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Human Trafficking Victims Barricaded from Resource Programs

Dylan Jorgensen

Department of Criminal Justice, University of South Carolina

CRJU-421: Victimization

Professor Albina Laskovtsov

November 30, 2022

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Human Trafficking Victims Barricaded from Resource Programs

Human Trafficking is a relatively new crime outlined by the United States Legislation. In

2000 the United States Congress passed the Victims of Trafficking and Violence Prevention Act.

This legislation outlined the trafficking of persons as 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,” (TVPA, 2000). After 2000, task forces were quickly formed due to the rise of what is

commonly referred to as, modern day slavery. Kyckelhahn and colleagues (2008), aimed to

identify the prevalence of these relatively new victims in the criminal justice system. During this

survey, they had found that there were over 1,000 federally funded investigations of human

trafficking with only 10% of them confirmed (Kyckelhahn et al., 2008). However, there are two

restrictions that make this prevalence rate not the most accurate number of victims of human

trafficking in the United States. The first restriction is that Kyckelhahn and colleagues (2008)

only identified federally funded investigations into human trafficking. In addition, the survey can

only identify open investigations and it is near impossible to identify all victims that are not able

to escape their offender. Official estimates suggest at least 14,500 to 17,500 people are annually

trafficked into the United States (Kyckelhahn et al., 2008). With the rise in human trafficking

victims coming forward and escaping from their offender, many states struggle with victim

resource programs and what programs are most effective in helping the victim through these

resource barriers. The barriers include physician awareness, retraumatization, and the impact of

COVID-19 with already unstable housing arrangements.

Physician awareness is an important factor in alerting officials and providing victims of

human trafficking with valuable and effective care. These physicians are often one of the first
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lines of defense in identifying human trafficking victims. Physician awareness is a common

assessment in hospitals to identify the lack of protocols for human trafficking victims at the state

level. Armstrong and colleagues (2019) investigated South Carolina hospitals’ implementation

and delivery systems in place to care for victims of human trafficking. They interviewed 18

participants from different hospitals across the state with 13 out of the 18 participants believing

that human trafficking is occurring within their area. Additionally, they found that individuals

with SANE certification (sexual assault nurse examiner) had more knowledge on protocols and

next steps when it came to human trafficking victims compared to those who did not have said

training (Armstrong et al., 2019). Similarly, in the state of Florida, Recknor and colleagues

(2019) had found commonality in the hospital staffs’ ability to better recognize the signs and

symptoms of human trafficking after proper training. However, training is often not required in

the majority of hospitals nationwide and results in most staff not receiving said training. With

little to no awareness of the signs and who to contact within the untrained hospital staff, the

victim is often released to the offender where they will continue to be victimized.

The physician awareness dilemma has also been identified on the federal level. Katsanis

and colleagues (2019) surveyed 900 physicians and registered nurses across the United States

and found that 66% of participants indicated confidence in their ability to define human

trafficking, but only 12% of them reported awareness on warning signs. In addition, the survey

found that none of the 20 specifically interviewed participants were aware of codes for specific

documentation of a person’s trafficked status. After establishing the lack of awareness on a

federal level, Katsanis and colleagues (2019) examined the use of electronic health records and

its potential advantages for physicians to identify possible human trafficking victims more

accurately. Electronic health records have become more readily available as technology
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continues to advance in society. The overall concept of electronic health records is to be able to

identify repeat visits from the same patient with indications of victimization. Katsanis and

colleagues (2019) argued for the inclusion of biometrics, such as fingerprints, within all patient

charts. This is due to a common failure seen within the victimized population as they often use

fake names out of fear, so it appears that this is their first visit. With the inclusion of electronic

health records, physicians without the SANE training found in South Carlina and Florida would

be able to identify repeat patients that have had repeated events of trauma more easily. The

implementation would ultimately allow the untrained physician to seek help from a SANE

certified physician to gather the additional resources for a patient.

Another resource barrier is the retraumatization through the repeat background

questioning by physicians of different specialties. Retraumatization is a large factor in victims

obtaining comprehensive healthcare. Most victims of human trafficking require multiple

physicians due to the extent of abuse they acquire throughout their victimization (Potocky,

2010). For example, an emphasis on providing psychiatric and mental health care is necessary as

it is commonly seen within this population (Recknor et al., 2019). This care in addition with any

physical health care would result in doctors asking similar questions that can require the victim

to verbally repeat their trauma several times focusing on the different aspects of mental and

physical abuse that they endured. This retraumatization occurs over a long period of time due to

the scheduling of different doctor visits as these physicians are not always working at the same

time (Todres et al., 2021). The state of Florida has composed several programs to achieve the

best resources for victims of human trafficking. Two programs that have been released in the

past two decades are the FFP (Florida Freedom project) and the THRIVE (Trafficking

Healthcare Resources and Intra-disciplinary Victim services and Education) program. Recknor
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and colleagues (2019) had found that these facilities had a large emphasis on team-oriented and

comprehensive services. The interviewees stated that this emphasis allowed them to help reduce

barriers such as retraumatization. This is due to communication between physicians not requiring

the victim to verbally repeat their trauma over a long period of time.

The FFP was funded by the Justice Department’s office for victims of crime shortly after

the Victims of Trafficking and Violence Prevention Act of 2000. The program aims to help

victims of human trafficking through the provision of housing, legal services, medical care, and

clinical intervention (Potocky, 2010). The efficacy of this program was evaluated and Potocky

(2010) found that the FFP improved the victim’s lives in the mental health and food provision

sections of analysis but limitations in the delivery of healthcare and housing to underserved

populations. The analysis in the housing sector showed 63% of victims either deteriorating or

remaining the same from in-take to when their case was closed (Potocky, 2010). In addition, the

analysis showed that two thirds of patients had no improvement from health care due to the

inability to seek healthcare without the proper legal identification and the high rate of dropout or

loss to follow up (Potocky, 2010). This decrease in the healthcare and housing sectors of the FFP

highlights the problems that need to be addressed in future programs as other sectors, such as

food provision, are already functional within this service. Specific factors that Potocky (2010)

highlighted within the two sectors were the difficulty in retraumatization from follow up visits

with different physicians as well as unsafe housing possibly allowing the victims to be

revictimized.

The state of Florida aimed to reduce the retraumatization found in Potocky’s study (2010)

through the development and implementation of the THRIVE program. This program focuses on

comprehensive and effective healthcare service delivery for the victims. Using the limitations of
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the FPP, the THRIVE program focuses on one specific need of human trafficking victims,

healthcare. This program utilizes multi-disciplinary physicians with high communication levels

to provide an effective system for the victims to receive healthcare (George et al., 2020). Using a

cohort of the 36 patients referred to the clinic, George and colleagues (2020) analyzed the

efficacy of the program along with the formation and operation in clinics. They found that one

hundred percent of the patients were satisfied or extremely satisfied with the ease of

communication and overall healthcare. In addition, they conducted follow up surveys with

patients that had closed cases and found eleven out of the thirteen cases had been established in

their new locations (George et al., 2020). Thus, the THRIVE program was able to indirectly

improve the housing problems also found in Potocky’s study (2010). Finally, George and

colleagues discussed the necessity of communication with a complex network of physicians.

With easier access to physicians of different specialties, patients must explain their history less

and are not repeatedly retraumatized.

Shortly after George and colleagues published their findings in 2020, COVID-19 greatly

decreased each sector’s effectiveness in provisions for victims of human trafficking. COVID-19

brought multiple stay at home ordinances and will forever influence the way medicine is

practiced in the future. The decrease in these resources has become even more noticeable with

the rise in online exploitation reports. The national center for missing and exploited children

have seen over a 100 percent increase of online exploitation reports from March to April of 2020

(Todres, 2021). The increase in online reports may be influenced through the lack of outlets

available for victims to come forward and find the resources that they need. COVID-19 has had

an impact on the availability to victim resources through the lack in hospital resources along with

school closures. Teachers are no longer able to strengthen bonds between themselves and
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students when the schools are not meeting in person. This eliminates one possible defense

against human trafficking and getting the children the resources necessary (Todres, 2021).

Hospital resources being scarce further limits a physician’s ability to identify human trafficking.

With telemedicine becoming more prominent in the world today, a one stop model, such as

THRIVE, has become harder to obtain (Todres, 2010). The level of communication decreases

between specialties since the physicians are working from home and they have differing

schedules that make it hard to meet at the same time (Malpass, 2022). In addition, COVID-19

regulations suggest not coming to the emergency room unless urgent and mandate personal

protective gear be always worn by physicians (Todres, 2021). These regulations have significant

impacts on the identification of human trafficking victims as they are not going to be as easily

noticed in emergency rooms compared to before the pandemic due to the overwhelming amounts

of patients. The victims are also going to be more overwhelmed by the protective gear that the

physicians are wearing when being examined as these patients have been found to possess

negative past experiences with authority figures (Todres, 2021). This would result in a lower

recorded number of human trafficking victims even though there are still the same number of

victims.

In addition to the healthcare sector, the housing sector has seen a great impact due to

COVID-19. Before the pandemic, there was still a great need for improvements in the housing

sector. Potocky (2010) found benefit in centralized housing for victims to decrease the

difficulties in accessing other services due to location. The difficulties in accessing all resources

have only increased with COVID-19’s advancement. The National Human Trafficking Hotline

witnessed an increase in emergency shelter requests by approximately fifteen percent from

January to April of 2020 (Administration for children & families, 2021). In addition, finding safe
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housing options for victims has presented difficult as all at-risk populations are also experiencing

housing insecurity (Todres, 2021). The federal government has taken some action to reduce

housing insecurity through the Coronavirus Aid, Relief, and Economic Security (CARES) Act.

The CARES Act provided a temporary solution through the halting of residential evictions until

December 31, 2020 (Administration for children & families, 2021). However, victims of human

trafficking are typically not aware of these acts taking affect, thus leaving them to be further

revictimized through the landlord’s exploitation of labor or sex for rent (Administration for

children & families, 2021).

The decline in these sectors is a major concern for the future of human trafficking victim

resource programs. Human trafficking occurs nationwide and has been researched similar to the

United States to discover the most effective measures to reduces present barriers. Unseen is an

organization that aids in specialist support for human trafficking survivors in the United

Kingdom. Malpass and colleagues (2022) specifically studied the inclusion of provided

technology to victims within the Unseen program. Through qualitative interviews of 31

participant from 13 different countries, Malpass and colleagues (2022) found that smartphones

helped survivors develop skills to transition themselves into independent living. In addition, they

found that participants were able to better navigate all the resources available to them and had an

easier time with translation through their devices (Malpass et al., 2022). The benefits from the

provision of technology by resource programs provide details such as the language barrier that is

scarcely researched in the United States.

New research is still being conducted nationwide and uncovers new barriers that victims

face nationwide for resource programs. To reduce these barriers that result in high loss rates for

victims accessing resource programs, new programs need to focus on the constantly advancing
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world that these victims live in. This can be done by placing more emphasis in better healthcare

and housing opportunities. The healthcare sector has displayed high rates of retraumatization.

The poor training protocols in place nationwide to aid in the identification of possible victims as

well as COVID-19 reducing trained physicians time with these victims are two key elements

needed to be addressed. Within the housing sector, victims are often found struggling for

emergency shelter requests and the current programs in place need to develop a solution for more

safe housing. Without safe housing, the victims will face revictimization and eventually directly

increase the high loss rate of these programs. The popularization of telemedicine may prove to be

a substantial factor in victims accessing all the resources that are available to them but without

safe housing the victims can easily lack the technology required. The provision of technology

within these resource programs can eliminate this barrier while improving the language barrier.

More programs and research such as the FFP, THRIVE program, and the Unseen program is

needed to keep chasing the seemingly never-ending barriers within human trafficking victim

resource programs.
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References

Administration for children & families, office on trafficking in persons (2021). Housing

resources during COVID-19 for human trafficking survivors. Retrieved From:

https://pascal-usc.primo.exlibrisgroup.com/permalink/01PASCAL_USCCOL/1oceqbt/

alma991026281836105618

Armstrong, S., Greenbaum, V., Lopez, C., Barroso, J. (2019). Preparedness to identify and care

for trafficked persons in South Carolina hospitals: A state-wide exploration. Journal of

Human Trafficking, 6(3), 281-308.

George, J., Malik, S., Symes, S., Caralis, P., Newport, D., Godur, A., Mills, G., Karmin, I.,

Menon, B., & Potter, J. (2020). Trafficking healthcare resources and intra-disciplinary

victim services and education (THRIVE) clinic: A multidisciplinary one-stop shop model

of healthcare for survivors of human trafficking. Journal of Human Trafficking, 6(1), 50-

60.

Katsanis, S., Huang, E., Young, A., Grant, V., Warner, E., Larson, S., & Wagner, J. (2019).

Caring for trafficked and unidentified patients in the EHR shadows: Shining a light by

sharing the data. PloS One, 14(3), e0213766.

Kyckelhahn, T., Beck, A., & Cohen, T. (2008). Characteristics of suspected human trafficking

incidents, 2007–08. Washington, DC: Bureau of Justice Statistics, U.S. Department of

Justice.

Malpass, A., Garbers, K., Saunders, L., Horwood, J., McLeod, H., Anderson, E., & Farr, M.

(2022). Overcoming digital exclusion during the COVID-19 pandemic: Impact of mobile

technology for survivors of modern slavery and human trafficking - a mixed method
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study of survivors and support service provider views. Journal of Human Trafficking, 1–

20.

Potocky, M. (2010). Effectiveness of services for victims of international human trafficking: An

exploratory evaluation. Journal of Immigrant & Refugee Studies, 8(4), 359–385.

Recknor, F., Gordon, M., Coverdale, J., Gardezi, M., & Nguyen, P. (2019). A descriptive study

of United States-based human trafficking specialty clinics. Psychiatric Quarterly, 91(1),

1–10.

Todres, J., Diaz, A. (2021). COVID-19 and human trafficking – the amplified impact on

vulnerable populations. JAMA Pediatr, 175(2), 123–124.

Victims of Trafficking and Violence Prevention Act of 2000, P.L. 106-386 Stat. 114(2000):

1464.