Occupational Injustice and Human Trafficking: Occupational Therapy's Role

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Occupational Injustice and Human Trafficking: Occupational Therapy’s Role

Toni Thompson, DrOT, OTR/L, C/NDT 4. Discuss the legal rights of people who have been trafficked to Senior Instructor, TherapyED, Evanston, IL receive occupational therapy services Selah Freedom Anti-Trafficking Agency, Tampa Bay area, FL 5. Identify the distinct value of occupation in practice, education, and research efforts to combat trafficking Jami Flick, MS, OTR/L Assistant Professor and Academic Fieldwork Coordinator, University of INTRODUCTION Tennessee Health Science Center, College of Health Professions, Depart- A form of modern slavery, human trafficking entails an industry ment of Occupational Therapy, Memphis, TN; Restore Corps, Memphis estimated to be worth between $32 billion and $120 billion that transcends most international borders (Bales, 2010; Bryant et Andrea Thinnes, OTD, OTR/L al., 2015; Dank et al., 2014; Eby, 2016; Nawyn et al., 2013). The Assistant Professor, Creighton University clandestine nature of trafficking hampers precise statistics of School of Pharmacy and Health Professions, Department of Occupational trafficked adults and minors and of exact financial terms (Dank et Therapy al., 2014; Nawyn et al., 2013). Omaha, Nebraska; Rejuvenating Women, Omaha, Nebraska The Protocol to Prevent, Suppress and Punish Trafficking in Persons (3P Protocol), developed by the United Nations (UN), This article was developed in collaboration with AOTA’s Mental Health defines trafficking in persons as: Special Interest Section. The recruitment, transportation, transfer, harboring, or ABSTRACT receipt of persons, by means of the threat or use of force or other forms of coercion, of abduction, of fraud, of decep- Human trafficking has emerged as a crime, an occupational injustice, tion, of the abuse of power or of a position of vulnerability, and a human rights violation that transcends international borders. or of the giving or receiving of payments or benefits to The United Nations developed the fundamental Protocol to Prevent, achieve the consent of a person having control over another Suppress and Punish Trafficking in Persons (3P Protocol) to guide person, for the purpose of exploitation. Exploitation shall national governments, private agencies, and individuals in enacting include, at a minimum, the exploitation of the prostitution standards, laws, and philosophies for action. Minimal literature in of others or other forms of sexual exploitation, forced labor occupational therapy addresses human trafficking (Bryant et al., or services, slavery or practices similar to slavery, servitude, 2015; Gorman & Hatkevich, 2016). However, occupational therapy or the removal of organs. (UN Office on Drugs and Crime practitioners possess important skills for developing interventions, [UNODC], 2018, 2019a) education, research, and advocacy efforts to positively affect the occupational participation of persons who have incurred biopsycho- Trafficking encompasses exploitation that can include sexual social deficits as a result of human trafficking situations. activities, labor practices, domestic servitude, forced marriage, debt bondage, organ removal and trafficking, child soldiers, and LEARNING OBJECTIVES any type of slavery practices (International Labour Organization After reading this article, you should be able to: [ILO], 2012; UNODC, n.d.). Persons who willingly engage in 1. Define four types of human trafficking activities to illegally cross international borders are not con- 2. Describe the 3P Protocol of the United Nations sidered trafficked, but rather engaging in the crime of people 3. Identify the biopsychosocial impairments found in persons smuggling (Office on Trafficking in Persons, 2017). Types of affected by human trafficking trafficking vary among countries, with worldwide estimates of

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Almost developed the international framework of the 3P Protocol with 21 million persons in the world are involved in coerced labor, three prongs of Prevention, Protection, and Prosecution. Many including construction, domestic, restaurant and retail work, nations, the U.S. Department of State, and individual states manufacturing, and agricultural activities (ILO, 2012). Approx- within the United States incorporate these prongs into laws, imately 74% of coerced workers are adults and 26% are chil- programs, and initiatives (UN Office of the High Commission dren. Government-related services account for 10% of coerced for Human Rights, n.d.; UNODC, 2009; U.S. Department of labor, in prisons, military agencies, and rebel forces, which may State, 2019a, 2019b; World Health Organization [WHO], 2012). include child soldiers (ILO, 2012). The Victims of Trafficking and Violence Protection Act of 2000 (TVPA) and four subsequent revisions defined trafficking EFFECTS OF HUMAN TRAFFICKING ON OCCUPATIONAL PARTICIPATION in persons as a crime, changing the legal status of trafficked Victims and survivors of trafficking undergo months to years of persons from criminal prostitutes to victims who merit com- forced daily activities, resulting in occupational deprivation that prehensive care, treatment, and protection (Polaris, 2013; U.S. can limit their abilities to engage in ADLs, formal education, Department of State, 2019a, 2019b). The Federal Strategic social participation, and meaningful occupational pursuits (Bry- Action Plan on Services for Victims of Human Trafficking in ant et al., 2015; Muraya & Fry, 2016). This deprivation through- the United States 2013–2017 (FSAP) offers specific goals and out childhood, adolescence, and adulthood, compounded by objectives to guide client-focused, trauma-informed care for sur- lack of medical, mental health, and dental care, often results in vivors of trafficking by U.S. federal agencies; state governmental considerable developmental delays, sensory deficiencies, and services; and private entities, including the Central Intelli- extensive biopsychosocial impairments. Shigekane (2007) deter- gence Agency, U.S. Immigration and Customs Enforcement, mined that “service providers assert that the needs of trafficking U.S. Department of Justice, legal professionals, and persons in survivors are far greater than those of other marginalized groups therapy and service delivery (Cerny, 2016; Kotrla & Wommack, … because they have lived under the abusive control of others” 2011; U.S. Department of Justice, Department of Health and (p. 122). Human Services, & Homeland Security, 2014). Each U.S. state bears responsibility for developing unique state trafficking laws NEED FOR GENDER-SPECIFIC APPROACHES and legal processes. For example, Florida laws expunge felony Members of the LGBTQ population present distinct needs, records for victims who were previously convicted and are calling for unique, dedicated approaches (Martinez & Kelle, now classified as victims (Florida State University, n.d.; Online 2013; Shigekane, 2007). Rafferty (2016) concluded that most Sunshine, 2016). governmental and private agencies should focus on recovery, education, and training efforts, primarily for women and girls, TRAFFICKED PERSONS’ LEGAL RIGHT TO RESTITUTION reflecting cultural beliefs that may overlook the trafficking of In March 2007, the UN elaborated on provisions for convicted men and of the LGBTQ population. traffickers to provide restitution toward their victims with “Because sexual violence against males is considered taboo in financial responsibility for remedial treatments, including occu- most societies, many male victims are constrained by societal bar- pational therapy (UNODC, 2009). In the United States, Title riers from reporting their ordeals” (Martinez & Kelle, 2013, p. 2). 18 U.S. Code § 2259(b)(3) of the TVPA defined this restitution In the United States, 33.4% of homeless heterosexual youth (National Crime Victim Law Institute, 2013; U.S. House of Rep- are exploited in trafficking, but LGBTQ youth make up 20% resentatives, n.d.). Traffickers frequently flee from detection by of homeless youth, with a 58.7% exploitation rate (Martinez enforcement or are incarcerated, which is the primary barrier & Kelle, 2013). These authors concluded that fewer men and to victims receiving restitution. In 2017, only 27% of human LGBTQ members report trafficking than other groups. More trafficking cases were awarded restitution in the federal courts evidence is needed to develop recovery programs for victims (Human Trafficking Legal Center & WilmerHale, 2018). across all gender and age ranges (de Chesnay, 2013; Jordan et al., 2013; Kaufman & Crawford, 2011; Kotrla & Wommack, TRAFFICKING IN OCCUPATIONAL THERAPY LITERATURE 2011; Lisborg, 2009; Lloyd, 2011; Macy & Graham, 2012; Macy The literature reflects minimal occupational therapy involve- & Johns, 2011; Meshkovska et al., 2015; Miller, 2011; Muraya & ment in human trafficking. Persons who are trafficked incur Fry, 2016; Okech et al., 2012; Schauer &Wheaton, 2006). “loss of the roles and occupations associated with their ages and typical developmental stages” (Bryant et al., 2015, p. 18). The INTERNATIONAL AND UNITED STATES TRAFFICKING LAWS authors contended that occupational therapy practitioners could In 2003, the UN General Assembly adopted the 3P Protocol as offer survivors opportunities to enhance life satisfaction. a foundational agreement, as opposed to a legally enforceable Phongphisutbubpa (2007) provided an organizational case document (UN Office of the High Commission for Human study of the oldest government-operated shelter for survi-

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Table 1. Potential Actions for Occupational Therapy Practitioners in Conjunction With the 3P Protocol (3PP)

Occupational Therapy Occupational Therapy Occupational Therapy 3PP Area 3PP Component Action: Clients Action: Providers Action: the Public

Be informed by awareness programs to alert consumers Help develop or partici- Provide education about and caregivers of risk fac- pate in public awareness Provide education for health trafficking: risk factors, tors, signs of trafficking, and campaigns and actions care providers to determine Prevention traffickers’ recruiting defense strategies through through presentations to signs in clients who are methods, and how to report presentations to groups, schools, work settings, civic trafficked or are at risk. trafficking. social media users, at-risk associations, private groups, groups, and concerned and nonprofit agencies. persons.

Participate in programs Develop occupation-based for children, caregivers, Provide education to identify Empower persons at risk to prevention programs and adults to enhance at-risk clients and develop avoid engaging in trafficking for at-risk consumers in Prevention occupational performance interventions that enhance and to avoid trafficking schools, after-school pro- for success in meaningful self-esteem and offer suc- recruitment tactics. grams, community centers, occupation and economic cess in occupations. and homeless shelters stability. .

Participate in intervention Provide education on strate- programs to enhance Advocate for the distinct val- gies to address occupational Prevention Provide for biopsychosocial acquisition of developmental ue of occupational therapy deprivation resulting from recovery. stages and adaptive life in recovery. trafficking. skills. Participate in recovery and community integration Educate community officials Provide for the immediate programs in residential Learn about and develop and members on strategies and long-term rehabilitation recovery, non-residen- Prevention research to promote evi- to incorporate survivors needs of trafficked persons, tial, outreach, and prison dence-based interventions. into living, work, and social including restitution. alternative programs. Create environments. programs relevant to development and culture.

Provide education on and Enhance consumers’ organi- participate in research to Advocate for the distinct Ensure that persons main- zational and advocacy skills develop occupation-based, role of occupational therapy Prevention tain their rights in criminal for negotiating the criminal culturally sensitive, and in recovery to professional justice proceedings . justice process. gender- and age-specific groups. interventions. Support institutional policies Adhere to an occupational to support defining, detect- Provide education for all Provide a proactive model therapy framework and ing, and reporting traffick- personnel to recognize and for workplace policies and Prevention approach to understand and ing; contribute to legislative report potential trafficking attitudes for recognizing and address potential trafficking policy formation for victim activity. reporting trafficking. activities. rights; and support recovery for victims.

Cooperate with criminal Novel interventions and Contribute to developing Pioneer novel interventions justice process addressing rehabilitation services for legislation and legislative Prevention for rehabilitating traffickers trafficked persons, solicitors, traffickers and solicitors efforts to include a consum- and purchasers. and traffickers. determined as candidates. er-centered approach.

(American Occupational Therapy Association, 2017; Bryant, et al., 2015; Cerny, 2016; Gorman & Hatkevich, 2016; Martin, 2015; U.S. Department of State, 2019a; U.S. Department of Justice, Health, and Human Services, & Homeland Security, 2014; United Nations Office on Drugs and Crime, n.d., 2009, 2016).

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THE 3P PROTOCOL: DIRECTIONS FOR OCCUPATIONAL THERAPY ACTION FOUNDATIONS FOR NOVEL OCCUPATIONAL APPROACHES Human trafficking crosses international borders, calling for The National Center for Victims of Crime (2012) determined occupational therapy approaches that traverse diverse cul- that 1 in 5 girls and 1 in 20 boys disclosed sexual abuse, with tures, nations, and people groups. Clay (2013) and Gibson and about 75% of that abuse coming at the hands of a known person colleagues (2011) proposed occupation-based recovery per- or family member. The most vulnerable period for both men spectives incorporating occupational therapy principles; the and women is between ages 7 and 13 years (National Center WHO International Classification of Functioning, Disability, for Victims of Crime, 2012). Experts from the Tampa Bay area’s and Health (ICF; 2001); and the Substance Abuse and Mental Selah Freedom anti-trafficking agency concluded that the Health Services Administration (SAMHSA, 2018) values. The undisclosed level of childhood sexual abuse may be closer to 1 need for services across diverse cultures also encompasses the in every 3 girls and 1 in every 5 boys, with a high rate of abuse fundamental beliefs found in position statements of the World by someone they knew well, including family members (K. Pen- Federation of Occupational Therapists (WFOT, 2019), the tacost, personal communication, November 17, 2015; C. Rose, American Occupational Therapy Association’s (AOTA’s) Vision personal communication, November 1, 2015, and March 29, 2025 (AOTA, 2017), and the goals of the FSAP (SAMHSA, 2017). Minors who are sexually trafficked, by definition incur 2018). Occupational therapy practitioners possess knowledge, repeated childhood sexual abuse. Hossain and colleagues (2010)

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suggested that sex trafficking survivors share strong similarities ing that abused persons often show pervasive biopsychosocial with persons who incur childhood sexual abuse, noting that problems. A pivotal, 23-year intergenerational study of minor trafficking often begins during childhood. and adult women with a history of childhood sexual abuse found Evidence related to childhood sexual abuse provides a that the participants demonstrated “cognitive deficits, depres- foundation for developing intervention approaches, consider- sion, dissociative symptoms, maladaptive sexual development,

Table 2. Approaches to Provide Occupational Intervention With Survivors

Conditions Familiar Presenting Affected Presenting to Occupational Occupational Symptoms and Occupational Sample Interventions Condition Therapy Therapy Goals Behaviors Components Practitioners Sports; mindfulness; Survivors of trauma or Manage triggers; Re-experiencing; IADLs; work; sleep; stress management Posttraumatic sexual abuse; military enhance stress man- reactive and avoid- rest; social partic- techniques; sensory stress disorder veterans; refugees; agement; regulate ance behaviors; ipation; physical approaches; present- (PTSD) survivors of domestic sleep and sensory impaired cognition activity focused approach; func- violence stability tional skill development

Poor self-esteem; Enhance self-esteem; Impairment across Persons with various impaired sleep, improve function in Activity groups; individu- Depression occupational con- depressive conditions nutrition, work, and rest, sleep, work, and alized cueing techniques tinuum leisure social participation

Refugees; domestic Facilitate physical Lack of education Unique learning strate- violence survivors; Education; work; and cognitive access Formal education- because of cognitive gies; time management; school drop-outs; self-esteem; eco- to school at all levels; al limitations difficulties or limited organizational skills; persons with learning/ nomic stability improve vocational access vocational aptitudes cognitive limitations skills

Persons with attention Unique learning and deficit disorder (ADD) Impaired educational Facilitate access Acquired learning Education, work, training strategies; time and ADD with hyper- and employment to educational and disabilities social participation management; organiza- activity; cognitive mastery employment mastery tional skills challenges

Substance abuse Pervasive cognitive, Impairment across Stress management; Persons with ethanol Enhance self-esteem; (forced or coping behavioral, physical occupational con- sensory modulation and substance abuse functional skills strategy) changes tinuum approaches

Musculo-skeletal Limited function Persons with orthope- Muscle, bone, neuro- Achieve optimal Physical and neurological and neurological of specific body dic injuries logical limitations physical performance rehabilitation problems components

Persons with cardiac Achieve optimal func- Cardio-pulmonary rehabili- Cardio-vascular Cardiac and pulmo- Impaired ability in and pulmonary tion and satisfaction tation techniques; energy conditions nary limitations functional abilities conditions in ADLs conservation in activities

Survivors of rape, Impaired body image; Impaired sexual Post-op healing tech- Gynecological incest; persons with Enhance sexual impaired sexual func- abilities; impaired niques; adaptive sexual difficulties sexually transmitted stability tion; see PTSD above structural elements techniques diseases

Persons in post-op Intestinal distress; Impaired stamina, Incorporate nutritional Mindfulness, relaxation Gastro-intestinal situations; bariatric diarrhea; concentra- concentration; plan to organize and techniques; nutritional (GI) difficulties conditions; GI reac- tion and functional impaired ability to execute ADLs; meal organization skills tions to medications impairment perform ADLs planning

(Abas et al., 2013; American Occupational Therapy Association, 2014; Bass et al., 2013; Briere & Scott, 2006; Bryant et al, 2015; Cole et al, 2016; Doroud et al., 2015; Gibson et al., 2011; Gorman & Hatkevich, 2016; Hardy et al., 2013; Hossain et al, 2010; Kira & Tummala-Narra, 2015; Lake, 2014; Lewis et al, 2015; Macy & Johns, 2011; Martin, 2015; Muraya & Fry, 2016; Rogers et al., 2014; Shigekane, 2007; Thompson, 2017; Warner et al., 2013).

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The participants showed an increased incidence The biopsychosocial model incorporates pervasive neurobe- of mental health disorders, revictimization, substance abuse, havioral, psychological, emotional, physiological, sensory, and tendency to be involved in domestic violence, and biological developmental difficulties found in survivors (Borrell-Carrió children presenting with developmental delays. et al., 2004; Hemmingsson & Jonsson, 2005; Smith et al., 2013). Based on similar histories and symptoms, several authors Recovery models serve to provide a base for trauma-informed suggested integrating interventions used with other vulnerable care. Clay (2013) proposed an occupation-based recovery model populations, such as domestic violence survivors and refugees, that incorporates occupational therapy principles, the WHO’s into those used with trafficking survivors (Lewis et al. 2015; ICF, and SAMHSA values, consistent with AOTA and WFOT Shigekane, 2007). Researchers noted that many survivors of standards for culturally sensitive, trauma-informed services that domestic violence and refugees demonstrated pervasive medical cross national and regional borders. Clay applied these 10 key problems, mental health conditions, PTSD, economic insecu- SAMHSA components: Hope, self-determination, non-linear rity, and substance abuse (Kira & Tummala-Narra, 2015). Many process, empowerment, responsibility, respect, peer support, researchers highlighted PTSD, depression, anxiety, and dissoci- individualized and person-centered recovery, strengths based, ation among women who survived a history of sexual trafficking and holistic care. A multidisciplinary recovery model adapted (Abas et al., 2013; Bass et al., 2013; Briere & Scott, 2015; Cole Erikson’s developmental stages to the recovery process, showing et al., 2016; Gibson et al., 2011). Victims of intimate partner recovery as a developmental, non-lineal process (Vogel-Scibilia and domestic violence, childhood sexual abuse, and refugee et al., 2009). The Wellness Recovery Action Plan provides trauma often demonstrate PTSD (Kira & Tummala-Narra, 2015; a unique, individualized recovery tool with five key compo- Shigekane, 2007). Symptoms of PTSD include: nents: Hope, personal responsibility, advocacy, education, and mutual support (Copeland, 2002). These models coordinate Re-experiencing, avoidance, numbing ... hyperarousal ... with elements of occupational health and recovery as defined [and] disturbances in self-regulatory capacities that have in the Occupational Therapy Practice Framework: Domain and been grouped into five categories: emotion regulation Process (3rd ed.; AOTA, 2014), SAMHSA (2018) principles, difficulties, disturbances in relational capacities, alter- WFOT (2019) standards, AOTA’s Vision 2025 (AOTA, 2017), and ations in attention and consciousness (e.g., dissociation), international values of the ICF (Pizzi, 2015; U.S. Department adversely affected belief systems, and somatic distress. of Justice, Health and Human Services, & Homeland Security, (Resick et al., 2012, p. 243) 2014). Practitioners have treated persons with PTSD and related conditions through mindfulness, sensory modulation and inte- CONCLUSION gration methods, physical rehabilitation approaches, spirituality Human trafficking is a human rights violation, an occupational techniques, and recreational sports (Hardy et al., 2013; Lake, injustice, and a heinous crime that transcends international 2014; Rogers et al., 2014; Warner et al., 2013). These treatment borders. This underground global industry contributes to methods can be adapted for use with trafficking survivors in considerable personal, familial, community, and international occupation-based programming. Occupation-based intervention disorganization, affecting persons of all ages, genders, and and client-centered approaches in social participation, phys- cultural backgrounds. The 3P Protocol developed by the UN ical activity, instrumental ADLs, work, education, sleep, and serves to organize the efforts of governmental services, private rest used with persons incurring mental health conditions can agencies, nonprofit organizations, and individuals for combating enhance life satisfaction, emotional stability, community inte- trafficking in the three main areas of prevention, protection, gration, and healthy life roles for trafficking survivors (Doroud and prosecution. Occupational therapy practitioners can use et al., 2015; Gibson et al., 2011; Martin, 2015). See Table 2 on current approaches and services with survivors of domestic vio- page CE-6. lence, refugees, and other persons experiencing trauma, mental Goals in all areas of Table 2 include facilitating community health deficits, sensory processing difficulties, and pervasive integration; enhancing emotional stability; improving social biopsychosocial impairments to develop services in prevention, participation through implementing unique supports; providing protection, and prosecution in the area of human trafficking. modifications; and designing approaches to develop meaningful Combining solid foundational models, evidence, creativity, and roles and life satisfaction. a wealth of experience, practitioners can implement trauma-informed, culturally sensitive, client-centered, occupation-based THEORETICAL BASES FOR OCCUPATIONAL THERAPY ACTION programming in the important area of addressing the effects of Evidence-based programs incorporate occupational ther- human trafficking. apy models to develop client-centered, occupation-based approaches. The PEO model advances the unique components

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Clay, P. (2013, December). Shared principles: The recovery model and occupa- ADDITIONAL RESOURCES tional therapy. Mental Health Special Interest Section Quarterly, 36(4), 1–3. Cole, J., Sprang, G., Lee, R., & Cohen, J. (2016). The trauma of commercial sexu- Selah Freedom is a national organization that provides various recovery al exploitation of youth: A comparison of CSE victims to sexual abuse victims programs, education across various professions, teen prevention, outreach, in a clinical sample. Journal of Interpersonal Violence, 31, 122–146. https://doi. and safe housing. org/10.1177/0886260514555133 Website: www.selah freedom.com. Address: PO Box 21415, Sarasota, FL 34276. Copeland, M. E. (2002). Wellness Recovery Action Plan: A system for mon- itoring, reducing, and eliminating uncomfortable or dangerous physical Hotline: 888-8-FREE-ME for victims, survivors, care providers, and the symptoms and emotional feelings. Occupational Therapy in Mental Health, 17, general public. 127–150. https://doi.org/10.1300/J004v17n03_09 Dank, M., Khan, B., Downey, P., Kotonias, C., Mayer, D., Owens, C., … Yu, L. The National Human Trafficking Resource Center provides referral ser- (2014). Estimating the size and structure of the underground commercial sex vices and houses a complete library of information economy in eight major U.S. cities. Washington, DC: The Urban Institute. Website: www.traffickingresourcecenter.org Retrieved from http://www.urban.org/sites/default/files/alfresco/publication- National Human Trafficking Hotline: 888-373-7888 SMS: 233733 (text pdfs/413047-Estimating-the-Size-and-Structure-of-the-Underground-Com- “HELP” or “INFO”) mercial-Sex-Economy-in-Eight-Major-US-Cities.PDF Languages: English, Spanish, and 200 more de Chesnay, M. (2013). Psychiatric-mental health nurses and the sex trafficking pandemic. Issues in Mental Health Nursing, 34, 901–907. https://doi.org/10.31 This hotline links all major governmental services involved in trafficking 09/01612840.2013.857200 and other resources. Doroud, N., Fossey, E., & Fortune, T. (2015). Recovery as an occupational jour- ney: A scoping review exploring the links between occupational engagement The U.S. Department of Homeland Security investigates trafficking and recovery for people with enduring mental health issues. Australian through the Immigration and Customs Enforcement and Homeland Security Occupational Therapy Journal, 62, 378–392. https://doi.org/10.1111/1440- Investigations agencies. 1630.12238 Website: www.ice.gov. Submit tips at www.ice.gov/tips. Eby, B. (2016). The economics of human trafficking. Institute for Faith, Work, Hotline: 866-347-2423; International: 802-872-6199. 24 hours a day, 7 days and Economics. Retrieved from https://www.tifwe.org/the-economics-of-hu- a week. man-trafficking/ Florida State University. (n.d.). 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ARTICLE CODE CEA0120 | JANUARY 2020 ARTICLE CODE CEA0120 | JANUARY 2020 CE-7CE-7 CE Article, exam, and certificate are also available ONLINE. Continuing Education Article Register at http://www.aota.org/cea or Earn .1 AOTA CEU (one contact hour and 1.25 NBCOT PDU). See page CE-9 for details. call toll-free 877-404-AOTA (2682).

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CE-8 ARTICLE CODE CEA0120 | JANUARY 2020 Continuing Education Article Earn .1 AOTA CEU (one contact hour and 1.25 NBCOT PDU). See page CE-9 for details. Final Exam How to Apply for Article Code CEA0120 Continuing Education Credit Occupational Injustice and Human A. To get pricing information and to register to take the exam online for the Trafficking: Occupational Therapy’s Role article Occupational Injustice and Human Trafficking: Occupational Therapy’s Role, go to http://store.aota.org, or call toll-free 800-729-2682. To receive CE credit, exam must be completed by B. Once registered and payment received, you will receive instant email January 31, 2022 confirmation. Learning Level: Intermediate to Advanced C. Answer the questions to the final exam found on pages CE-9 & CE-10 Target Audience: Occupational Therapy Practitioners by January 31, 2022 Content Focus: Domain: Client Factors; OT Process: Occupational Therapy- D. On successful completion of the exam (a score of 75% or more), you will Evaluation and Interventions immediately receive your printable certificate.

1. Which of the following activity is not a form of human trafficking? A. People smuggling United Nations Office on Drugs and Crime. (2019b). United Nations Convention against Transnational Organized Crime and the Protocols Thereto. Retrieved B. Sexual exploitation from https://www.unodc.org/unodc/en/treaties/CTOC/index.html#Fulltext C. Domestic servitude U.S. Department of Justice, Health and Human Services, & Homeland Security. D. Debt bondage (2014). Federal strategic action plan on services for victims of human trafficking in the United States 2013–2017. Washington, DC: Global Publishing Services. U.S. Department of State. (2019a). 3Ps: Prosecution, protection, and prevention. 2. Service providers often distinguish the more intense needs of Retrieved from https://www.state.gov/3ps-prosecution-protection-and-pre- services for victims and survivors of human trafficking from vention/ other marginalized groups because the victims and survivors U.S. Department of State. (2019b). Trafficking in persons report. Retrieved from often: https://www.state.gov/wp-content/uploads/2019/06/2019-Trafficking-in-Per- sons-Report.pdf A. Are separated from their family, friends, and support U.S. House of Representatives. (n.d.). 18 USC 2259: Mandatory restitution. systems Retrieved from http://uscode.house.gov/view.xhtml?req=18+US- B. Live under the abusive control of others C+2259%28b%29%283%29&f=treesort&fq=true&num=7&hl=true&edi- tion=prelim&granuleId=USC-prelim-title18-section2259 C. Miss out on learning opportunities that non-trafficked Victims of Trafficking and Violence Protection Act of 2000, Pub. L. 106-386, 114 persons experience Stat. 1464. D. Demonstrate multiple biopsychosocial deficits Vogel-Scibilia, S. E., McNulty, K. C., Baxter, B., Miller, S., Dine, M., & Frese, F. J., 3rd. (2009). The recovery process utilizing Erikson’s stages of human development. Community Mental Health Journal, 45, 405–414. https://doi. 3. Trafficking takes on many forms of forced servitude that varies org/10.1007/s10597-009-9189-4 across many borders. What are the estimated percentages of Warner, E., Koomar, J., Lary, B., & Cook, A. (2013). Can the body change the worldwide trafficking by gender and age? score? Application of sensory modulation principles in the treatment of traumatized adolescents in residential settings. Journal of Family Violence, 28, A. About 21% men, 49% women, 23% girls, and 7% boys 729–738. https://doi.org/10.1007/s10896-013-9535-8 B. About 49% men, 23% women, 21% girls, and 7% boys World Federation of Occupational Therapists. (2019). Position statements. Retrieved from https://wfot.org/resources/list-of-position-statements C. About 7% men, 21% women, 49% girls, and 23% boys World Health Organization. (2012). Human trafficking: Understanding and D. About 23% men, 49% women, 21% girls, and 7% boys addressing violence against women. Geneva, Switzerland: International Labour Organization. 4. The United Nations (UN) 3P Protocol to guide the international World Health Organization. (2001). International classification of functioning, approach to sex trafficking defines the scope of approaches for disability and health. Geneva: Author. nations, agencies, and individuals to take in: Zimmerman, C., Hossain, M., & Watts, C. (2011). Human trafficking and health: A conceptual model to inform policy, intervention and research. A. Prevention, protection, and promotion Social Science & Medicine, 73, 327–335. https://doi.org/10.1016/j. B. Protection, prosecution, and preparation socscimed.2011.05.028 C. Prevention, protection, and prosecution D. Protection, programming, and protection

ARTICLE CODE CEA0120 | JANUARY 2020 ARTICLE CODE CEA0120 | JANUARY 2020 CE-9CE-9 CE Article, exam, and certificate are also available ONLINE. Continuing Education Article Register at http://www.aota.org/cea or Earn .1 AOTA CEU (one contact hour and 1.25 NBCOT PDU). See page CE-9 for details. call toll-free 877-404-AOTA (2682).

5. Which of the following are persons who have been sexually 9. Occupational therapy practitioners possess skills and exper- trafficked least likely to demonstrate? tise to develop various services directed to the field of human A. Dental problems, posttraumatic stress disorder, and trafficking. Which area is most likely the focus of occupational results of forced substance abuse approaches? B. Anorexia, allergic conditions, and weight loss A. Labor standards for work settings, education programs, C. Gynecological diseases, flashbacks, and developmental and on-the-job training delays B. Prevention, intervention, education, and advocacy efforts D. Childhood sexual abuse history, depression, and sensory and programs deficits C. Adaption of programs, services, and terms directed to legislation efforts 6. The group of homeless youth with the highest rate of being D. Research on novel methods of care at the point of cap- exploited in trafficking is: ture or rescue from trafficking A. Minor girls 10. Occupational therapy practitioners continually seek to develop B. Minor boys and provide novel services. In the emerging area of trafficking C. LGBTQ youth prevention, protection, intervention, and prosecution, the D. All genders related conditions of which populations are least likely to serve as foundational bases on which to develop service delivery? 7. Which of the following provides the most enforceable legal A. Survivors of domestic violence and partner abuse entity related to human trafficking? B. Persons with a history of childhood sexual abuse A. The Victims of Trafficking and Violence Protection Act C. Political refugees who travel across national borders and Reauthorization Acts D. Military veterans and current military members B. The UN’s Protocol to Prevent, Suppress, and Punish Trafficking in Persons 11. Many models are applicable to use with survivors. Which C. The Federal Strategic Action Plan on Services for Victims program model specifically incorporates the comprehensive of Human Trafficking in the United States symptoms and behaviors that survivors of trafficking often D. The UN’s 3P Protocol of Prevention, Protection, and demonstrate? Prosecution A. The biopsychosocial model B. Recovery model developed by Clay 8. The main impediments to trafficking survivors receiving restitution, including occupational therapy services, from their C. The Wellness Recovery Action Plan model convicted traffickers include: D. Each case or program requires a unique model A. Inability to prove survivors’ symptoms caused by being trafficked 12. In developing trafficking recovery programs, which core components should occupational therapy practitioners include? B. Lack of defined standards for occupational therapy in trafficking recovery A. Compassion, care, and collaboration C. Revictimization and reentry of persons who have been B. Nonlinear development, support, and hope trafficked C. Person, environment, and occupation D. Convicted traffickers are incarcerated or flee, making D. Goal-setting, interaction skills, and positive attitude enforcement difficult Now that you have selected your answers, you are only one step away from earning your CE credit.

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