6


Victim and Support Services

Victim and support services include a collection of services provided by an array of government agencies and nongovernmental organizations to individuals in need of assistance. Providers of these services to victims and survivors of commercial sexual exploitation and sex trafficking of minors include

•    individuals (e.g., case managers, social workers, child protection workers);

•    agencies and systems (e.g., child welfare, child protective services, the Department of Justice’s Office for Victims of Crime);

•    programs specifically designed to address commercial sexual exploitation and sex trafficking of minors (e.g., direct care/service providers, advocacy organizations);

•    programs that provide services to victims without recognizing their circumstances (e.g., runaway/homeless youth shelters);

•    programs that serve victims but lack a clear plan for responding (e.g., domestic violence shelters and runaway/homeless youth shelters); and

•    programs that are aware of commercial sexual exploitation and sex trafficking of minors but believe that serving these victims is beyond their scope of practice.

By the very definition of their work, all victim and support service professionals are working with vulnerable and victimized youth. As described in Chapter 3, victims/survivors of and minors at risk of commercial sexual



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6 Victim and Support Services Victim and support services include a collection of services provided by an array of government agencies and nongovernmental organizations to individuals in need of assistance. Providers of these services to victims and survivors of commercial sexual exploitation and sex trafficking of minors include • individuals (e.g., case managers, social workers, child protection workers); • agencies and systems (e.g., child welfare, child protective services, the Department of Justice’s Office for Victims of Crime); • programs specifically designed to address commercial sexual ex- ploitation and sex trafficking of minors (e.g., direct care/service providers, advocacy organizations); • programs that provide services to victims without recognizing their circumstances (e.g., runaway/homeless youth shelters); • programs that serve victims but lack a clear plan for responding (e.g., domestic violence shelters and runaway/homeless youth shel- ters); and • programs that are aware of commercial sexual exploitation and sex trafficking of minors but believe that serving these victims is beyond their scope of practice. By the very definition of their work, all victim and support service pro- fessionals are working with vulnerable and victimized youth. As described in Chapter 3, victims/survivors of and minors at risk of commercial sexual 235

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236 Commercial Sexual Exploitation and Sex Trafficking of Minors exploitation and sex trafficking may be vulnerable to or have experienced other forms of abuse. Further, these youth frequently are systems-involved and/or in need of or currently receiving some form of support services. As a result, these youth may come into contact with victim and support service professionals. Therefore, these professionals need to be prepared to recog- nize and address risk for or past or ongoing victimization by commercial sexual exploitation and sex trafficking among the children and adolescents in their care. Failure to do so increases the possibility that those at risk will become victims and that victims will remain vulnerable to further exploita- tion and abuse and miss opportunities for assistance. This chapter begins with an overview of current practices in victim and support services designed to prevent, identify, and respond to the commercial sexual exploitation and sex trafficking of minors in the United States. The discussion highlights several noteworthy practices for assisting and supporting victims and survivors, including direct care and services, training and education of personnel, and protocols for assisting victims/ survivors, among others. The chapter describes work at the federal, state, and local levels by both government agencies and nongovernmental orga- nizations. The chapter then reviews the state of existing research on victim and support services. Next is a discussion of challenges and opportunities related to these services. The chapter concludes with the committee’s find- ings and conclusions on the role of victim and support service programs and professionals in addressing the commercial sexual exploitation and sex trafficking of minors in the United States. Current Practices in Victim and support services Nationally, a number of efforts are aimed at providing victim and sup- port services to victims and survivors of commercial sexual exploitation and sex trafficking of minors. These include • curriculum development and education for at-risk children and adolescents, victims and survivors, and service providers; • training for victim and support service professionals; • direct care and support services for victims and survivors; • outreach and public awareness initiatives; • programs designed to prevent commercial sexual exploitation and sex trafficking of minors; and • hotlines (or help lines). The specific goals, target populations, sources of funding, ideology, and designs of these efforts vary significantly. Examples of each are provided later in this section.

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Victim and Support Services 237 The committee learned about current practices in victim and support services from a variety of sources, including published research on com- mercial sexual exploitation and sex trafficking of minors, research in related fields of practice and study, and testimony during the committee’s work- shops and site visits. The information thus gathered is summarized in this section. While some of the examples given are part of broader initiatives that involve other sectors (e.g., law enforcement, health care), this chapter focuses primarily on those aspects of this work related most directly to vic- tim and support services. Multisector approaches are mentioned here, but are covered in greater detail in Chapter 10. This review is not meant to be an exhaustive accounting of such services, but to illustrate a range of cur- rent efforts and actors and to call attention to areas that require additional consideration. Finally, it should be noted that most of these activities have not been empirically evaluated; as a result, the committee does not intend to imply that it is endorsing any specific approach. Child Welfare Victims and survivors of commercial sexual exploitation and sex traf- ficking of minors may come to the attention of child welfare professionals. In addition, child welfare agencies may already be working with victims and survivors of these crimes but not recognize them as such (Adams, 2012; Walts et al., 2011). Because the ability of these professionals to identify victims and respond to their needs is essential to developing an overall response to commercial sexual exploitation and sex trafficking of minors, they need to be prepared to carry out these roles. Child welfare is well positioned to assume two important roles: (1) preventing commercial sexual exploitation and sex trafficking among populations already involved in child welfare, and (2) identifying and assisting victims and survivors of these crimes in their care. Child welfare is a “group of services designed to promote the well-be- ing of children by ensuring safety, achieving permanency, and strengthening families to care for their children successfully” (Child Welfare Information Gateway, 2013). Child welfare encompasses public and private child wel- fare agencies; out-of-home care, such as group homes, residential treatment facilities, and foster care; and in-home care, such as family preservation services (Child Welfare Information Gateway, 2013). While one of the primary roles of child welfare is to prevent the abuse, neglect, and exploitation of children, this role traditionally has not been applied to extrafamilial victimization. According to the Department of Health and Human Services’ Administration for Children and Families, “in general, child welfare agencies do not intervene in cases of harm to children caused by acquaintances or strangers. These cases are the responsibility of

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238 Commercial Sexual Exploitation and Sex Trafficking of Minors law enforcement” (Child Welfare Information Gateway, 2013, p. 2). As a result, child welfare historically has not been actively involved in ad- dressing the commercial sexual exploitation and sex trafficking of minors. This lack of involvement presents a number of problems for victims and survivors of these crimes and the range of professionals who encounter them. First, as described in Chapter 1, commercial sexual exploitation and sex trafficking of minors, at their core, are forms of child abuse, and child welfare agencies therefore should have a responsibility to assist victims and survivors of these crimes as part of their overall charge. In addition, child welfare caseworkers may serve an important role as “gateway providers” to supportive services for victims/survivors of abuse (Dorsey et al., 2012). In this capacity, child welfare professionals can help ensure that victims of commercial sexual exploitation and sex trafficking of minors have access to needed services. As noted in Chapter 3, involvement in the child welfare system, includ- ing out-of-home placement, such as in group homes and foster care, may be a risk factor for commercial sexual exploitation and sex trafficking of minors. Understanding the potential risks related to involvement in the child welfare system can help child welfare professionals recognize and ad- dress both risk and ongoing or past exploitation among the children and adolescents in the state’s care. Failure to do so increases the likelihood that these youth will remain vulnerable to further exploitation and abuse. The committee learned about several noteworthy models for interven- tion by the child welfare system: creating a specific “allegation of harm” for commercial sexual exploitation and sex trafficking of minors to improve case management, requiring reporting to child protective services, raising awareness and building capacity in child welfare, and developing state guidelines and tools for child welfare professionals. Examples of each are described below. Creating an “Allegation of Harm” for Commercial Sexual Exploitation and Sex Trafficking of Minors Several states, including Connecticut, Florida, and Illinois, have taken the step of designating human trafficking as a specific abuse allegation. For example, the Illinois Safe Children Act includes “human trafficking of chil- dren” as an allegation of harm in the Statewide Automated Child Welfare Information System (SACWIS), a state-based intake and case management tool for alleged child maltreatment (State of Illinois Department of Children and Family Services, 2011).1 This system serves as a central data collection point that helps maintain a complete case management history of child 1  llinois I Safe Children Act, August 20, 2010.

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Victim and Support Services 239 maltreatment (Children’s Bureau, 2012). The law stipulates that victims of commercial sexual exploitation and sex trafficking of minors should be considered “abused” under the Abused and Neglected Child Reporting Act and the Juvenile Court Act.2 As a result, when an individual under age 18 is taken into custody for a prostitution offense, law enforcement must notify the Illinois Department of Children and Family Services of the allegation of human trafficking. The Department of Children and Family Services, in turn, is required to open an investigation into the abuse within 24 hours of the initial report (State of Illinois Department of Children and Family Services, 2011). In fiscal year 2012, the Department of Children and Fam- ily Services conducted 103 investigations of reports of human trafficking of children, 14 of which revealed credible evidence that the abuse had oc- curred (State of Illinois Department of Children and Family Services, 2013). As discussed in Chapter 2, however, these reporting rates significantly un- derrepresent the actual number of underage victims of commercial sexual exploitation and sex trafficking. This new allegation of harm also helps ensure that suspected cases of commercial sexual exploitation and sex trafficking of minors are catego- rized within the SACWIS system as “human trafficking,” as opposed to other reported types of child maltreatment (e.g., domestic violence, sexual abuse, incest, or other forms of physical abuse). In addition, the allegation can help officials collect and analyze state-level data and coordinate case management for victims (Children’s Bureau, 2012). Requiring Reporting to Child Protective Services In Massachusetts, all suspected cases of commercial sexual exploitation and sex trafficking of minors must be referred to child protective services.3 A report to child protective services prompts referral to a case coordina- tor, which in turn activates a comprehensive, coordinated response to the victim/survivor. (See Chapter 10 for a detailed discussion of the role of child protective services in a multisector response to commercial sexual exploita- tion and sex trafficking of minors in Suffolk County, Massachusetts.) Raising Awareness and Building Capacity in Child Welfare Although the committee learned about a handful of examples of anti- trafficking work that involve child welfare, child welfare overwhelmingly is perceived as underrepresented or absent in such efforts (Brittle, 2008; Fong 2  bused A and Neglected Child Reporting Act. 3  assachusetts M HB 3808, An Act Relative to the Commercial Exploitation of People, Feb- ruary 19, 2012.

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240 Commercial Sexual Exploitation and Sex Trafficking of Minors and Berger Cardoso, 2010; Walts et al., 2011; Wilson and Dalton, 2008). Reasons for a lack of child welfare engagement include inadequate train- ing, insufficient resources, high caseloads, and the perception that victims of commercial sexual exploitation and sex trafficking of minors should be handled in the juvenile justice system as opposed to child welfare (Walts et al., 2011; Wilson and Dalton, 2008). In an attempt to address the need to respond to victims and survivors of these crimes who are in the state’s care, the International Organization for Adolescents and the Center for the Human Rights of Children at Loyola University Chicago developed a hand- book for child welfare agencies—Building Child Welfare Response to Child Trafficking Handbook (Walts et al., 2011). This handbook was developed in partnership with the Illinois Department of Children and Family Services to help child welfare agencies meet their responsibility of identifying and serving trafficking victims as required by the Illinois Safe Children Act.4 Developing State Guidelines and Tools for Child Welfare Professionals Some states have taken additional steps to strengthen the capacity of child welfare and child protection professionals to respond to the com- mercial sexual exploitation and sex trafficking of minors. For example, the State of Florida’s Department of Children and Family Services has devel- oped specific guidelines to assist child welfare and child protection profes- sionals with reporting allegations of human trafficking of children (State of Florida Department of Children and Families, 2009b). In addition, the state developed a tool to assist child protection investigators in identifying victims of human trafficking (State of Florida Department of Children and Families, 2009a). Currently, guidance of this nature is lacking at the federal level and within most states. Federal and State Government Numerous federal agencies are charged with and engaged in respond- ing to human trafficking. To help coordinate these various federal efforts to address the problem, the Trafficking Victims Protection Act (TVPA) of 2000 created the President’s Interagency Task Force to Monitor and Com- bat Trafficking. Members of the task force include the Department of State, Department of Defense, Department of Justice, Department of the Interior, Department of Agriculture, Department of Labor, Department of Health and Human Services, Department of Transportation, Department of Educa- tion, and Department of Homeland Security, among others. Each agency is responsible for responding to different (and sometimes complementary 4  llinois I HB 6462, Safe Children Act, August 20, 2010.

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Victim and Support Services 241 or overlapping) aspects of human trafficking within its jurisdiction. (See Chapter 10 for a more detailed discussion of this task force.) The committee learned about several noteworthy models for interven- tion within federal and state government: at the federal level, making fed- eral benefits and services available to victims of trafficking, funding service organizations, and providing employment and job training to trafficking victims; and at the state level, using a statewide coordinated care approach to the provision of victim and support services. Examples of each are de- scribed below. The primary focus of this section is on the efforts of federal and state agencies whose work on human trafficking relates directly to the provision of victim and support services to victims/survivors of commer- cial sexual exploitation and sex trafficking who are U.S. citizens or lawful permanent residents under age 18. Making Federal Benefits and Services Available to Victims of Trafficking According to its report to the President’s Interagency Task Force to Monitor and Combat Trafficking in Persons, the Department of Health and Human Services engages in a number of efforts focused on preventing, identifying, and responding to human trafficking. These efforts include regional training and meetings; outreach efforts to raise public awareness (e.g., the Rescue and Restore Victims of Human Trafficking campaign); technical assistance to program grantees who work with victims of human trafficking; and funding for the National Human Trafficking Resource Center, a national resource for victims of human trafficking and the public (U.S. Department of State, 2012). In addition, the Department of Health and Human Services developed a guide to federal benefits and services available to victims of trafficking (HHS, 2012). This resource provides program-by-program information on benefits and services and includes eligibility requirements. Domestic victims/ survivors of human trafficking (both U.S. citizens and legal permanent residents) may be eligible for, among others, Temporary Assistance for Needy Families; Medicaid; the Children’s Health Insurance Program; the Supplemental Nutrition Assistance Program; the Special Supplemental Nu- trition Program for Women, Infants, and Children; and selected Substance Abuse and Mental Health Services Administration and Health Resources and Services Administration programs. However, the extent to which these services and benefits are accessed by domestic victims/survivors of human trafficking is unknown, as is the extent to which victim and support service providers are aware of services and benefits available to domestic victims/ survivors of human trafficking. In April 2013, the President’s Interagency Task Force to Monitor and Combat Trafficking in Persons released a federal strategic action plan on

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242 Commercial Sexual Exploitation and Sex Trafficking of Minors services for victims of human trafficking in the United States (President’s Interagency Task Force to Monitor and Combat Trafficking in Persons, 2013).5 This 5-year plan envisions “that every victim of human trafficking is identified and provided access to the services they need to recover and rebuild their lives through the creation of a responsive, sustainable, compre- hensive, and trauma-informed victim services network that leverages public and private partners and resources effectively” (President’s Interagency Task Force to Monitor and Combat Trafficking in Persons, 2013, p. 12). Among its goals, the plan calls for expanding access to services for victims of human trafficking throughout the United States. While the plan describes specific strategies for a range of agencies to increase access to victim and support services, it will be important to assess the extent to which this oc- curs in the plan’s implementation over time. Funding Service Organizations The Department of Justice provides funding to victim services orga- nizations through grants made by the Office for Victims of Crimes. Ac- cording to its report to the President’s Interagency Task Force to Monitor and Combat Trafficking in Persons, the Department of Justice, through its Office for Victims of Crime, provided funding to “eleven victim service organizations with a demonstrated history of providing trauma-informed, culturally competent services to male and female victims of sex trafficking and labor trafficking” (U.S. Department of State, 2012). This funding sup- ports the provision of services at the local, regional, and national levels. The 2013 reauthorization of the TVPA has supplemented these programs by authorizing the Department of Health and Human Services (specifically the Assistant Secretary for Children and Families) to issue up to four grants to entities (i.e., states or units of local government) that “[have] developed a workable, multi-disciplinary plan to combat sex trafficking of minors,” with the requirement that two-thirds of the funding be used for residential care and services for minor victims and survivors of sex trafficking, to be provided by nongovernmental organizations.6 In addition, funds are used to develop interagency partnerships (described in Chapters 5 and 10) and public outreach and awareness campaigns (U.S. Department of State, 2012). This small number of grantees and programs may not be surprising given that work on commercial sexual exploitation and sex trafficking of minors in the United States is in the early stages, but it does suggest how 5  s A of this writing, this plan was open to public comment. The final plan may be revised to reflect that input. 6  iolence Against Women Reauthorization Act of 2013 (VAWA) § 1241 (2013) (the TVPA V Reauthorization of 2013 was attached as an amendment to VAWA).

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Victim and Support Services 243 much additional work and funding would be required to bring these ser- vices to scale. Providing Employment and Job Training to Trafficking Victims The Department of Labor offers employment and training services to victims of severe forms of trafficking, as required by the TVPA. In addition, the TVPA stipulates that victims of convicted traffickers are entitled to full restitution for the labor they performed (U.S. Department of State, 2012). The extent to which these services and benefits are available to domestic victims/survivors of commercial sexual exploitation and sex trafficking of minors is unknown, as is the extent to which victim and support service providers are aware of job training and/or restitution available to domestic victims/survivors of human trafficking. Using a Statewide Coordinated Care Approach to the Provision of Victim and Support Services Georgia Care Connection was established by Georgia’s Governor’s Office for Children and Families to serve as a central, statewide hub for victims and survivors of commercial sexual exploitation and sex trafficking of minors and for professionals (e.g., law enforcement personnel, school personnel, child welfare professionals, health care providers) seeking to help them (Georgia Care Connection Office, 2013). Through a broad net- work of state and local service providers and professionals, Georgia Care Connection coordinates a “comprehensive care plan” for victims and sur- vivors (Georgia Care Connection Office, 2013). This comprehensive plan integrates and coordinates prevention, intervention, and treatment services (e.g., legal, mental and physical health, housing) that are guided by the specific the needs of each victim/survivor. Nongovernmental Organizations Nongovernmental organizations (NGOs) serving victims and survivors of commercial sexual exploitation and sex trafficking of minors include specialized direct service providers, faith-based organizations, service pro- viders and community resources that serve other populations, advocacy organizations, and private foundations, among others. Some NGO efforts to address commercial sexual exploitation and sex trafficking of minors are integrated into broader service portfolios, while others focus exclusively on these crimes. Some NGO efforts are national or international in scope, while others focus their efforts regionally or locally. Finally, some NGOs focus on all forms of human trafficking (e.g., labor and sex) and the range

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244 Commercial Sexual Exploitation and Sex Trafficking of Minors of populations affected (e.g., minors and adults), while others focus on spe- cific subpopulations (e.g., lesbian, gay, bisexual, and transgender [LGBT] individuals; minors; U.S. citizens; legal permanent residents). The committee learned about several noteworthy models for involve- ment by NGOs: curriculum development and education, training for victim and support service professionals, direct care and services, outreach and public awareness initiatives, prevention efforts, and hotlines. Examples of each are described below. While many of the organizations and efforts described in this section provide a range of services that fit within multiple categories, the discussion highlights specific program elements of note for each. Curriculum Development and Education A number of NGOs have developed and implemented curricula de- signed to reach individuals at risk for and/or victims/survivors of com- mercial sexual exploitation and sex trafficking of minors. One example is the My Life, My Choice (MLMC) curriculum, an educational curriculum developed by the Boston-based My Life, My Choice initiative, which works to identify and intervene with adolescent girls who are vulnerable to com- mercial sexual exploitation and sex trafficking (My Life, My Choice, 2012). The MLMC curriculum consists of 10 sessions led and facilitated by trained staff, typically a licensed clinician and a survivor of commercial sexual exploitation or sex trafficking (Goldblatt Grace, 2012). The cur- riculum can be delivered in a variety of settings (e.g., group homes and resi- dential facilities, child protective services offices, juvenile justice facilities, community-based organizations). The curriculum was developed for girls aged 12 to 18 who are at risk for or are victims/survivors of commercial sexual exploitation and sex trafficking. Thus, the goals of the curriculum in- clude preventing commercial sexual exploitation and sex trafficking among at-risk adolescents and preventing revictimization among those previously exploited. The MLMC curriculum was designed to alter participants’ be- havior by changing their attitudes, knowledge, and skills (i.e., improving attitudes regarding sexual health and self-esteem, increasing knowledge of the relationship between substance use and commercial sexual exploitation and sex trafficking, and developing skills to access resources and recognize potential exploiters) (Goldblatt Grace, 2012). Facilitators of the MLMC curriculum administer pre- and posttest measures to evaluate participants’ progress across the 10-week curriculum. Participants are asked to report on their attitudes and knowledge regarding commercial sexual exploitation and sex trafficking and their skills to avoid future exploitation (Goldblatt Grace, 2012).

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Victim and Support Services 245 Training for Victim and Support Service Professionals In addition to curricula designed to reach individuals at risk for or victims/survivors of commercial sexual exploitation and sex trafficking, a number of NGOs have developed and implemented training for victim and support service professionals, among others. For example, Girls Educational and Mentoring Services (GEMS)—a New York City–based nonprofit organization that provides services to girls and young women (aged 12 to 24) who have experienced commercial sexual exploitation and sex trafficking—has developed and implemented two curricula for organizations working with victims/survivors of these crimes. The first, the Office of Juvenile Justice and Delinquency Preven- tion’s Commercial Sexual Exploitation of Children Community Interven- tion Project (CCIP) Train-the-Trainer curriculum, is designed to provide an overview of issues related to commercial sexual exploitation and sex trafficking of minors for victim and support service providers, law enforce- ment personnel, health care professionals, child welfare professionals, legal professionals (e.g., prosecutors, legal aid/public defenders, family court officials), school personnel, and first responders. Specific topics include pre- vention and identification strategies, assessment and counseling techniques, and investigation and interviewing strategies, among others. Second, the Victim, Survivor, Leader™ curriculum is designed to assist organizations interested in developing and providing “specialized services” for female victims and survivors of commercial sexual exploitation and sex traffick- ing. In addition to these two curricula, GEMS offers technical assistance to organizations seeking additional guidance on the design and delivery of services to victims/survivors of commercial sexual exploitation and sex trafficking (GEMS, 2013). Other examples of organizations that conduct training for an array of victim and support service providers (among other sectors) include Motivating, Inspiring, Supporting, and Serving Sexually Exploited Youth; Polaris Project; Standing Against Global Exploitation; and Shared Hope International. Direct Care and Services A number of organizations provide direct care and services to victims and survivors of commercial sexual exploitation and sex trafficking of mi- nors. Examples include temporary and longer-term shelter, intensive case management, victim outreach, support groups, counseling and therapeutic services, mentoring, and legal assistance. For example, Courtney’s House is a survivor-run organization that provides services to victims and survivors of commercial sexual exploitation

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260 Commercial Sexual Exploitation and Sex Trafficking of Minors nects victims/survivors with community resources to provide support for education and job training, assistance in the process of applying for public benefits, legal advocacy and services, and health care services. SAVI clini- cians coordinate services with partners in the Mount Sinai Medical Center, including the Mount Sinai Adolescent Health Center, and with community- based resources, such as GEMS (Lattimer, 2012). Challenges and Opportunities Despite the number of efforts currently under way to provide victim and support services, broad consensus exists among professionals in each sector that serves victims/survivors of commercial sexual exploitation and sex trafficking that too few services are available to meet current needs. In addition, the services that do exist are unevenly distributed geographically, lack adequate resources, and vary in their ability to provide specialized care to victims/survivors of commercial sexual exploitation and sex trafficking. This section describes some of the overarching challenges to providing vic- tim and support services to minors exploited through commercial sexual exploitation and sex trafficking and points to a number of opportunities to reach those in need of assistance. Lack of Adequate Shelter and Housing In a survey of law enforcement personnel familiar with sex trafficking cases, 65 percent identified shelter and housing as the most needed service for victims (Clawson et al., 2006). According to a number of reports, emer- gency, short-term, and long-term housing for victims of commercial sexual exploitation and sex trafficking is limited, and in many parts of the country is nonexistent (Aron et al., 2006; Clawson and Goldblatt Grace, 2007; Clawson et al., 2009a; Ferguson et al., 2009; Finklea et al., 2011; Giardino and Sanborn, 2011; Gragg et al., 2007; Shared Hope International, 2012). For example, a recent survey of 68 organizations providing shelter services to victims of human trafficking in the United States and U.S. territories found that 2,173 beds were available to human trafficking victims for at least one overnight stay (Polaris Project, 2012b). Of these, 678 were shelter beds exclusively designated for victims of human trafficking, and 525 were designated for victims of sex trafficking. Minors were eligible for shelter beds at 38 of the 68 organizations surveyed, representing a total of 1,196 shelter beds available to minor victims of human trafficking (Polaris Project, 2012b). Another survey, of 341 individuals from 117 programs funded by the Department of Health and Human Services, found that most female victims of commercial sexual exploitation and sex trafficking were placed in shelters that traditionally served victims of domestic violence and sexual

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Victim and Support Services 261 assault, that shelter stays were time limited, and that housing for male victims of commercial sexual exploitation and sex trafficking was lacking (Clawson et al., 2009b). This lack of housing for victims/survivors of com- mercial sexual exploitation and sex trafficking was echoed by participants in the committee’s workshops and site visits (Phillips, 2012). Participants in the New York City site visit noted that appropriate and acceptable shelter options are in particularly short supply for individuals who may face additional discrimination (Holzman, 2012; Westmacott, 2012b). For example, transgender youth may not be given the opportunity to designate the sex-specific housing with which they identify, potentially exposing them to violence and/or discrimination. Although the New York City Department of Homeless Services developed a policy to allow shelter placements to be determined by an individual’s stated identity (New York City Department of Homeless Services, 2006), it is unclear how well and how often this policy is implemented in practice (Westmacott, 2012b). Few Victim and Support Services for Boys As noted earlier in the chapter, few victim and support service providers work with male victims and survivors of commercial sexual exploitation and sex trafficking. This deficiency is noted in the literature (Clawson et al., 2009a) and also was cited in testimony to the committee during its site visits and public workshops (Frundt, 2012; Goldblatt Grace, 2012; Phillips, 2012; Westmacott, 2012b). Given the growing recognition among research- ers and service providers that boys and young men are victims and survivors of commercial sexual exploitation and sex trafficking, greater attention is needed to preventing and identifying these crimes committed against these youth. In addition, more work is needed to ensure that gender-specific ser- vices are available to meet the needs of male victims of commercial sexual exploitation and sex trafficking. Lack of Awareness Among Service Providers Victim and support service providers working with vulnerable youth may lack an understanding of commercial sexual exploitation and sex traf- ficking, and therefore may not recognize youth in their care who are at risk of or are victims/survivors of these crimes. As a result, they fail to connect youth in need to appropriate and timely services. As described earlier in this chapter, a number of efforts are under way to train service providers in and raise public awareness of commercial sexual exploitation and sex traffick- ing of minors in the United States. Broadening the reach of these existing efforts is one strategy for increasing understanding and recognition of these crimes. Ideally, as individuals and entities work to enhance the availability

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262 Commercial Sexual Exploitation and Sex Trafficking of Minors and accessibility of training for victim and support service professionals, they will engage in the evaluation of programs, practices, and policies and will explore innovative strategies for delivery and dissemination of this training (e.g., the use of technology). Lack of Information Sharing and Communication Among Victim and Support Service Providers As noted earlier in this chapter, victims and survivors of commercial sexual exploitation and sex trafficking may require a range of victim and support services (e.g., mental health and substance abuse services, housing/ shelter). As a result, victims and survivors are likely to interact with a number of agencies and professionals. Ensuring that victims and survivors receive all the services they need requires communication and coordination among victim and support service providers. Unfortunately, mechanisms that support information sharing and communication may not exist among service providers and systems of care that interact with victims and survi- vors of commercial sexual exploitation and sex trafficking. As noted earlier in this chapter, some of the challenges related to information sharing and communication among multiple service providers and systems of care can be addressed by case management. Multisector collaboration, described in Chapter 10, also can address challenges related to information sharing and communication. Impact on Service Providers of Working with Victims and Survivors A significant body of research suggests that professionals working with vulnerable and traumatized populations may experience negative effects from their support role, also known as vicarious victimization, secondary trauma, or vicarious trauma (Cornille and Meyers, 1999; Pearlman and Mac Ian, 1995; Salston and Figley, 2003). One recent qualitative study found that working with victims/survivors of sex trafficking has an impact on the physical and psychological health of health care and victim and support service providers (Kliner and Stroud, 2012). Study participants reported experiencing burnout (e.g., compassion fatigue) and secondary traumatic stress (e.g., sleep disturbance). Although the study sample was small (n = 12), these findings support the testimony of participants during the committee’s public workshops and site visits. Those involved in efforts to evaluate and provide victim and support services for victims and survi- vors of commercial sexual exploitation and sex trafficking need to examine the impact of this work on service providers. Findings from this research can inform strategies for supporting both victims/survivors and the profes- sionals who work with them.

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Victim and Support Services 263 Lack of Consensus on Services and Service Delivery A number of national and international efforts have been undertaken to define comprehensive services or a “continuum of care” for victims of human trafficking (Aron et al., 2006; Chicago Alliance Against Sexual Ex- ploitation, 2012; Clawson et al., 2009b; Macy and Johns, 2011; Piening and Cross, 2012). For example, the Chicago Alliance Against Sexual Ex- ploitation recently proposed a statewide system of specialized services for survivors of prostitution and sex trafficking, including services spe- cifically for minors (Chicago Alliance Against Sexual Exploitation, 2012). Components of this proposed system include shelter, physical and mental health services, street outreach, transportation assistance, legal advocacy, employment and education resources, and referrals for other services (e.g., substance abuse treatment) (Chicago Alliance Against Sexual Exploitation, 2012). The proposal calls for all services to be provided by “both survivors and professional staff who are trained in the provision of trauma-specific services” (Chicago Alliance Against Sexual Exploitation, 2012, p. 12). While there is some agreement on specific services needed, consensus currently is lacking on the range of services that should be available to as- sist and support victims and survivors of commercial sexual exploitation and sex trafficking effectively over time. Consensus also is lacking on the most effective or efficient model of service delivery for victims and survi- vors of these crimes. Additional research is needed to determine the range of services needed and to evaluate the delivery of services to populations in need. Finally, it should be noted that the delivery of comprehensive services cannot be accomplished through victim and support services alone. The need for a multisector response to commercial sexual exploitation and sex trafficking of minors is discussed in detail in Chapter 10. FINDINGS AND CONCLUSIONS Given their unique perspective, expertise, and resources and the likeli- hood that they are already working with youth vulnerable to and victimized by commercial sexual exploitation and sex trafficking, victim and support services have a responsibility to recognize these crimes and to address the needs of these youth in their care. The committee’s review of the literature and its careful consideration of expert testimony revealed several themes related to the provision of victim and support services to these youth. This chapter has highlighted a range of noteworthy and emerging efforts to provide these services. However, the committee emphasizes the urgent need to evaluate these and future efforts. The committee formulated the following findings and conclusions regarding the provision of victim and

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264 Commercial Sexual Exploitation and Sex Trafficking of Minors support services to victims/survivors of commercial sexual exploitation and sex trafficking of minors: 6-1 Victims and survivors of commercial sexual exploitation and sex trafficking are frequently in need of services, often including out-of-home placement. 6-2 Advocates, victim and support service providers, governmental and nongovernmental entities, and other groups that deal with commercial sexual exploitation and sex trafficking of minors in the United States increasingly are calling for the use of trauma- informed care for victims and survivors of these crimes. 6-3 Given the growing support for and implementation of trauma- informed care, trauma-specific treatment, and trauma-focused services for victims and survivors of commercial sexual exploi- tation and sex trafficking, a more thorough evaluation of the effectiveness of these approaches is warranted. 6-4 Given the growing support for and implementation of case management and survivor-led and survivor-informed services for victims and survivors of commercial sexual exploitation and sex trafficking, a more thorough evaluation of the effectiveness of these strategies is warranted. 6-5 Broad consensus exists among professionals in each sector that serves victims/survivors of commercial sexual exploitation and sex trafficking that there are too few services available to meet current needs, and that services that do exist are unevenly dis- tributed geographically, lack adequate resources, and vary in their ability to provide specialized care to victims/survivors of these crimes. 6-6 Emergency, short-term, and long-term housing for victims/ survivors of commercial sexual exploitation and sex trafficking is limited, and in many parts of the country is nonexistent. 6-7 Few victim and support service providers work with male vic- tims and survivors of commercial sexual exploitation and sex trafficking. More work is needed to ensure that gender-specific services are available to meet the needs of these youth.

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Victim and Support Services 265 6-8 Professionals working with vulnerable and traumatized popula- tions may experience negative effects of their support role, also known as vicarious victimization, secondary trauma, or vicari- ous trauma. 6-9 Research on victim and support services can help build a much- needed evidence base for promising and best practices for vic- tims and survivors of commercial sexual exploitation and sex trafficking of minors in the United States to inform future work. Broad dissemination of the findings of this research through publication in the peer-reviewed literature is needed so that this evidence base will be critically reviewed. 6-10 With few exceptions, current victim and support services for victims and survivors of commercial sexual exploitation and sex trafficking of minors lack plans and mechanisms for evaluation and outcome measurement. 6-11 Additional research is needed to determine the range of services needed to assist and support victims and survivors of commer- cial sexual exploitation and sex trafficking of minors and to evaluate the delivery of services to populations in need. References Adams, S. 2012. Workshop presentation to the Committee on the Commercial Sexual Exploi- tation and Sex Trafficking of Minors in the United States, on the Larkin Street Youth Services, May 9, 2012, San Francisco, CA. Aron, L. Y., J. M. Zweig, and L. C. Newmark. 2006. Comprehensive services for survivors of human trafficking: Findings from clients in three communities. Washington, DC: Urban Institute Justice Policy Centre. Baker, J. 2012. Workshop presentation to the Committee on the Commercial Sexual Exploi- tation and Sex Trafficking of Minors in the United States, on Using Multidisciplinary Responses, May 9, 2012, San Francisco, CA. Bennett, L., S. Riger, P. Schewe, A. Howard, and S. Wasco. 2004. Effectiveness of hotline, advocacy, counseling, and shelter services for victims of domestic violence: A statewide evaluation. Journal of Interpersonal Violence 19(7):815-829. Boston GLASS (Boston Gay and Lesbian Adolescent Social Services). 2013. Services. http:// www.jri.org/services/health-hiv-lgbtq-services/health-and-prevention-services/boston- glass/services (accessed April 29, 2013). Brittle, K. 2008. Child abuse by another name: Why the child welfare system is the best mechanism in place to address the problem of juvenile prostitution. Hofstra Law Review 36:1339-1415. Chicago Alliance Against Sexual Exploitation. 2012. Proposal: A statewide system of spe- cialized services for survivors of prostitution and sex trafficking. Chicago, IL: Chicago Alliance Against Sexual Exploitation.

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