1
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Casassa K, Ploss A, Karandikar S. "He Loves Me Hard and Then He Abuses Me Hard": How Service Providers Define and Explain Trauma Bonds Among Sex Trafficking Survivors. Violence Against Women 2024; 30:1354-1377. [PMID: 36798031 DOI: 10.1177/10778012231158104] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
There is a dearth of research on trauma bonding among victims of sex trafficking. This study aims to fill this gap by seeking to understand how service providers working with survivors of sex trafficking conceptualize and observe trauma bonding in their clients. This qualitative study involved interviews with 10 participants. Purposeful sampling was employed among licensed social workers or counselors. Two themes emerged: defining trauma bonding (with four subthemes: embracing intensity, power imbalance, distortion of love, and inescapability) and the development of trauma bonds (with three subthemes: universality, gendered, and grooming). These findings provide much-needed insight into the complexities of trauma bonding.
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Affiliation(s)
- Kaitlin Casassa
- College of Social Work, The Ohio State University, Columbus, Ohio, USA
| | - Alexa Ploss
- College of Social Work, The Ohio State University, Columbus, Ohio, USA
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2
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Gautham I, Coverdale J, Nguyen PT, Gordon MR. Clinical and Advocacy Implications of the Dobbs vs. Jackson Women's Health Organization Ruling on Trafficked Persons. Violence Against Women 2024:10778012241231779. [PMID: 38425289 DOI: 10.1177/10778012241231779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
The United States Supreme Court decision on the case of Dobbs vs. Jackson Women's Health Organization abolished federal protections of abortion, leaving abortion legislation at the discretion of individual states. Trafficked persons are a population especially vulnerable to the impacts of this ruling. Because there is no existing literature describing the effects of restrictive abortion legislation on this group, we described some of the potential consequences of restrictive abortion laws for sex and labor trafficked persons, based on real case examples. We describe steps that should be taken to sufficiently protect and support pregnant trafficked women in relation to the Dobbs law.
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Affiliation(s)
- Ila Gautham
- School of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - John Coverdale
- School of Medicine, Baylor College of Medicine, Houston, TX, USA
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, USA
- Anti-Human Trafficking Program, Baylor College of Medicine, Houston, TX, USA
| | - Phuong T Nguyen
- School of Medicine, Baylor College of Medicine, Houston, TX, USA
- Anti-Human Trafficking Program, Baylor College of Medicine, Houston, TX, USA
| | - Mollie R Gordon
- School of Medicine, Baylor College of Medicine, Houston, TX, USA
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
- Anti-Human Trafficking Program, Baylor College of Medicine, Houston, TX, USA
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3
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Doychak K, Raghavan C. Trauma-Coerced Attachment: Developing DSM-5’s Dissociative Disorder “Identity Disturbance due to Prolonged and Intense Coercive Persuasion”. EUROPEAN JOURNAL OF TRAUMA & DISSOCIATION 2023. [DOI: 10.1016/j.ejtd.2023.100323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
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4
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Coverdale J, Gordon MR, Beresin EV, Guerrero APS, Louie AK, Balon R, Morreale MK, Aggarwal R, Brenner AM. Access to Abortion After Dobbs v. Jackson Women's Health Organization: Advocacy and a Call to Action for the Profession of Psychiatry. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2023; 47:1-6. [PMID: 36369427 PMCID: PMC9652041 DOI: 10.1007/s40596-022-01729-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Affiliation(s)
| | | | | | | | | | | | | | | | - Adam M Brenner
- University of Texas Southwestern Medical Center, Dallas, TX, USA
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5
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Dando CJ, Ormerod TC, Atkinson-Sheppard S. Parental experiences of the impact of grooming and criminal exploitation of children for county lines drug trafficking. J Public Health (Oxf) 2022:6843552. [DOI: 10.1093/pubmed/fdac112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 05/17/2022] [Accepted: 09/27/2022] [Indexed: 11/25/2022] Open
Abstract
Abstract
Background
County lines is used to describe the illicit drug supply model whereby drugs are transported from one area of the country to another, often by children believed to have been physically and psychologically coerced to do so. County lines is a serious threat to public health, with significant negative impacts on the physical and psychological health and wellbeing of children and families.
Methods
We conducted in-depth interviews with parents of children involved in county lines to understand their experiences and the impact of grooming and recruitment. Interviews were conducted between December 2019 and January 2021. Thematic analysis identified four primary themes: (i) out of nowhere behaviour change, (ii) escalation and entrenchment, (iii) impact of intervention failures and (iv) destructive lifestyle choices.
Results
Parents from across England all reported similar experiences, and so these data offer novel insight into potential grooming and recruitment indicators. All were frustrated by the prevailing vulnerable narrative, which they argued hindered understanding. A lack of consultation, and reports of numerous intervention failures was common.
Conclusion
The importance of giving parents a voice and involving them as a potential first line of defence, and how the current vulnerability narrative appears to be closing impactful education opportunities are discussed.
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Affiliation(s)
- Coral J Dando
- University of Westminster Department of Psychology, , London W1W 6UW , UK
| | - Thomas C Ormerod
- University of Sussex School of psychology, , Falmer BN1 9PL , UK
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6
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Vujanovic AA, Gordon MR, Coverdale JH, Nguyen PT. Applying Telemental Health Services for Adults Experiencing Trafficking. Public Health Rep 2022; 137:17S-22S. [PMID: 35775909 DOI: 10.1177/00333549221085243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Anka A Vujanovic
- Trauma and Stress Studies Center, Department of Psychology, University of Houston, Houston, TX, USA
| | - Mollie R Gordon
- Anti-Human Trafficking Program, Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - John H Coverdale
- Anti-Human Trafficking Program, Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Phuong T Nguyen
- Anti-Human Trafficking Program, Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
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7
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Casassa K, Knight L, Mengo C. Trauma Bonding Perspectives From Service Providers and Survivors of Sex Trafficking: A Scoping Review. TRAUMA, VIOLENCE & ABUSE 2022; 23:969-984. [PMID: 33455528 DOI: 10.1177/1524838020985542] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
A trauma bond is an emotional attachment between an abuser and victim. Trauma bonds in sex trafficking compel victims to submit to continued exploitation and protect the trafficker. This scoping review examines trauma bonds in sex trafficking situations, its conceptualizations, and key characteristics. Ten databases were searched using sex trafficking AND trauma bonding-related terms; sex trafficking AND Stockholm syndrome, attachment, coercion, and manipulation. Articles were included if they featured trauma bonding, were published in English after 2013, or featured sex trafficking victims or traffickers in a Western country. Fifteen articles were included. The features of trauma bonding identified in these articles were (1) imbalance of power that favors trafficker, (2) traffickers' deliberate use of positive and negative interactions, (3) victim's gratitude for positive interactions and self-blame for the negative, and (4) victim's internalization of perpetrator's view. We also identified four aspects related to trauma bonding: (1) prior trauma made victims vulnerable, (2) victim's feelings of love remained even after exiting trafficking, (3) love is why victims do not prosecute traffickers, and (4) traffickers' intentional cultivation of the trauma bond. No article indicated how trauma bonds could be severed and replaced with healthy attachments. These findings reveal the need for practitioners and law enforcement and criminal justice professionals to address trauma bonding in both trafficking and posttrafficking situations. The findings also represent potential targets for urgently needed interventions that promote the replacement of trauma bonds with healthy attachments.
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Affiliation(s)
- Kaitlin Casassa
- College of Social Work, 2647The Ohio State University, Columbus, OH, USA
| | - Logan Knight
- College of Social Work, 2647The Ohio State University, Columbus, OH, USA
| | - Cecilia Mengo
- College of Social Work, 2647The Ohio State University, Columbus, OH, USA
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8
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Perry EW, Osborne MC, Lee N, Kinnish K, Self-Brown SR. Posttraumatic Cognitions and Posttraumatic Stress Symptoms Among Young People Who Have Experienced Commercial Sexual Exploitation and Trafficking. Public Health Rep 2022; 137:91S-101S. [PMID: 35775917 DOI: 10.1177/00333549211041552] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES The impact of posttraumatic cognitions on the development and maintenance of posttraumatic stress symptoms (PTSS) is understudied among children and adolescents who have experienced commercial sexual exploitation/trafficking (CSE/T). The objectives of this study were to (1) explore posttraumatic cognitions among help-seeking young people aged 11-19 who have experienced CSE/T; (2) determine whether experiencing direct violence, witnessing violence, polyvictimization (ie, multiple exposures to different categories of potentially traumatic events), or demographic characteristics differentially affect whether these young people meet clinical criteria for posttraumatic cognitions using established cutoffs; and (3) explore associations between posttraumatic cognitions and PTSS among young people who have experienced CSE/T. METHODS This study is a secondary analysis of a baseline cross-sectional survey of 110 young people with substantiated CSE/T experiences who started trauma-focused cognitive behavioral therapy (mean [SD] age = 15.8 [1.5]) from August 1, 2013, through March 31, 2020, in a southeastern US state. We used descriptive statistics, adjusted modified Poisson regression, and adjusted linear regression to test study objectives. RESULTS Fifty-seven of 110 (51.8%) young people aged 11-19 met clinical criteria for posttraumatic cognitions. Increased age and a greater number of trauma categories experienced were significantly associated with meeting clinical criteria for posttraumatic cognitions. On average, higher posttraumatic cognition scores were associated with higher PTSS scores, controlling for demographic characteristics (β = 0.95; 95% CI, 0.64-1.26). CONCLUSIONS These findings underscore the importance of assessing comprehensive trauma history and PTSS of young people who have experienced CSE/T, with added usefulness of measuring cognitive appraisals to inform a therapeutic treatment plan. Measuring cognitive appraisals that may influence PTSS and therapeutic success can ensure an effective public health response for this population.
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Affiliation(s)
- Elizabeth W Perry
- 1373 School of Public Health, Georgia State University, Atlanta, GA, USA.,1373 Mark Chaffin Center for Healthy Development, Georgia State University, Atlanta, GA, USA.,1373 Center for Research on Interpersonal Violence, Georgia State University, Atlanta, GA, USA
| | - Melissa C Osborne
- 1373 Center for Research on Interpersonal Violence, Georgia State University, Atlanta, GA, USA.,1373 Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, Atlanta, GA, USA
| | - NaeHyung Lee
- 1373 School of Public Health, Georgia State University, Atlanta, GA, USA.,1373 Mark Chaffin Center for Healthy Development, Georgia State University, Atlanta, GA, USA.,1373 Center for Research on Interpersonal Violence, Georgia State University, Atlanta, GA, USA
| | | | - Shannon R Self-Brown
- 1373 School of Public Health, Georgia State University, Atlanta, GA, USA.,1373 Mark Chaffin Center for Healthy Development, Georgia State University, Atlanta, GA, USA.,1373 Center for Research on Interpersonal Violence, Georgia State University, Atlanta, GA, USA
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9
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Trauma-informed interventions for counselling sex trafficking survivors. INTERNATIONAL JOURNAL FOR THE ADVANCEMENT OF COUNSELLING 2022. [DOI: 10.1007/s10447-022-09465-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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10
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Gordon MR, Coverdale J, Chervenak FA, McCullough LB. Undue burdens created by the Texas Abortion Law for vulnerable pregnant women. Am J Obstet Gynecol 2022; 226:529-534. [PMID: 34954218 DOI: 10.1016/j.ajog.2021.12.033] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 12/09/2021] [Accepted: 12/17/2021] [Indexed: 11/25/2022]
Abstract
The new Texas abortion law requires the physician to determine whether a fetal heartbeat is present and prohibits abortion after a heartbeat has been documented. An exception is allowed when a "medical emergency necessitated the abortion." These and other provisions of the statute are to be enforced through "civil actions" brought by private citizens. This article identifies 3 populations of vulnerable women who will experience undue burdens created by the Texas abortion law. We begin with an account of the concept of undue burden in the jurisprudence of abortion, as expressed in the 1992 US Supreme Court case, Planned Parenthood v. Casey of Southeastern Pennsylvania. We then provide an evidence-based account of the predictable, undue burdens for 3 populations of vulnerable women: pregnant women with decreased freedom of movement; pregnant minors; and pregnant women with major mental disorders and cognitive disabilities. The Texas law creates an undue burden on these 3 populations of vulnerable women by reducing or even eliminating access to abortion services outside of Texas. The Texas law also creates an undue burden by preventably increasing the risks of morbidity, including loss of fertility, and mortality for these 3 populations of vulnerable women. For these women, it is indisputable that the Texas law will create undue burdens and is therefore not compatible with the jurisprudence of abortion as set forth in Planned Parenthood v. Casey because a "significant number of women will likely be prevented from obtaining an abortion." Federal courts should therefore strike down this law.
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11
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Koegler E, Howland W, Gibbons P, Teti M, Stoklosa H. "When Her Visa Expired, the Family Refused to Renew It," Intersections of Human Trafficking and Domestic Violence: Qualitative Document Analysis of Case Examples from a Major Midwest City. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP4133-NP4159. [PMID: 32924747 DOI: 10.1177/0886260520957978] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
This study aimed to further understand typologies of trafficking that occur in the home, by an individual's intimate partner (IP) or family members and this overlap with extant knowledge on perpetrator manipulation via the Power and Control Wheel. Inductive and deductive techniques were used to analyze secondary data from a federally funded anti-trafficking program in a Midwest metropolitan area recorded between 2008 and 2017. Cases were included if there was indication of sex or labor exploitation initiated by an IP, family member, or other in the domestic setting via elements of abuse; 59 cases of 213 met this criteria. Most cases included the IP as the trafficker, followed by family members, then others in the domestic setting. Abuse was more commonly used than the threat of abuse. From the Power and Control Wheel, the most frequent types of abuse were using privilege, physical abuse, economic abuse, isolation, and sexual abuse. Case typologies included: those with elements of sex trafficking, specifically forced commercial sex by an IP or family member; those with elements of labor trafficking such as domestic servitude (with or without childcare provision abuse), exploitation in a family business by an IP or family member, or work environments by family and non-family; those with elements of sex and labor trafficking included servile partnerships and forced marriage. Trafficking exploitation by an IP, family member, or in the domestic setting is not uncommon. Intimate relationships with a trafficker, psychological coercion, and threats may reduce reporting of abuse, subsequent provision of services, and result in misclassification as victims of IP violence. This study sheds light on various typologies of trafficking and exploitation in the domestic setting, further expanding the anti-trafficking movement's evidence base for intervention and prevention and adding complexity and nuance to the pathways to trafficking exploitation.
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Affiliation(s)
- Erica Koegler
- University of Missouri-St. Louis, St. Louis, Missouri, USA
| | | | - Patric Gibbons
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Hanni Stoklosa
- HEAL Trafficking, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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12
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Human Trafficking in Rehabilitation: What Nurses Need to Know. Rehabil Nurs 2021; 47:24-30. [PMID: 34772899 DOI: 10.1097/rnj.0000000000000356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Violence and human trafficking are frequently paired and violate human rights. Human trafficking is a complex, global health issue. Trafficking survivors report seeking medical care for women's services, physical abuse, mental health, and gastrointestinal issues while being held in captivity. However, the majority of healthcare providers are unaware or unprepared to intervene, thus missing the chance to identify victims during these encounters. Rehabilitation nurses are no exception. Trafficking victims may come in contact with rehabilitation nurses because of injuries or chronic diseases caused by trafficking abuse. This article shares human trafficking red flags, victims' access to services, barriers to identification, and nursing interventions and implications.
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13
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Fraley HE, Aronowitz T. Obtaining Exposure and Depth of Field: School Nurses "Seeing" Youth Vulnerability to Trafficking. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:7547-7573. [PMID: 30879385 DOI: 10.1177/0886260519836779] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Trafficking of youth is a growing phenomenon. How commercially exploited youth present in schools is multifaceted and poorly understood. Like other providers, school nurses are on the frontlines, yet can misunderstand youth who are commercially exploited. Using Grounded Theory, we employed theoretical sampling with school nurses and survivors of trafficking to generate a theory that explains (a) the factors that increase the risk of youth being trafficked and (b) how school nurses might identify youth at risk of being trafficked. The emerging theory developed from the data was Obtaining Exposure and Depth of Field: School Nurses "Seeing" Youth Vulnerability to Trafficking. Voices of school nurses and survivors illuminated the invisibility of youth in schools who are victims of trafficking and the magnified lens of exploiters who see their vulnerability. The lens of school nurses can be refocused to "see" youth who are victims of trafficking presenting at school.
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14
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Mobasher Z, Baldwin SB, Navarro B, Bressler-Montgomery D, King J, Family L, Smith LV, Kuo T. Knowledge and perceptions of human trafficking among community-based and faith-based organization members in South Los Angeles. Glob Health Promot 2021; 29:45-56. [PMID: 34325563 DOI: 10.1177/17579759211028177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The objectives of this study were (1) to assess the knowledge and perceptions of human trafficking (HT) among leaders and staff from 11 community-based organizations (CBOs) and faith-based organizations (FBOs) in South Los Angeles, and (2) to identify gaps in knowledge of HT and inform community organizations regarding possible best practices in health promotion for addressing this emerging public health problem. A self-administered survey was conducted during the period from 4 December 2015 to 28 January 2016. Descriptive statistics were generated and a logistic regression model was constructed using SAS 9.3. A total of 277 CBO and FBO leaders and staff completed the survey. Participants demonstrated high levels of knowledge of HT but their knowledge was not comprehensive, as gaps exist in recognizing the context in which HT usually takes place; understanding the local laws that govern this activity; and ways to follow related policies/procedures when the problem is suspected. A majority (a) believed there were not enough services in Los Angeles County to help survivors of HT, (b) could not recognize the signs of HT, and (c) did not know what steps to take if they suspected this criminal activity. A statistically significant association was found between education and participants' knowledge of HT, and with their beliefs and attitudes toward this violation of human rights. Study findings suggest that, generally, CBO/FBO leaders and staff in South Los Angeles have good knowledge about HT. However, notable gaps in knowledge and misperceptions remain, suggesting opportunities for Public Health to further educate and intervene.
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Affiliation(s)
- Zahra Mobasher
- Division of Community Health Services, Los Angeles County Department of Public Health, Los Angeles, CA, USA
| | - Susie B Baldwin
- Office of Women's Health, Los Angeles County Department of Public Health, Los Angeles, CA, USA
| | - Beatriz Navarro
- Division of Community Health Services, Los Angeles County Department of Public Health, Los Angeles, CA, USA
| | - Deanna Bressler-Montgomery
- Division of Community Health Services, Los Angeles County Department of Public Health, Los Angeles, CA, USA
| | - Jan King
- Division of Community Health Services, Los Angeles County Department of Public Health, Los Angeles, CA, USA
| | - Leila Family
- Office of Health Assessment and Epidemiology, Los Angeles County Department of Public Health, Los Angeles, CA, USA
| | - Lisa V Smith
- Office of Health Assessment and Epidemiology, Los Angeles County Department of Public Health, Los Angeles, CA, USA.,Department of Epidemiology, University of California, Los Angeles (UCLA) Jonathan and Karin Fielding School of Public Health, Los Angeles, CA, USA
| | - Tony Kuo
- Department of Epidemiology, University of California, Los Angeles (UCLA) Jonathan and Karin Fielding School of Public Health, Los Angeles, CA, USA.,Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.,Population Health Program, UCLA Clinical and Translational Science Institute, Los Angeles, CA, USA
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15
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Knott LE, Salami T, Gordon MR, Torres MI, Coverdale JH, Nguyen PT. Motivational Interviewing as a Therapeutic Strategy for Trafficked Persons. J Cogn Psychother 2021; 35:104-115. [PMID: 33990443 DOI: 10.1891/jcpsy-d-20-00028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
It is estimated that 40 million people worldwide have experienced human trafficking (UN, International Labour Organization & Walk-Free Foundation, 2019), with 313,000 trafficked persons in the state of Texas alone (Busch-Armendariz et al., 2016). These staggering numbers are indicative of human trafficking as a growing public health concern. To date researchers have neither studied nor proposed a specific psychotherapeutic modality in the treatment of trafficked persons. Given the unique concerns of this populations, including mistrust of authority, emotional coercion, and abuse by traffickers, often co-occurring substance use concerns, and difficulty with standard treatment adherence, we propose a therapeutic strategy that might assist providers in addressing a broad range of concerns, particularly assisting trafficked persons in the effort to leave their situation. This strategy is motivational interviewing (MI; Miller et al., 2009) and has shown substantial efficacy to enhance motivation to change as applied within in a broad range of healthcare settings. We briefly review the broad tenants of MI and illustrate its application within two hypothetical cases of trafficking. Future research that examines the potential benefits of MI within trafficking populations is warranted.
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16
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Unertl KM, Walsh CG, Clayton EW. Combatting human trafficking in the United States: how can medical informatics help? J Am Med Inform Assoc 2021; 28:384-388. [PMID: 33120418 DOI: 10.1093/jamia/ocaa142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 05/11/2020] [Accepted: 06/15/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Human trafficking is a global problem taking many forms, including sex and labor exploitation. Trafficking victims can be any age, although most trafficking begins when victims are adolescents. Many trafficking victims have contact with health-care providers across various health-care contexts, both for emergency and routine care. MATERIALS AND METHODS We propose 4 specific areas where medical informatics can assist with combatting trafficking: screening, clinical decision support, community-facing tools, and analytics that are both descriptive and predictive. Efforts to implement health information technology interventions focused on trafficking must be carefully integrated into existing clinical work and connected to community resources to move beyond identification to provide assistance and to support trauma-informed care. RESULTS We lay forth a research and implementation agenda to integrate human trafficking identification and intervention into routine clinical practice, supported by health information technology. CONCLUSIONS A sociotechnical systems approach is recommended to ensure interventions address the complex issues involved in assisting victims of human trafficking.
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Affiliation(s)
- Kim M Unertl
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Colin G Walsh
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ellen Wright Clayton
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,School of Law, Vanderbilt University, Nashville, Tennessee, USA.,Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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17
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Menon B, Stoklosa H, Van Dommelen K, Awerbuch A, Caddell L, Roberts K, Potter J. Informing Human Trafficking Clinical Care Through Two Systematic Reviews on Sexual Assault and Intimate Partner Violence. TRAUMA, VIOLENCE & ABUSE 2020; 21:932-945. [PMID: 30453846 DOI: 10.1177/1524838018809729] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND There is a lack of evidence on the clinical management of patients who have suffered human trafficking. Synthesizing the evidence from similar patient populations may provide valuable insight. This review summarizes findings on therapeutic interventions for survivors of sexual assault and intimate partner violence (IPV). METHOD We conducted two systematic reviews using the MEDLINE database. We included only randomized controlled trials of therapies with primary outcomes related to health for survivors of sexual assault and IPV. For the sexual assault review, there were 78 abstracts identified, 16 full-text articles reviewed, and 10 studies included. For the IPV review, there were 261 abstracts identified, 24 full-text articles reviewed, and 17 studies included. Analysis compared study size, intervention type, patient population, primary health outcomes, and treatment effect. RESULTS Although our search included physical and mental health outcomes, almost all the studies meeting inclusion and exclusion criteria focused on mental health. The interventions for sexual assault included spiritually focused group therapy, interference control training, image rehearsal therapy, sexual revictimization prevention, educational videos, cognitive behavioral therapy, and exposure therapy. The interventions in the IPV review included group social support therapy, exposure therapy, empowerment sessions, physician counseling, stress management programs, forgiveness therapy, motivational interviewing, and interpersonal psychotherapy. CONCLUSIONS Insights from these reviews included the importance of culturally specific group therapy, the central role of survivor empowerment, and the overwhelming focus on mental health. These key features provide guidance for the development of interventions to improve the health of human trafficking survivors.
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Affiliation(s)
- Blaine Menon
- Miller School of Medicine, The University of Miami, Miami, FL, USA
| | | | | | - Adam Awerbuch
- Miller School of Medicine, The University of Miami, Miami, FL, USA
| | - Luke Caddell
- Miller School of Medicine, The University of Miami, Miami, FL, USA
| | - Ken Roberts
- Miller School of Medicine, The University of Miami, Miami, FL, USA
| | - Jonell Potter
- Miller School of Medicine, The University of Miami, Miami, FL, USA
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18
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Haney K, LeBeau K, Bodner S, Czizik A, Young ME, Hart M. Sex Trafficking in the United States: A Scoping Review. JOURNAL OF EVIDENCE-BASED SOCIAL WORK (2019) 2020; 17:714-748. [PMID: 32678726 DOI: 10.1080/26408066.2020.1765934] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
PURPOSE Human trafficking is a public health social work issue. This review aimed to present the current state (nature and extent) of sex trafficking research, categorize best practices, and identify recommendations for professionals. METHODS Comprehensive literature searches of online databases were conducted to identify eligible articles from January 2000 to March 2019. RESULTS The search yielded 467 studies, 87 met the predetermined criteria for inclusion. Seven themes identified: awareness, identification, at-risk populations, health issues, implementation of trafficking legislation, service and program implementation, and exploiters. DISCUSSION AND IMPLICATIONS FOR PRACTICE Findings indicate the need for additional research to determine the most effective practices to increase awareness and identification, widespread TVPA implementation, reduce risk factors and resulting health disparities, offer services to survivors and prevention of potential victims. CONCLUSION There should be significant efforts to enhance all sex trafficking research in the United States to implement effective, sustainable and evidence-based interdisciplinary interventions.
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Affiliation(s)
- Kanathy Haney
- Health Sciences, Palm Beach State College , Lake Worth, Florida, USA
- Department of Epidemiology, University of Florida , Gainesville, Florida, USA
| | - Kelsea LeBeau
- Department of Epidemiology, University of Florida , Gainesville, Florida, USA
| | - Samantha Bodner
- Department of Epidemiology, University of Florida , Gainesville, Florida, USA
| | - Annika Czizik
- Department of Medical Geography in Public Health, University of Florida , Gainesville, Florida, USA
| | - Mary Ellen Young
- Department of Occupational Therapy, University of Florida , Gainesville, Florida, USA
| | - Mark Hart
- Department of Epidemiology, University of Florida , Gainesville, Florida, USA
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Lawrence M, Bauer P. Knowledge Base of Nurses Before and After a Human Trafficking Continuing Education Course. J Contin Educ Nurs 2020; 51:316-321. [PMID: 32579227 DOI: 10.3928/00220124-20200611-07] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 12/18/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Recent research shows up to 88% of human trafficking victims are seen in a health care setting sometime during their coerced servitude. Nurses are in key positions to identify trafficked victims but often lack sufficient information about how to assess and report trafficked victims. METHOD This article includes participant data from one presurvey and two postsurveys from a human trafficking continuing education course. RESULTS Data demonstrate a precourse knowledge base deficit about human trafficking. The postcourse surveys indicated that participants had increased knowledge and desire to implement the course information to identify trafficked individuals. CONCLUSION Nurses learning about human trafficking through continuing education courses can be invaluable in identifying and helping trafficked victims. [J Contin Educ Nurs. 2020;51(7):316-321.].
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Lepianka C, Colbert AM. Characteristics and Healthcare Needs of Women Who Are Trafficked for Sex in the United States: An Integrative Literature Review. JOURNAL OF FORENSIC NURSING 2020; 16:6-15. [PMID: 32068675 DOI: 10.1097/jfn.0000000000000273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Human sex trafficking is a major public health issue. The United States is the second largest market for sex-trafficked women, yet few healthcare interventions, designed for women specifically, have been identified. The purpose of this review was to present a systematic review of the literature on the characteristics and healthcare needs of women who have been trafficked for sex in the United States. METHODS This literature review was conducted following the methodology outlined by Whittmore and Knalf and written using Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. Cumulative Index to Nursing & Allied Health, PsychInfo, PubMed, and Scopus databases were searched. A quality assessment tool was used to determine rigor of the studies included in this review. RESULTS Nine publications met the inclusion criteria. Three studies specifically explored health. Four studies were composed solely of women born outside the United States, and two studies reported differences across many variables, including overall health, between women born outside the United States and women born within the United States. A lack of resources and an inadequate response by the health system resulted in care that was not optimal. CONCLUSION There are differences between U.S.-born and non-U.S.-born victims. Evidence on the healthcare needs of U.S.-born women trafficked for sex in the United States is extremely limited. Research focusing on the health perceptions of women survivors of human sex trafficking may shed light on how they perceive health, care, and the health system and what they identify as important for key stakeholders to understand.
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Richie-Zavaleta AC, Villanueva A, Martinez-Donate A, Turchi RM, Ataiants J, Rhodes SM. Sex Trafficking Victims at Their Junction with the Healthcare Setting-A Mixed-Methods Inquiry. ACTA ACUST UNITED AC 2019; 6:1-29. [PMID: 32190715 DOI: 10.1080/23322705.2018.1501257] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
U.S.-born citizens are victims of human trafficking typically exploited through sex trafficking. At least some of them interact with healthcare providers during their trafficking experience; yet a majority goes unidentified. Although protocols and training guides exist, healthcare providers often do not have the necessary skills to identify and assist victims of sex trafficking. Understanding where victims seek care and barriers for disclosure are critical components for intervention. Thus, this study interviewed survivors of sex trafficking to ascertain: a) healthcare settings visited during trafficking, b) reasons for seeking care, and c) barriers to disclosing victimization. An exploratory concurrent mixed-methods approach was utilized. Data were collected between 2016-2017 in San Diego, CA and Philadelphia, PA (N = 21). Key findings: 1) Among healthcare settings, emergency departments (76.2%) and community clinics (71.4%) were the most frequently visited; 2) medical care was sought mainly for treatment of STIs (81%); and 3) main barriers inhibiting disclosure of victimization included feeling ashamed (84%) and a lack of inquiry into the trafficking status from healthcare providers (76.9%). Healthcare settings provide an opportunity to identify victims of sex trafficking, but interventions that are trauma-informed and victim-centered are essential. These may include training providers, ensuring privacy, and a compassionate-care approach.
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Affiliation(s)
- Arduizur Carli Richie-Zavaleta
- Department of Community Health and Prevention, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
| | - Augusta Villanueva
- Department of Community Health and Prevention, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
| | - Ana Martinez-Donate
- Department of Community Health and Prevention, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
| | - Renee M Turchi
- Department of Community Health and Prevention, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
| | - Janna Ataiants
- Department of Community Health and Prevention, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
| | - Shea M Rhodes
- Institute to Address Commercial Sexual Exploitation, Villanova University Charles Widger School of Law, Villanova, PA, USA
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Sanchez RV, Speck PM, Patrician PA. A Concept Analysis of Trauma Coercive Bonding in the Commercial Sexual Exploitation of Children. J Pediatr Nurs 2019; 46:48-54. [PMID: 30852255 DOI: 10.1016/j.pedn.2019.02.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 02/19/2019] [Accepted: 02/19/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND The sex trafficking of adolescents is known as commercial sexual exploitation of children (CSEC). CSEC is a complex phenomenon where identification requires understanding of developmental disruptions from toxic bonding experiences that increase in complexity over time. These toxic bonding experiences forced through coercive methods disrupt the holistic development of a self in the CSEC victim that interferes with daily functions, decision-making and social and emotional development. Lacking in the literature is a conceptual foundation for trauma coerced bonding. PURPOSE The purpose of the analysis is to define and clarify the future concept of trauma coerced bonding from trauma bonding as it relates to CSEC victimization. METHODS The concept analysis used Rodgers' evolutionary method to search four databases (PubMed, CINHAL, Scopus, and Google Scholar [for grey literature]), using terms associated with various descriptions of trauma bonding (for instance, Stockholm syndrome), resulting in twenty papers for review. RESULTS Attributes, antecedents, and consequences of trauma bonding were delineated and explained. It became apparent through this analysis that the concept of trauma bonding of adolescents exposed to CSEC is very different from other forms of trauma bonding, leading this author to a more precise term, trauma-coercive bonding. Trauma coercive bonding is a long process that is a developmentally disruptive form of bonding that has ramifications throughout the life span. DISCUSSION Trauma coercive bonding is influenced by more than just an emotional bond. The proposed definition of trauma coercive bonding brings an in-depth description of vulnerabilities and disruptions to childhood when CSEC, which persists long into adulthood. CONCLUSION Future qualitative research should pursue a grounded theory of trauma coercive bonding to further explain and study this phenomenon.
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Affiliation(s)
- Rosario V Sanchez
- Rutgers University-Newark, School of Nursing, United States of America.
| | - Patricia M Speck
- University of Alabama at Birmingham, School of Nursing, United States of America
| | - Patricia A Patrician
- University of Alabama at Birmingham, School of Nursing, United States of America
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Abstract
Human trafficking is a global problem reaping $150 billion annually, mainly from commercial sex or forced labor activities involving adult and child victims. Eighty-seven percent of human trafficking victims are known to have been seen by a healthcare provider at least once during the time held captive, but due to lack of awareness, this opportunity to identify and aid victims is often missed. Home healthcare providers have access to homes where human trafficking victims may be hidden in plain sight. It is critical that home healthcare providers know the signs of human trafficking, how to screen a potential victim, how to report any suspicious activities, and ways to remain safe while working in the community. If a human trafficking victim or perpetrator is identified or even suspected, home healthcare providers should move to a safe location and call the 24/7 National Human Trafficking Hotline (1-888-373-7888).
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Iglesias-Rios L, Harlow SD, Burgard SA, Kiss L, Zimmerman C. Mental health, violence and psychological coercion among female and male trafficking survivors in the greater Mekong sub-region: a cross-sectional study. BMC Psychol 2018; 6:56. [PMID: 30541612 PMCID: PMC6292017 DOI: 10.1186/s40359-018-0269-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 11/12/2018] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Human trafficking is a pervasive global crime with important public health implications that entail fundamental human rights violations in the form of severe exploitation, violence and coercion. Sex-specific associations between types of violence or coercion and mental illness in survivors of trafficking have not been established. METHODS We conducted a cross-sectional study with 1015 female and male survivors of trafficking (adults, adolescents and children) who received post-trafficking assistance services in Cambodia, Thailand or Vietnam and had been exploited in various labor sectors. We assessed anxiety and depression with the Hopkins Symptoms Checklist (HSCL-25) and post-traumatic stress disorder (PTSD) symptoms with the Harvard Trauma Questionnaire (HTQ), and used validated questions from the World Health Organization International Study on Women's Health and Domestic Violence to measure physical and sexual violence. Sex-specific modified Poisson regression models were estimated to obtain prevalence ratios (PRs) and their 95% confidence intervals (CI) for the association between violence (sexual, physical or both), coercion, and mental health conditions (anxiety, depression and PTSD). RESULTS Adjusted models indicated that for females, experiencing both physical and sexual violence, compared to not being exposed to violence, was a strong predictor of symptoms of anxiety (PR = 2.08; 95% CI: 1.64-2.64), PTSD (PR = 1.55; 95% CI: 1.37-1.74), and depression (PR = 1.57; 95% CI: 1.33-1.85). Among males, experiencing physical violence with additional threats made with weapons, compared to not being exposed to violence, was associated with PTSD (PR = 1.59; 95% CI: 1.05-2.42) after adjustment. Coercion during the trafficking experience was strongly associated with anxiety, depression, and PTSD in both females and males. For females in particular, exposure to both personal and family threats was associated with a 96% elevated prevalence of PTSD (PR = 1.96; 95% CI: 1.32-2.91) and more than doubling of the prevalence of anxiety (PR = 2.11; 95% CI: 1.57-2.83). CONCLUSIONS The experiences of violence and coercion in female and male trafficking survivors differed and were associated with an elevated prevalence of anxiety, depression, and PTSD in both females and males. Mental health services must be an integral part of service provision, recovery and re-integration for trafficked females and males.
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Affiliation(s)
- Lisbeth Iglesias-Rios
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, USA.
| | - Siobán D Harlow
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
| | - Sarah A Burgard
- Department of Sociology, College of Literature Science, and the Arts, University of Michigan, Ann Arbor, MI, USA
| | - Ligia Kiss
- Gender Violence and Health Centre, Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Cathy Zimmerman
- Gender Violence and Health Centre, Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
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Dando CJ, Brierley R, Saunders K, Mackenzie JM. Health inequalities and health equity challenges for victims of modern slavery. J Public Health (Oxf) 2018; 41:681-688. [DOI: 10.1093/pubmed/fdy187] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 09/21/2018] [Accepted: 10/05/2018] [Indexed: 01/12/2023] Open
Abstract
AbstractBackgroundModern slavery is a serious organized crime, with severe consequences for the physical and mental health of victims, and so has public health implications. Anecdotally many victims of sex slavery experience difficulties accessing healthcare. Public Health England recently articulated the importance of health engagement to address modern slavery but little is known about the experiences of the survivors.MethodsWe conducted in depth interviews with Albanian female survivors of sex slavery who all displayed significant and complex health needs. Interviews were conducted between July 2017 and January 2018. Thematic analysis identified four primary themes: (i) barriers to access, (ii) negotiating access, (iii) health needs and care received and (iv) overall experience of primary care.ResultsSurvivors experienced repeated challenges accessing healthcare, for themselves and their children, and initially could not access GP services. When accompanied by an advocate they reported qualitatively and quantitatively improved experiences resulting in improved permeability. Confusion surrounding eligibility criteria and a lack of understanding of modern slavery emerged as the primary barriers, fueling biased adjudications.ConclusionsThe importance of advocates, enabling rights-based approaches, improving understanding about access to health services for vulnerable groups, and a need for education across health service settings are discussed.
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Affiliation(s)
- Coral J Dando
- Department of Psychology, University of Westminster, 115 New Cavendish Street, London, UK
| | - Robin Brierley
- West Midlands Ant-Slavery Network, 43 Temple Row, Birmingham, UK
| | - Karen Saunders
- Public Health England, 5 St Phillips Place, Birmingham, UK
| | - Jay-Marie Mackenzie
- Department of Psychology, University of Westminster, 115 New Cavendish Street, London, UK
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Abstract
Human trafficking is a form of interpersonal trauma that has significant mental health impacts on survivors. This study examined psychological symptoms in 131 survivors of sex and labor trafficking, including people trafficked into or within the United States. High rates of depression (71%) and posttraumatic stress disorder (PTSD) (61%) were identified. Two thirds of survivors also met criteria for multiple categories of Complex PTSD (C-PTSD), including affect dysregulation and impulsivity; alterations in attention and consciousness; changes in interpersonal relationships; revictimization; somatic dysregulation; and alterations in self-perception. Although there were not significant differences in the prevalence rates of diagnoses of PTSD or depression between survivors of sex and labor trafficking, important group differences were identified. Compared to survivors of labor trafficking, sex trafficking survivors had higher prevalence rates of pre-trafficking childhood abuse and a higher incidence of physical and sexual violence during trafficking. They reported more severe post-trauma reactions than labor trafficking survivors, including more PTSD and C-PTSD symptoms. They were also more likely to meet criteria for comorbid PTSD and depression, while labor trafficking survivors were more likely than sex trafficking survivors to meet criteria for depression alone. An analysis of gender differences found that trafficking survivors who identified as transgender endorsed more PTSD and C-PTSD symptoms, than male or female survivors. Childhood abuse exposure was linked to PTSD and C-PTSD in trafficking survivors, and trafficking type was predictive of the number of trauma-related symptoms beyond the role of pre-trafficking child abuse. Implications for assessment and intervention with trafficking survivors are discussed.
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Affiliation(s)
- E K Hopper
- a The Trauma Center at Justice Resource Institute, Director, Project REACH , 1269 Beacon St. Brookline, MA , USA
| | - L D Gonzalez
- b Boston College, Consultant, Project REACH , 1269 Beacon St. Brookline, MA , USA
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Hopper EK, Azar N, Bhattacharyya S, Malebranche DA, Brennan KE. STARS experiential group intervention: a complex trauma treatment approach for survivors of human trafficking. ACTA ACUST UNITED AC 2018; 15:215-241. [DOI: 10.1080/23761407.2018.1455616] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
| | - Naomi Azar
- The Trauma Center at Justice Resource Institute, Brookline, MA, USA
| | - Sriya Bhattacharyya
- Boston College, Lynch School of Education, Counseling Psychology, Chestnut Hill, MA, USA
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What Therapies are Favored in the Treatment of the Psychological Sequelae of Trauma in Human Trafficking Victims? J Psychiatr Pract 2018; 24:87-96. [PMID: 29509178 DOI: 10.1097/pra.0000000000000288] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Human trafficking is a major public health concern that brings about deleterious psychological consequences and sequelae. Although a number of risk and protective factors for the health consequences of human trafficking victims have been identified, there is a dearth of information in the area of treatment. Specifically, we found no articles comparing the different components of prevailing trauma treatment strategies, and the potential usefulness of these strategies in the treatment of human trafficking victims. To this end, we compared and contrasted the different therapeutic treatments typically implemented with victims of trauma (including domestic violence victims and torture victims), and discussed how the different components of these treatments may or may not be helpful for human trafficking victims. We assessed the impact of these treatments on the psychological consequences of trauma and, in particular on posttraumatic stress disorder. We also assessed the potential usefulness of these treatments with co-occurring problems such as substance use, psychosis, dissociation, and other mood and anxiety disorders. On the basis of the prevailing research, we highlighted cognitive therapies as being preferred in addressing the needs of human trafficking victims. Mental health providers who work with human trafficking victims should become aware of and practiced in the use of cognitive therapeutic approaches in treating this population. Efficacy and effectiveness studies are needed to validate our recommendations.
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Robitz R, Gajaria A, Stoklosa H, Jones E, Baldwin SB. A Young Transgender Woman with Fatigue, Malnutrition, and a Previous Suicide Attempt. Psychiatr Ann 2018. [DOI: 10.3928/00485713-20180211-02] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Powell C, Asbill M, Louis E, Stoklosa H. Identifying Gaps in Human Trafficking Mental Health Service Provision. ACTA ACUST UNITED AC 2017. [DOI: 10.1080/23322705.2017.1362936] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Clydette Powell
- Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Michelle Asbill
- School of Social Work, University of Illinois Urbana-Champaign, Urbana-Champaign, IL, USA
| | - Elizabeth Louis
- Counseling and Human Development Services, University of Georgia, Atlanta, GA, USA
| | - Hanni Stoklosa
- Department of Emergency Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
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Recknor FH, Gemeinhardt G, Selwyn BJ. Health-care provider challenges to the identification of human trafficking in health-care settings: A qualitative study. ACTA ACUST UNITED AC 2017. [DOI: 10.1080/23322705.2017.1348740] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Frances H. Recknor
- University of Texas Health Science Center, School of Public Health, Houston, Texas, USA
| | - Gretchen Gemeinhardt
- University of Texas Health Science Center, School of Public Health, Houston, Texas, USA
| | - Beatrice J. Selwyn
- University of Texas Health Science Center, School of Public Health, Houston, Texas, USA
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Thompson CD, Mahay A, Stuckler D, Steele S. Do clinicians receive adequate training to identify trafficked persons? A scoping review of NHS Foundation Trusts. JRSM Open 2017; 8:2054270417720408. [PMID: 28904806 PMCID: PMC5588808 DOI: 10.1177/2054270417720408] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Objective We investigate whether physicians in secondary care in the English NHS receive adequate training to recognise and appropriately refer for services those persons suspected to be victims of human trafficking. Design Freedom of Information requests were sent to the 105 England’s NHS Trusts delivering acute care in England. Setting NHS Trusts providing secondary care in England. Participants English NHS Trusts. Main outcome measures We requested data about the training provided on human trafficking to clinicians, including the nature, delivery, and format of any education, and any planned training. Results A total of 89.5% of the 105 Trusts responded. Of these Trusts, 69% provide education to physicians on human trafficking, and a further 6% provide training but did not specify who received it. The majority of Trusts providing training did so within wider safeguarding provision (91%). Only one trust reported that it provides stand-alone training on trafficking to all its staff, including physicians. Within training offered by Trusts, 54% observed best practice providing training on the clinical indicators of trafficking, while 16% referenced the National Referral Mechanism. Amongst those not providing training, 39% of Trusts report provision is in development. Conclusions Our results find that 25% of NHS Foundation Trusts appear to lack training for physicians around human trafficking. It is also of concern that of the Trusts who currently do not provide training, only 39% are developing training or planning to do so. There is an urgent need to review and update the scope of available training and bring it into alignment with current legislation.
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Affiliation(s)
| | - Arun Mahay
- Barts and The London School of Medicine and Dentistry, London E1 2AT, UK
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Le PD. "Reconstructing a Sense of Self": Trauma and Coping Among Returned Women Survivors of Human Trafficking in Vietnam. QUALITATIVE HEALTH RESEARCH 2017; 27:509-519. [PMID: 27206456 DOI: 10.1177/1049732316646157] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Survivors of human trafficking who return to their community of origin must cope with the trauma they experienced as victims as well as the conditions that contributed to their trafficking vulnerabilities. In this article, I examine the psychosocial adjustment process among women survivors of trafficking who returned to Vietnam. Supplemented by participation observation, thematic analysis of in-depth interviews with survivors revealed that throughout the trafficking process, the women experienced multiple abuses and changes in relationships and environments. The women coped by navigating a process of "reconstructing a sense of self," seeking congruence between their self-understandings and the changing contextual factors while exhibiting three main coping strategies: regulating emotional expression and thought, creating opportunities within constraints, and relating to cultural schemas. The findings underscore the importance of considering contextual factors such as cultural norms and societal values in efforts to assist trafficked survivors reintegrate into their communities.
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Identification and Management of Human Trafficking Victims in the Emergency Department. Adv Emerg Nurs J 2017; 39:31-51. [DOI: 10.1097/tme.0000000000000138] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Fehrenbacher AE, Chowdhury D, Ghose T, Swendeman D. Consistent Condom Use by Female Sex Workers in Kolkata, India: Testing Theories of Economic Insecurity, Behavior Change, Life Course Vulnerability and Empowerment. AIDS Behav 2016; 20:2332-2345. [PMID: 27170035 PMCID: PMC5016559 DOI: 10.1007/s10461-016-1412-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Consistent condom use (CCU) is the primary HIV/STI prevention option available to sex workers globally but may be undermined by economic insecurity, life-course vulnerabilities, behavioral factors, disempowerment, or lack of effective interventions. This study examines predictors of CCU in a random household survey of brothel-based female sex workers (n = 200) in two neighborhoods served by Durbar (the Sonagachi Project) in Kolkata, India. Multivariate logistic regression analyses indicated that CCU was significantly associated with perceived HIV risk, community mobilization participation, working more days in sex work, and higher proportion of occasional clients to regular clients. Exploratory analyses stratifying by economic insecurity indicators (i.e., debt, savings, income, housing security) indicate that perceived HIV risk and community mobilization were only associated with CCU for economically secure FSW. Interventions with FSW must prioritize economic security and access to social protections as economic insecurity may undermine the efficacy of more direct condom use intervention strategies.
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Affiliation(s)
- Anne E Fehrenbacher
- Department of Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles, 650 Charles E Young Drive South, Los Angeles, CA, 90095, USA
| | - Debasish Chowdhury
- Public Health Foundation of India (PHFI), Sector-44, Plot No-47, Gurgaon, 122003, India
| | - Toorjo Ghose
- School of Social Policy & Practice, University of Pennsylvania, 3701 Locust Walk, Caster D17, Philadelphia, 19104, USA
| | - Dallas Swendeman
- Center for HIV Identification, Prevention and Treatment Services (CHIPTS), Department of Psychiatry and Biobehavioral Science, David Geffen School of Medicine, University of California, Los Angeles, 10920 Wilshire Blvd., Suite 350, Los Angeles, CA, 90024, USA.
- Department of Epidemiology, Fielding School of Public Health, 10920 Wilshire Blvd., Suite 350, Los Angeles, 90024, USA.
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Perceptions of Psychological Coercion and Human Trafficking in the West Midlands of England: Beginning to Know the Unknown. PLoS One 2016; 11:e0153263. [PMID: 27149330 PMCID: PMC4858279 DOI: 10.1371/journal.pone.0153263] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 03/25/2016] [Indexed: 11/19/2022] Open
Abstract
Modern slavery is less overt than historical state-sanctioned slavery because psychological abuse is typically used to recruit and then control victims. The recent UK Draft Modern Slavery Bill, and current UK government anti-slavery strategy relies heavily on a shared understanding and public cooperation to tackle this crime. Yet, UK research investigating public understanding of modern slavery is elusive. We report community survey data from 682 residents of the Midlands of England, where modern slavery is known to occur, concerning their understanding of nonphysical coercion and human trafficking (one particular form of modern slavery). Analysis of quantitative data and themed categorization of qualitative data revealed a mismatch between theoretical frameworks and understanding of psychological coercion, and misconceptions concerning the nature of human trafficking. Many respondents did not understand psychological coercion, believed that human trafficking did not affect them, and confused trafficking with immigration. The public are one of the most influential interest groups, but only if well informed and motivated towards positive action. Our findings suggest the need for strategically targeted public knowledge exchange concerning this crime.
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Shandro J, Chisolm-Straker M, Duber HC, Findlay SL, Munoz J, Schmitz G, Stanzer M, Stoklosa H, Wiener DE, Wingkun N. Human Trafficking: A Guide to Identification and Approach for the Emergency Physician. Ann Emerg Med 2016; 68:501-508.e1. [PMID: 27130802 DOI: 10.1016/j.annemergmed.2016.03.049] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 03/25/2016] [Accepted: 03/29/2016] [Indexed: 10/21/2022]
Abstract
Human trafficking is a significant human rights problem that is often associated with psychological and physical violence. There is no demographic that is spared from human trafficking. Traffickers maintain control of victims through physical, sexual, and emotional violence and manipulation. Because victims of trafficking seek medical attention for the medical and psychological consequences of assault and neglected health conditions, emergency clinicians are in a unique position to recognize victims and intervene. Evaluation of possible trafficking victims is challenging because patients who have been exploited rarely self-identify. This article outlines the clinical approach to the identification and treatment of a potential victim of human trafficking in the emergency department. Emergency practitioners should maintain a high index of suspicion when evaluating patients who appear to be at risk for abuse and violence, and assess for specific indicators of trafficking. Potential victims should be evaluated with a multidisciplinary and patient-centered technique. Furthermore, emergency practitioners should be aware of national and local resources to guide the approach to helping identified victims. Having established protocols for victim identification, care, and referrals can greatly facilitate health care providers' assisting this population.
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Affiliation(s)
- Jamie Shandro
- Division of Emergency Medicine, University of Washington School of Medicine, Seattle, WA; ACEP Public Health and Injury Prevention Committee.
| | - Makini Chisolm-Straker
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY; HEAL Trafficking
| | - Herbert C Duber
- Division of Emergency Medicine, University of Washington School of Medicine, Seattle, WA; ACEP Public Health and Injury Prevention Committee
| | - Shannon Lynn Findlay
- Department of Emergency Medicine Residency, University of Iowa School of Medicine, Iowa City, IA; ACEP Academic Affairs Committee
| | - Jessica Munoz
- Pali Momi Medical Center, Emergency Services, Aiea, HI
| | - Gillian Schmitz
- ACEP Academic Affairs Committee; Department of Emergency Medicine, University of Texas Health Science Center at San Antonio, TX
| | - Melanie Stanzer
- Emergency Medicine Residency, John Peter Smith Health Network, Fort Worth, TX, and the EMSC
| | - Hanni Stoklosa
- HEAL Trafficking; Departments of Emergency Medicine and Medicine, Harvard Medical School, Boston, MA
| | - Dan E Wiener
- ACEP Public Health and Injury Prevention Committee; Bronx Lebanon Hospital Center, Bronx, NY
| | - Neil Wingkun
- ACEP Public Health and Injury Prevention Committee; Department of Emergency Medicine, University of Texas-Houston, Houston, TX
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Gibbons P, Stoklosa H. Identification and Treatment of Human Trafficking Victims in the Emergency Department: A Case Report. J Emerg Med 2016; 50:715-9. [PMID: 26896287 DOI: 10.1016/j.jemermed.2016.01.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 12/22/2015] [Accepted: 01/07/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND Human trafficking victims experience extreme exploitation and have unique health needs, yet too often go undetected by physicians and providers in the Emergency Department (ED). We report a clinical case of human trafficking of a white, English-speaking United States citizen and discuss the features of presentation and treatment options for human trafficking victims upon presentation to the ED. CASE REPORT A 29-year-old woman with a past medical history significant for intravenous drug abuse and recent relapse presented to the ED after a reported sexual assault. The patient was discharged that evening and returned to the ED the following day acutely suicidal. The patient divulged that she had been kidnapped and raped at gunpoint by numerous individuals as a result of a debt owed to her drug dealers. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Many human trafficking victims present to an ED during the course of their exploitation. To that end, EDs provide one of a limited set of opportunities to intervene in the human trafficking cycle of exploitation, and physicians as well as other ED staff should be equipped to respond.
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Affiliation(s)
- Patric Gibbons
- University of Massachusetts Medical School, Brigham and Women's Hospital, Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts
| | - Hanni Stoklosa
- University of Massachusetts Medical School, Brigham and Women's Hospital, Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts
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