Confronting Commercial Sexual Exploitation and Sex Trafficking of Minors in the United States (2013) / Chapter Skim
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7 Health and Health Care
7 Health and Health Care
Pages 271-296
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From page 271... ...
. Front-line practice settings in which these providers work and where victims of commercial sexual exploitation and sex trafficking may present for services include, among others, emergency departments, urgent care, primary care clinics, adolescent medicine clinics, school clinics, shelters, specialty clinics (obstetrics/gynecology, psychiatry)
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From page 272... ...
The chapter concludes with the committee's findings and conclusions regarding the roles of health care providers in addressing commercial sexual exploitation and sex trafficking of minors in the United States. Victims and survivors of commercial sexual exploitation and sex trafficking of minors may experience a variety of physical and mental health illnesses and injuries.
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From page 273... ...
, a lack of disclosure by victims, potential and perceived complications related to mandated reporting, and a lack of policies and protocols related to these crimes to assist health care providers in assessing and treating victims. Lack of Understanding of Commercial Sexual Exploitation and Sex Trafficking of Minors The need for education and training of health care providers on the topic of commercial sexual exploitation and sex trafficking of minors has been identified as a barrier faced by these professionals in identifying and providing services to victims (Clawson and Goldblatt Grace, 2007; Fong and Berger Cardoso, 2010; Okech et al., 2011)
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From page 274... ...
. The first part was a survey designed to assess the knowledge and comfort level of emergency department providers in identifying and treating victims of human trafficking; the second part entailed development and testing of an intervention designed to train providers in the emergency department in identifying and treating victims.
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From page 275... ...
Yet a number of barriers to the training of health care providers in these areas exist, including stereotypes and misperceptions about commercial sexual exploitation and sex trafficking of minors, limited availability of evidence-based training/educational programs, funding constraints, and competing priorities for health professionals' time and educational efforts. Stereotypes and Misperceptions Stereotypes and misperceptions surrounding commercial sexual exploitation and sex trafficking of minors may contribute to health care providers' inability to identify and assist victims effectively.
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From page 276... ...
As previously noted, data are lacking with which to evaluate the effectiveness of current educational efforts in enhancing providers' ability to identify and assist victims. Although limited research has examined how health care providers receive training in domestic violence and child abuse, these fields of study entail issues that are similar to or overlap with those encountered with commercial sexual exploitation and sex trafficking of minors (see Chapter 3)
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From page 277... ...
. Although no studies have examined to what extent lack of disclosure contributes to nonidentification of victims, it is of interest that some organizations have begun to address this potential barrier through use of a model screening protocol for domestic violence, adapted to help victims of commercial sexual exploitation and sex trafficking.
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From page 278... ...
However, the solution to identifying and assisting victims of commercial sexual exploitation and sex trafficking of minors may not be as simple as mandatory reporting. Mandating reporting of extrafamilial child abuse such as commercial sexual exploitation and sex trafficking of minors may place further strain on the child welfare system.
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From page 279... ...
. As with child abuse and intimate partner violence, the perceived barrier for health care providers regarding mandated reporting of commercial sexual exploitation and sex trafficking of minors arises when a provider must balance the protection of a patient's confidential information, often necessary to facilitate disclosure of sensitive information, with the obligation to report abuse knowing that in some cases, doing so could put victims at greater risk for harm, particularly from their exploiters and traffickers.
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. In fact, during its San Francisco site visit, the committee learned about one agency's development of its own screening protocol for commercial sexual exploitation and sex trafficking of minors that was modeled after its domestic violence screening protocol (Chang, 2012)
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Models of Care Given the lack of evidence-based models for use by health providers in identifying and assisting victims of commercial sexual exploitation and sex trafficking of minors, the committee examined other models of care, including those for intimate partner violence, child maltreatment, sexual assault services, and public health, which face similar challenges and barriers to the identification and management of victims. The committee heard testimony from representatives of several agencies that have adapted and modified these models in their efforts to provide health care services to victims of commercial sexual exploitation and sex trafficking of minors.
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From page 282... ...
Therefore, this approach may give providers opportunities to assist trafficking victims. Sexual Assault and Violence Intervention Program Agencies also have increased their attention to the identification, assessment, and even management of victims of commercial sexual exploitation and sex trafficking of minors by integrating services and resources focused on these victims into established child abuse and/or intimate partner violence programs.
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From page 283... ...
It also has worked with those who deal with victims of interpersonal violence, including police investigators and health and mental health care providers, to serve victims of commercial sexual exploitation as well as domestic violence victims. Child Advocacy Centers and Sexual Assault Response Teams Child advocacy centers (CACs)
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From page 284... ...
In so doing, they are attempting to broaden the reach of their interventions within their communities and shift attention toward prevention at all levels, recognizing that different interventions will be required at the primary, secondary, and tertiary levels of prevention in addressing commercial sexual exploitation and sex trafficking of minors. For example, Asian Health Services developed several programs based on a public health model to focus community efforts on early primary prevention (e.g., education on healthy relationships for the younger adolescent population)
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From page 285... ...
. Current programs offering education and training for health care providers on human trafficking and more specifically on commercial sexual exploitation and sex trafficking of minors vary greatly, and an evidence base and outcome data indicating the effectiveness or success of any particular programs are lacking.
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From page 286... ...
The five-session series provides an overview of commercial sexual exploitation of minors, the medical evaluation of suspected victims, extended medical history, special related topics, and a victim/ survivor-centered approach to working with these youth. The program has had 260 participants to date, and outcome data have yet to be published (Greenbaum, 2012)
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From page 287... ...
In addition, none of the screening tools, instruments, or questions have been evaluated to date for their ability to correctly identify victims of trafficking. BOX 7-1 Examples of Tools for Identifying Victims/Survivors of Commercial Sexual Exploitation or Sex Trafficking The following tools have been developed to assist health care providers in identifying victims of commercial sexual exploitation and sex trafficking: • apid Screening Tool for Child Trafficking and Comprehensive Screening R and Safety Tool for Child Trafficking: Two screening tools developed by the International Organization for Adolescents for use as a guide in identifying minors that are potentially being trafficked (Walts et al., 2011)
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From page 288... ...
may be particularly useful when working with victims of commercial sexual exploitation, particularly because, as noted earlier, they may not see themselves as victims and may refuse assistance when it is offered (Clawson and Goldblatt Grace, 2007; Crane and Moreno, 2011; Holzman, 2012; Ring, 2012; Smith et al., 2009)
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From page 289... ...
. The authors acknowledge the limitations of available research on effective mental health treatments for victims of commercial sexual exploitation, and encourage mental health practitioners to base their current treatment options on "ex
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From page 290... ...
. In addition, during many of its site visits with service providers currently caring for survivors of commercial sexual exploitation and sex trafficking, the committee heard about the need for long-term mental health services for victims, particularly given issues of reintegration into mainstream life and the need to help those who may have reentered "the life" of commercial sexual exploitation (Latimer, 2012; Phillips, 2012; Ring, 2012; Steever, 2012)
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From page 291... ...
7-3 Assessment and screening tools and intervention programs for use by health care providers in identifying and assisting victims of commercial sexual exploitation and sex trafficking of minors in the United States need to be developed and evaluated. 7-4 Professionals and researchers can look to lessons learned and potential best practices from the health sector's response to similar and overlapping public health issues, such as domestic violence and child abuse, as examples of the health care pro vider's role in addressing and responding to commercial sexual exploitation and sex trafficking of minors in the United States.
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From page 292... ...
2012. Workshop presentation to the Committee on the Commercial Sexual Exploitation and Sex Trafficking of Minors in the United States, on the Asian Health Services, May 9, 2012, San Francisco, CA.
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From page 293... ...
2012. Site visit presentation to the Committee on the Commercial Sexual Exploitation and Sex Trafficking of Minors in the United States, on My Life, My Choice, March 23, 2012, Boston, MA.
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From page 294... ...
2012. Workshop presentation to the Committee on the Commercial Sexual Exploitation and Sex Trafficking of Minors in the United States, on the Motivating, Inspiring, Supporting, and Serving Sexually Exploited Youth (MISSSEY)
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From page 295... ...
2012. Site visit presentation to the Committee on the Commercial Sexual Exploitation and Sex Trafficking of Minors in the United States, San Francisco Juvenile Probation Department, May 11, 2012, San Francisco, CA.
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From page 296... ...
2011. Human trafficking and health: A con ceptual model to inform policy, intervention and research.
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