Streamlining healthcare delivery for sex-trafficked adolescents.

Recent years have elucidated that trafficking in the pediatric population constitutes a broader pattern of child maltreatment. Given the inconsistent engagement with the medical system that trafficked youth can experience, there is growing advocacy promoting streamlined provision of specialized services. One innovative example includes the Adolescent Protection Collaborative (APC) launched at the Children's Hospital of Philadelphia in 2021. The APC was conceptualized to serve the overlapping populations of youth impacted by sex trafficking victimization and child welfare involvement. In an effort to consolidate care and address a range of needs across the biopsychosocial spectrum, the APC brought together a child abuse pediatrician, adolescent medicine physician, and social worker to provide coordinated, real-time care during each clinic visit. It is hoped that the APC may represent a novel approach to balancing the medico-legal aspects of trafficking aftercare with the youth-empowering features of adolescent medicine and social care.

Human trafficking risk factors, health impacts, and opportunities for intervention in Uganda: a qualitative analysis.

BACKGROUND: Human trafficking is a global public health issue that is associated with serious short- and long-term morbidity. To address and prevent human trafficking, vulnerabilities to human trafficking and forces sustaining it need to be better understood among specific subpopulations. We aimed to explore risk and protective factors for human trafficking, the health impact of exploitation, and barriers and facilitators of seeking help throughout the human trafficking trajectory among forced labor and sex trafficking victims in Kampala, Uganda. METHODS: Between March and November 2020, in-depth, semi-structured qualitative interviews were conducted with 108 victims of forced labor and sex trafficking who had completed a human trafficking survey conducted by the Uganda Youth Development Link (UYDEL). Participants who experienced various forms of exploitation were purposively invited for qualitative interviews and a convenience sample was interviewed. Interviews explored personal history, trafficking recruitment, experiences of exploitation and abuse, and experiences seeking help. Interviews were analyzed using a combination of deductive and inductive thematic analysis. Themes and subthemes were organized using an adapted conceptual framework of human trafficking. RESULTS: Poverty and an abusive home life, frequently triggered by the death of a caretaker, underpinned vulnerability to human trafficking recruitment. Limited education, lack of social support, and survival needs pushed victims into exploitative situations. Victims of human trafficking were systematically exploited and exposed to dangerous working conditions. Victims suffered from sexually transmitted diseases, incontinence, traumatic fistulae, musculoskeletal injuries, and mental health symptoms. Lack of awareness of resources, fear of negative consequences, restrictions on movement, and dependence on the trafficker and exploitation income prevented victims from seeking help. The police and healthcare workers were the few professionals that they interacted with, but these interactions were oftentimes negative experiences. CONCLUSIONS: To address and prevent human trafficking, localized interventions are needed at all stages of the human trafficking trajectory. Health impacts of human trafficking are severe. As some of the few professionals trafficking victims interact with, police and healthcare workers are important targets for anti-trafficking training. Improved understanding of human trafficking drivers and barriers and facilitators to seeking help can inform the design of necessary interventions.

Victims of human trafficking and exploitation in the healthcare system: a retrospective study using a large multi-state dataset and ICD-10 codes.

Trafficking and exploitation for sex or labor affects millions of persons worldwide. To improve healthcare for these patients, in late 2018 new ICD-10 medical diagnosis codes were implemented in the US. These 13 codes include diagnosis of adult and child sexual exploitation, adult and child labor exploitation, and history of exploitation. Here we report on a database search of a large US health insurer that contained approximately 47.1 million patients and 0.9 million provider organizations, not limited to large medical systems. We reported on any diagnosis with the new codes between 2018-09-01 and 2022-09-01. The dataset was found to contain 5,262 instances of the ICD-10 codes. Regression analysis of the codes found a 5.8% increase in the uptake of these codes per year, representing a decline relative to 6.7% annual increase in the data. The codes were used by 1,810 different providers (0.19% of total) for 2,793 patients. Of the patients, 1,248 were recently trafficked, while the remainder had a personal history of exploitation. Of the recent cases, 86% experienced sexual exploitation, 14% labor exploitation and 0.8% both types. These patients were predominantly female (83%) with a median age of 20 (interquartile range: 15-35). The patients were characterized by persistently high prevalence of mental health conditions (including anxiety: 21%, post-traumatic stress disorder: 20%, major depression: 18%), sexually-transmitted infections, and high utilization of the emergency department (ED). The patients' first report of trafficking occurred most often outside of a hospital or emergency setting (55%), primarily during office and psychiatric visits.

Healthcare Use and Case Characteristics of Commercial Sexual Exploitation of Children: Teen Victims Versus High-Risk Teens.

INTRODUCTION: The overall goal of this study was to provide further information about the characteristics of commercial sexual exploitation of children (CSEC) victims by comparing the characteristics of a known victim pool to high-risk patients identified. The specific objectives of this study were to describe patient demographic characteristics, pediatric healthcare use, familial psychosocial characteristics, and child sexual abuse case characteristics present in youth identified as high risk for CSEC victimization compared with a sample of known victims. METHODS: A retrospective chart review was conducted on patients presenting to the emergency department or Child Advocacy Center for a concern of sexual abuse/assault at a midwestern U.S. academic pediatric medical center. Adolescents aged 12-21 years were included in the study. RESULTS: In the current study, multiple CSEC risk factors were noted to increase odds for CSEC victimization: homelessness or life on the streets, runaway behavior, living with mother only, placement in a juvenile detention center, placement in a residential treatment center or group home, and number of living arrangements (four or greater). Multiple elements of high-risk sexual behavior increased odds of CSEC victimization: legally age-inappropriate sex, gonorrhea diagnosis, trichomonas diagnosis, other sexually transmitted infection (STI) diagnoses, number of STIs, and chlamydia diagnosis. DISCUSSION: These findings suggest that age of sexual partners and number and types of STIs are associated with CSEC and should be validated in other groups. In addition, these data suggest that use of cocaine and opiates could serve as an important, yet underrecognized, risk factor.

Sex Trafficking in New York City and Vulnerabilities to Re-Trafficking.

Human trafficking occurs in a cycle of coercion and exploitation of vulnerable people; yet, little is known about those who are trafficked more than one time (re-trafficked). Our study sought to describe the trafficking experiences and explore vulnerabilities to re-trafficking in an urban, majority immigrant, population. This study is part of a parent cohort study that enrolls patients at the EMPOWER Center in New York City, which provides trauma-informed obstetric and gynecologic services to victims of sexual- and gender-based violence. Retrospective chart review was conducted on patients with a history of sex trafficking who were evaluated at the EMPOWER Center from February 2013 to January 2021. A total of 87 patients were enrolled in this study, 23 (26.4%) of whom had been re-trafficked. All were women. Most (88.5%) were victims of international trafficking, most often from Mexico or the Caribbean/Central America. Nine (10.3%) reported contraceptive use and six (6.9%) experienced forced substance use while trafficked. The most reported barriers that women faced in escaping trafficking were threat of violence (28.7%) and financial dependence (19.5%). Re-trafficked patients were more likely to have a history of being undocumented (odds ratio [OR] = 5.29; 95% confidence intervals [CI] [1.34, 20.94]) and experienced childhood sexual abuse (OR = 2.99; 95% CI [1.10, 8.16]), experienced childhood physical abuse (OR = 3.33; 95% CI [1.18, 9.39]), and lived with a non-parent family member (OR = 6.56; 95% CI [1.71, 25.23]). Although these vulnerabilities were no longer significant when analyzed in a parsimonious multivariate logistic regression model adjusting for the other significant variables, likely due to the limited sample size. Almost half (46.0%) reported ongoing emotional effects from being trafficked, which did not vary by re-trafficking status. Our study highlights potential pre-trafficking vulnerabilities, illustrates the complexity of the trafficking experience, and presents potential risk factors for being re-trafficked.

A Socioecological Approach to Understanding Secondary Trauma in Professionals Working with Survivors of Sex Trafficking: A Hierarchical Regression Analysis.

Individuals who are trafficked for sex have high rates of trauma exposure prior to and while being trafficked; therefore, professionals who work with this population are potentially exposed to high levels of trauma details increasing their risk of developing secondary traumatic stress (STS). This study investigated the STS symptoms of professionals working with survivors of sex trafficking utilizing a socioecological framework to guide the design and analysis. An online survey was completed by 583 respondents from a broad range of organizational settings who completed measures tapping into STS symptoms, lifetime trauma exposures, history of being sex-trafficked, dose of direct and indirect trauma exposure at work, use of emotional and instrumental support to cope, state report cards on sex trafficking policies, and organizational-level practices toward being STS informed. STS scores among professionals working with survivors of sex trafficking were high, with those in child welfare settings reporting the highest levels of STS. Hierarchical regression analysis indicates higher STS was associated with variables at all levels of the socioecological model except the macrosystem, with fewer years of experience, a history of being sex trafficked, higher dose of indirect exposure, less use of emotional support, and lower organizational STS scores predictive of higher distress. Together, study findings indicate that STS is a significant concern in the anti-trafficking workforce and that a socioecological framework is useful for understanding STS impacts, highlighting the value of multiple response strategies across levels. This analysis suggests that organizational-level strategies to ameliorate/buffer impacts of occupation-related trauma exposure among these professionals can be especially impactful.

"Drugs Can Be a Great Coercion": Service Providers' Perspectives on the Relationship between Substance Use and Trauma Bonding among Survivors of Sex Trafficking.

While research has demonstrated a complex relationship between sex trafficking and substance use, the relationship between substance use and trauma bonding is not well understood. A trauma bond refers to an emotional attachment that can develop between victims and their abusers. This study aims to explore the relationship between substance use and trauma bonding among survivors of sex trafficking from the perspective of service providers working directly with survivors of sex trafficking. This qualitative study involved in-depth interviews with 10 participants. Purposeful sampling was employed among licensed social workers or counselors working directly with survivors of sex trafficking. Audio recordings of interviews were transcribed and coded using aspects of a grounded theory approach. Three themes emerged from the data regarding the relationship between substance use and trauma bonding among survivors of sex trafficking: substance use as a tactic, substance use as a risk factor, and substance use as a potential trauma bond. These findings support the need to treat substance use and mental health concerns concurrently among sex trafficking survivors. Additionally, these findings can inform legislators and policymakers as they consider the needs of survivors.

Comparative healthcare use by adolescents screening positive for sexual exploitation.

BACKGROUND: Although screens for commercial sexual exploitation of children (CSEC) have been developed, little is known about how adolescents at high risk for, or victims of, CSEC compared to non-CSEC adolescents in healthcare utilization as previous studies have not included a control group. OBJECTIVE: Identify where and how often CSEC adolescents presented to medical care in 12 months prior to being identified as compared to non-CSEC adolescents. PARTICIPANTS AND SETTING: Adolescents between 12 and 18 years seen in a tertiary pediatric health care system in a Midwestern city with a metropolitan population of >2 million. METHODS: This was a 46-month retrospective case-control study. Cases included adolescents who screened high risk or positive for CSEC. Control group 1 included adolescents who screened negative for CSEC. Control group 2 were adolescents who were not screened for CSEC, matched to cases and to control group 1. The three study groups were compared for frequency of, location of, and diagnosis given for medical visits. RESULTS: There were 119 CSEC adolescents, 310 CSEC negative, and 429 unscreened adolescents. Compared to the controls, CSEC positive adolescents sought care less frequently (p < 0.001) and were more likely to present to an acute care setting (p < 0.0001). CSEC cases sought medical care in the acute setting more commonly for inflicted injuries (p < 0.001), mental health (p < 0.001), and reproductive health (p = 0.003). In primary care, CSEC adolescents were more commonly seen for reproductive health (p = 0.002) and mental health (p = 0.006). CONCLUSIONS: CSEC adolescents differ from non-CSEC adolescents in frequency, location, and reasons for seeking healthcare.

Are we seeing the unseen of human trafficking? A retrospective analysis of the CTDC k-anonymized global victim of trafficking data pool in the period 2010-2020.

BACKGROUND: Human trafficking is considered a hidden global crime with unsubstantiated numbers. Despite the challenges in counting or measuring this crime, reports revealed the presence of around 40.3 million victims worldwide. Human trafficking results in severe detrimental impacts on both mental and physical health. Given the sensitivity and negative consequences of human trafficking on the global system and victims, and considering the scarce research in this area, our current study aimed at describing the (i) Sociodemographic profiles of anonymized victims, (ii) Means of control, and (iii) Purpose of trafficking, utilizing the largest anonymized and publicly available dataset on victims of human trafficking. METHODS: This is a retrospective secondary analysis of the Counter-Trafficking Data Collaborative (CTDC) data pool in the period from 2010 to 2020. The utilized dataset is called the k-anonymized global victim of trafficking dataset, and it is considered the largest global dataset on victims of human trafficking. Data from the k-anonymized data pool were extracted and exported to Statistical Package for Social Sciences, SPSS® version 27.0 for Windows (IBM Corp. Version 27.0. Armonk, NY) for quality check and analysis using descriptive statistics. RESULTS: A total of 87003 victims of human trafficking were identified in the period from 2010 to 2020. The most age category encountered among victims was 9-17 years with 10326 victims (11.9%), followed by 30-38 years with 8562 victims (9.8%). Females comprised 70% of the sample with 60938 victims. The United States (n = 51611), Russia (n = 4570), and the Philippines (n = 1988) comprised the most countries of exploitation/trafficking. Additionally, the year 2019 witnessed the greatest number of victims registered for assistance by anti-trafficking agencies with around 21312 victims (24.5%). Concerning means of control, threats, psychological abuse, restriction of the victim's movement, taking the victim's earnings, and physical abuse were the most reported means. 42685 victims (49.1%) reported sexual exploitation as the purpose of their trafficking, followed by forced labor with 18176 victims (20.9%). CONCLUSION: Various means and methods can be used by traffickers to control the victims to be trafficked for many purposes, with sexual exploitation and forced labor being the most common ones. Global anti-trafficking efforts should be brought together in solidarity through utilizing the paradigm of protection of victims, prosecution of traffickers, prevention of trafficking, and inter-sectoral partnerships. Despite being a global concern with various reports that tried to capture the number of trafficked victims worldwide, human trafficking still has many unseen aspects that impose a significant challenge and adds to the global burden in combatting this threat.

Exploitation, Labor and Sex Trafficking of Children and Adolescents: Health Care Needs of Patients.

Exploitation and labor and sex trafficking of children and adolescents is a major public health problem in the United States and throughout the world. Significant numbers of US and non-US-born children and adolescents (including unaccompanied immigrant minors) are affected by this growing concern and may experience a range of serious physical and mental health problems associated with human trafficking and exploitation (T/E). Despite these considerations, there is limited information available for health care providers regarding the nature and scope of T/E and how providers may help recognize and protect children and adolescents. Knowledge of risk factors, recruitment practices, possible indicators of T/E, and common medical, mental, and emotional health problems experienced by affected individuals will assist health care providers in recognizing vulnerable children and adolescents and responding appropriately. A trauma-informed, rights-based, culturally sensitive approach helps providers identify and treat patients who have experienced or are at risk for T/E. As health care providers, educators, and leaders in child advocacy and development, pediatricians play an important role in addressing the public health issues faced by children and adolescents who experience exploitation and trafficking. Working across disciplines with professionals in the community, health care providers can offer evidence-based medical screening, treatment, and holistic services to individuals who have experienced T/E and assist vulnerable patients and families in recognizing signs of T/E.

Recruitment and Entrapment Pathways of Minors into Sex Trafficking in Canada and the United States: A Systematic Review.

The domestic sex trafficking of minors is occurring across Canada and the United States. Understanding the routes into sex trafficking, including the way traffickers target, recruit and enmesh youth in the sex trade is invaluable information for service providers and law makers developing prevention and intervention initiatives. This review synthesized research on the exploitation processes and tactics employed by traffickers in the sex trafficking of domestic minors in Canada and the US. The authors comprehensively and systematically searched five electronic databases and obtained additional publications and grey literature through a backward search of the references cited in articles reviewed for inclusion.  Inclusionary criteria included: Studies published in the English language between January 1990 and June 2020 containing original research with quantitative or qualitative data on the recruitment or pathways into sex trafficking for minors trafficked within the US and Canada. The search yielded 23 eligible studies. The synthesis of the studies in the review converged on the notion of sexual exploitation occurring on a continuum comprising of three components; the recruitment context, entrapment strategies utilized by traffickers, and enmeshment tactics used to prolong exploitation. Findings highlight the significant physical, psychological and emotional hurdles faced by youth victims of sex trafficking and point to the importance of comprehensive and holistic approaches to prevention and intervention practices.

Addressing the psychological trauma in human trafficking victims: A brief review.

OBJECTIVE: This systematic review of the literature aims to systematize the current knowledge on psychological treatments implemented with trafficked children and adults, specifically exploring their effect on the mental health recovery of victims. Integrating this information is an important step to informing practice, as well as examining gaps in the literature and enlightening future research. METHOD: A systematic search was conducted of five electronic databases for journal articles published until October 2019. This study followed the protocol based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (Moher et al., 2009) recommendations. RESULTS: The search yielded six articles for inclusion in the review. Evidence for the efficacy of interventions to increase the mental health recovery of victims is inconclusive as most studies presented a range of methodology limitations, which in turn are related to difficulties with causal inferences and low external validity. CONCLUSION: There is a need for further research in this area to increase informed practices and interventions with human trafficking victims. Implications for practice and research are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

"She was willing to send me there": Intrafamilial child sexual abuse, exploitation and trafficking of boys.

BACKGROUND: Boys subject to intrafamilial child sexual exploitation and abuse (CSEA) - in particular, cases which begin as incest and later evolve into child trafficking for sexual exploitation - face many barriers in disclosing their exploitation, often leaving victims and survivors feeling isolated from society and dismissed or mishandled by service providers such as law enforcement officers, child protection specialists, medical staff and mental health professionals. OBJECTIVE: This study explores the unique characteristics of intrafamilial CSEA through the sex trafficking of boys, and the barriers to disclosure and recovery experienced by male victims and survivors. PARTICIPANTS AND SETTING: Ten adult male survivors of intrafamilial child trafficking for sexual exploitation were interviewed multiple times to gain a deeper understanding of intrafamilial CSEA and how it compares and contrasts with non-familial CSEA. Participants in this study primarily came from North America. METHODOLOGY: Multiple semi-structured online interviews were conducted with these 10 adult male survivors because they experienced 1) intrafamilial CSEA and 2) being trafficked by their families to be sexually exploited by non-familial perpetrators. The participants were then asked to compare and contrast intrafamilial and non-familial CSEA. The research team employed a descriptive phenomenological approach and interview transcripts were coded, analyzed, and compared to identify patterns of non-verbal CSEA indicators and thematic narratives. The study also explored the internal and external barriers to disclosure reported by participants. Trauma-informed, person-centered practices were used throughout the entirety of the study to minimize harm to participants. The research team employed a co-productive approach using participants' initial interviews and feedback to formulate new questions for later rounds of interviews and by having the participants confirm the accuracy of their respective quotes and case summaries. RESULTS AND DISCUSSION: This study highlights several CSEA modalities, such as "boy-swap" events and local/national/transnational trafficking rings engaged in CSEA of boys. It also discusses how survivors' experiences differed between intrafamilial and non-familial CSEA and trafficking, and how familial settings may facilitate concealment of CSEA. Participants described various modus operandi used by abusers, traffickers, and buyers of all genders. While all 10 intrafamilial CSEA cases included male perpetrators, female perpetrators were also present in nine of them. In addition, participants identified various psychological and physiological CSEA and trafficking indicators that evidenced their victimization during their childhood years. All 10 survivors reported long-term health consequences into adulthood and scored highly on Adverse Childhood Experiences (ACEs) questionnaires. RECOMMENDATIONS AND CONCLUSION: Findings underscore the importance of trauma-informed practices for identifying, liberating, and rehabilitating victims and survivors. Participants reported receiving more effective assistance from service providers that exhibited trauma-informed practices. Traditional gender stereotypes may hinder the ability of service providers to recognize and provide support to boys victimized and trafficked by their families for CSEA. Consequently, service providers may stand to benefit from training on 1) trauma-informed, person-centered practices and 2) conscious and unconscious biases, particularly those related to gender. Survivors in recovery require expanded support services, such as the provision of safe housing, online/in-person support communities, and professional/life skill training. Co-productive research methods that integrate the views and experiences of CSEA and trafficking survivors are also recommended.

Expert Testimony in Sex Trafficking Cases.

In the courtroom, the credibility of sex trafficking survivors is often called into question. Particularly of interest are the survivors' complex behaviors and reactions, which may be misunderstood as being incongruent with claims that they were sex trafficked. Expert testimony may be essential to help the trier of fact understand the seemingly counterintuitive behavior of trafficking survivors. This article describes current laws against sex trafficking and challenges to prosecution arising from common misconceptions about survivors. We summarize clinical research on the mental health sequelae of sex trafficking. We review published judicial opinions that describe the use of expert testimony in sex trafficking prosecutions. Our case review shows that forensic psychiatrists are infrequently used as experts in this setting. Forensic psychiatrists, particularly those with expertise in traumatic stress or sex trafficking, can play an important role in explaining how trauma and psychopathology can cause survivors to recant testimony, be reluctant to engage, or respond in other ways that weaken their perceived credibility. Forensic psychiatrists can also assess for treatment needs to calculate restitution for trafficking survivors more accurately.

An integrated approach to providing care for people who have been trafficked.

People who have been trafficked often have complex medical and psychiatric needs. Integrated care is a treatment approach that may be used to improve the care of this population. The authors describe the integrated care model and how it may be applied to this population. They also describe some of the benefits and challenges of using an integrated care model with this population.

Provider challenges in responding to retrafficking of juvenile justice-involved domestic minor sex trafficking survivors.

BACKGROUND: Domestic minor sex trafficking (DMST) survivors are disproportionately involved in the juvenile justice system, but frequently run away and experience retrafficking. However, little research explores how practitioners who work with juvenile justice-involved DMST survivors address such dynamics. OBJECTIVE: This study examines challenges related to chronic runaway behaviors and related retrafficking of juvenile justice-involved DMST survivors from the perspective of practitioners. PARTICIPANTS AND SETTING: 35 in-depth interviews were conducted with social service and justice system practitioners working with DMST survivors in a Midwestern metropolitan area. METHODS: Inductive analysis of the transcribed interviews involved a multi-phase, independent co-coding process conducted by three members of the research team, including selective coding, open coding, and taxonomic analysis to identify recurring themes and subthemes. Core themes that focused on challenges experienced by practitioners working with minors who chronically ran away and returned to a trafficking situation were further developed. RESULTS: Practitioners reported that their ability to provide care to minors returning to trafficking situations was limited because of their informal authority in the juvenile justice system, inaccessibility of residential therapeutic care and drug treatment, and punitive measures directed toward parents seeking assistance from Children's Division. Provider narratives indicated that without effective interventions, minors typically exit a retrafficking situation only after experiencing emotional distress, extreme violence, pregnancy or birth, or contracting an STI. CONCLUSIONS: Non-punitive responses to address chronic runaway behaviors and retrafficking of minors in the justice system include: placement with foster families trained in dynamics of sex trafficking, trauma, and runaway behaviors; safety planning including risk assessments and providing resource information about drop in centers and healthcare; revising hotlining procedures for concerned parents; and increasing minors' access to trauma-informed residential care, therapeutic care, and substance use treatment by legislatively expanding healthcare coverage under Safe Harbor laws.

Practitioner Experiences Responding to Suicide Risk for Survivors of Human Trafficking in the Philippines.

Human trafficking survivors experience elevated suicide risk in comparison to the general population. Anti-trafficking service providers in the Philippines have identified capacity building in suicide prevention as a critical priority given the insufficient number of trained mental health professionals and lack of culturally adapted evidence-based interventions in the Philippines. We conducted a focused ethnography exploring the experiences of non-mental health professionals working in the anti-human trafficking sector in the Philippines in responding to suicidality among survivors of human trafficking (n = 20). Themes included: emotional burden on service providers, manifestations of stigma regarding suicide, lack of clarity regarding risk assessment, lack of mental health services and support systems, transferring responsibility to other providers, and the need for training, supervision, and organizational systems. We discuss implications for training service providers in the anti-human trafficking sector, as well as cultural adaptation of suicide prevention interventions with human trafficking survivors in the Philippines.

An Analysis of Romantic Partnership Dynamics in Domestic Minor Sex Trafficking Case Files.

Domestic minor sex trafficking (DMST) is the commercial sexual exploitation of a minor citizen or legal resident within the United States. Previous research suggests that although DMST is often discussed as though it is a uniform phenomenon, traffickers may use different tactics and exploit different victim vulnerabilities depending upon their established relationships with those who are at-risk for trafficking. The purpose of this qualitative study, therefore, is to explore the relationship patterns and dynamics that emerge between DMST victims and their romantic partner traffickers. This study utilizes the secondary case files of 38 domestic minors who were trafficked for sex by their romantic partners in one state in the United States between 2012 and 2017. The study is conceptualized according to the principles of directed content analysis and multiple case study design and relies heavily on previous research findings related to victim-trafficker relationship typology. The authors conducted two rounds of coding before applying themes to the case files. The analysis revealed that DMST victims trafficked by romantic partners are often influenced by environmental circumstances, such as gang involvement and family systems involvement. Romantic partner traffickers use specific recruitment tactics to entrap their victims, and exercise methods such as caregiving, sexual violence, and psychological violence to maintain control over their victims. Study results provide a significant extension to the anti-trafficking field's understanding of DMST and the romantic partner relationships that underpin it. The results suggest that anti-trafficking advocates should screen at-risk adolescents for gang involvement, family involvement in the sex industry. They should also educate at-risk adolescents about DMST as a potential component of teen dating violence.

Trauma Bonding Perspectives From Service Providers and Survivors of Sex Trafficking: A Scoping Review.

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.

Rigor and Respect: Recruitment Strategies for Engaging Vulnerable Populations in Research.

Engaging vulnerable populations in research is a critical focus for researchers seeking to find ways to improve safety and well-being for broader populations. Vulnerabilities often co-occur, meaning that individuals may experience vulnerabilities in multiple facets of their life (e.g., victim of abuse and mental health diagnoses). Unfortunately, many vulnerable populations remain underinvestigated due to difficulty reaching, engaging, and safely including such populations in research. While most researchers assert the importance of including vulnerable populations in research, few actively and successfully recruit them. Many vulnerable populations are understandably weary of research participation. Victims and survivors of domestic minor sex trafficking (DMST) are one such vulnerable population, in that identification may incur substantial risk for DMST victim's physical safety and well-being. In addition, DMST victims and survivors often experience co-occurring vulnerabilities including substance use, histories of abuse, delinquency, and poor mental health. Accordingly, they are notoriously difficult to recruit for research participation. The current paper uses a detailed case example to describe the recruitment and retention strategies used by one researcher to promote DMST survivor research participation. A candid account of challenges, successes, and lessons learned is offered in service of building methodological techniques for recruitment that both honor participant experiences while championing methodological rigor. Findings detail the importance of trust and a trauma-informed approach to qualitative data collection and analysis. Authors include specific strategies to promote comfort and candor amid traumatic response in ways that may empower research participants. A detailed discussion of how such strategies may be adapted for vulnerable populations beyond DMST victims and survivors is provided.