sepowitz et al, 2013).
Mental health care providers can apply their
knowledge about domestic violence, trauma
and sexual abuse to better understand a
trafficking victims fear and reluctance to leave
the relationship, and grasp the severity of
mental health consequences.

In addition, common myths and stereotypes about sex trafcking can affect judgment
and response. Common myths include that only happens abroad or it was consensual. The more
mental health providers know about this population, including the mindset of a victim, the better equipped
they will be to identify victims and focus on prevention strategies.

Understanding the Mindset of a Victim

VICTIMS OFTEN DO NOT SEE THEMSELVES AS VICTIMS
VICTIMS MAY FEEL SHAME, SELF BLAME AND FEELINGS OF UNWORTHINESS OF A
BETTER LIFE
VICTIMS MAY BE COACHED TO LIE TO MENTAL HEALTH PROFESSIONALS AND
OFTEN GIVE FABRICATED HISTORIES WITH SCRIPTED STORIES
VICTIMS ARE OFTEN FEARFUL AND DISTRUST LAW ENFORCEMENT AND
GOVERNMENT SERVICES DUE TO FEAR OF ARREST
VICTIMS MAY HAVE FORMED A TRAUMA BOND WITH THEIR
EXPLOITER AND MAY HAVE DEEP LOYALTIES AND POSITIVE
FEELINGS FOR THEIR ABUSER
VICTIMS OFTEN FEAR FOR THEIR OWN SAFETY AND THE
SAFETY OF THEIR LOVED ONES DUE TO THREATS OF
VIOLENCE
DRUGS OFTEN PLAY A ROLE IN SEX TRAFFICKING
SITUATIONS- SOMETIMES AS A WAY TO COPE
OR VICTIMS SOMETIMES ENTER THE LIFE
TO SUPPORT A DRUG HABIT

If you suspect Human Trafficking, call the National Human Trafficking Hotline at 1-888-3737-888

COMMON MENTAL HEALTH

INDICATORS OF TRAFFICKING

Post-traumatic stress disorder

Anxiety disorder

Panic disorder

Obsessive compulsive disorder

Dissociative disorder

Major depressive disorder

Substance abuse disorder

Explosive disorders/violence

Intermittent Explosive Disorder

(Williamson et al 2010)

Possible Physical Sex Trafficking

Indicators

Discrepancy in reported age and apparent age

Evidence of sexual trauma

Signs of self-inflicted injury or suicide attempts

Cigarette burns

Fractures

Bruises and or contusions

Tattoos found on the body may serve as a brand

that the victim belongs to a certain trafficker

Respiratory infections

Drug related health issues such as asthma,

Hepatitis C, skin infections

Tension headaches, back pain, stomach pains

Malnutrition and poor diet

Dehydration

Unexplained scars

Injuries to head and mouth

(Dovydaitis, 2010)

Possible Sexual Health indicators of

Sex Trafficking

Multiple Sexually transmitted Infections

HIV infection

Pregnancy

Abortion complications

Vaginal discharge and infection from using items

inserted into the vagina to block menstruation

Vaginal wall tears

Traumatic Fistulas

(Issac et al, 2011)

If you suspect Human Trafficking, call the National

Human Trafficking Hotline at 1-888-3737-888

RED FLAGS
Chronic runaway
History of abuse

curfew violations and other status

offenses

Traveling with an older male

Use of street lingo with references to

the game the life

Presence of an older boyfriend

Lack of identification

Unusual tattoos or branding marks

Dominating or controlling
boyfriend or female in the room
who refuses to leave

Involvement with the juvenile

justice system through truancy,

Claim that the patient is just

visiting the area and unable to
provide a home address
(STIR TRAINING MATERIAL ,
2013)

THE ROLE OF TRAUMA

Sex trafficking victims have endured a high level of
trauma and require services and interventions that do
not inflict further trauma such as physical restraint,
isolation or harsh verbal interrogation.

According to the National Center for Trauma-Informed Care, traumainformed care is an approach to engaging clients with histories of trauma
that recognizes the presence of trauma symptoms and acknowledges the
role that trauma has played in their lives.

Traumatic experiences can be dehumanizing, shocking

or terrifying and often include a loss of safety and
the betrayal by a trusted person or institution
(National Center for Trauma-Informed Care, 2013).

Instead of:

WHATS WRONG WITH YOU? or

WHY ARE YOU DOING THIS?
ask

WHAT HAS HAPPENED TO YOU?

This change reduces the blame and shame that some people experience when
being labeled. It also builds an understanding of how the past impacts the
present, which effectively makes the connections that progress toward healing
and recovery (Substance Abuse and Mental Health Services Administrations
National Center for Trauma-Informed Care).

Treatment needs of the

Sexually Exploited
Safety
Stabilization of trauma symptoms
Positive social support either through
a mentor or someone they can trust
Lifestyle change including addressing
possible drug use or addiction
Counseling, either individual
or group, to deal with traumatic
experiences
Reconnect with family and address
relationship issues
Learn to feel safe and to develop selfsoothing techniques
Address core beliefs about self and the
world
Learn to anticipate future triggers
Address the trauma bond between
victim and trafficker
(STIR, 2014)

If you suspect Human Trafficking, call the

National Human Trafficking Hotline at
1-888-3737-888

According to one study out of the University Of Pennsylvania

School Of Social Work, the majority of sexually exploited
teens were victims of earlier childhood sexual abuse (Estes and
Weiner, 2001).

NOTICING THE WARNING SIGNS CAN HELP VICTIMS

RECEIVE THE SERVICES THEY NEED SO THEY ARE NOT
FURTHER TRAUMATIZED.
Extreme anger
Running away
Guilt and low self-worth
Self-harm and/or selfmutilation
Multiple sexual
partners
Eating disorders
Mood swings
Difficulty forming
relationships
Flashbacks and/or
nightmares

Confusion
Depression
Withdrawal and
isolation
Somatic complaints
Sleep disturbance
Academic
decline
Suicidal thoughts

Dramatic change in
behavior
Truancy or school
avoidance
Substance abuse
Antisocial behavior
(National Institute of
Mental Health)
(The National Child
Traumatic Stress
Network 2013)

They are not out playing in

the front yard or in school
daydreaming about becoming
a prostitute
Sarah, a survivor

My childhood was not a

childhood. In my family, men
had sex with little girls. It was
our normal.
Elisabeth, a survivor

He seemed very nice at first.

I actually thought he cared
about me.
Cody, a survivor

I was just trying to get a better

life the fastest way I could
Monique, a survivor

Between 244,000 and 325,000 American youth

are considered at risk for sexual exploitation,
and an estimated 199,000 incidents of sexual
exploitation of minors occur each year in the
United States (Estes & Weiner, 2001).
The average age at which girls first become
exploited through prostitution is 1214 years
old (US Department of Health and Human
Services, 2013).
Minors in sex trafficking nearly always have
a pimp someone who they view as their
protector but who in fact is managing and
benefitting from the sexual exploitation of the
child (Shared Hope International, 2009).

TRAFFICKED
YOUTH ARE
VICTIMS, NOT
CRIMINALS.
In many cases, youth who come
in contact with law enforcement
are arrested and treated as
criminals or delinquents, which
results in further harm to the
child. (Polaris Project, Sex
Trafficking of Minors and Safe
Harbor 2013).

Adolescent boys and lesbian, gay, bisexual,

transgendered
and
queer/questioning
(LGBTQ) can also be victims. According to
recently released study, boys make up almost
half of the victim population (Bigelsen, 2013).
Along with a means to recruit victims,
traffickers use technology to reach a wide
client base for prostitution services. The
perceived anonymity of online transactions
has emboldened traffickers to openly recruit,
buy and sell their victims via the internet
(Boyd, 2012).

If you suspect Human Trafficking, call the

National Human Trafficking Hotline at
1-888-3737-888

Trust between the

victim and the
mental health
provider
is essential.
If you suspect your client could be a victim of
sex trafficking, the first step is to get them alone
in a confidential location for an interview.
If the client is in immediate danger, call 911.

Sample messages to use with a victim to gain trust:

You can trust me.
I am here to help you.
My first priority is your safety.
We will give you the care you need.
We can help you find a safe place to stay.
No one has the right to hurt you or make you do things against
your will

SCREENING QUESTIONS TO ASK:

Can you come and go as you please?

Has anyone ever paid someone else to have sex with you (like
a boyfriend, boss, manager, etc)
Tell me about that tattoo.
Do you have to work to contribute money to your family?
Do you have a boyfriend? If so, how old is he and what do
you like to do together? Where did you meet?
Have you ever run away from home? If so, where did you stay
and who did you stay with?

Important Interview Tip:

Mirror the language of the victim. For example, if she refers to her
abuser as boyfriend then use this word instead of pimp or abuser.
Most sex trafficking victims run from treatment multiple times - it takes
an average 3-7 attempts before actually leaving the life (Hernandez,
2013).
Treatment of sex trafficking clients may be intermittent. It is important
to work on a safety plan with the victims input so she can have it in case
she returns to the life.
According to De Chesnay (2013)

Do what you can.

Assume that the first visit is the last.

Have you ever had to do things in order to stay somewhere

that you did not want to do?
Has anyone ever taken pictures of you and put them on the
internet?
Have you been physically harmed in any way?
Where are you staying?
Are you or your boyfriend a member of a gang?
Has anyone ever paid you to have sex with them?
(Ohio Human Trafficking Task Force Human Trafficking
Screening Tool, 2013)

If you suspect Human Trafficking, call the National

Human Trafficking Hotline at 1-888-3737-888

After victim identification,

what do I do?

If the victim is under 18, it is mandatory under federal law to report sexual exploitation of children.
Notify the police, sex crimes vice squad, and Child Protective Services.
Call the National Human Trafficking Resource Center to report the incident and ask for help.
The centers phone number is 1-888-3737-888.
Contact the National Center for Missing and Exploited Children to report suspected sexual
exploitation of a minor.

1-800-THE-LOST (1-800-843-5678)

Sources:

Belser, P. (2005). Forced Labour and Human Trafficking: Estimating the

Profits. International Labour Office: Geneva.
Bigelsen, J. (2013). Homelessness, Survival Sex and Human Trafficking: As
Experienced by the Youth of Covenant House, New York.
Boyd, Danah (2012). Human Trafficking and Technology: A Framework
for Understanding the Role of Technology in the Commercial Sexual
Exploitation of Children in the U.S
Chisolm-Straker, M., Richardson, L., Cossio, T. (2012). Combating slavery
in the 21st century: the role of emergency medicine. Journal of Healthcare
for the Poor and Underserved, 23(3), 980-987.
Dorais, M. and Corriveau P. (2009). Gangs and Girls: Understanding
Juvenile Prostitution. Trans. Peter Feldstein. Montreal: McGill-Queens
University Press.
Dovydaitis, T. (2010). Human Trafficking: The Role of the Health Care
Provider. Journal of Midwifery & Womens Health. 2010 Sep-Oct; 55(5):
462467.
End Child Prostitution, Child Pornography and the Trafficking of Children
for Sexual Purpose (2013). And Boys Too
Estes, R and Weiner, N. (2001). The Commercial Sexual Exploitation of
Children In the U. S., Canada and Mexico University of Pennsylvania. School of Social Work. Center for the Study of Youth Policy.
Harris, K. (2012). The State of Human Trafficking in California.
Hernadez, Barbara Identification and Treatment of Domestic Minor Sex Trafficking National At-Risk Education Network, 2013
Issac, R; Solak, J; and Giardino,A. (2011). Health Care Providers Training Needs Related to Human Trafficking: Maximizing the Opportunity to Effectively Screen and Intervene,
Journal of Applied Research on Children: Informing Policy for Children at Risk: 2(1)
National Academy of Sciences. (2013). Confronting Commercial Sexual Exploitation and Sex Trafficking of Minors in the United States, 271-296.
Ohio Human Trafficking Task Force Recommendations. Human Trafficking Screening Tool 2013.
Williamson, E; Dutch, N. and Clawson, H. (2010). Evidence-Based Mental Health Treatment for Victims of Human Trafficking. Study of HHS Programs Serving Human Trafficking Victims.

Dominique Roe-Sepowitz, MSW, PhD, Director, STIR

Kristine Hickle, MSW, Associate Director of Research Development, STIR
Angelyn Bayless, Director of Communications, STIR
For more information, please contact:

Office of Sex Trafficking Intervention Research

Phone (602) 496-0093
Dominique.Roe@asu.edu
http://ssw.asu.edu/research/stir