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date: 22 November 2017

Human Trafficking: Overview

Abstract and Keywords

Human trafficking (HT), also known as modern-day slavery, has received significant emphasis during the last decade. Globalization and transnational migration trends continue to amplify economic disparities and increase the vulnerability of oppressed populations to HT. The three major types of HT are labor trafficking, sex trafficking, and war slavery. Victims of HT are exploited for their labor or services and are typically forced to work in inhumane conditions. The majority of these victims are from marginalized populations throughout the world. Although both men and women are victims of HT, women and children are heavily targeted. Interdisciplinary and multi-level approaches are necessary to effectively combat HT. Combating HT is particularly relevant to the profession of social work with its mission of social justice. To address the needs of the most vulnerable of society, implications for social workers are discussed.

Keywords: human trafficking, labor trafficking, sex trafficking, war slavery, social work education & practice, social work

Introduction

Human trafficking (HT), also known as modern-day slavery, has recently received significant consideration in global circles. Globalization and transnational migration trends continue to amplify economic disparities and increase the vulnerability of oppressed populations to different forms of HT. Most victims of HT are generally exploited for labor or sexual purposes. A smaller proportion are victims of organ removal or unethical adoption processes (Roby & Bergquist, 2014). Persons most vulnerable to HT are generally the poor, the marginalized, and individuals seeking employment opportunities. Three major types of HT today are labor trafficking, sex trafficking, and war slavery. In the United States, The Victims of Trafficking and Violence Victim Protection Act (TVPA) of 2000 (P.L. 106-386) provided the following definition of HT:

  1. (a) sex trafficking in which a commercial sex act is induced by force, fraud, or coercion, or in which the person induced to perform such an act has not attained 18 years of age; or

  2. (b) the recruitment, harboring, transportation, provision, or obtaining of a person for labor or services, through the use of force, fraud, or coercion for the purpose of subjection to involuntary servitude, peonage, debt bondage, or slavery. (United States Department of State, 2000, p. 8)

Global estimates of HT are difficult to gather due to the secretive nature of contemporary slavery, and there is some discrepancy between figures. Bales (2004), an expert on HT, reports an estimated 27 million people exist in some form of modern-day slavery throughout the world. The International Labour Office (2013) estimates there are approximately 21 million people victims of human trafficking throughout the world. In the United States, roughly 17,000 people are trafficked into slavery each year (Bales, 2009).

Labor Trafficking

The International Labour Office (2013) estimates there are currently approximately 14.2 million victims of labor trafficking worldwide. Labor trafficking can be found in virtually every industry throughout the world. Victims of labor trafficking are forced to work without payment or without sufficient payment often in horrible conditions. Individuals are exploited for labor within their own country or across international borders, with migrants being particularly susceptible to this form of trafficking (United States Department of State, 2013). Debt bondage is the provision of services for personal debt and is recognized as the most prevalent type of labor trafficking. This type of trafficking exists mostly in India, Pakistan, Bangladesh, and Nepal (Bales, 2004).

Within the United States, common forms of labor trafficking are domestic servitude, agricultural or farming work, and factory work (Polaris Project, 2013a). Labor trafficking has also been discovered in strip clubs, in peddling and begging rings, and in the hospitality industry (Polaris Project, 2013a). Traveling sales crews that sell magazines or other items have been identified as being particularly exploitive of young adults between ages 16 and 28 (Polaris Project, 2013b). Both male and female victims are recruited with promises of opportunities to travel and earn a high income (Polaris Project, 2013b). Victims typically have limited formal education and low incomes (Polaris Project, 2013b). After an initial “honeymoon” period where the victims are treated well, they are isolated and removed from familiar territory (Polaris Project, 2013b). They may experience physical abuse, emotional abuse, or threat of abandonment (Polaris Project, 2013b).

Sex Trafficking

The International Labour Office (2013) estimates that there are 4.5 million victims of sex trafficking worldwide. Victims and their families are often misinformed regarding employment opportunities and/or the nature of the sex trade (Roby, 2005). In Thailand, impoverished families in rural areas are offered between $200 and $2000 for the contractual work of their daughter in factories or restaurants (Lusk & Lucas, 2009). When these young girls arrive in the city they are sold to brothels and forced to work in the sex industry (Bales, 2004). A brothel owner can earn up to $80,000 a month if twenty victims have sex with fourteen clients per day (Bales, 2004).

In the United States, sex traffickers generally prey upon the most vulnerable of society, often targeting individuals that have a history of mental, physical, or sexual abuse (Polaris Project, 2013c). Sex trafficking occurs in the following settings: residential brothels, hostess clubs, online escort services, fake massage businesses, strip clubs, and street prostitution (Polaris Project, 2013c). The Internet has been identified as the primary strategic tool of sex traffickers and perpetrators to sell and purchase sexual services in the United States (Polaris Project, 2013c). Pornography, chat rooms, personal ads, and fake massage parlors are advertised on various websites, such as Backpage.com (Polaris Project, 2013c). Online predators seek out the emotionally vulnerable in cyberspace and attempt to lure individuals into the sex industry with fraudulent information (Polaris Project, 2013c). Recent studies suggest that minors are the most susceptible population to become victims of sex trafficking in America (Kotrla, 2010) The sex trafficking of youth in the United States is known as domestic minor sex trafficking (DMST).

War Slavery

Around the world, about 2.2 million people experience war slavery (International Labour Office, 2013). War slavery may be perpetrated by rebel groups or enforced by state authorities in the form of forced labor. War slavery, also referred to as state-imposed forced labor, is sometimes government sanctioned. For example, the dictatorship of Burma has enslaved tens of thousands of civilians for military campaigns and construction projects (Bales, 2004). The United Nations has reported the recruitment of child soldiers in 55 countries including: Afghanistan, Burma, Chad, the Democratic Republic of the Congo, Somalia, South Sudan, Sudan, Syria, and Yemen (as cited in Schlein, 2014). Globally there are between 250,000 and 300,000 child soldiers under the age of 18 (as cited in Schlein, 2014).

Special Groups of HT Victims

Present estimates and data indicate that the majority of HT victims today are women and girls (United States Department of State, 2013). A global study completed by the United Nations Office on Drugs and Crime (UNODC) demonstrated that women and children are more vulnerable to HT (United Nations Office on Drugs and Crime, 2012). Women are particularly vulnerable to HT in the domestic service industry where informal employment is not usually regulated by government labor laws (United States Department of State, 2013). The feminization of poverty and gender-biased cultural norms that encourage the subjugation of women increase their vulnerability to HT.

Worldwide, approximately 5.5 million victims of human trafficking are under the age of 18 (International Labour Office, 2013). Approximately 1.2 million children are trafficked annually worldwide (Blumhofer, Shah, Grodin, & Crosby, 2011). The UNODC noted a general trend of increased child trafficking throughout the world, which was most prevalent in Africa (United Nations Office of Drugs and Crime, 2012). Armed conflict leaves children particularly vulnerable to trafficking, especially when children are refugees or are internally displaced (United States Department of State, 2013). Children are also trafficked for sexual exploitation, construction, begging, petty theft, domestic work, sweat shop work, and organ harvesting (Kara, 2009).

When women are trafficked the children they leave behind are especially vulnerable to exploitation (Faulkner, Mahapatra, Heffron, Nsonwu, & Busch-Armendariz, 2013). Although current estimates of trafficked parents and their children are unavailable, the impact of trafficking on the family unit cannot be overlooked (Faulkner et al., 2013). The effects of separation of trafficked individuals from their families is similar to the disruption that occurs in transnational families (Faulkner et al., 2013). Both groups experience many challenges which lead to an unstable family unit. Children born into trafficking situations are another extremely vulnerable group. Further research is necessary to document and understand the experiences of second generation victims of HT.

Key Determinants of HT

The key determinants of HT are related to “push and pull factors” and theories of migration. The “push” factors which contribute to the possibility of being trafficked are: poverty, limited employment, economic and political instability, environment decay, natural disasters, conflict-related displacement, limited educational opportunities, and family violence (Bryant-Davis, Tillman, Marks, & Smith, 2009). Examples of the “pull” factors increase probability of entering situations of HT are: demand for cheap labor and services, higher wages, and increased life opportunities. Vulnerable populations that reside in areas where several “push” factors are present have increased likelihood of entering the trafficking process.

Global Policy

In 2000, the United Nations implemented the Palermo Protocol or The Protocol to Prevent, Suppress and Punish Trafficking in Persons, Especially Women and Children (United States Department of State, 2013). The Palermo Protocol provides guidance for governments to prevent HT, protect victims of HT, and prosecute traffickers (United States Department of State, 2013). This protocol has since been adopted by over 150 countries (United States Department of State, 2013). The practical implementation of these laws and punishment of human traffickers’ remains problematic as relatively few traffickers are prosecuted (United States Department of State, 2013). Identification of victims continues to be challenging with only approximately 40,000 victims identified worldwide in 2012 (United States Department of State, 2013).

Space needs to be deleted. The legislative discourse on HT has largely ignored the poor societal conditions that support labor trafficking (Alvarez & Alessi, 2012). Political activists and popular media have mostly focused on the sex trafficking of women and children (Alvarez & Alessi, 2012). Due to this narrow lens regarding HT, men trafficked for labor are often overlooked and may not receive support (Alvarez & Alessi, 2012). Alvarez and Alessi (2012) assert the importance of creating policies which address the societal conditions that support global labor exploitation in all its forms. High numerical estimates of labor trafficking victims, approximately 14.2 million worldwide, indicate the need for greater attention to labor exploitation in political arenas.

The pervasiveness of labor trafficking in virtually every formal and informal industry cannot be battled by labor laws and policies alone (Jägers & Rijken, 2014). Multinational corporations can have a significant impact on the reduction of labor trafficking by following fair labor practices that do not violate human rights (Jägers & Rijken, 2014). In 2011, the Human Rights Council of the United Nations adopted the U.N. Guiding Principles on Business and Human Rights Framework (Human Rights Council, 2011). This resolution encourages corporations to voluntarily accept responsibility for protecting human rights in the workplace. Without legal obligation, the adoption of these principles within corporations offers a transparency to labor practices (Jägers & Rijken, 2014). Multinational corporations that neglect to embrace these principles are subject to societal pressure and public scrutiny.

Although some may doubt the capability of public opinion and societal forces to curtail labor trafficking, the strength of corporate responsibility is gaining support. Fair trade labeling has met some success in curtailing child labor and unfair labor practices (Baradaran & Barclay, 2011). To obtain a fair trade label, companies voluntarily participate in private monitoring to ensure safe working conditions, adequate compensation, and healthy labor practices (Baradaran & Barclay, 2011). Fair trade labels certify that products have been manufactured and traded without child labor and meet standards for quality economic, social, and environmental conditions (Baradaran & Barclay, 2011). Fair trade labeling organizations, such as Transfair USA and Fairtrade Labelling Organization (FLO), promote greater transparency among businesses and ethical trading practices (Baradaran & Barclay, 2011). Fair trade organizations have had a significant impact on reducing child labor in the production of tea, coffee, and cocoa in various countries worldwide (Baradaran & Barclay, 2011). Creating governmental policies that support validated fair trade organizations could generate needed awareness necessary to effectively combat labor trafficking.

Policy regarding sex trafficking remains controversial due to discord regarding the varying approaches toward the regulation of the commercial sex industry. Sex worker advocates view the criminalization of prostitution as disrespecting the agency of women and limiting their ability to work (Berger, 2012). Sex worker advocates push for the legalization and regulation of prostitution to improve their ability to negotiate terms within the commercial sex industry (Marinova & James, 2012). Berger (2012) claims that emphasis on ending demand, which criminalizes buyers of sexual services, only drives commercial sex activity farther underground where potential for violence increases. Pro-worker advocates also contend that the legalization of prostitution would actually improve health services for sex workers and enhance their safety (Berger, 2012). If sex workers are lawfully engaged in the commercial sex industry, the probability of violent acts committed against them would be reduced (Berger, 2012). However, feminist and human rights advocates adamantly oppose these policies.

Varying policy approaches to sex trafficking have been implemented throughout the world. The legalization of sex work in the Netherlands and Greece has been found to actually increase the number of HT victims (Marinova & James, 2012). In the Netherlands the reported number of HT victims was 228 in 1998 (Marinova & James, 2012). By 2008, the number of HT victims had jumped to 826 (Marinova & James, 2012). Some take an abolitionist approach which views sexual exploitation, including trafficking and purchasing of sexual services, as acts of violence against a person’s dignity (Marinova & James, 2012). Within this abolitionist concept individuals that engage in prostitution are viewed as victims of subjugation and objectification (Marinova & James, 2012). Qualitative evidence in Sweden suggests that the abolitionist approach decreases the purchase of sexual services (Marinova & James, 2012). Sweden applied criminalization policies that targeted the purchaser of sexual services, rather than the provider, and the trafficker (Marinova & James, 2012). In Sweden prevention measures of education and awareness campaigns were implemented to inform citizens and combat HT (Marinova & James, 2012). Although many nations have adopted the Palermo Protocol, the success of HT policies worldwide is largely dependent upon the actual implementation within each nation.

U.S. Policy

In the United States, HT has become a domestic problem with transnational dimensions. The passing of the Victims of Trafficking and Violence Protection Act (TVPA) in 2000 was a significant hurdle in the fight against HT (Polaris Project, 2014b). This legislation was similar to the Palermo Protocol in its approach to HT, with its focus on prevention of HT, prosecution of human traffickers, and protection for HT victims (Polaris Project, 2014b). This legislation mandated that HT be considered a federal crime. Under the direction of the Office of Refugee Resettlement, the Anti-trafficking in Persons Program (ATIP) was initiated in response to the TVPA. This program collaborates with several agencies nationwide to raise awareness and support victims of HT. For example, the National Human Trafficking Resource Center established a national hotline for trafficking victims and is supported by ATIP. The Office to Monitor and Combat Trafficking in Persons was also established with this legislation. Various adjustments and improvements have been made to the TVPA of 2000 with subsequent legislation. The act was reauthorized as the Trafficking Victims Protection Reauthorization Act in 2003, 2005, 2008, and 2013 (Polaris Project, 2014b). The TVPA has had a significant impact upon trafficking activity with reauthorized funding for federal anti-trafficking programs and specialized services to victims.

Challenges and Consequences of Human Trafficking

Even with strong policies to combat HT, the challenges of adequately addressing this complex issue can seem insurmountable within the context of globalization. The impact of global markets and technological advances including mechanization processes amplifies the gap between rich and poor. Multinational corporations make market decisions in the best interest of their companies without much consideration for labor opportunities, working conditions, environmental consequences, or the social costs to the surrounding community (Ross-Sheriff, 2007). Although these organizations are attempting to increase corporate responsibility related to these human and environmental factors, economic disparities continue to grow ever wider (Ross-Sheriff, 2007). As a result, low-skilled individuals living in economically developing nations become more vulnerable to HT. People searching for greater life opportunities and chances for financial stability become ensnared in precarious situations that may threaten their lives.

The accurate identification of traffickers and victims eludes law enforcement authorities and health professionals. Victims of HT may be linguistically, culturally, and geographically isolated from the community without legal documentation. The use of the Internet to conduct illicit business transactions, such as solicitation for labor or sexual services, further obscures victims from the public eye. The actual apprehension of traffickers is also impaired by HT conducted via the Internet where computer IP addresses rarely lead to an arrest. If the human trafficker can be found, victims of HT may not be interested in prosecuting their trafficker, due to fear of retaliation or possibility of deportation.

Moreover, the consequences of prolonged exposure to traumatic experiences severely impacts victims’ physical and mental health. According to Oram, Stöckl, Busza, Howard, and Zimmerman (2012), possible physical consequences of HT include: headaches, fatigue, back and stomach pain, memory problems, traumatic brain injury, and sexually transmitted infections. The mental health disorders of HT victims may be similar to those that have lived in an active war zone or experienced torture (Williamson, Dutch, & Clawson, 2008). Prevalent mental health symptoms of HT victims include: anxiety, depression, suicidal ideation, and PTSD (Dovydaitis, 2010). These health consequences indicate the life-altering cost to victims of HT. Despite traumatic experiences, some victims of HT exhibit resilience and hope for the future (Faulkner et al., 2013).

To assist HT victims along the path to recovery multidisciplinary efforts are required. Law enforcement officials, medical personnel, border patrol security officers, legal professionals, community organization representatives, faith-based leaders, and mental health counselors must collaborate to confront this problem collectively. Social workers can fill the role of coordinator in arranging treatment for HT victims in the following settings: police stations, law offices, hospitals, court rooms, and mental health clinics (Busch-Armendariz, Nsonwu, & Heffron, 2014). With a mission of social justice and advocacy, social workers should be at the forefront in combating HT with a focus on interdisciplinary collaboration.

Implications for Social Work, Education, and Practice

To address the multidimensional dilemma of HT, social workers should utilize a multisystemic approach of prevention, intervention, education, training, and advocacy. Social workers should be involved in prevention programming to minimize the risk factors that increase the probability of trafficking activity. Empirically relevant interventions that are trauma-informed and culturally competent are essential components to addressing HT. As professionals, social workers should be at the forefront, educating youth and communities regarding the nature of HT and its consequences. HT must be added to social work curricula in institutions of higher learning. Human service programs will look to social workers to provide training for professionals who assist in identifying victims, making proper referrals, and providing clinical treatment. Finally, social workers need to be involved in advocating for legislation and encouraging faith-based initiatives that reduce HT.

Prevention of Human Trafficking

The precursor to eliminating HT begins with fulfilling the needs of vulnerable populations worldwide. Human traffickers generally seek to enslave those persons that are excluded from society, i.e. marginalized ethnic minorities, undocumented immigrants, the indigenous, the poor, and persons with disabilities (United States Department of State, 2013). Victims are often fraudulently lured into HT with promises of employment and a better life (Hodge & Lietz, 2007). Less frequently, recruiters approach families of those who live in poverty and purchase children with promises to their caregivers for improved opportunities for them in another country (Hodge & Lietz, 2007). In the United States, Fong and Cardoso (2010) purport that “runaway, homeless, kidnapped children or children in or leaving foster care are at elevated risk of forced prostitution and trafficking” (p. 311).

The discussion for prevention of HT has rarely acknowledged the breakdown of the traditional family as a “push” factor. Strengthening the family unit through micro-credit, education, health prevention, and faith-based initiatives could significantly reduce the vulnerability of persons to HT. There are several evidence-based programs which have proven to curtail high-risk behavior of children and youth (United Nations Office on Drugs and Crime, 2013b). The implementation of these programs among vulnerable populations could have a dramatic effect on HT activity. Improving family bonds can provide protection for potential victims and diminish the propensity of adults to turn to the HT “business” for income or personal pleasure.

Creating awareness among vulnerable populations is another key to the prevention of HT. Awareness campaigns that target marginalized populations could limit the ability of traffickers to draw people into dangerous conditions. Culturally sensitive campaigns should access the most vulnerable of society, specifically reaching out to impoverished communities and rural areas. For example, within the United States January has been designated as National Slavery and HT Awareness Month (Obama, 2013).

Faith-based communities can also assist in educating their members about the prevalence and the prevention of HT. Awareness regarding signs of labor and sexual exploitation within these communities can aid in identification of victims. Faith-based leaders can work with health professionals, social service providers, and law enforcement representatives to combat HT within their local communities. Faith-based initiatives can help reduce the risk of individuals to exploitation by educating their members regarding tactics of traffickers and online safety.

Services to Victims

Proper victim identification has been a major barrier to provision of services to HT victims (United States Department of State, 2013). Victims of HT are sometimes identified as illegal immigrants or criminals and may be subject to: arrest, detention, deportation, or prosecution (United States Department of State, 2013). In the United States, law enforcement officers are most likely to come across victims of HT in their line of work (Wilson et al., 2006). The call for increased victim identification training among government officials has been heard. The Anti-Human Trafficking Manual for Criminal Justice Practitioners identifies common experiences of HT victims and procedures to follow upon discovery of an HT victim (United Nations Office on Drugs and Crime, 2013a). The manual encourages criminal justice practitioners to refer the victim for counseling services for stabilization if deemed necessary. Social workers can liaison with law enforcement to coordinate multidimensional care that includes: medical services, counseling services, case management, housing services, legal services, income support, and employment services (United Nations Office on Drugs and Crime, 2013a).

According to Busch-Armendariz et al. (2014), using an Ecological Systems Perspective to guide service delivery for HT victims has demonstrated effectiveness. Social workers that were designated as the single point-of-contact for HT victims were able to provide “improved consistency, efficiency, and effective delivery of services that ultimately resulted in better services to survivors” (Busch-Armendariz et al., 2014, p. 13). Using this model, social workers are able to advocate for HT victims in accessing services and navigating legal processes (Busch-Armendariz et al., 2014).

During the first encounter with HT victims, social workers may utilize the Comprehensive Human Trafficking Assessment developed by the Polaris Project (Polaris Project, 2013d). This assessment provides a wide-range of questions for service professionals to help identify a HT victim which includes: general trafficking questions, sex trafficking questions, and labor trafficking questions (Polaris Project, 2013d). Social workers should attempt to make adjustments to the assessment for cultural sensitivity (Polaris Project, 2013d). Social workers should also be prepared to deal with multiple clinical issues of an HT victim, that is, psychological abuse, physical abuse, sexual abuse, forced or coerced use of drugs or alcohol, social restriction and emotional manipulation, economic exploitation and debt bondage, legal insecurity, and high-risk abusive working conditions (Zimmerman et al., 2011).

Currently, there are limited evidence-based interventions for the clinical treatment of HT victims. Williamson, Dutch, and Clawson (2008) report that post-traumatic stress disorder (PTSD) is the most commonly cited disorder in scholarly research on HT victims. Anxiety disorders, mood disorders, dissociative disorders, and substance-related disorders have also been identified as prevalent disorders among HT victims (Williamson, Dutch, & Clawson, 2008). Until appropriate treatments have been established researchers suggest utilizing treatments that have proven effective with similar populations, that is, migrant laborers, victims of sexual abuse and violence, and victims of torture (Williamson, Dutch, & Clawson, 2008).

Clawson, Salomon, and Grace (2008) recommend using trauma-informed services with victims of HT. Trauma-informed care includes having knowledge of the traumatic experiences of victims (Clawson, Salomon, & Grace, 2008). Trauma-informed services also provide a therapeutic framework for understanding the vulnerability of victims and the impact of multiple traumatic events (Williamson, Dutch, & Clawson, 2008). Busch-Armendariz et al. (2014) report that a victim-centered approach has enhanced services to HT victims and improved professional competency.

Fong and Cardoso (2010) suggest utilizing trauma-focused cognitive behavioral therapy (TF-CBT) with child trafficking victims. TF-CBT has been tested in random clinical trials with child sexual abuse victims for the treatment of symptoms of PTSD, depression, anxiety, and behavioral problems (Fong & Cardoso, 2010). The TF-CBT model centers on educating the client about sexual abuse and trauma during individual sessions and joint parent-child therapy sessions (Fong & Cardoso, 2010). Relaxation skills, emotional regulation, coping skills, and safety planning are reviewed (Fong & Cardoso, 2010). TF-CBT could be extremely beneficial to child trafficking victims with modifications, for example, excluding a parental figure in sessions due to absence of one nearby (Fong & Cardoso, 2010). Further exploration regarding effectiveness with adult sex-trafficking victims and trafficked victims is warranted.

For the treatment of PTSD, there is empirical evidence for the use of cognitive-behavioral therapy (CBT) that integrates cognitive restructuring and exposure therapy (Williamson, Dutch, & Clawson, 2008). CBT has also been found effective in treatment for anxiety disorders and mood disorders (Williamson, Dutch, & Clawson, 2008). Major depressive disorder is a frequent diagnosis of HT victims (Williamson, Dutch, & Clawson, 2008). Further exploration on empirically based treatment for victims of HT is necessary.

Using empirically relevant modalities, although important, is not enough for the treatment of this especially vulnerable population. Due to the complex trauma that victims of HT have likely experienced, the use of a trauma-informed response is necessary for all service providers that may come into contact with HT victims. This involves recognizing the possible distrust and fear a victim may have of authority figures and being particularly sensitive to past experiences of trauma. Giving the victim time to process and make important life decisions (for example, regarding prosecution or self-deportation) directly after a traumatic experience is critical to obtaining relevant information. Also, the transnational nature that sometimes occurs with HT compels service providers to utilize cultural humility. The goal of the service provider should be to establish a foundation of trust and mutual respect. With this in place, victims of HT will likely experience greater success in therapeutic treatment.

Agency-Based Responses

There are few organizations that deal specifically with trafficking victims within the United States. The Salvation Army STOP-IT program is a faith-based agency that serves victims of HT in Chicago, Illinois (Knowles Wirsing, 2012). This agency uses a comprehensive model to provide crisis intervention, victim identification, training, and service coordination to victims of HT. The STOP-IT program serves male and female victims of labor and sex trafficking. In 2011, the STOP-IT program actively assisted 79 people and they continue to receive regular referrals (Knowles Wirsing, 2012). Using a comprehensive model of treatment that liaison with an array of community services is undoubtedly the most effective approach to intervention with victims of HT.

The Girls Educational & Mentoring Services program (GEMS) has also met some success with providing services to sexually exploited youth and children in New York City. The GEMS program provides direct intervention through short-term and crisis care, transitional and supportive housing, court advocacy, and holistic case management (GEMS, 2013). The case management services include trauma-based therapy and individual support sessions (GEMS, 2013). In addition, they provide an educational program, a youth development program, and a youth leadership program (GEMS, 2013). As part of the youth outreach program, members conduct peer-led facility outreach workshops within residential facilities and detention facilities (GEMS, 2013). Peer-led trainings are dynamic in their approach to HT. Evaluation of peer-led trainings vis-à-vis adult-led trainings might generate significant results for agency based responses.

Education in Schools

Educational and outreach programs should be implemented in school systems to increase awareness among youth. These programs must include information about online predators and false advertisement for employment. As Internet access becomes ever more accessible, guarding against masquerading predators becomes more challenging. Seemingly legitimate job postings online can lead to entrapment. Traffickers may groom their victims over time with luxurious gifts or promises of high-paying jobs (Kotrla, 2010). Youth need to be educated regarding the sophisticated tactics that traffickers might use to lure them into possible HT or exploitation.

A harm reduction program completed in Minnesota demonstrated that educational efforts were successful in reducing the risk of girls being sexually exploited (Pierce, 2012). In combination with multi-level interventions, healthy sexuality education and peer support groups were provided (Pierce, 2012). Implementing psycho-education programs regarding HT within public school systems can inform youth of their rights. With a special emphasis on educating marginalized groups, outreach programs can enlighten individuals and help to curb HT.

Education in Institutions of Higher Learning

The topic of HT must be included in social work curricula. Thus far, the literature for health professionals on HT has covered the following topics: trafficking definition and scope, health consequences, victim identification, appropriate treatment, referral to services, legal issues, security, and prevention (Ahn et al., 2013). These topics set the groundwork for the development of curriculum on trafficking (Ahn et al., 2013). Theoretical approaches to trafficking are also necessary. Ahn et al. (2013) suggest using the Social-Ecological Model to address this multi-systemic problem. This model encourages prevention strategies be used at the individual, relationship, community, and societal levels (Centers for Disease Control and Prevention, 2009).

Social workers must be educated in trauma-informed care to provide services to victims of HT. High rates of physical and sexual violence experienced by trafficking victims (Oram et al., 2012) indicate the need for trauma-informed services. Addressing the possible multiple victimizations that trafficking victims may have experienced requires a special sensitivity to trauma.

Furthermore, social workers should receive cultural competence training to effectively work with victims of HT. Although impossible to learn every culture, social workers can be educated in socio-cultural anthropology to limit ethnocentric perspectives. Becoming familiar with socioeconomic conditions of the HT victim prior to entrapment and cultural norms regarding labor practices, gender roles, and migration patterns would assist the social worker in better understanding victims of HT. Adding a second language component to social work curricula could also assist social workers in meeting the needs of diverse populations.

Due to the possible millions of sex addicts in America and a dearth of certified addiction counselors, sexual addiction counseling should be included in graduate and post-graduate education (Hagedorn, 2009). Hagedorn (2009), an expert in addiction treatment, suggests more institutions offer an empirical-based training protocol on sexual addiction counseling. The United States has been identified as a destination country, importing thousands of people for sexual purposes (United States Department of State, 2013; Landesman, 2003). The growth of the commercial sex industry calls for a greater therapeutic treatment response.

Training

Due to the hidden nature of HT, social workers must be trained in victim identification. The 2013 TIP Report calls for social workers to be informed “because children who have been abused at home, have run away, are alcohol- or drug-dependent, or are in the care of child-welfare agencies are at high risk for HT” (United States Department of State, 2013). The Rescue and Restore Victims of Human Trafficking Campaign offers a list of possible clues that someone may be a victim of trafficking: “evidence of being controlled; evidence of inability to move or leave a job; bruises or other signs of battering; fear or depression; non-English speaking; recently brought to this country; and lack of passport, immigration, or identification documents (Administration for Children and Families, 2013; Dovydaitis, 2010, p. 464). Social workers must also be prepared to recognize the common health problems of victims, for example, anxiety, chronic pain, cigarette burns, complications with unsafe abortion, contusions, depression, fractures, gastrointestinal problems, headaches, oral health problems, pelvic pain, post-traumatic stress disorder, sexually transmitted infections, suicidal ideation, unhealthy weight loss, unwanted pregnancy, and vaginal pain (Dovydaitis, 2010).

Advocacy for HT Victims

Social workers and health professionals can advocate for legislation that gives stiffer penalties to traffickers and purchasers of sex. Generating awareness of HT in local communities and agencies with the use of awareness materials can help to inform victims and advocates (Polaris Project, 2014a). Social workers must be change agents at the state, national, and international levels. On an international level, the United States has taken the lead in combating HT with the creation of the Office to Monitor and Combat Trafficking in Persons (Polaris Project, 2014b). This office compiles the global Trafficking in Persons (TIP) report yearly which is an effective tool for monitoring and measuring HT throughout the world.

Conclusion

With increased globalization and mobility, HT is an expanding global health issue that largely effects marginalized populations, especially women and children. Modern day slavery is primarily driven by a lack of legal employment opportunities and unchecked capitalism. Improved employment policies in both the country of origin and the destination country would destroy the profit motive for HT. Challenging the societal conditions that support the exploitation of human beings will require a multidisciplinary approach. Collaborative efforts among law enforcement officials, medical personnel, border patrol security officers, legal professionals, community organization representatives, faith-based leaders, and mental health counselors can help to effectively address the needs of HT victims.

Social workers can serve as a point of contact among health professionals in coordinating treatment and assisting HT victims in navigating their alternatives in health care and legal systems. Social work professionals, with a mandate of social justice, should be at the forefront of prevention efforts, policy reform, educational campaigns, and empirically relevant therapeutic interventions to combat HT. By combining disciplinary efforts and multi-level approaches HT can become a phenomenon of the past.

References

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