March/April 2016 Issue

Fighting Youth Sex Trafficking — The Social Worker's Role
By Christina Reardon, MSW, LSW
Social Work Today
Vol. 16 No. 2 P. 10

The secretive nature of trafficking and a lack of research funding limit understanding of the problem, but social workers can learn to identify and engage victims.

Organizations around the world have partnered with Florida-based Born2Fly on educational programs to prevent youth sex trafficking. But Diana Scimone, Born2Fly's president, struggles to convince school officials in the United States to work with her because many of them don't realize that trafficking is a problem in their communities.

In her role as human trafficking program manager for the Illinois Department of Children and Family Services, Stacy Sloan, MSW, works to raise awareness of youth sex trafficking across the state. But that work is often stymied by the belief that trafficking is only an issue in big cities like Chicago.

Carly Kalish, MSW, RSW, is a social worker serving youths who have been involved in sex trafficking. But she knows her help can only go so far when the public associates trafficking with movies like Taken that portray traffickers as strange men who snatch young people away and force them into sexual slavery in foreign countries.

As these examples illustrate, there are many misperceptions about the nature of youth sex trafficking and, unfortunately, social workers are not immune to these misperceptions. Unless social workers recognize that youth sex trafficking affects youths from all backgrounds in all areas, they may be missing important opportunities to identify victims and help survivors get the help they need.

"Social workers need to realize how important a role they play in all of this," says Eliza Reock, director of programs for Shared Hope International, an antitrafficking organization based in Vancouver, WA. "Social workers are in such a critical place to start identifying these [victims]."

A Knowledge Gap
Under federal law, sex trafficking involves the recruitment, harboring, transportation, provision, or obtaining of a person to perform commercial sex acts induced by force, fraud, or coercion (US Department of Health & Human Services, 2012, August 8). All children under age 18 engaged in commercial sex acts are considered victims of trafficking. A "commercial sex act" does not have to involve an exchange of money but instead anything of value, such as food, shelter, or drugs (US Department of Health & Human Services, 2012, August 2).

It is extremely difficult to identify how many youths are victims of sex trafficking in the United States. A commonly cited figure proposed by Estes and Weiner is that between 244,000 and 325,000 youths are at risk for sex trafficking in the United States (Institute of Medicine and National Research Council, 2013). Research by Davis and Flowers indicates that between 1 and 2 million youths between the ages of 5 and 15 experience domestic sex slavery each year (Countryman-Roswurm & Bolin, 2014).

Accurate prevalence data are hard to come by for several reasons, including a lack of self-disclosure on the part of victims. The secretive nature of trafficking and a lack of funding to research also limit understanding of the true scope of the problem (Countryman-Roswurm & Bolin).

Researchers, advocates, and service providers can't even agree on common terminology. Some sources will refer to "child sex trafficking" or "sex trafficking of minors," while others will refer to "domestic minor sex trafficking," "commercial sexual exploitation of children," or other terms. There also is disagreement about what age a person needs to be considered a victim; some observers say victims must be under 18, while others include young people up to age 22 in their definitions (Countryman-Roswurm & Bolin). (Social Work Today does not endorse one term over another. For simplicity and consistency, the term "youth sex trafficking" is used in this article.)

Perhaps the biggest barrier to clarity about the scope of youth sex trafficking in the United States is that victims are often misidentified or not identified at all by professionals who work with youths. Many social workers aren't prepared to encounter victims because these social workers either don't know the warning signs of trafficking or aren't actively looking for them among the youths they serve.

This knowledge gap is illustrated by a study conducted by researchers at the Medical College of Wisconsin and Children's Hospital of Wisconsin (Beck et al., 2015). The researchers sent a survey to service providers, including social workers, who would be most likely to encounter victims of youth sex trafficking. In two clinical vignettes included in the survey, less than one-half of respondents correctly identified a minor as a trafficking victim (48%) and correctly differentiated a trafficking victim from a child abuse victim (42%).

The results of the survey show how important it is that social workers and other service providers receive training on how to identify victims of youth sex trafficking, says Angela Rabbitt, DO, FAAP, one of the study's authors. The majority of survey respondents (63%) said they had never received such training.

"[Social workers and other service providers] need to be aware of the scope of the problem, who they need to screen, and how to screen," says Rabbitt, an assistant professor of pediatrics at the Medical College of Wisconsin and a youth abuse pediatrician at Children's Hospital of Wisconsin. "Such knowledge is vital because [these providers] are often the first people to have the chance to talk to the youth alone and can identify victims."

Identifying Victims, Engaging Survivors
While each case of youth sex trafficking is different, there are certain warning signs that are common among victims. Risk factors and indicators of youth sex trafficking include the following (Countryman-Roswurm & Bolin; Rabbitt, 2015):
• a history of childhood neglect, abuse, and/or trauma, particularly youth sexual abuse;
• difficult relationships with caregivers;
• family history of substance abuse and criminal activity;
• involvement in abusive or violent dating relationships;
• being homeless and/or a runaway;
• living in a shelter or group home;
• knowing peers or family members who are involved in the sex trade;
• branding/tattoos;
• risky sexual behaviors;
• isolation from peers, friends, and family members; and
• mental health issues such as depression, anxiety, PTSD, ADHD, and chronic stress.

Since social workers may come across many youths with one or more of these risk factors or indicators, it's important that social workers become attuned to subtle clues that may specifically indicate youth sex trafficking, says Kalish, an individual and family therapist at East Metro Youth Services in Toronto, Ontario, Canada. Examples of subtleties a youth may display are having multiple cell phones, going through prominent changes in appearance, having hair and nails done, having expensive items that they don't have the money to afford, withdrawing from usual group of friends or peers, and only spending time with a partner.

Kalish says social workers also must familiarize themselves with the language of the sex trade. Knowing this language will help social workers recognize and comprehend certain words and expressions used by victims, such as "the game," "bottom," "stable," and "daddy." (Shared Hope International has a glossary of common sex trafficking terms at sharedhope.org/the-problem/trafficking-terms.)

"There's a language you have to look for," Kalish says. "If our clients speak French, we better speak French."

Social workers who suspect that a youth has been trafficked should consider their approach carefully. Trafficking victims are unlikely to disclose right away, and confronting them with suspicions could seriously harm the therapeutic alliance. Social workers need to be aware of the strong trauma bonding that often occurs between victims and their traffickers and realize that clinical interventions may not be viewed by victims as helping, Sloan says.

"These kids go kicking and screaming [into services]," she says. "They don't feel that they've been rescued."

Social workers should learn about the mandated reporting laws in their state and be aware that they might be required to call the police and/or child welfare agencies if they suspect trafficking. Social workers are often also advised to call the National Human Trafficking Resource Center hotline at 888-373-7888.

An approach focused on motivational interviewing and stages of change can be an effective way to build trust and rapport with a youth sex trafficking victim, Kalish says. For example, if a victim has no intention to leave the trafficking lifestyle, a social worker can at least work with the victim to ensure that the victim stays as safe as possible. If the victim later is considering leaving the lifestyle, then the social worker can facilitate a process where the victim discusses the pros and cons of trafficking and starts to develop a plan to leave.

The most important thing for social workers to remember is to remain nonjudgmental and to not impose their own beliefs about sex trafficking on the child, Kalish says. "You have to be able to stomach that young people are having sex for money and even though we want them to leave, they may not want to leave," she says.

Social workers must be careful not to assume that treating youth sex trafficking victims is the same as treating child abuse victims, Rabbitt says. For example, putting trafficking victims in group homes for abused and neglected children may not be safe because these facilities might not provide adequate security to deter traffickers intent on trying to coerce the victims back into trafficking.

In addition, social workers must realize that the public perceptions of child abuse victims and youth sex trafficking victims are often completely different, Reock says. While child abuse victims are seen as innocent, youth sex trafficking victims are often made to feel guilty about "choosing" the lifestyle and are labeled as prostitutes. These negative perceptions about youth sex trafficking might make victims less likely to seek help or continue services.

In some cases, the best course of action may be to connect victims to specialized services and programs designed to address the multilayered trauma experienced by trafficking victims, says Erin K. Wirsing, MSW, DELTA program manager at Devereux Florida, an organization serving youths and families. The DELTA program includes a range of services—including residential treatment, individual and group counseling, psychiatric services, nursing care, and foster care—for trafficking victims. Such a variety of services allow Devereux to create an empowerment plan tailored to each victim.

"Youths range in their responses to therapy, and things are going to be very different for each one," Wirsing says. "So we try to be really patient and meet them where they're at."

Getting Involved
Social workers who want to better serve youth victims of sex trafficking must prepare adequately. Services will be more effective and efficient if social workers take time to know what to do before they encounter victims.

Sloan says one good place for social workers to start is to connect with their state or local child welfare agencies to see what information and resources they have to offer. Other resources include the National Center for Missing & Exploited Children, antitrafficking organizations such as Shared Hope International, and federal government websites.

Once social workers learn more about youth sex trafficking, they should consider how to increase their colleagues' awareness of the issue, says Eric Underly, MS, family case management supervisor at Children's Hospital of Wisconsin Community Services. After working with a trafficked youths several years ago, Underly decided to become more knowledgeable about trafficking and now provides guidance to coworkers, has conducted trainings, and presents at conferences.

Another way to build community and professional awareness of youth trafficking is to get involved in multidisciplinary antitrafficking teams and task forces that unite social workers with law enforcement officials, health care providers, representatives of the judiciary, and others. Such teams and task forces ensure that the community's response to youth trafficking is coordinated and covers all aspects of care for victims, from prevention to protection to prosecution, Scimone says.

"It's about getting everyone on the same page and creating a continuum of care," she says. "If people aren't connected and talking to each other, then how can [they] anything get done?"

A proper response to youth sex trafficking requires the social work profession as a whole to do some soul searching about whether it has drifted too far from its social justice roots, says Karen Countryman-Roswurm, PhD, LMSW, executive director of the Center for Combating Human Trafficking at Wichita State University in Kansas. For example, the increasing professionalization of social work has given social workers a level of privilege that can estrange them from youth victims of sex trafficking, many of whom are deeply distrustful of professionals trying to help them.

And social workers partnering on multidisciplinary antitrafficking teams must be careful not to experience role drift and shy away from defending a social justice view of victims. Social workers should not be afraid to stand up for the person-centered, empowerment-based perspective of their profession, Countryman-Roswurm says.

"As a social work profession, it's well past time for social workers to rise up and be very proud of social work," she says. "[Social workers] may be survivors' only advocates. We need to walk alongside them and facilitate a process where they move from a place of pain to holistic prosperity. Rather than being the professional with all of the answers, you need to be willing to put the survivor at the center and they get to be the expert of their own lives."

— Christina Reardon, MSW, LSW, is a freelance writer based in Harrisburg, PA, and a contributing editor at Social Work Today.

References
Beck, M. E., Lineer, M. M., Melzer-Lange, M., Simpson, P., Nugent, M., & Rabbitt, A. (2015). Medical providers' understanding of sex trafficking and their experience with at-risk patients. Pediatrics, 135(4), e895-e902.

Countryman-Roswurm, K., & Bolin, B. L. (2014). Domestic minor sex trafficking: Assessing and reducing risk. Child and Adolescent Social Work Journal, 31(6), 521-538.

Institute of Medicine & National Research Council. (2013). Confronting commercial sexual exploitation and sex trafficking of minors in the United States. Washington, DC: The National Academies Press.

Rabbitt, A. (2015). The medical response to sex trafficking of minors in Wisconsin. WMJ, 114(2), 52-59; quiz 60.

US Department of Health & Human Services. (2012, August 8). Fact sheet: Child victims of human trafficking. Retrieved from http://www.acf.hhs.gov/programs/endtrafficking/resource/fact-sheet-child-victims-of-human-trafficking.

US Department of Health & Human Services. (2012, August 2). Fact sheet: Sex trafficking. Retrieved from http://www.acf.hhs.gov/programs/endtrafficking/resource/fact-sheet-sex-trafficking-english.

[Sidebar]

A COMMON BOND
Emily Forward understands the plight of youth caught up in the world of trafficking because she was once caught up in it, too.

As a peer support worker at East Metro Youth Services in Toronto, Ontario, Canada, Forward taps her lived experience to provide guidance and encouragement to youths involved in trafficking. One way Forward connects to youths is through community outreach presentations aimed at youths in places such as schools, shelters, and transitional living facilities. She helps youths who disclose that they've been trafficked access services. She offers advice to youths about navigating the criminal justice system, coping skills, self-care, and building the resiliency they need to move on with their lives and heal.

Forward's past experience strengthens her rapport with youths and provides a level of comfort that many trafficked youths don't feel with professionals in the behavioral health field. She helps youths see that they are not alone in their struggles. She builds relationships with youths that help them eventually let go of their apprehension and distrust of other services.

"They're much more comfortable talking to people who are a bit younger and have lived experienced so they know what they're going through," Forward says. "It's like talking to a friend and offering whatever support I can to make things for easier for them."

After she left the world of trafficking, Forward began to struggle with her emotional and mental health. A police officer she knew put her in touch with Carly Kalish, MSW, RSW, now an individual and family therapist at East Metro Youth Services. Kalish eventually encouraged Forward to apply to be a peer support worker.

The interactions Forward has with trafficked youths aren't only therapeutic for them; her own healing is encouraged in the process. The interactions have boosted her self-esteem and given purpose to her lived experience. Forward recognizes the value of her experiences as a peer support worker and believes they will help her as she aspires to earn a degree in social work. "I have a very unique specialized knowledge, and I am going to use it to help," she says.

In addition to their direct interaction with youth, Forward and her fellow peer support workers also do presentations for professionals such as police officers, teachers, social workers, and health care providers to help them better understand human trafficking and how to appropriately engage trafficked youths. Her advice to social workers who want to better serve trafficked youths is simple: Keep an open mind and don't expect changes overnight.

"It's really, really important to meet [youth] where they are at," she says. "It might take many, many sessions for them to recognize that they are being exploited. You have to be patient with them; otherwise, they're going to stop coming and think that you don't get it."

— CR