10


Multisector and Interagency Collaboration

Previous chapters have demonstrated that commercial sexual exploitation and sex trafficking of minors are intrinsically multifaceted such that they cannot be understood or addressed effectively through any one sector or discipline alone. Rather, an adequate response requires participation from numerous actors, including victim and support service providers, health and mental health care providers, legislators, law enforcement personnel, prosecutors, public defenders, educators, and the commercial sector. These actors work within different sectors, such as the nonprofit, health care, legal, and commercial sectors, and at different levels of government, including local, state, and federal. Individuals, groups, and organizations working within these systems can become “siloed,” gaining expertise by working primarily within their individual domains or specific areas of expertise, and can have differing goals, missions, and perspectives on how commercial sexual exploitation and sex trafficking of minors should be handled. This can create barriers to collaborating effectively to address these problems.

In the health context, multisector and interagency collaboration refers to various governmental, nongovernmental, social, and public organizations, groups, and individuals coalescing around a shared common focus with the potential to affect current and future health (Armstrong et al., 2006; Nowell and Froster-Fishman, 2011). (Note that while the committee uses the terms “multisector” and “interagency,” the literature and various fields of practice use the term “multidisciplinary” synonymously.) In a report on the future of public health in the 21st century (IOM, 2002), the Institute of Medicine cites the need for planned interaction among all



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10 Multisector and Interagency Collaboration Previous chapters have demonstrated that commercial sexual exploita- tion and sex trafficking of minors are intrinsically multifaceted such that they cannot be understood or addressed effectively through any one sector or discipline alone. Rather, an adequate response requires participation from numerous actors, including victim and support service providers, health and mental health care providers, legislators, law enforcement per- sonnel, prosecutors, public defenders, educators, and the commercial sector. These actors work within different sectors, such as the nonprofit, health care, legal, and commercial sectors, and at different levels of government, including local, state, and federal. Individuals, groups, and organizations working within these systems can become “siloed,” gaining expertise by working primarily within their individual domains or specific areas of expertise, and can have differing goals, missions, and perspectives on how commercial sexual exploitation and sex trafficking of minors should be handled. This can create barriers to collaborating effectively to address these problems. In the health context, multisector and interagency collaboration refers to various governmental, nongovernmental, social, and public organiza- tions, groups, and individuals coalescing around a shared common focus with the potential to affect current and future health (Armstrong et al., 2006; Nowell and Froster-Fishman, 2011). (Note that while the committee uses the terms “multisector” and “interagency,” the literature and vari- ous fields of practice use the term “multidisciplinary” synonymously.) In a report on the future of public health in the 21st century (IOM, 2002), the Institute of Medicine cites the need for planned interaction among all 337

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338 Commercial Sexual Exploitation and Sex Trafficking of Minors relevant community-related organizations (government, nongovernmental organizations [NGOs], businesses, schools, media, and health care delivery systems). Multisector and interagency collaborative approaches can become catalysts for the design and implementation of strategies and policies with a good chance of being timely, effective, relative, and sustainable (Buffardi et al., 2012). This chapter focuses on the growing emphasis on multisector and inter- agency collaborative approaches to addressing the systemic issues of com- mercial sexual exploitation and sex trafficking of minors. These approaches range from formal relationships based on memoranda of understanding (MOUs) to ad hoc and case-by-case arrangements drawing on networks of informal personal contacts. The chapter begins with an explanation of the value of such approaches. Next, because multisector and interagency work on commercial sexual exploitation and sex trafficking of minors in the United States has been underexamined, the chapter presents lessons from related fields of practice and areas of research, including child maltreat- ment, domestic violence, and sexual assault. The chapter then describes a number of noteworthy multisector and interagency efforts in the area of commercial sexual exploitation and sex trafficking of minors, including task force models and other state- and county-based collaborations. The committee used agency and organization reports, its public workshops, and its site visits to learn about these efforts; the descriptions of these efforts are meant to complement and supplement the limited published research. It should be noted that these models and activities have not been empirically evaluated. Thus, while the committee does not intend to imply that it is endorsing these approaches, it does endorse additional examination of their effectiveness. After reviewing these efforts, the chapter describes continuing challenges to multisector and interagency collaboration and identifies op- portunities for additional collaboration. The final section presents findings and conclusions. Value of multisector and interagency responses and collaboration Collaboration among multiple sectors, agencies, and organizations has the potential to help diverse entities gain a mutual understanding of commercial sexual exploitation and sex trafficking of minors, which may enable them to address the crimes themselves, as well as the needs of victims/survivors, more effectively (Clawson et al., 2006; Piening and Cross, 2012). Through regular meetings and other information-sharing mechanisms, agencies and organizations from different sectors can formal- ize networks and forge institutionalized relationships among actors and across siloes. Collaboration can engender intervention at various levels,

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Multisector and Interagency Collaboration 339 such as awareness raising, information sharing, resource sharing, and co- ordinated response to real-time situations. According to the Department of Justice’s Office for Victims of Crime: The advantage of multidisciplinary anti-trafficking Task Forces is in the maintenance of a strategic, well-planned, and continuously fostered collab- orative relationship among law enforcement, victim service providers, and other key stakeholders. A multidisciplinary response to human trafficking raises the likelihood of the crime being discovered, provides comprehensive protection of the victim, and increases coordinated investigative and pros- ecutorial efforts against the perpetrator. (OVC and BJA, 2011, Sec. 3.2) Noting the promise of multisector and interagency collaboration, the Department of Justice has provided funding for communities to establish anti-human trafficking task forces, which include “state and local law enforcement, investigators, victim service providers, and other key stake- holders” (Office of Justice Programs, 2013, p. 1). Other multisector and interagency efforts to address commercial sexual exploitation and sex traf- ficking of minors have been established without direct federal funding. As a result of the influence and goals of different funding sources, as well as the needs and strengths of communities, different sectors take lead roles in organizing and catalyzing action in collaborative networks. Thus, one task force might be led by law enforcement, while another might be more NGO driven. Also variable is the extent to which a particular task force includes representatives from multiple sectors. And in addition to multisector col- laborations, intrasector and specific cross-sector collaborations are possible. In some cases, information and communication technologies facilitate connectedness and information sharing among collaborators (Stoll et al., 2012), although sharing of information is complicated by trust, privacy, legal, and data security concerns. In other cases, a formal MOU is helpful to designate the roles and parameters for collaboration and partnership (Piening and Cross, 2012). While this chapter focuses on a few models of multisector and interagency collaboration, the committee does not advocate a one-size-fits-all approach to collaboration and acknowledges a variety of formulations, strategies, and mechanisms that support collaboration. As noted, few of these approaches have been evaluated, so the committee does not intend to endorse or promote any particular model of practice. It merely notes that communities that have established channels for collaboration among people who work in diverse sectors appear to have had some success in addressing commercial sexual exploitation and sex trafficking of minors. Ideally, multisector and interagency approaches to commercial sexual exploitation and sex trafficking of minors in the United States would in- clude all groups necessary to adequately address the needs of victims and the prosecution of exploiters, traffickers, and purchasers. A robust litera-

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340 Commercial Sexual Exploitation and Sex Trafficking of Minors ture evaluating the components of a multisector response to human traffick- ing or what individuals, organizations, and systems should be included does not exist. Nevertheless, the committee views the individuals, organizations, and systems listed in Box 10-1 as important components of a multisector response to commercial sexual exploitation and sex trafficking of minors (Clawson et al., 2006; Gonzales et al., 2011; Nair, 2011; OVC and BJA, 2011; Piening and Cross, 2012; Polaris Project, 2012). Perhaps as important as involving the relevant individuals, organiza- tions, and systems is the process for collaborating. The committee learned from site visit participants, workshop presenters, and published reports that multisector and interagency collaboration benefits from having a co- BOX 10-1 Components of a Multisector Response to Commercial Sexual Exploitation and Sex Trafficking of Minors in the United States • Local law enforcement • State law enforcement • Federal law enforcement • State social service agencies • Nongovernmental social service agencies • Nongovernmental advocacy organizations • Local prosecutors • State and county prosecutors • Federal prosecutors • Defense attorneys • Judges • Victims/survivors • Media • Private sector • Researchers and academics • Child welfare • Juvenile justice • Health care providers, including mental health care providers • Faith-based groups • Public officials • Social activists • Homeless advocates • Lesbian, gay, bisexual, and transgender (LGBT) advocates • Educators SOURCES: Clawson et al., 2006; Gonzales et al., 2011; Nair, 2011; OVC and BJA, 2011; Piening and Cross, 2012; Polaris Project, 2012.

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Multisector and Interagency Collaboration 341 ordinator or coordinating agency, frequent formal and/or informal com- munication, personal commitment from individuals, consensual (rather than top-down) decision making, and organizational support (Nicholson et al., 2000). Lessons Learned from Multisector and interagency Approaches TO Child Maltreatment, DOMESTIC VIOLENCE, AND SEXUAL ASSAULT While little published research exists on multisector and interagency responses to the commercial sexual exploitation and sex trafficking of mi- nors, the literature indicates that coordinated multidisciplinary approaches have long been endorsed as an effective way to respond to the related and overlapping areas of child abuse and neglect (Alexander, 1993; Hochstadt and Harwicke, 1985; OJJDP, 1998). Key features of successful child mal- treatment multidisciplinary teams noted in the literature include • commitment from the ground up, as well as from leaders (mandat- ing adoption of the multidisciplinary team approach will not suc- ceed unless those responsible for its implementation are committed to its success and believe it is worthwhile); • clear definitions of (and mutual respect for) the roles of each of the involved agencies and professionals; • creation and adoption of a clear mission statement (representing shared values and commitment); • development of written agreements (MOUs and/or joint protocols for child abuse investigation and intervention) specifying the ways in which team members will communicate and coordinate regard- ing cases and victims; • a regular process for honest review and discussion of cases and is- sues (for example, regular case reviews) and a culture that allows for respectful disagreement and questioning of one another; • open and respectful communication and ongoing relationships; and • joint training and team social activities. Examples of multidisciplinary teams and interagency approaches cre- ated to address child maltreatment and domestic violence include children’s advocacy centers (CACs) and family justice centers (FJCs). Examples of multidisciplinary teams and interagency approaches that have been used to address sexual assault include sexual assault response teams (SARTs). Each of these models is described in the sections that follow.

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342 Commercial Sexual Exploitation and Sex Trafficking of Minors Children’s Advocacy Centers A range of multidisciplinary team models have been used to respond to child maltreatment cases. Facility-based CACs are one such model. The purpose of a CAC is to provide a child-friendly environment and to central- ize and coordinate the investigation of child abuse cases and related social, physical, and mental health care, as well as advocacy services (Cross et al., 2008). CACs require the use of multidisciplinary teams (which include law enforcement investigators, child protection workers, prosecutors, and mental health and other health care professionals, among others) to coor- dinate forensic interviews, medical evaluations, therapeutic interventions, and victim advocacy in connection with case review and case tracking. First developed in 1985, CACs now number more than 900 nationwide; 750 of these centers meet national accreditation standards set and administered by the National Children’s Alliance (2013). Despite the existence of these standards, individual CACs vary greatly in how they were created, how they are organized, and how services are administered. Leadership within CACs comes from a variety of distinct traditions and perspectives, including prosecution, law enforcement, and physical and mental health. Collocation of various professionals and victim services is a feature of most CACs, al- though the specific agencies and services at a CAC facility vary significantly from jurisdiction to jurisdiction. Studies comparing the efficacy of CACs with that of other approaches to multidisciplinary and interagency coordination have yielded mixed re- sults, underscoring the complexity and difficulty of evaluating such efforts (Cross et al., 2008; Faller and Palusci, 2007). For example, Cross and colleagues (2008) conducted a multisite evaluation of CACs, collecting data between 2001 and 2004 on more than 1,000 cases of sexual abuse. Outcome data from four CACs were compared with outcome data from communities without CACs. The authors found that • there was significantly more evidence of coordinated investigations for the CACs; • more children involved with a CAC received a forensic medical examination; • a referral for mental health services was made in 72 percent of CAC cases, versus only 31 percent of comparison community cases; • parents and caregivers in the CAC sample were more satisfied with the investigation than those in the comparison sample (although the only difference found for children was that they were less frightened if they were interviewed at a CAC than at a non-CAC site);

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Multisector and Interagency Collaboration 343 • all of the CACs in the study were regarded as community leaders and experts in the area of child abuse; and • only CACs with strong involvement from law enforcement and district attorneys’ offices showed an impact on criminal justice outcomes. Cross and colleagues (2008) note several limitations of their research, including the small sample size and the absence in the sample of specific types of CACs (e.g., smaller CACs in suburban or rural locations and CACs based in prosecutors’ offices), making it difficult to generalize their findings to all CACs. Other studies have demonstrated more clearly the value and effective- ness of multidisciplinary teams and CACs. In 2006, for example, Shadoin and colleagues conducted cost-benefit and cost-effective analyses of pro- grams and services for child maltreatment. The researchers used contingent valuation methodology to study and elicit individuals’ willingness to pay for the services provided by a local CAC and concluded that the CAC program generated important net benefits that were valued by individual members of the community (Shadoin et al., 2006). In another example, a study in Florida found that benefits of multidisciplinary teams included increased substantiation of cases and a shorter investigative period, regardless of whether a CAC model or a Florida child protection team model (a local variation on the multidisciplinary team approach) was used, suggesting that interagency coordination was the key factor responsible for improve- ments over traditional child protective services interventions (Wolfteich and Loggins, 2007). Finally, another study found that the use of CACs to respond to child maltreatment increased felony prosecutions of child sexual abuse cases (Miller and Rubin, 2009). As discussed in earlier chapters of this report, child maltreatment cases bear strong similarities to cases involving commercial sexual exploitation and sex trafficking of minors. Indeed, in most communities, many of the same professionals are responsible for some aspect of the response to both child abuse and commercial sexual exploitation and sex trafficking of minors, especially when the latter are recognized and treated as a subset of the former (as this report argues they should be). It therefore follows that building upon and using existing CACs, multidisciplinary teams, and MOUs (or other protocols outlining agreements regarding collaboration and coordination of efforts) focused on child maltreatment may be one sensible starting point for undertaking collaboration to assist victims and survivors of commercial sexual exploitation and sex trafficking of minors and to investigate and prosecute cases. Potential advantages to using exist- ing CACs to organize improved responses to commercial sexual exploita- tion and sex trafficking of minors include

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344 Commercial Sexual Exploitation and Sex Trafficking of Minors • an established, extensive network (more than 900 in the United States) and support that exist for CACs throughout the United States; • the availability at CACs of trained child forensic interviewers, medical evaluation and services, and victim advocacy and mental health services; and • the ability of CACs to innovate and develop services responsive to local needs.1 Kristi House, a children’s advocacy center in Miami, is an example of how the structure and resources of an established CAC can be leveraged to provide services to victims and survivors of commercial sexual exploitation and sex trafficking of minors. In 2007, Kristi House created Project GOLD (Girls Owning their Lives and Dreams) to provide links to health services, case management, and therapy services specifically for victims of these crimes. In addition, Kristi House has plans to open an emergency drop-in shelter for victims of these crimes in early 2013 (Kristi House, 2012). While CACs are one well-established model of care, it is important to recognize the ways in which victims and cases of commercial sexual exploi- tation and sex trafficking of minors differ from victims and cases of child maltreatment traditionally dealt with by CACs and other multidisciplinary teams. As noted in Chapters 6 and 7, additional professionals, agencies, and services may be required to ensure an appropriate response to victims of commercial sexual exploitation and sex trafficking of minors. Some of the differences noted in earlier chapters include the need for enhanced security procedures because of the possibility of exploiter/trafficker retalia- tion; the need for advanced training in forensic interviewing so interviewers understand how best to talk to victims of these crimes; and the need for enhanced and expanded victim and support services, such as stronger case management and specialized mental health care. In addition, many CACs may be focused on younger victims (e.g., ages 6-12) and consequently may not be as welcoming for adolescent victims and survivors of commercial sexual exploitation and sex trafficking.2 Box 10-2 describes an example of how the CAC model has been adapted to address the unique needs of those at risk for and victims and survivors of commercial sexual exploitation and sex trafficking of minors. 1  -mail E communication received by T. Huizar, Executive Director, National Children’s Al- liance, November 19, 2012. 2  -mail communication received by T. Huizar, Executive Director, National Children’s Al- E liance, November 19, 2012.

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Multisector and Interagency Collaboration 345 BOX 10-2 High-Risk Victims Model: Adaptation of the Children’s Advocacy Center Model to Meet the Needs of Those at Risk for and Victims and Survivors of Commercial Sexual Exploitation and Sex Trafficking of Minors Recognizing the need to prevent and address the commercial sexual exploi- tation and sex trafficking of minors in their community, a variety of agencies in Dallas, Texas (including the Dallas Police Department, victim and support service agencies, and nonprofit organizations) came together to form a High-Risk Victims Working Group. This group meets at least once a month and focuses specifically on chronic runaways—a population that the Dallas Police Department identified as being at high risk for commercial sexual exploitation and sex trafficking. The group determined that the children’s advocacy center (CAC) approach would need to be modified or expanded to meet the distinct needs of minors who are at risk for or are victims and survivors of commercial sexual exploitation and sex trafficking. As a result of the group’s collaboration and reconceptualization, high-risk individuals and victims/survivors are referred to and served by the Letot Center, a runaway shelter, rather than the existing CAC model. The Letot Center has developed and delivers tailored programs and services for these youth. The Dallas Police De- partment considers this model to be an “adolescent advocacy center” and more appropriate than the CAC model for servicing these youth. SOURCE: Fassett, 2012. Family Justice Centers (FJCs) FJCs are a model of multisector and interagency collaboration similar to CACs. In an FJC, a multidisciplinary team of professionals is collocated and works together to provide coordinated services to victims of domestic violence. The first FJC opened in 2002 in San Diego (Gwinn et al., 2007). Since then, about 80 have been created (Family Justice Center Alliance, 2013). FJCs are designed to “provide one place where victims can go to talk to an advocate, plan for their safety, interview with a police officer, meet with a prosecutor, receive medical assistance, receive information on shelter, and get help with transportation” (Family Justice Center Alliance, 2013). As described in Chapters 3 and 6, commonalities between commer- cial sexual exploitation and sex trafficking and domestic violence include similar power and control dynamics and the need for safe shelter.

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346 Commercial Sexual Exploitation and Sex Trafficking of Minors Sexual Assault Response Teams SARTs (sometimes referred to as sexual assault interagency councils [SAICs], sexual assault multidisciplinary action response teams [SMARTs], or coordinated community response [CCR] teams) are another notable model of multisector collaboration. SARTs are community-based inter- ventions that provide comprehensive care to victims of sexual assault and coordinate the legal, medical, mental health, and advocacy response (Gree- son and Campbell, 2013). SARTs represent a shift from a case focus to a victim/survivor focus that emphasizes the centrality of victims/survivors and their needs to the overall process of dealing with sexual assault (Latimer, 2012; National Sexual Violence Resource Center, 2006). SARTs engage in a variety of activities, including, among others, conducting multidisciplinary training, providing direct support and advocacy to victims and survivors, developing protocols and policies for responding to cases, conducting case review to coordinate the response to cases, and educating the public about sexual violence and resources available to survivors (Office of Justice Pro- grams, 2011; Zajac, 2009). Evaluations of the impact and effectiveness of SARTs (and similar mul- tidisciplinary efforts to respond to sexual assault, as well as family violence) are scarce. For example, fewer than a quarter of respondents to one recent national survey of SARTs (23 percent, n = 54) stated that their SART and its activities had been evaluated (Zajac, 2009). The evaluations reported consisted primarily of gauging victims’ satisfaction with services, the reli- ability of evidence collection, and satisfaction with sexual assault training. Despite the limited evidence on their effectiveness, however, SARTs, like FJCs, are examples of multisector collaboration in similar and related areas of victimization that may offer valuable insights and support for the development of multisector and interagency responses to commercial sexual exploitation and sex trafficking of minors. multisector and interagency efforts to address commercial sexual exploitation and sex trafficking of minors As noted throughout this report, since passage of the Trafficking Vic- tims Protection Act (TVPA) in 2000, the federal government has made sig- nificant investments in efforts to prevent and address the commercial sexual exploitation and sex trafficking of minors, efforts that include multisector and interagency collaboration. Some of these efforts—particularly those focused primarily on collaboration among federal, state, and local law en- forcement—have been described in earlier chapters. In addition, the federal government engages in a number of interagency efforts focused mainly on

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Multisector and Interagency Collaboration 347 international human trafficking (e.g., U.S. Immigration and Customs En- forcement and the Office of Refugee Resettlement). In accordance with the committee’s charge, this section reviews multisector and interagency efforts as they relate to domestic human trafficking and specifically, to the extent possible, to commercial sexual exploitation and sex trafficking of minors in the United States. Task Forces Funded by the Department of Justice The Department of Justice’s (DOJ’s) anti-human trafficking task forces are one federally supported model of interagency and multisector col- laboration to prevent and address commercial sexual exploitation and sex trafficking of minors in the United States. While the committee recognizes that task forces exist at the federal, state, and local levels, those involving federal agencies are doing some of the most visible work. This section de- scribes some of the major DOJ task forces focused on commercial sexual exploitation and sex trafficking of minors in the United States. Cook County Human Trafficking Task Force Multisector and interagency collaboration is a key feature of the ap- proach of Cook County (Illinois) to commercial sexual exploitation and sex trafficking of minors. Formal collaboration among sectors and agen- cies occurs through the federally funded Cook County Human Trafficking Task Force, which is co-led by the Cook County State’s Attorney’s Office; the U.S. Attorney’s Office; the Northern District of Illinois; and two local NGOs, the Salvation Army’s STOP-IT Program and the International Or- ganization for Adolescents (Greene, 2012). Members of this task force employ a mix of strategies in the pursuit of vigorous prosecution of exploiters, traffickers, and purchasers and the provision of comprehensive victim and support services for victims and sur- vivors of commercial sexual exploitation and sex trafficking. For example, the STOP-IT Program has an office embedded at the State’s Attorney’s Office, where service providers are able to assist victims as soon as they come to the attention of law enforcement (Knowles-Wirsing, 2012). In ad- dition, the U.S. Attorney’s Office convenes a subgroup of the task force each month. In these sessions, representatives of federal and local prosecutors, the Federal Bureau of Investigation (FBI), the county sheriff, local police, and the Internal Revenue Service, among others, meet to discuss openly every case of commercial sexual exploitation and sex trafficking of minors that is under investigation or assigned to a prosecutor (Nasser, 2012). Another aspect of Cook County’s multisector approach to commer- cial sexual exploitation and sex trafficking of minors is that the work of

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358 Commercial Sexual Exploitation and Sex Trafficking of Minors tation and sex trafficking is a lack of training. Lack of training assumes added significance when a problem requires that a range of sectors work together. It is critical for professionals in all agencies and sectors that serve youth to be adequately prepared to identify and assist victims/survivors of commercial sexual exploitation and sex trafficking, and training is an es- sential element of such preparation. While unable to assess current levels of training across sectors and systems that serve children and adolescents, the committee learned that a lack of training—and of availability of training—remains a challenge to adequately addressing the commercial sexual exploitation and sex traffick- ing of minors in the United States. Current multisector and interagency col- laborations present an opportunity to provide training across systems and agencies. Many of the efforts described in this chapter, such as Georgia Care Connection and the Multnomah County community response, use cross- sector training to enhance partnerships and conduct retraining to address turnover within systems and organizations. However, more work is needed to bring these efforts to scale and to ensure that training is evaluated and informed by evidence. Lack of Shared Frameworks, Data Systems, and Incentives Another barrier to multisector and interagency collaboration is the lack of a shared understanding of commercial sexual exploitation and sex trafficking of minors, particularly with respect to victims and survivors. As noted throughout this report, victims and survivors of commercial sexual exploitation and sex trafficking may be perceived and treated differently by different sectors and systems. They may be viewed as “bad kids,” uncoop- erative youth, and criminals by some and as youth in need of assistance, victims, and survivors by others. These perceptions are influenced by such factors as local laws and practices (as described in Chapter 4), levels of awareness and biases (as described in Chapter 7), and the presence of task forces (as described in Chapter 5). Having a shared understanding of com- mercial sexual exploitation and sex trafficking of minors is particularly important when agencies and sectors collaborate. Workshop presenters and site visit participants stressed that until the various sectors and systems have a shared understanding of commercial sexual exploitation and sex traffick- ing of minors, work to address these problems will be impeded (Baker and Nelson, 2012). Concerns about privacy, confidentiality, and data sharing also can in- hibit collaboration across sectors and among agencies and systems, such as health care, juvenile justice, law enforcement, schools, and child protective services. As noted in Chapter 4, certain laws (i.e., the Family Educational Rights and Privacy Act [FERPA] and the Health Insurance Portability and

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Multisector and Interagency Collaboration 359 Accountability Act [HIPAA]) regulate how information is shared and with whom. In addition, the lack of integrated data systems can make sharing data and coordinating services difficult. For example, few municipalities or states have data systems that share or link data from different systems to facilitate effective communication and case management. In many cases, concerns about confidentiality, data sharing, and potential legal liability, whether perceived or real, serve as barriers to effective coordination among the multiple systems and sectors addressing commercial sexual exploitation and sex trafficking of minors in the United States. Finally, the lack of explicit incentives for collaboration across sectors and among agencies and systems is another barrier to addressing com- mercial sexual exploitation and sex trafficking of minors in the United States effectively. Multisector approaches may require that professionals and systems accept alternative frameworks and new practices, undergo additional and ongoing training, or engage in increased interaction with new partners, which in turn may require more work. Without clear incen- tives for collaboration, individuals may be resistant to such additional work, regardless of its effectiveness. Participants in the multisector and interagency approaches described in this chapter have acknowledged the need to address the perceived or real burden of additional work involved in such collaborative efforts. One strategy for incentivizing collaboration, used by Multonomah County, Alameda County, and Suffolk County, is to create paid positions and to institutionalize collaboration through formal arrangements (Alameda County District Attorney’s Office, 2012; Baker and Nelson, 2012; Goldblatt, 2012). Stakeholders can draw valuable lessons from collaborations among child protective services, law enforcement, juvenile justice, health care, and other sectors that have required agencies and systems to create shared frameworks, to share data, and to devise incentives for collaboration. CACs, FJCs, and SARTs (described earlier in this chapter) are three models that may provide insights in this regard. Lack of Sustained Funding Lack of funding in both the short and long terms is often a barrier to sustaining multisector collaborations and partnerships. The presence of funding can serve as the catalyst to encourage individuals from different sectors to start working together, and also can promote the evaluation of efforts. Conversely, in the absence of sustained funding, multisector efforts may be unable to continue. One strategy described in this chapter for work- ing with the limited funds available to support multisector approaches to commercial sexual exploitation and sex trafficking of minors in the United States is to adapt or expand models used to address related and overlapping

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360 Commercial Sexual Exploitation and Sex Trafficking of Minors issues. CACs, such as Kristi House, or multidisciplinary SARTs, such as those used by Multnomah County, are noteworthy examples of multisec- tor approaches that have been adapted and expanded to meet the needs of victims/survivors of commercial sexual exploitation and sex trafficking of minors. At the same time, ample funding in the absence of political will or strong leadership is unlikely to establish lasting multisector collabora- tion. Conversely, with political will and/or strong leadership, even limited resources can be leveraged to accomplish beneficial changes that can then serve as the basis for continued progress and justification for increased resources in the future. The Dallas High-Risk Victims Working Group, de- scribed earlier in this chapter (see Box 10-1), is an example of a multisector effort that started without any funding, but was supported by the shared commitment of service providers, law enforcement, government agencies, and others in the community (Fassett, 2012). While the dedication of an influential leader is often critical to initiating and maintaining focus on a problem such as commercial sexual exploita- tion and sex trafficking of minors, a commitment to multisector approaches needs to be institutionalized to ensure that a continued focus on the prob- lem is not dependent on the passion and personality of a strong leader. Widespread community awareness and acknowledgment of the seriousness of commercial sexual exploitation and sex trafficking of minors are pivotal to ensuring that adequate attention and resources are devoted to develop- ing solutions and to overcoming the challenges inherent in multisector and interagency coordination. Barriers to Communication Another barrier to multisector collaboration is the challenges of com- munication among individuals in different sectors. Different organizational cultures within sectors often entail different terminologies, definitions, and world views. Communication plays a key role in successful multisector col- laboration. For example, sharing information about cases of commercial sexual exploitation and sex trafficking of minors across sectors and among agencies and systems requires communication and a shared understanding of the problem and solutions (Alameda County District Attorney’s Office, 2012; Baker and Nelson, 2012; Goldblatt, 2012; Littrell, 2012). Regular meetings of groups and task forces can create a sense of shared purpose and community among participants. Many factors are involved in facilitating the ideal communication environment for collaborators, including who is able to speak and when, and whether the ideas of certain individuals or groups are accepted or perceived as more or less valid than those of others. The highly coordinated multidisciplinary case review activities of SEEN in

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Multisector and Interagency Collaboration 361 Suffolk County and H.E.A.T. Watch in Alameda County, discussed earlier in this chapter, are noteworthy examples of how multiple agencies and sec- tors have made frequent communication an integral part of their overall approach to addressing commercial sexual exploitation and sex trafficking of minors. Foot and colleagues (Foot and Toft, 2010; Foot and Vanek, 2012; Stoll et al., 2012) studied the communication contexts that engender collabora- tion among individuals and groups that work on antitrafficking efforts. Stoll and colleagues (2012) demonstrate the potential for information and communication technology to provide a platform for communication and connectedness to support the building of multisector collaborations. Con- nectedness among antitrafficking networks was instantiated by exchanging contact information and objectives, enabling connections through coordi- nating meetings, and reinforcing connections through follow-up meetings and events (Stoll et al., 2012). Caution is warranted, however, as informa- tion and communication technology can either strengthen connectedness or result in miscommunication or mishandling of information. While les- sons can be drawn from this research and efforts in Suffolk County and Alameda County, among others, additional research is needed to advance understanding of communication strategies for multisector collaboration. Limited Resources for Rural and Tribal Communities Commercial sexual exploitation and sex trafficking of minors do not occur exclusively in urban areas. However, most of the infrastructure de- signed to respond to these crimes is located in cities. For example, most task forces and service providers are located in urban areas (BJA and OVC, 2012). As a result, most rural areas have few resources with which to re- spond to these crimes. Similarly, while some evidence suggests high rates of commercial sexual exploitation and sex trafficking of American Indian and Alaska Native adolescents (Koepplin and Pierce, 2009; Pierce, 2012), few resources currently are dedicated to addressing these crimes among these populations. Despite the general lack of resources for rural areas and tribal commu- nities, the need for additional attention to commercial sexual exploitation and sex trafficking of minors among these populations is increasingly being acknowledged (Pierce, 2012; President’s Interagency Task Force to Moni- tor and Combat Trafficking in Persons, 2013). However, special challenges and barriers may be entailed in preventing, identifying, and responding to commercial sexual exploitation and sex trafficking of minors in rural areas and in tribal communities. As limited as awareness of and training on these issues are nationally, for example, research indicates that levels of awareness and training are even lower in rural areas. A study on the

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362 Commercial Sexual Exploitation and Sex Trafficking of Minors identification of victims and potential victims of human trafficking found that, among a random sample of 60 counties across the United States, law enforcement personnel in rural counties often lacked awareness of and/or training in human trafficking (Newton et al., 2008). The authors found that service providers in larger metropolitan counties reported recognizing human trafficking more often than service providers in rural and suburban counties. Finally, the authors found that service providers in rural areas were especially lacking in training in human trafficking (Newton et al., 2008). The committee spoke with several service providers that are mak- ing an effort to expand their services to outlying parts of their state, but nearly all noted challenges to providing services to rural areas, including long distances for staff travel, the lack of reliable transportation for victims and survivors to reach service providers, and few housing options (Carlson, 2012; Goldblatt, 2012). In its examination of the evidence, the committee was able to identify just a handful of task force and multisector efforts focused exclusively on human trafficking in rural communities and among Native populations. One example of a multisector approach to addressing commercial sexual exploitation and sex trafficking of Native Americans is the Phoenix Project in Minnesota, a collaboration between the Minnesota Indian Women’s Resource Center and the Division of Indian Work, the Minneapolis Police Department, and Hennepin County Juvenile Probation. Through this effort, these organizations have developed a formal process for referring Native girls who are suspected of being commercially sexually exploited or traf- ficked for sex to culturally based, gender-focused services (Pierce, 2012). Specifically, if victimization is suspected or disclosed to an outreach worker or law enforcement personnel, the victim is referred to the Minnesota In- dian Women’s Resource Center for services, including educational programs on healthy relationships, support groups, and case management (Pierce, 2012). In addition, the Minnesota Indian Women’s Resource Center advo- cates for program participants with child protective services and schools and provides referrals to other programs and services (i.e., basic needs, shelter) as needed (Pierce, 2012). More research is needed to advance understanding of the extent of commercial sexual exploitation and sex trafficking of minors in rural areas and tribal communities, as well as the potential for multisector collabora- tion to address these problems among these populations. Multisector Information-Sharing Tools As noted above, information-sharing tools can offer a beneficial oppor- tunity for multisector collaboration. In the last decade, such tools have been developed for the law enforcement sector as the U.S. government has sought

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Multisector and Interagency Collaboration 363 to improve and centralize information- and intelligence-sharing capabilities among various government agencies. One example is the Department of Homeland Security’s coordinated national network fusion centers, which centralize information and data collection on potential terrorist threats at the national, state, and local levels (Department of Homeland Security, 2013). Another initiative is the Regional Information Sharing Systems (RISS) Program, a congressionally funded program that allows access to in- formation and data for law enforcement and criminal justice professionals. These systems increasingly are being used to investigate case of commercial sexual exploitation and sex trafficking of minors in the United States. While direct access to these systems is limited to law enforcement, they have the potential to serve as models for information-sharing plat- forms across sectors dealing with domestic commercial sexual exploitation and sex trafficking of minors. A movement is occurring toward building technological systems and platforms that enable real-time data collection and analysis to facilitate rapid response to vulnerable and at-risk minors (Latonero, 2011). One challenge to developing such information-sharing technologies is that the process itself requires multisector collaboration. Government, the private sector, social services, and the research community need to be involved in such a development project. The Obama Administra- tion has stated its intent to use technology to respond to human trafficking in the United States (White House Office of the Press Secretary, 2012), as have private-sector technology firms such as Microsoft (Microsoft Research and Microsoft Digital Crimes Unit, 2012) and Google (Ungerleider, 2012) and nongovernmental organizations such as Polaris Project (Latonero, 2011). How these entities can ultimately work together to develop shared information environments for multisector collaboration to address commer- cial sexual exploitation and sex trafficking of minors in the United States remains to be seen. findings and conclusions While this chapter has provided examples of a range of current and emerging models of multisector collaboration to address commercial sexual exploitation and sex trafficking of minors in the United States, the com- mittee does not advocate a one-size-fits-all approach and acknowledges a variety of formulations, strategies, and mechanisms whereby collaboration and partnerships may occur. The committee’s review of the literature and its careful consideration of expert testimony revealed several themes related to multisector and interagency approaches to preventing, identifying, and re- sponding to commercial sexual exploitation and sex trafficking of minors in the United States. This chapter has highlighted a range of noteworthy and emerging efforts and drawn lessons from multisector approaches in related

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364 Commercial Sexual Exploitation and Sex Trafficking of Minors fields of practice. However, the committee reminds readers that evaluation of these and future efforts is a crucial need. In addition, the committee formulated the following findings and conclusions: 10-1 Multisector and interagency collaboration is necessary to re- spond adequately to the multifaceted nature of commercial sexual exploitation and sex trafficking of minors. 10-2 Existing multisector and interagency approaches to child mal- treatment, sexual assault, and domestic violence can serve as models for approaches to address commercial sexual exploita- tion and sex trafficking of minors. 10-3 Federally funded task forces are highly visible multisector ap- proaches, yet have not yet been evaluated for effectiveness. 10-4 Many of the same challenges that exist in individual sectors and systems (e.g., communication, funding, information sharing) arise within multisector and interagency approaches and need to be resolved. 10-5 Sustained funding, strong leadership, and formal arrangements are important drivers for the institutionalization of multisector and interagency approaches. 10-6 Broad-based multisector and interagency collaborative ap- proaches that are victim centered and tailored to the unique needs and circumstances of victims/survivors and their commu- nities appear to hold the most promise for positively impacting commercial sexual exploitation and sex trafficking of minors in the United States. References Alameda County District Attorney’s Office. 2010. District attorney’s office unveils H.E.A.T. Watch. http://www.alcoda.org/news/archives/2010/jan/office_unveils_heat_watch (ac- cessed July 10, 2013). Alameda County District Attorney’s Office. 2012. H.E.A.T. Watch program blueprint. http:// www.heat-watch.org/heat_watch (accessed September 13, 2012). Alexander, R. C. 1993. To team or not to team: Approaches to child abuse. Journal of Child Sexual Abuse 2:95-97. Armstrong, R., J. Doyle, C. Lamb, and E. Waters. 2006. Multi-sectoral health promotion and public health: The role of evidence. Journal of Public Health 28(2):168-172.

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