Human Trafficking


Course Objectives

  • Describe the types of human trafficking
  • Determine Factors that place a person at greater risk of being a victim of human trafficking
  • Identify social services available for rescue, food, clothing and shelter referrals
  • Identify hotlines for reporting human trafficking
  • Validated assessment tools for identifying a human trafficking victim
  • Describe procedures for sharing information related to human trafficking with a patient​​​

What is Human Trafficking?
The United Nations defines human trafficking as:
“The recruitment, transportation, transfer, harboring or receipt of persons, by means of the threat or use of force or other forms of coercion, of abduction, of fraud, of deception, of the abuse of power or of a position of vulnerability or of the giving or receiving of payments or benefits to achieve the consent of a person having control over another person, for the purpose of exploitation.”

San Francisco is considered a prime destination for human trafficking due to its ports, airports, industry, and rising immigrant populations. Human trafficking is the second largest and fastest growing criminal industry in the world with as many as 27 million individuals living in slavery-like conditions throughout the world.  

Types of Human Trafficking
The 3 most common types of human trafficking are sex trafficking, forced labor, and debt bondage. Forced labor, also known as involuntary servitude, is the biggest sector of trafficking in the world, according to the U.S. Department of State. Debt bondage is another form of human trafficking in which an individual is forced to work in order to pay a debt.

Sex trafficking disproportionately affects women and children and involves forced participation in commercial sex acts. In the United States, any child under the age of 18 who has been involved in a commercial sex act is considered a trafficking victim. Women and girls make up 80% of the people trafficked transnationally.

Yearly, traffickers exploit 1 million children in the commercial sex trade.
Perceptions of human trafficking often involve women forced into prostitution. This is just one aspect of human trafficking. Survivors of trafficking also include men and children, and these survivors are exploited by any number of means.

Victims may be forced into any of the following types of labor, among others:

Domestic servitude 
• agricultural work
• manufacturing
• janitorial services
• hotel services
• construction
• health and elder care
• hair and nail salons
• prostitution
• strip club dancing

Some survivors are “mail-order” brides who believe they are going to a new country for marriage, but instead are enslaved.  All nationalities and ethnic groups are vulnerable to human trafficking. Any given country may be a source of forced labor, a place of transit, or a destination. 

The Needs of Survivors of Human Trafficking
Survivors of human trafficking are forced, tricked or misled into modern-day slavery.  If they are able to escape a shrouded abduction and hidden enslavement, they have specific needs that are unique to their situation. Survivors may have experienced profound trauma, lack linguistic skills in the country of their escape, and struggle with basic functioning after trafficking.  The United Nations, and the United States government are all committed to meeting the unique needs of human trafficking survivors, with the aim of ending this particularly heinous crime once and for all.  

Signs of HumanTrafficking
A person who has been trafficked may:

  • Show signs that their movement is controlled
  • Have false identity or travel documents
  • Not know their home or work address
  • Have no access to their earnings
  • Be unable to negotiate working conditions
  • Work excessively long hours over long periods
  • Have limited or no social interaction
  • Have limited contact with their families or with people outside of their immediate environment
  • Think that they are bonded by debt
  •   Examples of Human Trafficking
    Forced Labor: A family gives up a child to an adoption agent in Nepal because they cannot afford to care for him. He is then, in turn, sold to a sweatshop owner who forces the child to learn to sew garments without pay for hours each day. The child receives minimal nutrition and does not attend school.
    Sex Trafficking: Two women from Korea are brought into San Francisco under the pretense that they will receive jobs as hostesses or waitresses. When they arrive, they are held captive and forced into prostitution, while their captor controls the money they receive. 
    Debt Bondage: A young woman from Russia has amassed grave credit card debt and is desperate to pay it off. A man who identifies himself as an employment agent offers her a job in the United States as a domestic employee.  She arrives in the San Francisco with a valid visa but it and her passport and taken from her. She is brought to a home where her movement is restricted. She is then told that she must work as a housekeeper to pay off the cost of her travel or her family will be killed.
    Child Sex Trafficking: A 15-year-old boy runs away from his home in San Francisco to Oakland, where he lives on the street. He is seduced by a pimp who coerces him into participating in a prostitution ring and controls all the profits generated.  

Victims and Assistance

Sex trafficking is a modern-day form of slavery in which a commercial sex act is induced by force, fraud, or coercion, or in which the person induced to perform such an act is under the age of 18 years. Enactment of the Trafficking Victims Protection Act of 2000 (TVPA) made sex trafficking a serious violation of Federal law. The TVPA also recognizes labor trafficking, which is discussed in a separate fact sheet.
As defined by the TVPA, the term ‘commercial sex act’ means any sex act on account of which anything of value is given to or received by any person.

The TVPA recognizes that traffickers use psychological and well as physical coercion and bondage, and it defines coercion to include: threats of serious harm to or physical restraint against any person; any scheme, plan, or pattern intended to cause a person to believe that failure to perform an act would result in serious harm to or physical restraint against any person; or the abuse or threatened abuse of the legal process.

Victims of Sex Trafficking and What They Face

Victims of sex trafficking can be women or men, girls or boys, but the majority are women and girls. There are a number of common patterns for luring victims into situations of sex trafficking, including:

  • A promise of a good job in another country
  • A false marriage proposal turned into a bondage situation
  • Being sold into the sex trade by parents, husbands, boyfriends
  • Being kidnapped by traffickers

Sex traffickers frequently subject their victims to debt-bondage, an illegal practice in which the traffickers tell their victims that they owe money (often relating to the victims’ living expenses and transport into the country) and that they must pledge their personal services to repay the debt.

Sex traffickers use a variety of methods to “condition” their victims including starvation, confinement, beatings, physical abuse, rape, gang rape, threats of violence to the victims and the victims’ families, forced drug use and the threat of shaming their victims by revealing their activities to their family and their families’ friends.

Victims face numerous health risks. Physical risks include drug and alcohol addiction; physical injuries (broken bones, concussions, burns, vaginal/anal tearings); traumatic brain injury (TBI) resulting in memory loss, dizziness, headaches, numbness; sexually transmitted diseases (e.g., HIV/AIDS, gonorrhea, syphilis, UTIs, pubic lice); sterility, miscarriages, menstrual problems; other diseases (e.g., TB, hepatitis, malaria, pneumonia); and forced or coerced abortions.

Psychological harms include mind/body separation/disassociated ego states, shame, grief, fear, distrust, hatred of men, self-hatred, suicide, and suicidal thoughts. Victims are at risk for Posttraumatic Stress Disorder (PTSD) – acute anxiety, depression, insomnia, physical hyper-alertness, self-loathing that is long-lasting and resistant to change (complex-PTSD).

Victims may also suffer from traumatic bonding – a form of coercive control in which the perpetrator instills in the victim fear as well as gratitude for being allowed to live.

Types of Sex Trafficking

Victims of trafficking are forced into various forms of commercial sexual exploitation including prostitution, pornography, stripping, live-sex shows, mail-order brides, military prostitution and sex tourism. Victims trafficked into prostitution and pornography are usually involved in the most exploitive forms of commercial sex operations. Sex trafficking operations can be found in highly-visible venues such as street prostitution, as well as more underground systems such as closed-brothels that operate out of residential homes. Sex trafficking also takes place in a variety of public and private locations such as massage parlors, spas, strip clubs and other fronts for prostitution. Victims may start off dancing or stripping in clubs and then be coerced into situations of prostitution and pornography.

Assistance for Victims of Sex Trafficking

When victims of trafficking are identified, the U.S. government can help them adjust their immigration status, and obtain support and assistance in rebuilding their lives in the United States through various programs. By certifying victims of trafficking, the U.S. Department of Health and Human Services (HHS) enables trafficking victims who are non-U.S. citizens to receive Federally funded benefits and services to the same extent as a refugee. Victims of trafficking who are U.S. citizens do not need to be certified to receive benefits. As U.S. citizens, they may already be eligible for many benefits.

Through HHS, victims can access benefits and services including food, health care and employment assistance. Certified victims of trafficking can obtain access to services that provide English language instruction and skills training for job placement. Since many victims are reluctant to come forward for fear of being deported, one of HHS’ most important roles is to connect victims with non-profit organizations prepared to assist them and address their specific needs. These organizations can provide counseling, case management and benefit coordination.

If you think you have come in contact with a victim of human trafficking, call the National Human Trafficking Resource Center at 1.888.373.7888. This hotline will help you determine if you have encountered victims of human trafficking, will identify local resources available in your community to help victims, and will help you coordinate with local social service organizations to help protect and serve victims so they can begin the process of restoring their lives.

Factors that place a person at greater risk of being a victim of human trafficking

Though there is no standard profile of a child-trafficking victim, several risk factors make certain children more susceptible. Reports indicate that traffickers often target children and youths with a history of sexual abuse, dating violence, low self-esteem, and minimal social support.

Runaway and homeless youths—male, female, and transgender—are at particularly high risk for becoming victims, though some trafficked youths continue living at home and attending school. There is also a strong correlation between sexually exploited youths and childhood sexual abuse, chronic maltreatment and neglect, and otherwise unstable home environments. Research findings estimate that between 33 and 90 percent of victims of commercial child sexual exploitation have experienced these types of abuses.3 Evidence also suggests that lesbian, gay, bisexual, or transgender (LGBTQ) youths can be up to five times more likely than heterosexual youths to be victims of trafficking due to the increased susceptibility that comes with the feelings of rejection and alienation that are often experienced by LGBTQ youths.

Possible risk factors associated with child trafficking include the following:
•lack of personal safety
•emotional distress
•family dysfunction
•substance abuse
•mental illness
•learning disabilities
•developmental delay
•childhood sexual abuse
•promotion of sexual exploitation by family members or peers
•lack of social support

Social workers who provide services to these victims indicate that feelings of isolation and abandonment are often reported but that the lack of a support network increases the vulnerability to trafficking. It is important to note that many teenage girls may be at risk of being recruited into the commercial sex industry simply by virtue of their normal maturation process. Wanting to take risks, feeling misunderstood by parents, and seeking romantic relationships can increase girls’ susceptibility to the recruitment tactics of sex traffickers or pimps. Findings also suggest that low self-esteem accompanies school failure for girls, and the resulting sense of a lack of self-worth may make them more vulnerable to recruitment.

However, once a student is victimized, identifying him or her can prove difficult for a variety of reasons: (1) the student’s reluctance to disclose the problem due to a sense of shame and fear; (2) the stigma associated with forced prostitution; (3) the power and control of the trafficker’s seduction and manipulation; and (4) the student’s inability to recognize that he or she is a victim and, therefore, is unwilling to seek help.

Possible behavioral indicators of a child sex trafficking victim include, but are not limited to, the following:

•an inability to attend school on a regular basis and/or unexplained absences
•frequently running away from home
•references made to frequent travel to other cities
•bruises or other signs of physical trauma, withdrawn behavior, depression, anxiety, or fear
•lack of control over a personal schedule and/or identification or travel documents
•hunger, malnourishment, or inappropriate dress (based on weather conditions or surroundings)
•signs of drug addiction
•coached or rehearsed responses to questions
•a sudden change in attire, behavior, relationships, or material possessions (e.g., expensive items)
•uncharacteristic promiscuity and/or references to sexual situations or terminology beyond age-specific norms
•a “boyfriend” or “girlfriend” who is noticeably older and/or controlling
•an attempt to conceal scars, tattoos, or bruises
•a sudden change in attention to personal hygiene
•tattoos (a form of branding) displaying the name or moniker of a trafficker, such as “daddy”
•hyperarousal or symptoms of anger, panic, phobia, irritability, hyperactivity, frequent crying, temper tantrums, regressive behavior, and/or clinging behavior
•hypoarousal or symptoms of daydreaming, inability to bond with others, inattention, forgetfulness, and/or shyness

Additional behavioral indicators for labor trafficking include the following:

•being unpaid, paid very little, or paid only through tips
•being employed but not having a school-authorized work permit
•being employed and having a work permit but clearly working outside the permitted hours for students
•owing a large debt and being unable to pay it off
•not being allowed breaks at work or being subjected to excessively long work hours
•being overly concerned with pleasing an employer and/or deferring personal or educational decisions to a boss
•not being in control of his or her own money
•living with an employer or having an employer listed as a student’s caregiver
•a desire to quit a job but not being allowed to do so

Hotline for Reporting

The National Human Trafficking Hotline supports victims and survivors, friends and family, law enforcement, service providers, government, professionals, practitioners and advocates in the human trafficking and related fields, community groups, and more through the following services:

  • Crisis assistance to victims of human trafficking
  • Report a human trafficking tip
  • Connect with anti-trafficking services in your area
  • Access general information and resources
  • Get involved in your community

The National Human Trafficking Hotline serves the United States and U.S. territories. Anyone in need of assistance and/or information and resources related to the issue of human trafficking can contact the National Hotline and access our services.
We encourage you to contact the hotline if you are a:

  • Victim or survivor of human trafficking
  • Someone who knows a potential victim of trafficking or has information about a potential trafficking case
  • Friend or family member of a trafficking victim or survivor
  • Social or legal service provider
  • Local, state, or federal law enforcement
  • Human trafficking task force or coalition
  • Practitioner or advocate in human trafficking and related fields
  • Frontline professional (e.g. educators, medical professionals)
  • Policymaker or government agency

Hotline calls are answered live, 24 hours a day, 7 days a week, by specially trained and experienced English and Spanish-speaking Anti-Trafficking Hotline Advocates. All Anti-Trafficking Hotline Advocates have undergone extensive training and evaluation prior to answering Hotline calls.

Your call will be answered live by a specially trained Anti-Trafficking Hotline Advocate. Spanish speaking Anti-Trafficking Hotline Advocates are available and for all other languages, the Anti-Trafficking Hotline Advocate will conference you in with a tele-interpreting service and continue the call in your preferred language. All communication with the National Human Trafficking Hotline is strictly confidential. You do not need to provide your name or any identifying details about your situation unless you are comfortable doing so.

The Anti-Trafficking Hotline Advocate will ask questions to ensure that you are safe (if applicable) and determine what type of assistance you are looking for and how we can help. Once any immediate safety concerns have been addressed (if applicable), the Anti-Trafficking Hotline Advocate is there to listen and discuss what options are available to you, based on your unique situation and needs.

If you are reporting a tip or seeking services, the Anti-Trafficking Hotline Advocate may conduct a brief assessment of trafficking indicators. For requests for services, the Anti-Trafficking Hotline Advocae will also need to ask you some details about yourself such as your age, gender, nationality and status in the U.S., preferred language, and location. This information will only be used to help us locate appropriate services in your area. The National Hotline serves all victims and survivors of human trafficking regardless of race, ethnicity, gender, gender identity, age, religion, national origin, sexual orientation, disability, or any other factor protected by local, state, or federal law. It is always up to the caller how much information you wish to provide.

The Anti-Trafficking Hotline Advocate may follow up by:

  • providing safety planning recommendations and general emotional support,
  • referring or connecting you directly to local social and/or legal services,
  • making a report to our law enforcement contacts,
  • providing technical assistance and resources.

The Anti-Trafficking Hotline Advocate will not take any action without your consent, except in circumstances where we suspect child abuse or if we have reason to believe there is imminent harm to you or others. If you just want to talk, we are here to listen.

The National Hotline is not a government entity. We are not law enforcement, immigration or an investigative agency. We are not a direct victim service provider. We help individuals access direct services through our extensive referral network and we facilitate reporting of potential human trafficking tips to specialized law enforcement agencies.

The National Human Trafficking Hotline handles reports of potential labor and sex trafficking situations, involving adults and minors, foreign nationals and US citizens, males, females, and transgender individuals. Tips may be made anonymously. 

 Each tip is unique and reporting decisions are made on a case-by-case basis to determine the most appropriate next steps that prioritize the safety and consent of individuals involved in the case. Every case received through the Hotline, email, or online tip report is individually reviewed and evaluated by a Supervisor to determine whether it should be passed on to an appropriate local, state, or federal investigative and/or service agency equipped to investigate the tip and/or respond to the needs of the potential victim. 

The nature of the response to a potential trafficking tip depends on the urgency of the situation, the unique needs and wishes of the victim (if known), the specificity of the information provided, the presence of indicators of severe forms of trafficking in persons, relevant state and/or federal laws, and the referral and reporting protocols established between the National Hotline and the local actors in a given area.
The National Hotline is not a law enforcement or an investigative agency. If a case is reported to law enforcement, the National Hotline cannot provide updates on the status of the case. If you receive additional information about the case, contact the National Hotline again and we can send a supplemental report to law enforcement.

The National Human Trafficking Referral Directory is a comprehensive, one-of-a-kind directory developed for the purpose of providing access to critical emergency, transitional, and long-term social service referrals for victims and survivors of human trafficking, reporting cases of potential human trafficking to specialized law enforcement and government agencies, and connecting individuals with training and technical assistance and opportunities to get involved in their communities. The directory includes direct service providers that have a designated mandate, program, staff member, and/or funding to provide social and/or legal services to victims of human trafficking, as well as indirect service that have a specific organizational or programmatic focus on the issue of human trafficking. The online directory covers all 50 states, the District of Columbia and U.S. territories. Organizations have opted-in to make their organization’s profile publicly searchable via the online directory. More information on the directory, including minimum inclusion criteria,. 

The National Human Trafficking Referral Directory does not include all available service providers and referrals. The National Hotline has also developed a robust internal directory of service providers, law enforcement, government agencies, task forces, coalitions and other organizations, individuals and collaborative initiatives working to combat human trafficking. National Hotline staff maintain regular contact with the organizations included in the directory to ensure that referrals are up-to-date, confirm referral protocols, stay informed of local anti-trafficking developments, follow up on the outcomes of referrals, and address any issues/questions that may arise. The internal directory contains more than 3,000 unique records and is accessible only to Hotline staff for the purposes of coordinating victim service referrals across a variety of fields, and making reports of potential human trafficking to specialized law enforcement and government agencies. 

Assessment Tools for Identifying a Human Trafficking Victim


The following document contains questions that can be used to assess a client for potential signs that she/he has been a victim of
human trafficking. The suggestions and indicators below are not exhaustive or cumulative in nature and each question taken alone
may not indicate a potential trafficking situation. Assessment questions should be tailored to your program and client’s specific needs.


As with any assessment of a victim of crime, there are some general points to be aware of when evaluating aclient’s needs. Listed below are general tips for conducting an assessment with a potential victim of trafficking.Please note that throughout this assessment the term “controller” is used generally to describe the potential trafficker or the person(s) who maintain(s) control over the potential victim(s).


Conduct the assessment in a comfortable and safe environment. If you are in a police station or in a
place where the physical space/conditions are limiting, attempt to create an environment that is as
calming and positive as possible.

Provide the individual with space when speaking with them.

Be relaxed and use an approachable tone, demeanor, and body language. Ask yourself the question “To
what degree does my present posture communicate openness and availability to the client”?

Use empathic listening. Empathic listening centers on being attentive, observing, and listening in order to
understand the client’s situation without making judgments.

While you engage in empathic and reflective listening make sure you are maintaining good eye contact
with the client. Good eye contact is another way of conveying “I want to hear what you have to say”.

If at all possible, try not to take notes and instead engage in active listening and write your notes
immediately following the meeting with the client. If note taking is necessary, let the individual know why
you need to write notes and for what purposes they may be used.

Be clear about your role and goals, and about the services that your agency can and cannot provide.

Explain why you care about the individual’s situation and that you have worked with and assisted other
individuals in situations that may be similar to his/her own. Explaining who you are and why you are
there is particularly important to correct any misperceptions of your role.


When appropriate, attempt to engage in casual conversation about lighter topics and ask questions to try
to get the individual to open up, even if it’s not about their trafficking situation or service needs.
Although the client might be confused, scared and/or distracted, engaging in casual conversation before
the assessment helps to build trust and set the tone for effective, non-defensive communication.

n your initial assessment, try to focus predominantly on assessments of their service needs, but weave in
other questions naturally and when appropriate.

It is often useful to start with questions that ascertain the lesser degrees of control before moving onto
the more severe methods of control.

Example: Inquiring about living or working conditions may be an easier topic to tackle initially
than directly inquiring about physical or sexual abuse that the victim may have sustained.

Be conscious of the language that you use when speaking with a potential victim of trafficking. Mirroring
the language that the potential victim uses can be a helpful first step.

Example: If the potential victim refers to her controller as her boyfriend, referring to that person
as a “pimp” or a “sex trafficker” may have a negative impact. Although these are terms that can
be used for controllers in the commercial sex industry, the potential victim may not identify this
person in this way.

The phrasing of all questions included in this assessment should be changed, amended or revised
to fit the client and context you are in.

It is also important to conduct assessments in a potential victim’s native language whenever possible.

Use trained interpreters sensitive to the nature of the crime and who are not in any way tied to
the potential victim or the potential trafficker’s community of origin.

Ensure that the interpreter is introduced and their role is fully explained.


Keep in mind that many victims do not self-identify as “human trafficking victims” due to a lack of
knowledge about the crime itself and the power and control dynamics typically involved in human
trafficking situations.

Be conscious of the fact that an individual in a trafficking situation has typically been conditioned by their
trafficker not to trust law enforcement and/or service providers.

Be aware of power dynamics when a third party is accompanying or interpreting for a potential victim.
Try to speak to the potential victim alone or secure an outside interpreter.

Be aware that canned stories are common and that the true story may not emerge until trust has been
built with the potential victim after multiple meetings.

Each client is going to tell his/her story differently and no client will present all of the elements of their
trafficking situation in a neat package.

It is imperative that the assessor remain flexible and prioritize the client’s needs and safety as the primary
reason for the assessment.


Be sure to conduct a safety check if the individual has recently exited the situation or if they are still in the

Is it safe for you to talk with me right now? How safe do you feel right now? Are there times when you
don’t feel safe?

Do you feel like you are in any kind of danger while speaking with me at this location?

Is there anything that would help you to feel safer while we talk?

If speaking with the individual over the phone:

Are you in a safe place? Can you tell me where you are?

Are you injured? Would you like for me to call 911/an ambulance?

If someone comes on the line, what would you like for me to do? Hang up? Identify myself as someone
else, a certain company/person/friend?

Also remind the individual to feel free to hang up at any point during the conversation if they believe that
someone may be listening in.

How can we communicate if we get disconnected? Would I be able to call you back/leave a message?
Would you prefer to call me back when you are in a safe place?


The following questions could be applicable to both situations of sex and labor trafficking. Please note that the
order listed is not intended to indicate the order in which the questions should be asked. The type and order of
questions should be tailored to a given situation and should be amended to react effectively and supportively to
the client.


How did you meet this person/find out about your job?
What were you told about the job before you started/what promises were made about the relationship?

Did your experience meet your expectations?

Do you feel you were ever deceived about anything related to your job/your relationship?

Did anything surprise you about this job/relationship?

Did conditions of your job/relationship change over time?

Were you ever forced to sign a contract that you didn’t understand or didn’t want to sign? Were the
contents of this contract used as a threat against you?

Did you feel like you understood your rights in this job/situation? Did you ever feel like anyone kept
you from accessing information about your rights?


Did you ever feel pressured to do something that you didn’t want to do or felt uncomfortable doing?

What were your expectations of what would happen if you left this person/situation or if you didn’t do
what this person told you to do?

Did anyone ever take/keep your legal papers or identification for you, such as your passport, visa,
driver’s license, etc.?

Did anyone ever threaten you or intimidate you?

What did this person tell you about what would happen if you were arrested/encountered an immigration

Did you ever see something bad happen to someone else who didn’t do something that was expected of
them? What happened to them? How did that make you feel?

Did you ever feel that if you left the situation, your life would become more difficult?


Did you have access to any money/the money you earn? Did anyone take your money or a portion of
your money? Did anyone hold your money for “safe keeping”

If the money you earned was kept in a bank account, who set up this bank account? Did anyone else
beside you have access to the account?

Were you required to make a certain amount of money every day/ week? Why did you feel that you had
to meet that amount? What did you think would happen if you didn’t make that much money?

Did you have fees that you had to pay to someone? How much money did you have left after you paid
everything you needed to pay? Could you spend the money the way you wanted to?

Did you owe any money to anyone in the situation? If so, who did you owe money to and why?
How did you incur this debt? How long have you had the debt? Did you debt increase overtime?
Did you feel that it was difficult to pay off your debt? Why?

What did you think would happen to you or other people in your life if you didn’t pay off your debt?


Did someone control, supervise or monitor your work/your actions?

Was your communication ever restricted or monitored?

Were you able to access medical care?

Were you ever allowed to leave the place that you were living/working? Under what conditions?

Was your movement outside of you residence/workplace ever monitored or controlled?

What did you think would have happened if you left the situation? Was there ever a time when you
wanted to leave, but felt that you couldn’t? What do you think would have happened if you left without
telling anyone?

Did you feel that it was your only option to stay in the situation?

Did anyone ever force you to do something physically or sexually that you didn’t feel comfortable doing?

Were you ever physically abused (shoved, slapped, hit, kicked, scratched, punched, burned, etc.) by

Were you ever sexually abused (sexual assault/unwanted touching, rape, sexual exploitation, etc.) by

Did anyone ever introduce you to drugs, medications as a method of control?


The following questions could be applicable in sex trafficking situations in general and are not specific to a
certain type of network or controller.

Did anyone ever pressure you to engage in any sexual acts against your will?

Did anyone ever take photos of you and if so, what did they use them for? Were these photos ever sent
to other people or posted on an online forum (Craigslist, Backpage, Myspace)?

Did anyone ever force you to engage in sexual acts with friends or business associates for favors/money?

Did anyone ever force you to engage in commercial sex through online websites, escort services, street
prostitution, informal arrangements, brothels, fake massage businesses or strip clubs? [See network
specific questions at end of document]

Were you required to earn a certain amount of money/meet a nightly quota by engaging in commercial
sex for someone? What happened if you did not meet this quota?

[For women only] Did anyone force you to continue to engage in commercial sex when you were on
your period? Were you ever asked or told to use anything that would prevent the flow of menstruation?

How old were you when you were in this situation? Did you ever see any minors (under 18 years old)
involved in commercial sex?

Were you ever transported to different locations to engage in commercial sex? Where were you taken and
who transported you?
Who decided whether or not you used a condom during sex acts?


How did you feel about where you worked? How did you feel about your employer/supervisor/crew
leader/or other controller?

Did you feel that you were paid fairly at this job?

What were your normal work hours? How many hours did you have to work each day?

What happened if you worked fewer hours or took breaks?

Did anyone ever threaten you if you indicated you did not want to work the hours expected of you?

Did you have to live in housing provided by the controller? What were the conditions like in this

Did you have to pay a fee to the controller in order to stay in this housing?

Did the controller ever promise to secure, renew or pay for your legal documents or work visa?

What were your weekly/monthly expenses to the controller?

Did the controller provide transportation to the work site? What did this look like?


The assessment questions below may be used to supplement the general trafficking questions where a particular type of trafficking has already been identified. These questions are not comprehensive and should be included as a part of the general trafficking assessment above.


Did you have days off? Were you able to leave the house on your days off? Were you ever expected to
complete work on your days off (still provide childcare, complete household chores before leaving, etc.)?

Were you ever able to leave the home to run errands, transport children to school or go to church? Were
you monitored or timed when you left the home for these things?

Did you have your own room in the home? Where did you sleep?

Did you have consistent access to food? Were you ever made to go without food?

Did you have access to medical care while you lived in the home?

What were your tasks in the home (childcare, cleaning, cooking, etc.)? How many hours did you work
during the day or night?

Were you allowed to communicate with your family/friends while you lived in the home?

Are you afraid that your controller might harm your family back in your hometown?

Did the controller ever force you to engage in sexual acts against your will at any time they requested it?

What did you think would happen if you refused to do this? [Personal Sexual Servitude]


How did you meet your [boyfriend/pimp/controller]?

Did the controller have a nickname, street name or alias?

Did the controller insist that you adopt a street name, nickname or alias?

Did the controller move you around to different locations? If so, how did you travel? How often?

Did the controller make you get a tattoo with his name, a phrase or symbol or mark you in any other way
(branding, etc.)? What did the tattoo or other mark mean to you/the controller?

How were the commercial sexual services advertised? Where did it take place?

Were you ever physically hit or slapped by the controller or anybody else? Can you tell me about a time
when that happened?

Did you ever see any other person being physically hit by the controller or anybody else? Can you tell me
about a time when that happened?

Did the controller compel multiple people to engage in commercial sex? What were their ages?

How were others recruited? Through the controller or through other victims? Were there specific
locations (bus-stops, shelters, etc.) that individuals were recruited from? Were you ever asked to recruit
other people?

Was there any other criminal activity present (gangs, drugs, theft, money laundering etc.)?


In the following questions, the term “partner” refers to an intimate partner which could be a dating relationship,
domestic partnership and/or marital relationship. The term “family member” refers to any relative, whether
immediate family or extended family member.

Sex Trafficking

Did your partner/family member ever ask you to engage in commercial sexual acts in order to “help the
relationship/the family”?

Did your partner/family member ever force you to engage in commercial sexual acts with friends or
business associates for favors/money?

Did your partner/family member ever force you to engage in commercial sex through online sites, escort
services, street prostitution, strip clubs, truck stops, fake massage businesses or residential brothels?

Did your partner/family member ever threaten you or abuse you if you indicated that you did not want
to engage in commercial sex or did not do what this person asked of you?

Did your partner/family member ever withhold financial support or restrict access to your children?

Labor Trafficking

Did your partner/family member ever force you to work inside or outside of the home for excessive
amounts of time?

Were you able to access the money that you earned from working outside the home?

Did your partner/family member ever force you to engage in sexual acts against your will at any time they
requested it? What did you think would happen if you refused to do this? [Personal Sexual Servitude]

Were you ever able to leave the home to run errands, transport children to school or go to church? Did
your partner/family member monitor or time you when you left the home for these things?

What were your tasks in the home (childcare, cleaning, cooking, etc.)? How many hours did you work
during the day or night?

Did your partner/family member ever punish you for not working or not completing domestic work?
For example, have your meals restricted?

Did your partner/family member ever threaten you or abuse you if you indicated that you did not want
to work or did not do what this person asked of you?


Did you live in the establishment where you worked?

If yes - Were you ever allowed to leave without being monitored?

If no - Were you transported to and from the place that you lived and the residence? Were you
monitored at the place that you lived?

Were you rotated to different establishments? How often were you moved?

What type of commercial front did the establishment have? How did they advertise their services? What
were their hours of operation?

Were there multiple controllers or was there one central controller?

How many individuals were compelled to engage in commercial sex at the establishment? What were
their ages?

How many times a day were you and these other individuals made to engage in commercial sex?

Where did the commercial sex take place? In the establishment itself, in a back room, or in an off-site

What were the demographics of the customers/Johns at the establishment?

Did customers/Johns of the establishment pay you directly or pay a controller? Was there a token

Did you receive tips directly from customers/Johns of the establishment? Were you able to keep these
tips? Could you spend the money the way you wanted to?

Did you have to pay a fee for your housing, management, food or transportation to anyone?

Did the establishment have a security camera or monitoring device? Did this make you feel like you
couldn’t leave?

Were the windows or doors of the establishment covered or blacked out?

Was there any other criminal activity present at the establishment (gangs, drugs, money laundering etc.)?


Did you live in the residence where you worked?

If yes, were you ever allowed to leave without being monitored?

If no, were you transported to and from the place that you lived and the residence? Were you
monitored at the place that you lived?

Were you rotated to different residences? How often were you moved?

Were there multiple controllers or was there one central controller?

How many individuals were compelled to engage in commercial sex at the establishment? What were
their ages?

How many times a day were you and these other individuals made to engage in commercial sex?

What were the demographics of the customers/Johns at the establishment?

Where did the commercial sex take place? Did it take place in the same place where you and others were
made to sleep?

Did customers/Johns of the establishment pay you directly or pay a controller? Was there a token

Did you receive tips directly from customers/Johns that came to the residence? Were you able to keep
these tips? Could you spend the money the way you wanted to?

How did the controllers advertise the commercial sexual services?

If through cards, what do the cards say? How do people get the cards? Are cards only given to
certain types of people (males versus females, only certain nationalities, etc.)?

Was there a specific procedure for entering the establishment (e.g. calling a number from outside)?

Did the residence have a security camera or someone watching the door? Did this make you feel like you
couldn’t leave the residence?

Human Trafficking CEU, Continuing Education course for Florida Nurses.

Was there any other criminal activity present at the establishment (gangs, drugs, money laundering etc.)?


Did you have a crew leader? What kind of role did she/he play in your day-to-day work activities?

Did you have the appropriate tools needed for the job you are doing? Were the tools in good condition?

Did you have to pay a fee in order to use these tools?

Were you exposed to pesticides or other chemicals while on the job?

Did you work in fields while they were being sprayed with pesticides or soon after the spraying
took place?

oWere you provided with gloves/masks as necessary when working with such chemicals?

Did you ever get injured at work? If so, were you permitted to seek medical attention?

Were you paid on a piece-rate basis depending on how much crop you harvest each day, or were you paid
a fixed sum of money?

How did you get to the work-sites? Were the vehicles safe and in good condition? Were the drivers safe
or reckless? Did you have to pay a fee for this transportation?

If you traveled with the company/employer/crew, were you always made aware of each location you
would be going to and how long you would be there?

Did you get paid for related tasks such as clearing land, loading, time traveled to work sites, spraying
fields with pesticides?

Did you have access to basic facilities at the work-sites?

Did you have to purchase your basic necessities directly from the employer? Did the prices of these
items seem unusually high? Did this create additional debt to your employer?

Did anyone ever say verbally abusive things to you (such as calling you names, making inappropriate or
sexual remarks to you)?

Florida Human Trafficking Continuing Education course to meet state requirements. Florida Board of Nursing Approved course with CE Broker reporting.


What were your hours like at your job?

Did you live on-site or with any of the other people you worked with?

Were you able to take regular breaks to eat, use the bathroom, or drink water?

Were you told you could only eat left-over food from the meals being prepared in your workplace?


If you traveled with a sales crew, were you made aware of each location you would be going to and how
long you would be there?

Where did you sleep while traveling with the sales crew? Did you have your own space or did you have
to share with others in the crew?

Did you have to meet a daily quota for your sales? Were there consequences or threats of consequences
if you did not meet the quota?

Were your meals ever restricted if you didn’t meet this daily sales quota? How often did you eat and how
did you pay for your meals?

Were you provided a daily stipend by anyone while selling the items? Were you allowed to spend this
however you wanted to?

Did the crew always ensure that you had a valid sales permit? Were you ever arrested for soliciting
without a permit?

Was there other illegal activity (drug use, alcohol use by minors, scams involving product sales, etc.)
occurring? Were you ever pressured to participate?

Did the crew leaders/managers ever sexually assault or harass individuals working on the sales crew?

Did anyone ever threaten to abandon you if you did not do what was expected of you?

Procedures for sharing information related to human trafficking with a patient

Maintaining Confidentiality

Key Terms

Privacy: It is a victim’s right to control disclosure of his or her story and personal information. Maintaining privacy may directly reduce the chances of revictimization.

Confidentiality: The rules prohibiting the disclosure of victim information.

  • Limits the disclosure of information without the victim’s consent.
  • Requires victim service providers to disclose any limits to confidentiality to the victim.

Privilege: Communications between certain professionals and victims as defined by statutes.

  • Is generally not privileged if overheard by a third party.
  • Varies by state.

Human trafficking victims have pronounced interests in privacy as do the organizations and task forces that serve them. For human trafficking victims, the need for autonomy and control over her/his body, the private details of her/his life, and the decisions that must be made relative to the crime (including whether and how to assist with a criminal prosecution of their trafficker) are often essential to recovery. Safety from future exploitation is also a real concern.

Laws designed to protect confidentiality and/or establish privilege are complex. Federal confidentiality laws and state confidentiality laws vary. Protecting victims requires understanding relevant privacy rules and regulations, evidentiary privileges, state and federal statutes, state and federal constitutional rights (including crime victims’ rights amendments), and the unique status of minors, persons with disabilities, or other potential classes of victims.

The Importance of Privacy and Confidentiality

The concept of privacy is broader than either confidentiality or privilege. All people have an interest in protecting their own privacy. People choose what personal information they reveal to their friends, neighbors, and professional acquaintances on a daily basis. Privacy laws (such as the Fair Credit Reporting Act) limit access to private information, such as banking and tax information, and apply broadly.

Confidentiality is a more limited concept that describes the laws, rules, and regulations that prohibit certain professionals from disclosing information that can be used to identify the individuals they serve. Confidentiality protects a broad range of information, including the identity of clients, medical records, immigration status, and other information.

Confidentiality rules can be found in professional ethics requirements (for attorneys, medical professionals, social workers, and law enforcement among others), grant funding requirements, and agency policies and procedures, among other places.

Privilege is a very specific legal protection that limits what information can be shared within a court proceeding. Each state specifies which professionals or relationships have privilege protections (most common are spouses, lawyers, doctors, and therapists), what information can be protected by privilege, and how privilege can be waived.

Sharing personal information without informed consent can be a violation of professional ethics for the provider and traumatizing for the victim. Confidentiality helps the victim feel safe when reporting crimes to police, receiving medical attention, or working with a service provider. It encourages victims to disclose information that may make them uncomfortable, embarrassed, or fearful; however, confidentiality is limited by policies and practices that are unknown to the victims. Victims often disclose their experiences to a victim service provider because of presumed confidentiality; however, there are several exceptions to confidentiality, which need to be taken into consideration before discussing the scope of confidentiality that can be guaranteed to a victim. It is very important for a task force to have clear outlines as to how confidentiality of data will be managed and maintained on all levels, and for all members of the task force to understand the policies, procedures, and ethical requirements that guide the other members.

Exceptions to Confidentiality

Additional Information and Training Resources:

There are limited exceptions to confidentiality and privilege protections. They are briefly noted below, but providers and law enforcement need to understand the specific rules, policies, and procedures that apply to their position within their organization. Revealing confidential information should never be done lightly and without a clear intention. Improper releases can be a violation of state or federal law.

  • Signed release. Victims can choose to permit the release of confidential and/or privileged information. Service providers and law enforcement should work to create Release Forms that allow limited information sharing that will be beneficial for the victim. Forms should include notification to the victim that the release can be revoked at any time and should describe the type of information to be shared and the purpose.
  • State mandatory reporting laws for child or vulnerable adult abuse. If you are a mandatory reporter of abuse of children and vulnerable adults in your state, there is no requirement to obtain a release when reporting information. It is necessary to notify the victim at the onset of your service provision that you are a mandated reporter and what areas require a report. If you have questions about mandatory reporting, check with your supervisor or your agency’s attorney.

State laws requiring a Duty to Warn. Some states require service providers to report a client’s detailed and specific plans to harm themselves or another person to the police or the intended victim of a threat of harm. In that case, the report would be an exemption to the confidentiality requirements.

Referral options for legal and social services 

Comprehensive Victim Services
There are a variety of different types of services that need to be explored when responding to victims of human trafficking. One key source of assistance that is often overlooked for victims of human trafficking is the Victims of Crime Act (VOCA) crime victim compensation programs. These programs, available in every state and territory, reimburse victims for such crime-related expenses as medical costs, mental health counseling, funeral and burial costs, and lost wages or loss of support. Both U.S. citizens/legal permanent residents and foreign national victims are eligible; however, there are limitations based on residency, reporting of the crime, and time elapsed since the crime occurred, which makes it important to connect with the local VOCA administrator to learn more. In addition to resources available through VOCA (which will vary from state to state), the following subsections address some suggested areas of consideration in the development of a comprehensive service model to assist and respond to all victims of human trafficking.

Safe Housing Options
Finding adequate and appropriate emergency, transitional, and long-term housing is often the biggest service-related challenge that task forces face. Service providers explore a variety of options depending on the local resources and needs of the victims. Task forces should take an expansive view of the housing options in their communities and seek partnerships to meet the diverse needs of trafficking victims.
Domestic violence shelters are often a resource for trafficking victims; however, few have housing services for men. Some domestic violence shelters are unwilling to extend their services to trafficking victims due to safety concerns and because the specific needs of trafficking victims might not be addressed by their programs. Other shelter programs may be specifically designed for men, youth, or specific cultural community members. Task forces must take care to provide appropriate training and support to programs that are expanding to serve trafficking victims. Seeking technical assistance from shelters that have successfully dealt with issues of access and placement is a helpful way to inform discussions with potential shelter partners in advance of placement.

In order to create specific housing facilities for human trafficking victims, task forces are encouraged to work with, integrate, and bolster existing housing resources in creative ways. For example, shelters may be able to make space available for long-term placements for trafficked persons, or make a financial agreement to ensure that one bed is always available for a trafficking victim. Transitional or affordable housing programs may provide access to long-term housing to support victims in attaining their long-term goals. More than in any other service area, task force members must think outside the box to create safe and affordable housing solutions.
Below are some strategies that task forces have used to identify safe housing options for victims:

  • Establish a shelter point of contact (POC) for the task force. This person will be the main POC for victim service providers and law enforcement to contact when shelter needs are identified. Shelter partners and the task force shelter POC can establish an ongoing mechanism to update on availability of space. This will help streamline the referral process and ensure placement in an expedient manner.
  • Seek federal victim assistance. Emergency shelter funds are available from federal victim assistance programs through Immigration and Customs Enforcement's (ICE) Homeland Security Investigations (HSI) and the Federal Bureau of Investigation's (FBI) victim specialists for up to 30 days if there are no other resources available.
  • Seek crime victim compensation. Crime victim compensation programs are available in every state and territory and may be able to assist victims with the cost of emergency housing needs that result from their victimization.
  • Secure short-term immigration relief through law enforcement task force partners. Work closely with law enforcement partners to reduce barriers for victims in accessing housing. This includes law enforcement partners requesting Continued Presence for foreign national victims so that employment authorization can be obtained as soon as possible, minimizing the need for long-term fully subsidized housing.
  • Establish procedures for utilizing shelters, screening practices, and law enforcement involvement. This is an important responsibility for a task force to agree upon. Criteria should be established in choosing shelters as partners (including trauma-informed and client-centered practices), as many well-meaning but unskilled nonprofessionals offer shelter to victims. It is also important for service providers to keep an open mind and give victims the final choice. For example, one service provider was reluctant to partner with a state certified shelter that mandated participation in religious services as a condition of shelter; however, when offered as one choice of many housing options, the case manager found that some victims found this environment both acceptable and healing.
  • Create Memorandums of Understanding (MOU). A best practice is to create MOUs with as many different safe, qualified shelter and housing options as possible. This may include domestic violence shelters, youth shelters, faith-based housing, single apartments, and group homes are in various locations. Be transparent with victims about the realities of each situation so they are more invested, and therefore more likely to remain, in a safe place.
  • Conduct a screening assessment. Victim service providers need time to conduct a screening assessment before placing a victim in a shelter or other housing alternative. The task force should collaborate to ensure that the appropriate information is obtained to determine which of the available housing options will be most appropriate for victims. Placement choices may be disastrous if this does not occur.
  • Take into consideration short-term housing options for victims with a criminal history that may prohibit them from placement in other housing. For victims forced to commit a criminal act as part of their exploitation, a criminal history may prohibit their placement with many of the more routine housing options. Victims that are also fighting addiction and substance abuse are often prohibited from placement in most shelters, including trafficking shelters. The immigration status of foreign victims may also impact placement. Working with your victim services committee, it’s important to brainstorm and identify partnerships locally that will provide housing for these victims while you work toward addressing the barrier to accessing long-term housing support services.
  • Ensure clear communication between the case manager and shelter staff. When the victim’s main case manager is not a member of the shelter staff, careful communication is critical in order to minimize problems. Victims may disregard or misunderstand shelter rules and compromise the safety of others. Or victims may not be participating in counseling groups and other shelter activities, which may cause resentment on the part of other residents. Some victims do not want to tell their stories in this environment.

Mental Health Needs

Key Term: Polyvictimization

Polyvictimization, also known as complex trauma, describes the experience of multiple victimizations of different types, such as sexual abuse, physical abuse, bullying, exposure to family violence, and more. This definition emphasizes different kinds of victimization, rather than just multiple episodes of the same kind of victimization, because it signals a generalized vulnerability. Research shows that the impact of polyvictimization is much more powerful than even multiple events of a single type of victimization.

The types of physical and psychological abuse human trafficking victims experience often lead to serious mental or emotional health consequences, including feelings of severe guilt, posttraumatic stress disorder, depression, anxiety, substance abuse (alcohol or narcotics), and eating disorders. Victims of trafficking often need psychological care as part of comprehensive medical treatment.

Providing culturally appropriate and trauma-informed mental health treatment can be challenging. Some of the commonly reported barriers and challenges to helping victims with their trauma include:

  • Limited availability and access to appropriate mental health services.
  • Difficulty establishing trusting relationships with survivors.
  • Mandated treatment efforts may be counterproductive when working with victims. This is particularly relevant in communities where the only means to access mental health services is to be kept in a locked treatment facility.
  • Co-occurrence of trauma, diagnosed mental health conditions, and substance abuse or addiction.
  • Victims have a long history of polyvictimization.
  • Victims may not define their experience as abusive or attempt to escape.
  • Cultural, linguistic barriers and isolation from home community.

Symptoms Reported by Traffickng Survivors

Depression, hopelessness, feelings of sadness and unhappiness, sudden or inexplicable crying 

Fear of being alone, distrust and fear of strangers

Loss of interest in things and/or inability to plan for the future

Recurrent or intrusive memories of abuse

Stress-related disorders, avoidance, disorientation, confusion, anxiety, phobias and panic attacks

Feeling inferior to others, feeling of being permanently damaged, fear of rejection

Sleeplessness, sleep disturbances, nightmares, and/or insomnia 

Sexual problems, including lack of sexual desire or oversexualized behaviors

Denial, memory loss, difficulty concentrating

Obsessions and compulsions

Anger, aggression, irritability, mood changes

Hallucinations or delusions

Changes in appetite or eating patterns, eating disorders

Somatization/psychosomatic symptoms

Exhaustion and constant fatigue

Self-harm and suicidal ideation

Isolating behavior 

Trauma bonds and attachment issues, Stockholm Syndrome

Guilt, shame, and/or self-blame 



Eye Movement Desensitization and Reprocessing (EMDR) therapy is recognized as an effective form of trauma treatment. It contains elements of many effective psychotherapies in structured protocols that are designed to maximize treatment effects. These include psychodynamic, cognitive behavioral, interpersonal, experiential, and body-centered therapies. Clinicians and trainings are available through the EMDR Institute.
In addition to the challenges noted above, it is also important to recognize that after such trauma, some victims may not feel comfortable with their sexuality. Individuals who experience severe exploitation may consider same-sex interactions. Service providers need to be aware, ready, and comfortable in helping victims through this process, as it can be a coping skill to deal with their traumatic experience by disassociating with their born gender. In order to meet the mental health needs of survivors of human trafficking successfully, it is important to first ensure basic safety and service needs. Establishing physical and psychological safety is a prerequisite in working with trafficking victims with trauma history. This requires working collaboratively with those involved with the case to assess current client safety needs and planning. Ensuring that task force members involved in a case span across systems of care can help in addressing multiple needs. In addition to assessing a client’s physical and mental health, it is important that providers working with victims have access to a range of trauma-specific interventions, including well trained clinicians who are willing and culturally competent to work with victims. There are many treatment approaches for polyvictimization, particularly for adolescents, including the use of educational support groups to address skills development, interpersonal connections, and competence and resiliency building.

SAGE is a human rights, nonprofit, survivor-run, drug, mental health, and trauma treatment center in San Francisco, California. Its peer counseling model avoids a traditional approach to trauma treatment that positions service providers as clinically neutral authority figures. Rather, SAGE provides client-centered supportive partnerships that address the social, political, and economic contexts of client difficulties. SAGE combines peer counseling with a host of other services, including alternative trauma treatments such as acupuncture, art therapy, massage, healing touch, movement, and drama.

Many victim service providers utilize art and music therapy to help survivors build connection between their physical symptoms and mental health, which has proven promising in rehabilitation programs. It is also important to consider the client’s cultural background and how that plays a role in resiliency and experience of receiving mental health support, particularly in the case of foreign national victims. Western-centered psychology practice may not emphasize culture and community relationships that can support survivor reintegration and promote healthy relationships. Social workers should be mindful that the therapy privilege does not apply in group settings and therefore be cautious about victim disclosure regarding aspects of the trafficking experience.

An alternative to clinical mental health support is a peer-support model. Peer-to-peer counseling and mentoring from survivors who are now serving in a victim services capacity make great support sources for victims. Victims are often more comfortable with peers who understand and experienced similar pain and exploitation in a nonjudgmental, empathetic way. It is also a way to help survivors build a new identity and remove feelings of isolation.
Additional Resources: 

  • Project REACH is a program that provides consultation and brief mental health services to trafficking victims throughout the United States. Project REACH provides services to pre-certified victims of human trafficking. The program has operated for 6 years and served hundreds of victims of human trafficking, including victims of sex trafficking, domestic servitude, and other forms of labor trafficking, and can serve as a great resource for training and technical assistance.
  • Trauma-Informed Approach and Trauma-Specific Interventions  SAMHSA follows six key principles of a trauma-informed approach to address trauma’s consequences and facilitate healing. Also featured are several evidence-based trauma-specific interventions. 

Address trauma bonding. Some traffickers have a complex emotional relationship with their victims, similar to a relationship where domestic violence is present. In this “relationship,” the trafficker wields complete control and induces commercial sex acts or forced labor in order to make money. Control and obedience are maintained through a combination of emotional manipulation, feigned affection, cultural beliefs about debt, and physical and emotional abuse. Victims often develop traumatic bonding and identification with their trafficker. Trauma bonding with an abuser is a survival strategy for victims of abuse and intimidation. For example, a victim who was abducted and raped may, years later, describe the captor as a “great person” with whom he/she formed an emotional bond, thus showing characteristics of a victim suffering from a trauma bond. Trauma bonding also does not have to be romantic in nature; it is essentially a false sense of relationship to another. Ensuring that mental health professionals trained in trauma bonding are available within your victim services response can be critical.

Though there are many challenges to meeting the mental health needs of trafficking victims, an effort to create a comprehensive approach across multiple systems of care offers the promise of responding to victims where they most need it. Building long-term trusting relationships, ensuring flexible models of treatment, and peer-to-peer support will empower and build self-esteem in your clients.

Substance Abuse Needs Case Study: 

In 2013, a federal grand jury charged Andrew Fields with engaging in a sex trafficking scheme whereby he controlled his victims by supplying them with highly addictive controlled substances and by using their fear of withdrawal symptoms to force them into prostitution for his profit. Fields recruited vulnerable young women who were engaging in prostitution or performing at strip clubs and then rapidly escalated their drug use into addiction. Convicted on multiple counts of sex trafficking, he is currently serving a 33-year sentence.

Common health issues found in victims may be from substance abuse problems or addictions resulting from either being coerced into drug use by their traffickers or by turning to substance abuse to help cope with or mentally escape their desperate situations. Partnering with substance abuse treatment programs that are also trauma-informed can be critical when developing your victim services committee.
Some human trafficking victims struggle with substance abuse, which may have been exploited by the trafficker. For example—

  • Recruitment through substance use: Traffickers may target individuals with existing substance abuse issues to recruit into a trafficking situation.
  • Control through substance addiction: Traffickers may also use substance addiction to keep victims in a trafficking situation. It can be framed as a reward or punishment, or as a way to decrease the victim’s ability to resist trafficking and abuse.
  • Substance abuse as a coping mechanism: Some victims of human trafficking may abuse substances as a response to the trauma of their trafficking victimization.

Various medical and mental health issues can arise due to substance abuse problems. Victims may have feelings of powerlessness stemming from the misperception that the incident or series of incidents are somehow their fault. Other needs include hotlines or response teams that screen for suicidal or homicidal ideations or respond to medical emergencies such as detox from substance abuse. These extreme but not uncommon scenarios underline the need to partner with service organizations that offer unique expertise in responding appropriately to such crisis situations.

The role of medical providers is to promote the health and well-being of their patients. Victims of human trafficking are at risk for a number of health problems and associated health issues that are usually direct results of their victimization.

The forms of abuse that trafficking victims experience include physical, sexual, and  psychological abuse; the forced or coerced use of drugs and alcohol; social restrictions and manipulation; economic exploitation and debt bondage; legal insecurity; and abusive working and living conditions. These abuses impact victims’ physical, reproductive, and mental health; may lead to the misuse of drugs or alcohol; diminish their social and economic well-being; and limit their access to health and other support services. Some of the most common health issues include sexually transmitted infections (STI), adverse reproductive health conditions, broken bones, untreated medical conditions, and dental injuries from violence.

Health care providers are in a unique position to identify and assist victims of human trafficking. They may encounter victims of sex trafficking, victims of labor trafficking, and victims who experienced both sex and labor trafficking. As front line providers, health care practitioners may encounter trafficking victims in their daily practices. This is particularly true for public health and emergency room professionals who serve uninsured and undocumented populations.

In many cultures, health care professionals have a trusted and respected status. For this reason, victims may be more likely to disclose their status to a health care provider if they feel safe and believe their disclosure will be kept in confidence. Because traffickers severely limit the contact of their victims, a health care provider may be the only contact the victim is allowed to have with the outside world. For these reasons, task forces should consider providing training to medical providers in their community and partner to provide referrals and services. Recognizing the indicators and understanding the context of trafficking are important for health care providers because these patients could be perceived as uncooperative. It is imperative for health care providers to use trauma-informed care when identifying and serving this population of patients.

Legal Needs

Trafficking victims may have a variety of legal needs and issues. Therefore, it is critical that task force members identify partners to meet all of these needs.

It is unlikely that one legal service provider will be able to meet all of the legal needs of all types of trafficking victims. Thus, task forces may need to identify a primary partner as well as several specialists to ensure that all legal needs can be met. Legal providers will likely need additional training and support to meet the unique needs of trafficking victims. Legal service providers also can be critical partners in the outreach and education initiatives of a task force, as well as provide assistance in accessing new sources of support for task force sustainability.

Smart Tip: Partnering With Law Firms

Attorneys need to know what is expected of them when representing victims of trafficking, such as unique sensitivities, case details, and victim needs. Law schools and clinics have high staff turnover and this can be harmful to the case. Setting clear expectations and parameters when working with law firms will help to avoid later misunderstandings.

The U.S. legal system is highly complex and fractured. Victims may face concurrent cases in the federal criminal court, local criminal court, immigration court, and local civil court, all related to the trafficking scheme, all at the same time (or stretched out over the course of several years), and the victim will likely have a different attorney for each case. Victims may be frustrated by the slow pace of the legal system. It is important to keep the victim informed of the status of any and all legal proceedings, and equally important for other providers working with the victim to understand the complexities of the legal process.
In addition to the legal needs detailed in this subsection, the legal needs below may be indirectly related to trafficking:

  • Minors: Minors may require legal representation in guardianship proceedings and education/school issues (placement, suspension, tuition).
  • Housing: Many trafficking survivors face housing problems such as needing emergency or long-term placement, eviction from a place of residence due to lack of income, or the consequences of breaking a lease early to leave a trafficking situation. Trafficking survivors with disabilities may need help enforcing disability discrimination housing laws.
  • Medical: Some survivors may need help maintaining the privacy of their medical records or applying for fee waivers for medical care.
  • Name and Gender Change: Some trafficking survivors request name changes for safety reasons, and some transgender trafficking survivors may request name and gender changes. 

Immigration Needs

Many foreign national victims prefer to remain in the United States. There are several immigration options that were specifically created for trafficking victims, including Continued Presence and the T visa, as well as options for crime victims that include trafficking victims, such as the U visa and Special Immigrant Juvenile Status. An immigration attorney can assess the victim’s options and assist her/him in filing the appropriate application. Other foreign national victims prefer to return to their home countries, and providers can assist with safe repatriation.

Smart Tip: Immigration relief and the timing of it can be a source of tension between task force members. It is important to plan in advance for how the task force would like to coordinate and support both short- and long-term forms of immigration relief. Continued Presence is tool for law enforcement to request short-term immigration relief that allows a foreign national victim of human traffickin to remain in the United States. Unlike the other immigration options, only law enforcement can file an application for Continued Presence; the victim cannot apply directly. State and local law enforcement can initiate Continued Presence applications via their local federal enforcement law office. The requirements for Continued Presence are that the immigrant is a victim of human trafficking and a potential witness in the investigation or prosecution of a trafficker. The victim’s cooperation with law enforcement is not required; however, law enforcement do need to have enough information to determine eligibility. Continued Presence is generally issued for 1 year, includes employment authorization, confers eligibility for many federally funded public benefits, and may be renewed in 1-year increments upon law enforcement request.

T nonimmigrant visas are issued by the U.S. Citizenship and Immigration Services (USCIS) agency. The victim files an application for a T visa. The requirements for a T visa are that the immigrant is a victim of human trafficking, is physically present in the United States on account of the trafficking, has complied with any reasonable requests for assistance in the investigation or prosecution of the trafficker (unless the victim is under 18 or is unable to comply due to physical or mental trauma), and would suffer extreme hardship if required to return to her/his home country. T visa applications may include a declaration from law enforcement, a prosecutor, or judge (federal, state, or local), but a declaration is not required. T visas are issued for 4 years, include employment authorization, and confer eligibility for many federally funded public benefits. T visas are also available to certain immediate family members of the victim. T visa holders (victims and their family members) also can apply for Permanent Resident status (a “green card”) after 3 years or the conclusion of the criminal case. Watch the DHS Instructional video for members of law enforcement when completing certification forms for victims of human trafficking or other serious crimes.

U nonimmigrant visas are issued by U.S. Citizenship and Immigration Services (USCIS) agency for victims of a variety of crimes and require law enforcement support (see DHS U Visa Law Enforcement Certification Resource Guide). The victim files an application for a U visa. The requirements for a U visa are that the immigrant is a victim of a qualifying crime (which includes human trafficking, sexual assault, involuntary servitude, peonage, slave trade, sexual exploitation, prostitution, and many other crimes), suffered substantial physical and/or mental abuse from the crime, has information about the crime, and has been/is being/is likely to be helpful in the investigation or prosecution of the crime. U visa applications must include a certification from a law enforcement agency, prosecutor, or judge (federal, state, or local). U visas are issued for 4 years and include employment authorization, but do not confer access to federally funded public benefits (although benefits at the state level may be available). U visas are also available to certain immediate family members of the victim. U visa holders (victims and their family members) also can apply for Permanent Resident status (a “green card”) after 3 years.

Special Immigrant Juvenile (SIJ) Status allows certain foreign national children who are abused, abandoned, or neglected to remain legally in the United States and to seek Permanent Resident status (a “green card”). The SIJ program is also administered by USCIS. Applicants must be under the age of 21 and unmarried. They must be declared a dependent on a juvenile court in the United States or the court must have legally committed or placed the child under the custody of an agency, entity, or individual. Juvenile courts must also find that the child’s reunification with one or both parents is not viable due to abuse, neglect, or abandonment, or a similar basis found under the law, and it is not in the best interest to be returned to his or her country of nationality or last habitual residence. Trafficked youth who are in the child welfare system often qualify for SIJS.

Asylum allows individuals to stay in this country if they have been persecuted in another country. Past persecution can have been based on membership in a particular social or religious group or what a government perceives as actions against its power. The persecutor must be the government or a group or individual(s) that the government is unwilling or unable to control. Trafficking survivors are also entitled to asylum in the United States if they have been trafficked to another country, are fleeing that country to escape bondage, or do not want to return to their country of origin because they fear being trafficked again. Those granted asylum may seek Permanent Resident status after one year. Those who are denied asylum may be required to enter removal proceedings.

Violence Against Women Act (VAWA) Self-Petition allows abused and battered female immigrants to file for legal status without having to rely on abusive U.S. citizens or abusive permanent resident spouses, parents, or children to sponsor their immigration applications. Abusers may force their spouses into labor or sex trafficking, and other traffickers use marriage as a means of coercion and control if the victim’s immigration status is tied to the spouse. Once a VAWA Self-Petition is approved, the immigrant survivor may seek Permanent Resident status. Some immigrant minors who have lived in the United States for an extended period of time and who are trafficked may qualify for Deferred Action for Childhood Arrivals (DACA), which enables them to obtain temporary citizenship status for two years and makes them eligible for work authorization.

Repatriation. Foreign national victims might prefer to return to their home country, and may need assistance in replacing their passport or other documentation. They should also be provided with referrals or resources that are available in their home country for survivors of trafficking.



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