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The International Labour Organization estimates that there are 20.9 million victims of human tra cking globally. Every country in the world is impacted by human tra cking and communities across the globe are changed forever as humans are sold into slavery, sexually exploited, and die in captivity. This 21st century slave trade feeds a global demand for cheap and vulnerable labour. In fact, the United Nations estimates that this multi- billion dollar industry is the third largest source of revenue for organized crime. Victims of tra cking often endure brutal conditions that results in physical, emotional, and psychological trauma. Victims are isolated from friends and family, subdued with drugs, and forced to live and work in unsanitary conditions. This presentation will provide clinicians with the knowledge on tra cking and give specifc tools that can be used to identify, intervene upon, and treat victims and survivors.

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  2. 2. “If we don't start with a wide humanitarian view point, how can we ever dream to work on peoples issues with behavioural, emotional and mental health problems” Sam Quinlan, iCAAD Director
  3. 3. CASE STUDIES Sara- 25 years old • Grew up in mid-high socioeconomic house hold • Parents married • Appears to be a tight knit family • Went to college • Met Trafficker online • Gradual change in communication to friends, family and lifestyle • Psychological Control and manipulation • Abuser used local law enforcement to block intervention attempt Joe- Now 15 years old • Taken from home in Guatemala at age 13 under the guise of making a better life • “Sponsored” into US by Traffickers in 2014 • Forced to work on chicken farms in Ohio • Trauma on every level, physical, emotional, repeated sexual victimization • Lived in subhuman conditions, total neglect, no running water, no electricity • Work 6am-8pm
  4. 4. WHAT DEFINES HUMAN TRAFFICKING? • The Act • Recruitment, transporting, harboring or hiding, acquiring • The Means • Threat or use force to remove, abduct, coerce, deception, fraud, abuse of power, paying a person to control the victim • The Purpose • EXPLOITATION- sex workers, prostitution, forced labor, slavery, removal of organs, financial gain
  5. 5. THE NUMBERS • At any given time in 2016, an estimated 40.3 million people are in modern slavery, including 24.9 in forced labour and 15.4 million in forced marriage • There are 5.4 victims of modern slavery for every 1,000 people in the world. • 1 in 4 victims of modern slavery are children • Out of the 24.9 million people trapped in forced labour, 16 million people are exploited in the private sector such as domestic work, construction or agriculture; 4.8 million persons in forced sexual exploitation, and 4 million persons in forced labour imposed by state authorities Source: Global Estimates of Modern Slavery: Forced Labour and Forced Marriage , Geneva, September 2017
  6. 6. Who is falling victim to trafficking? Of the 40.3 million…
  7. 7. HOW MUCH IS A LIFE WORTH? #NoPriceOnPeople
  8. 8. BILLION DOLLAR INDUSTRY • 109,081,500,000.00 GBP or $150 Billion Dollar in earnings • $99 billion from commercial sexual exploitation • $34 billion in construction, manufacturing, mining and utilities • $9 billion in agriculture, including forestry and fishing • $8 billion dollars is saved annually by private households that employ domestic workers under conditions of forced labor International Labor (ILO) Organization, 2017
  9. 9. REASONS TRAFFICKING OCCURS • Globalization • Poverty • Political Issues • Child Soldiers • Forced Begging • Forced Labor • Removal of Organs • Sexual Exploitation • Selling Children • Forced Marriage • Financial Gain
  10. 10. Trends in the forms of exploitation among detected trafficking victims, 2007-2014
  11. 11. Understanding Methods Used in Human Trafficking
  12. 12. WHY? Reporter: How do you get a girl to do this? Matthew: It just happens. Like most of these girls they’re broken. It’s not hard. You get in there, you find the crack, some are drugs, they need to hear I love you. I’m here to take care of you. She’ll do it. Reporter: Why will she do it. Matthew: Because you sold her a dream. Knowing someone cares. It’s an illusion.
  13. 13. Power and Control Using Coercion and Threats Threatening Family Blackmail Harming another for another’s disobedience Emotional Violence Isolate from social support Shame Humiliation Affection to violence Physical Violence Torture Branding Forced drug use Deny food or bathroom Sexual Violence Prostitution Gang Rape Sexual Shaming Purposeful Manipulation Exploiting insecurities Exploiting life gaps (i.e. absent Father) Economic Dependence Take all assets and money from victim Refuse to let them go to school Isolation Inability to access support resources Unfamiliar/unaware of geo location Total control over the victim’s movements (Smith, Healy, Vardaman, & Snow, 2009)
  14. 14. ENTRAPMENT BY ANY MEANS NECESSARY • Fear: deportation, prosecution or legal problems, causing or creating harm to ones family and a lack of trust in the government • Lack of knowledge about alternatives • Isolation: to control or mediate the ability to escape. Isolation may be geographically, physically or through a language barrier • Psychological Confinement • When attained gives way to ultimate compliance
  15. 15. ENTRAPMENT BY ANY MEANS NECESSARY Psychological entrapment: includes debt bondage, the use of drugs and alcohol addiction, and threats of shaming and humiliation.
  17. 17. EXAMPLES OF FORCE, FRAUD & COERCION • Force: • Physical Abuse • Kidnapping • Physical Restraint • Fraud: • Illegitimate Contacts • False Promises • Fake Businesses • Fake Visa Documents
  18. 18. EXAMPLES OF FORCE, FRAUD & COERCION • Coercion: • Psychological Manipulation • Threats • Spoken Threats about victims family or others • Implied Threats to create a climate of fear (electric fences, guns, lies) • Control of children • Trafficker has possession of documents
  19. 19. WARNING SIGNS OF DOMESTIC MINOR SEX TRAFFICKING (Smith, Healy, Vardaman, & Snow, 2009)
  20. 20. THE ULTIMATE GOAL OF TRAFFICKERS Mental Defeat • Mental defeat is what follows total behavioral and cognitive submission • The perceived loss of all autonomy, a state of giving up in one’s mind all efforts to retain one’s identify as human being with a will of one’s own.
  21. 21. OUTCOME FOR VICTIMS • PTSD • Complex Trauma • Dissociative Disorders • Anxiety Disorders • Depressive Disorders • Attachment Disorders • Developmental Disorders • Eating Disorders • Self-Mutilation • Substance Use Disorders
  22. 22. Treating Victims of Human Trafficking
  23. 23. PTSD SYMPTOMS REPORTED BY VICTIMS • Recurrent thoughts/memories of terrifying events • Recurrent thoughts/memories of terrifying events • Recurrent nightmares • Feeling detached/withdrawn • Unable to feel emotion • Easily Startled • Difficulty concentrating • Sudden emotional or physical reaction when reminded of traumatic even • Trouble sleeping • Feeling on guard • Feeling irritable , outbursts of anger • Avoiding activities that remind of the traumatic even • Inability to remember part of or most of traumatic even • Loss of interest in daily activities • Feeling hopeless • Avoiding thoughts or feelings associated with traumatic events (Zimmerman et al., 2006)
  24. 24. COMPLEX TRAUMA • Associated with chronic, prolonged, repetitive exposure to traumas • Sexual trauma, physical beatings, starvation, constant fear, being trapped and unable to escape and being subject to subhuman living conditions for a prolonged period of time. • Sex trafficking incorporates, grooming, pornography and ritual abuse and prostitution • Psychological Entrapment
  25. 25. TRAUMA • Affects those directly exposed and those around them • Wives and children of men who suffer from PTSD tend to become depressed, insecure, anxious and/or substance abusers • Trauma is about perception • Natural response to an abnormal situation
  26. 26. INFLOW (I AM THE VICTIM) Done to Me Client Victim
  27. 27. OUTFLOW (I AM THE PERP) Done to Someone Else Victim Client
  28. 28. CROSSFLOW (VICARIOUS TRAUMATIZATION) (Domestic Violence) Client
  29. 29. REFLEXIVE (DONE TO SELF) (Drinking, Drugs, Self-Mutilation) Client
  30. 30. SEXUAL ACTING OUT (SEX FOR DRUGS) • Re-traumatization • Boundary Issues • Sex confused with love • Comfort/self-soothing • Control • A way to get drugs • Product of abusive relationships
  31. 31. TRAUMA INFORMED INTERVENTION TM • Interventionist should be able to work with PTSD and Dissociative Disorders • Grounding techniques • Danger of re-traumatization • Gender of Clinician • Eating Disorder assessment • Self-mutilation assessment • Appropriate treatment placement • Dangers of the “Surprise Model”
  32. 32. DISSOCIATION • A natural response to trauma • Temporarily escape a trauma or traumatic memory by walling off and separating the memory • The memory is split off, fragmented or compartmentalized • These memories are stored in the brain
  33. 33. TRIGGERS • Visual • Auditory • Smell • Taste • Physical/Kinesthetic • Tactile
  34. 34. TRIGGERS • Pain • Dates or Seasons • Stressful events (critical boss) • Thoughts • Behaviors • Defenses down • Combinations (fireworks)
  35. 35. INDICATORS OF DISSOCIATION • Stiff or still body • Slow to respond • Flat emotions, numb • Inattention • Disorientation • Robotic behavior • Misses conversation • Not feeling expected pain • Memory lapses • Tuned out • Dazed look • Blank stare • De-realization • Eyes closed • Rapid blinking • Self-soothing
  36. 36. • Because of the nature of trauma, we often do not see symptoms of trauma when the person is in a dangerous place • Often they will come out when a person is feeling safe • Trauma survivors do not like surprises
  37. 37. TRAUMA INFORMED INTERVENTION TM • Co-therapy • Transparent vs. Surprise • Confrontational methodologies are counter indicated • Involvement of multi level agencies and services • Building of coping skills
  38. 38. COUNTERING TRAUMA BONDS • Responses to trauma may be automatic or uncontrollable, and are thought to be wired into us to protect our own survival. • Often times, involves hormonal fluctuations in the brain • It is crucial that these responses are understood in the context of an individual’s experience of abuse and overall environment in which they live (Smith, Healy, Vardaman, & Snow, 2009)
  39. 39. TRAUMA INFORMED INTERVENTION TM • Important to help family establish boundaries • Boundaries will be tested/ usually never held • Parents must have boundaries they can maintain • Kicking out of the house often not realistic • Parents can’t do it • Psychiatric issues • Think outside the box
  40. 40. TRAUMA INFORMED INTERVENTION TM • Bond with the Client/Respect • Know the lingo • Be the limit setter for the family • Family needs a lot of support and guidance • Importance of case management/staying with the family • Emphasize importance of family treatment (alanon, families anonymous, therapy, etc.)
  41. 41. TRAUMA INFORMED INTERVENTION TM • Family system must be addressed and generational issues examined. • Educate parents about the tip of the iceberg • Educate parents about drugs and alcohol on an immature undeveloped brain • Shift in pediatric paradigm
  42. 42. TRAUMA INFORMED INTERVENTION TM • Violence • High tolerance for pain • Coupled with severe mental health or primary psych • Severely disjointed family system • Need to locate and extract client • Interfacing with legal i.e. FBI, Scotland Yard, task forces
  43. 43. TRAUMA INFORMED INTERVENTION TM Professional’s Role • Examine whether the behaviors are addiction or high-risk behaviors. • Make correct placement • Look at behavior within the context of the family system. • Teach families communication and bonding skills. • Work within the scope of your practice and training
  45. 45. ANXIETY, DEPRESSION & MOOD DISORDERS • Generalized Anxiety Disorder • Panic Attacks • Obsessive Compulsive Disorder
  46. 46. SUBSTANCE USE DISORDERS SUBSTANCE USE DISORDER IS BASED ON EVIDENCE OF IMPAIRED CONTROL, SOCIAL IMPAIRMENT, RISKY USE, AND PHARMACOLOGICAL CRITERIA. • Alcohol Use Disorder • Tobacco Use Disorder • Cannabis Use Disorder • Opioid Use Disorder • Stimulant Use Disorder • Poly-Substance Use Disorder • Human trafficking reports indicate that substance use issues are critical health concerns for 1 in 4 trafficking survivors Trauma-Informed Treatment of Substance Use Disorders in Trafficking Survivors
  47. 47. “Human trafficking victims have greater needs because they basically walk away from their situation with nothing except the clothes on their back. Thus, they have no way to feed themselves, nowhere to live, and no transportation” (Logan et al. (2009) p. 17).
  48. 48. COMPARISON OF PATHOLOGY AND STRENGTHS PATHOLOGY STRENGTHS Person is defined as a “case”; symptoms add up to diagnosis Person is defined as unique; traits, talents, resources add up to strengths Therapy is PROBLEM focused Therapy is POSSIBILITY focused Personal accounts aid in the evocation of diagnosis through reinterpretation by an expert Personal accounts are the essential route to knowing and appreciating the person Practitioner is skeptical of personal stories, rationalizations Practitioner knows the person from the inside out Childhood trauma is the precursor or predictor of adult pathology Childhood trauma is not predictive, it may weaken or strengthen the individual Centerpiece of therapeutic work is the treatment plan devised by practitioner Centerpiece of work is the aspirations of the family and individual Practitioner is the expert on the victim’s lives Individuals and families are the experts Choice, control, commitment, and personal development are limited by pathology Choice, control, commitment, and personal development are open Resources for work are the knowledge and skills of the professional Resources for work are the strengths, capacities, and adaptive skills of the individual, family, and community. Help is centered on reducing the effects of symptoms and the negative personal and social consequences of actions, emotions, thoughts, or relationships Help is centered on getting on with one’s life, affirming and developing values and commitments, and making and finding membership in or as a community
  49. 49. MENTAL HEALTH NEEDS OF A VICTIM • Foreign-born victims of human trafficking experience many stressors • Victims initially experience emotional trauma from being deceived by perpetrators • Often times, these people are someone whom the victim already knew and trusted, possibly family • Violation of trust causes the victim to deeply question the motives of others, as well as their own sense of self • Traffickers intimidate victims by threatening to harm their families if they try and escape or talk to law enforcement • Victims are keenly aware that traffickers have harmed other families, as a result of the enslaved family members resistance • International traffickers have a well developed communication network that crosses borders • Lack of trust in law enforcement and government officials contributes to mental health problems • When government representatives are complicit in human trafficking by participating or accepting bribes to turn a blind eye.
  50. 50. NEED FOR A CONTINUUM OF CARE • Trust-building is at the foundation of effective service delivery when working with victims • Clinical and medical professionals, law enforcement, social services, and anyone a part of the extended client care team MUST understand the importance and value of TRUST • Victims may be very wary of being revictimized • Foreign-born victims are especially vulnerable, because they might not know their rights, local law, or cultural norms. • Educating foreign-born victims on the United States rights to confidentiality, legal representation, and self-determination, is a fundamental component in addressing their immediate and long term needs
  51. 51. BEST PRACTICE IN THE DELIVERY OF SERVICE • Developments in the field of antitrafficking work have begun to evaluate efficacy of service deliver and evidence-based practices • The President’s “Interagency Task Force” and the “Federal Strategic Action Plan on Services for Victims of Human Trafficking” determined that: • The best practices involve comprehensive client-first, survivor-first, victim-centered approaches, and trauma- informed services.
  52. 52. TRUST BUILDING FROM THE VICTIM’S PERSPECTIVE • Building trust with the client is the foundation in providing best practices • Victims have been lied to by their captors as fraud, is a key element of initially gaining trust and maintaining control • Professionals must acknowledge this; Since their client’s trust has been violated, they may be reluctant to trust others • Trust-building process is facilitated by professionals, when they: • Create an atmosphere where the victim is recognized as the expert of their own experience • Create a judgement-free zone • Are accepting of the decisions and choices their client has and will make
  53. 53. THE NEED FOR CASE MANAGEMENT COLLABORATION • Interdisciplinary teams, and case collaboration and coordination, are crucial components to providing best practices to a victims of human trafficking • Teams of professionals from different disciples will synchronize services to be holistic, and avoid possibility of a second trauma • Open communication and trust is essential between professionals and survivors
  54. 54. PUTTING THE VICTIM’S NEEDS FIRST • Victim-centered approach, is a best practice that specifically designs programs to meet the specific needs of individual survivors • Victim-centered approach is developed through a survivor’s lens, rather than what might be best for the professional or the structures in which they typically conduct their work • Specialized intervention strategies are vitally important: • Utilize a single point-of-contact service delivery paradigm • Facilitates wraparound services, while maintaining a survivor-first and victim-centered approach • Interventionist also serves and point-of-contact for all other professionals and groups involved with the case
  55. 55. NEED FOR CULTURAL COMPETENCY • A survivor-centered approach recognizes and affirms that culturally competent services for clients are essential when working with victims • Cultural competence extends beyond ethnicity and race, to encompass learning specifically about the crime of trafficking and its impact on survivors and their families • Specialized intervention services need to be culturally grounded and consider: • Age and development stage • Type and length of exploitation • Relationship with traffickers • Nationality • Previous history of victimization • If language skills of victim are different than the therapist, it is critically important to utilize a translator
  56. 56. WORKING WITH THE FAMILY SYSTEM FOR SUSTAINABLE RECOVERY • De-pathologize the Family • Educate around the dynamics of mental health and/or addictions in the family • Denial as fierce protection • Begin to look at ways to support health, not demise • Difficulty around Re-unification
  57. 57. NEEDS AND CHALLENGES AFTER FAMILY REUNIFICATION • Time of joy and adjustment • Expect: ease and turbulence with newly reunited family members • Mental health resources are frequently needed because of the stress of acculturation and integration processes for their newly arrived family members • Victims exploited who are parents, are often separated from their children for years. Often times, another family member assumes their role. At reunification: • Child: difficultly recognizing biological parent in their parent role = struggles with being overwhelmed • Victim parent: sees child struggling = feelings of guilt
  58. 58. WORKING WITH THE FAMILY SYSTEM FOR SUSTAINABLE RECOVERY • Initial crisis support • Information and History Gathering • Assessment • Preparation for Intervention • Treatment Center Options
  59. 59. WORKING WITH THE FAMILY SYSTEM FOR SUSTAINABLE RECOVERY • Client enters with clinical information • Begin Family Health Plan • Support Health Not Demise • Plan for Boundaries and Self-care • Families know what to expect • Prepare for legal issues and involvement
  60. 60. WORKING WITH THE FAMILY SYSTEM FOR SUSTAINABLE RECOVERY • Support Each Other (Board of Directors) • Education • Twelve step support Groups (Alanon, Naranon, Families Anonymous) • Decrease Anxiety Once in Treatment (Paradigm Shift)
  61. 61. WORKING WITH THE FAMILY SYSTEM FOR SUSTAINABLE RECOVERY • Continued Support for a year • Family Alumni Group • Advocate for the families • Advocate for the treatment center • Advocate for the client
  62. 62. WORKING WITH THE FAMILY SYSTEM FOR SUSTAINABLE RECOVERY • Interpret clinical updates for the family/ helps manage the family- supporting the treatment team • Supports clinical recommendations • Helps when client calls home complaining
  63. 63. WORKING WITH THE FAMILY SYSTEM FOR SUSTAINABLE RECOVERY • Referrals for Treatment • Therapy • Family Therapy • Legal and Advocacy Groups
  64. 64. BARRIERS TO TREATING VICTIMS • Resulting mental health conditions • Lack of Resources • Complexity of the legal cases • Totality of needs • Lack of Awareness throughout the country, world and service providers • Lack of Treatment • Survivors may have developed coping strategies that present in challenging the helping professional: The survivor may be distrusting or actively defensive or angry toward those in the helping profession i.e. counselors, social workers, law enforcement
  65. 65. BARRIERS TO TREATING VICTIMS TRUST • Trust used to gain access to Victim • Crucial to remember these responses are understood in the context of the individuals experience of abuse and trauma, and overall environment in which they live. These responses may be autonomic or uncontrollable linked to the hormonal and biochemical response in the brain.
  66. 66. TRUST AND TRAFFICKING • Betrayed by those you should be able to trust • Trust is used to groom • Trust is paramount to healing
  68. 68. GENERAL INDICATORS OF TRAFFICKING VICTIMS • Be fearful of police/authorities • Be fearful of the trafficker, believing their lives or family members’ lives are at risk if they escape • Exhibit signs of physical and psychological trauma e.g. anxiety, lack of memory of recent events, bruising, untreated conditions • Be fearful of telling others about their situation • Be unaware they have been trafficked and believe they are simply in a bad job • They May:
  69. 69. GENERAL INDICATORS OF TRAFFICKING VICTIMS • They May: • Have limited freedom of movement • Be unpaid or paid very little • Have limited access to medical care • Seem to be in debt to someone • Have no passport or mention that someone else is holding their passport • Be regularly moved to avoid detection • Be controlled by use of witchcraft e.g. Ju Ju
  70. 70. SEXUAL EXPLOITATION • Be aware: ordinary residential housing/hotels are being used more and more for brothels. • People forced into sexual exploitation may: • Be moved between brothels, sometimes from city to city • Sleeping on work premises • Display a limited amount of clothing, of which a large proportion is sexual • Display substance misuse • Be forced, intimidated or coerced into providing sexual services • Be subjected to abduction, assault or rape • Be unable to travel freely e.g. picked up and dropped off at work location by another person • Have money for their services provided collected by another person
  71. 71. FORCED LABOUR • Where all the work is done under the menace of a penalty or the person has not offered himself voluntarily and is now unable to leave. They may experience: • Threat or actual physical harm • Restriction of movement or confinement • Debt bondage i.e. working to pay off a debt or loan, often the victim is paid very little or nothing at all for their services because of deductions • Withholding of wages or excessive wage reductions • Withholding of documents e.g. passport/security card • Threat of revealing to authorities an irregular immigration status • Their employer is unable to produce documents required
  72. 72. FORCED LABOUR CONTINUED… • Poor or non-existent health and safety standards • Requirement to pay for tools and food • Imposed place of accommodation (and deductions made for it) • Pay that is less than minimum wage • Dependence on employer for services • No access to labour contract • Excessive work hours/few breaks
  73. 73. “An abuse of a child’s vulnerability by a person’s position of power or trust, exploiting that position to obtain sexual services in exchange for some form of favour such as alcohol, drugs, attention or gifts” – Engage Team, Blackburn
  74. 74. CHILD ABUSE: HIDING IN PLAIN SIGHT • You may notice a child that is: • Often going missing/truanting • Secretive • Has unexplained money/presents • Experimenting with drugs/alcohol • Associating with/being groomed by older people (not in normal networks) • In relationships with significantly older people • Taking part in social activities with no plausible explanation • Seen entering or leaving vehicles with unknown adults • Showing evidence of physical/sexual assault (including STD’s) • Showing signs of low self image/self harm/eating disorder
  75. 75. CRIMINAL ACTIVITIES • The person is recruited and forced/deceived into conducting some form of criminal activity such as pick pocketing, begging, cannabis cultivation and benefit fraud. • Same indicators as for forced labour but for cannabis cultivation you may also notice: • Windows of property are permanently covered from the inside • Visits to property are at unusual times • Property may be residential • Unusual noises coming from the property e.g. machinery • Pungent smells coming from the property
  76. 76. DOMESTIC SERVITUDE • They may: • Be living and working for a family in a private home • Not be eating with the rest of the family • Have no bedroom or proper sleeping place • Have no private space • Be forced to work excessive hours; “on call” 24 hours a day • Never leave the house without the ‘employer’ • Be malnourished • Be reported as missing or accused of crime by their ‘employer’ if they try to escape
  77. 77. SHIFTING PERSPECTIVE We must stop treating the stigma and begin treating the human.
  78. 78. Addiction Victim of Trafficking Co-Morbidity WHAT HAVE WE MISSED?
  79. 79. QUESTIONS Heather R. Hayes, M.Ed., LPC, CAI, CIP (770) 335-5004 Holly Ryan, LCSW, LADC, SAP 470-505-9939