SOWK 635- Fall 2016
Critical Appraisal of Evidence Report
December 13, 2016
Background of Research Problem
Human Trafficking is a crime that is undetected to the average American citizen. Slavery was visible, legal and acceptable when America was first colonized until the Civil War. After the ratification of the 13th amendment in 1865 which states “Neither slavery nor involuntary servitude, except as a punishment for crime whereof the party shall have been duly convicted, shall exist within the United States, or any place subject to their jurisdiction.” (US, 1776). Slavery was outlawed but did not cease: slavery went underground.
Modern slavery is referred to as “human trafficking”. This is defined by the United Nations Office on Drugs and Crime as “the recruitment, transportation, transfer, harbouring 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 …. for the purpose of exploitation”. There are two origins of trafficked individuals; people brought into the US from out of the country and American citizens trafficked from within the country. Hardy (2013) reports that Human Trafficking is assumed to be limited to third world countries. However, it is estimated that 300,000 female girls are currently being trafficked in the US, and 325,000 children in the US are at risk of being trafficked for sex according to Estes and Weiner (2001). These slaves are generalized into two separate work forces, manual labor and sex for commerce (Coverdale, 2016). The process of finding, grooming, and using young Americans for the sale of nonconsensual sex is referred to as Domestic Minor Sex Trafficking when it involves a victim under the age of 18 years old. The acronym for this practice is DMST (Kaplan, 2015).
Most victims of DMST become exploited between 12 and 14 years old, but some are as young as 10 (Kaplan, 2015). 70 – 90% of female victims were sexually abused before being sold for commercial sex (Countryman-Roswurm, 2014). Living in poverty, poor social skills, a history of physical abuse, living in a high crime area, being a “run-away are risk factors for becoming a victim of trafficking (Coverdale, 2015). The common narrative is that these marginalized and at risk youth are lured into captivity through coercion that promises them the security, love, addiction, force, and authority (Kaplan, 2015). Dependence on their pimp forms a trauma bond which blinds the child from understanding their true reality as a commercial asset (Nichols, 2014). Many children are trafficked from their homes by family members who are also the providers to the basic survival needs of a child (Horn, 2013).
Guiding Practice Based Research Question
“Can identifying the population most at risk of being trafficked, tracking victims, and addressing traumas reduce the number of children in DMST?” The literature available indicates that children who are abused are at risk of becoming DMST victims, however once they are able to leave the practice they return to a trafficked status because it is the reality they know and the only security they understand. Can identifying abused children and addressing their mistreatment bolster their immunity to trafficking? Once victims are identified, could tracking them through the judicial, Child services, and or foster care system produce a result where fewer children return to trafficking because they have not fallen through cracks in the system? Can building treatment systems that are trauma informed decrease the number of children re-victimized into DMST?
Victims of DMST rarely identify with the status of “victim”, rather they feel they are willing participants. They may believe they are having sex to please their boyfriend who is really a pimp in disguise, or they may believe that sex is the tool they can use to stay alive (Walsh, 2016). Children in the sex trade perceive their participation as “survival sex”, sex acts which provide them with housing, food, and clothing so that they can remain alive (Countryman-Roswurm, 2014). They may perceive that they have chosen this course of action and are making a conscious choice to break moral and legal boundaries. Many law enforcement, medical personnel, public officials and members of the general public may agree with this stance: that a child prostitute has the ability to decide to engage in sex in exchange for something of value be it coin or commodity. This perception of the child prostitute as a conscious criminal creates a barrier to providing funding and services which would change their status and eliminate their need to prostitute (Countryman-Roswurm, 2014). A “victim centered” approach to ending DMST would take into consideration the ways children became victims and the reasons they appear to select to stay victimized (Walsh, 2016).
Screening children for risk of abuse and vulnerability to trafficking is not universally approved or implemented because many pediatricians do not believe there is a need for even a brief screening in a routine check-up (Hansen, 2016). Annual pediatric check-ups may be the only contact a child has with a professional potentially trained to identify abuse and with access to mental health and other resources the child may need. This intervention could reduce a child’s risk of becoming victimized. Early screenings for incest or other forms of sexual abuse can detect and interrupt the training of a child to reduce their physical boundaries and accept that their body is a sexual tool (Hansen, 2015). DMST victims often develop serious mental and physical health problems that impact them for the rest of their lives and when treated, the bill is passed on to the tax payers. Victims may develop missing and broken teeth, bruises, fractured bones, frequent or unsafe abortions, PTSD, depression, sexually transmitted illnesses, drug addiction and suicidal thoughts (Hornor, 2015). There is no universally accepted screening tool to identify sexual abuse or DMST. When a minor comes into a physician setting they are often accompanied by an adult who may be a parent or guardian. This adult may answer all of the questions asked by the medical staff. Gracehaven, a shelter program in OHIO for DMST victims suggests that asking the pediatric patient who their boyfriend is, how they met, who their friends are, where they live and if they are free to come and go as they please are nonthreatening threshold questions that can indicate if further screening is needed (Walsh, 2016). Medical students and pediatricians are not aware of the scope of this problem, nor do they feel they have resources to appropriately respond to an identified object of sex trafficking (Titchen,2015) A 2014 article by Bespalova, Morgan, and Coverdale reviewed n9ne screening tools for identifying trafficking victims and concluded that none were the appropriate length, format or asked the correct questions.
Children who encounter law enforcement as a part of prostitution are at risk being treated as criminals and not receiving screenings for abuse, DMST or other traumas. Police officers are not routinely trained to identify victims of DMST (Countryman-Roswurm, 2014). The police do not know the appropriate terminology and the youth have a systematic fear of the police which has been instilled in them as a control mechanism by their pimp. A 2006 study found that 92% of American police departments had not had any training on identifying DMST and just 12% of officers believe that trafficking happens in their jurisdiction (Nichols, 2014). When police in Duluth, Minnesota were given training on identifying a DMST victim and the forces that created the victimization the police were able to make the distinction that although they received hundreds of calls for domestic violence, they had received no calls about human sex trafficking. The police identified that there was a lack of trust and began exploring the Minnesota laws which let them escort victims to shelters and provide them with resources even if they were arresting the victim (Walsh, 2016).
There is no universally accepted screening tool to identify sexual abuse or DMST. When a minor comes into a physician setting they are often accompanied by an adult who may be a parent or guardian. This adult may answer all of the questions asked by the medical staff. Gracehaven, a shelter program in OHIO for DMST victims suggests that asking the pediatric patient who their boyfriend is, how they met, who their friends are, where they live and if they are free to come and go as they please are nonthreatening threshold questions that can indicate if further screening is needed.
Evidence Based Intervention
The majority of victims of DMST have had a lifetime of traumas. Their childhood traumas of incest, sexual abuse, physical abuse and alienation made them more vulnerable to being trafficked. Trafficking is an additional level of trauma. Lifespan traumas increase the likelihood a person will develop Post Traumatic Stress Syndrome (Briere, 2015). There are no established therapies specifically for PTSD suffering victims of trafficking. Victims of DMST are young and often in transit between captivity, incarceration, hospitalization. Without stability they cannot undergo long term therapy. A short term approach is ideal.
It is a combination of cognitive-behavioural and testimony Compared against four sessions of Supportive Counseling, and one session of Psychoeducation, NET had the highest rate of clients no longer qualifying as PTSD one year later (Neuner, 2004). NET is a short term therapy approach that addresses multiple traumas without placing emphasis on any one trauma. NET employs symbols to indicate traumas, grief, victories and the lifeline of the patient. The therapist creates a written document of the story told by the patient. The patient creates a chronological story and organizes their experiences into a coherent narrative (Robjant, 2010).
Evidence Based Assessments and/or Screening Tools
American College of Obstetricians and Gynecologists have recognized that gynecological appointments are one of the few instances when a woman may be seen by a physician without another adult in the room, the same is true of teens who have gynecological visits. Victims of DMST have a higher rate of STI, a greater need for abortion and a greater rate of damage to their sexual organs (Hansen, 2015). Screening for violence in this medical setting could capture a greater number of victims. While there are no uniformly approved assessments for DMST victim status, the “Danger Assessment” screening tool for Femicide is appropriate for this population. This is a multivariate twenty question survey developed by a nurse to measure the risk a woman is in from “femicide” or “attempted femicide” meaning death at the hands of an intimate partner. It is designed to raise awareness in the subject of what situations are indicating she is at risk of harm and is intended to be the beginning stage of safety planning. This assessment was studied in eleven cities and administrations by health care providers were compared to the result when police and other emergency personnel gave the questions. The answers remained significantly similar. It can accurately identify most of the women in homes where the woman would be killed or suffer an attempt on her life (Hart, 2009). This assessment also screens well to identify women are low risk. More study is required on various ethnic groups. The wording may need to be explained or changed due to cultural sensitivity. This tool is intended to be used regularly as a part of client interviews even when no abuse is suspected. Implementation of this scale is the beginning of risk management and safety planning.
Sex Trafficking involves three parties, one victim, one sexual offender who sells the child for sex and one sexual predator buying the child for sexual service. Two thirds of the people involved in the transaction are sex offenders. The Static 99R is a ten question actuarial risk assessment screening designed to give an estimate of the risk of sexual recidivism in an adult male who has been convicted of, or charged with, sexual assault on a child or nonconsenting adult (Hart, 2009). The use of this tool may result in civil commitments in twenty US states. The Static-99R is an evolution from the Static-99, the most commonly used screening tool in the US and Canada (Helmus, 2007). It varies by one question and has been judged to be similar enough to the Static-99 that evaluation of the older tool applies to the newer instrument. The Static-99R was tested in Germany concurrently against three other assessment measures in a 9-year study (Judge, 2014). It had the best predictive results. It is reliable with developmentally delayed offenders, mentally ill offenders, and male to female transgendered offenders who have not had their penis removed. The screening results show definite but no statistically significant variability with non-Caucasian offenders. It is not appropriate for use with females, minor males, or the population of offenders who offended while institutionalized but whose institutionalization is not a result of a sexual offence. The survey is completed by an administrator reviewing the records on the subject. Where official documents are not available the subject’s self-report is acceptable. Only the question about living with a romantic partner for two years or more can be left blank. Answers are scored, and tabulated then compared to the coding scales resulting in a score indicating risk.
Domestic Minor Sex Trafficking a topic often discussed in terms of international law and crimes on featured on police procedural television shows for shock value. Means of identifying the population and reducing the number of children drawn into trafficking are not given equal attention (Sanford, 2016). The Department of Justice has put together a handbook for victims of human trafficking that suggests any victim in need of medical attention seek it at county health clinics, health fairs and college health programs. None of these venues offer trauma informed care. There are not enough trauma informed practitioners offering medical or mental health services.
The adults and service providers who are most likely to interact with children at risk of exploitation are not provided with the means or interest to screen for vulnerability. Once children are identified, there are not protections, housing, and care available to the children. As social workers we are pledged to defend the dignity of every human, however we are failing the victims of sex trafficking. Once they do end their path as a victim they are often too old and disenfranchised to attend school and gather skills to have a self-sufficient life. Left untreated they suffer debilitating mental health issues. Broken bones, burn marks and other physical reminders of their time as a victim remain throughout their lives.
The most humane courses of action involve stopping children from being victimized by placing adults in their lives such as pediatricians who have to see the children in order for them to enroll in school or receive public assistance. These adults should be fully trained to recognize the warning signs of abuse and empowered to report it or take further action such as a mental health referral to bolster the young person’s immunity to this abuse. The other noticeable option is to be aware of who the sexual predators are and their likelihood to recidivism. Screenings should be created for adults who have been convicted of abusing children through DMST and interventions to address those urges and crimes should be used with this population.
Pimps selling children into sex do so because it is a profitable business earning more money than gang related drugs and theft. As a society we talk about “pimping” our rides, going to “Pimp and Ho parties” and have made pimps into iconic figures instead of the boogie men they are to both children and the adults they control and sell. Girls are sexualized early and consistently told how pretty they are and that any mistreatment by boys their own age is “because he likes you”. From a young age society should be teaching children to have agency over their own bodies, making it more difficult for someone else to abuse them or sell them. Refusing to sexualize children of either gender would be a start to changing how society perceives children.
Sex trafficking is ignored, invisible to the average American citizen and usually discussed in either a sensational manner such as pop culture television or a Liam Nelson Movie, or as a feature of a third world population. As a society we should normalize discussions of this crime and learn to see it for what it is so that we can treat it and heal the victims.
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