Occupational Injustice and Human Trafficking: Occupational Therapy's Role
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Continuing Education Article Earn .1 AOTA CEU (one contact hour and 1.25 NBCOT PDU). See page CE-9 for details. Earn .1 AOTA CEU (one contact hour and 1.25 NBCOT PDU). See page CE-9 for details. 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 ARTICLE CODE CEA0120 | JANUARY 2020 CE-1CE-1 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). those trafficked to be 21% men, 49% women, 23% girls, and 7% Rights, n.d.; UNODC, 2019b). The 3P Protocol delineated boys, not including the lesbian, gay, bisexual, transgender, and an international guide for nations, governmental agencies, questioning (LGBTQ) population (UNODC, 2018). Sex traffick- nongovernmental groups, and individuals to direct efforts ing involves coercing minors or adults into sex-related activities, within respective nations and across borders. The UNODC including pornography, sexual dancing, and sexual acts. 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