U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation

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ADDRESSING THE NEEDS OF VICTIMS OF HUMAN TRAFFICKING: CHALLENGES, BARRIERS, AND PROMISING PRACTICES

Heather J. Clawson, Ph.D. and Nicole Dutch, B.A

I. STUDY OVERVIEW II. UNDERSTANDING THE NEEDS OF VICTIMS OF HUMAN This is the fifth in a series of Issue Briefs TRAFFICKING produced under a contract with the U.S. Department of Health and Human Services Common Needs (HHS), Office of the Assistant Secretary for Planning and Evaluation (ASPE), to conduct When service providers and law a study of HHS programs serving human enforcement personnel were asked to trafficking victims. Funded in the fall of describe the needs of victims of human 2006, the purpose of this exploratory project trafficking, a common response was, “what is to develop information on how HHS don’t they need.” The table on the next page programs are currently addressing the needs shows the responses given by those service of victims of human trafficking, including providers participating in the study.1 The domestic victims, with a priority focus on safety needs of victims were identified as domestic youth. This project also reviewed the first priority by all of those working with relevant literature, and identified barriers victims. According to law enforcement and and promising practices for addressing the providers, screening for safety needs (for needs of victims of human trafficking, with both the victims and providers) is part of a goal of informing current and future every assessment they conduct. Safety program design and improving services to needs are often met when the next priority this extremely vulnerable population. need for (safe) emergency housing is This issue brief focuses on the needs of addressed. Other emergency needs include victims of human trafficking and the food and clothing and, for international services available to meet those needs. victims, translation services to avoid Additionally, it discusses challenges and feelings of isolation and to facilitate barriers to providing services to victims, communication regarding other needs. international and domestic, adults and minors, and highlights innovative solutions Once emergency needs are met, other needs to these challenges and promising practices that present themselves in the short- and to overcome barriers . Throughout the brief long-term need to be met. These include we make distinctions, where appropriate, housing (transitional and permanent for between international adult victims, adults, and foster care or permanent international minor victims, and domestic placement for minors), legal assistance (e.g., minor victims. No information was help in understanding legal rights, legal available regarding domestic adult victims representation and, for as agencies did not report providing services to this population. There also is no current 1 A complete listing of the programs research or literature providing information participating in the study, along with a detailed on serving this population. description of the methods use to collect information will be available in the final report released Summer 2008. ______

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Needs of Victims of Human Trafficking

International Domestic Minors Adults Minors Emergency Safety X X X Housing X X X Food/clothing X X X Translation X X Legal guardianship X X Short-/Long-term Transitional housing X X Long-term housing X X Permanency placement X Legal assistance X X X Advocacy Translation X X X Medical care X X X Mental health/ X X X counseling Substance abuse X* treatment Transportation X X Life skills X X X Education X X X Financial assistance/management X X Job training/employment X X X Child care X X X Reunification/repatriation X X X *While substance abuse treatment may be a need for international victims, it was only identified as a need for domestic minor victims. international victims, assistance with filing treatment for physical injuries, and dental T-visa applications, and immigration care. Other service needs include child care petitions), and advocacy (e.g., assistance (for both adults and minors with children), retrieving identification documents, education (GED assistance, enrollment in completing applications, attending school, technical training/certification), life appointments, and navigating the different skills training (including assisting some U.S. systems, including criminal international victims with operation of basic justice, child welfare, immigration, human household appliances, using public services, transportation, etc.). transportation, using a telephone, mailing a letter, etc.), job training, finding Additionally, service providers and law employment, financial management, and enforcement note that most victims also where appropriate, family reunification or need health screening (tuberculosis, sexually repatriation. transmitted diseases, pregnancy), vaccinations/immunizations, medical ______

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______In addition to the above service needs, indicating he/she was a victim of human service providers report that all victims of trafficking. This experience exacerbated the trafficking have some type of mental health client’s situation and need for ongoing legal need.2 Specifically, service providers assistance. indicated that as a result of the trauma experienced, victims need trauma Legal assistance is one other area where counseling and for domestic minor victims there are differences in degree or type of in particular, they often need anger need between international and domestic management, conflict resolution, and family victims. While both have legal needs, counseling. international victims, often in the U.S. illegally, have more complex legal needs Differences in Needs usually related to their immigration status. This includes needing representation at While the needs are relatively similar deportation hearings, assistance with regardless of whether someone is an applications for T visas and derivative visas, international or domestic victim, adult or and renewal applications. minor, one point is clear—the magnitude of these needs varies for each victim depending While it is not necessarily unique to on his or her circumstances. domestic victims, service providers report that domestic victims often present with For example, international victims often serious substance abuse issues. Some express a greater and more urgent need to providers report that while international obtain employment than domestic victims victims also need assistance with similar do. This is reportedly the result of their problems, they are less likely to admit they desire to send money back home to support have a problem out of shame, fear of stigma, their families. or denial that their substance abuse constitutes a problem. In some cases, the Additionally, while obtaining identification service providers do not want to indicate this documents (e.g., passports, birth certificates, as a need of international victims for fear driver’s licenses) is reported to be an access to treatment records will be important need for all victims in order to subpoenaed and used against the victim in a access services, it is especially important for legal case (criminal, civil, or immigration). international victims to have some form of identification or legal documentation on Regardless of the victim, law enforcement hand. One service provider told of an and service providers stress that it is not so incident where a client was removed from much the type of needs that vary by victim, public transportation and placed in detention but the duration of services required to because the client did not have any address those needs and the level of identification on his/her person and had not difficulty obtaining such services. yet received his/her certification letter III. SERVICES AVAILABLE FOR VICTIMS OF HUMAN TRAFFICKING 2 For more information on the mental health needs and services available for victims of Prior to the passage of the Trafficking human trafficking, see “Treating the hidden Victims Protection Act of 2000 (TVPA), wounds: Trauma treatment and mental health law enforcement and service providers recovery for victims of human trafficking” at report struggling to piece together the http://aspe.hhs.gov/hsp/07/HumanTrafficking/ or comprehensive services needed by http://www.icfi.com/markets/social-programs/ international victims of human trafficking with scarce resources. Under the TVPA,

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______HHS was designated as the agency trafficking to receive certification he or she responsible for helping these victims of must first be determined to be a victim of a human trafficking become eligible for severe form of trafficking as defined by the benefits and services and funds were TVPA and he or she must be willing to allocated for the delivery of such benefits comply with all reasonable requests to assist and services. One responsibility of HHS is law enforcement in the investigation of the to certify adult international victims of trafficking case (minor victims are exempt trafficking who are not U.S. citizens or legal from this requirement). Following this permanent residents (LPRs) once they are determination, the victim must complete a identified. This certification allows adult bona fide application for a T visa, receive a international victims to receive the same T visa, or be granted “continued presence” benefits and services available to refugees. by federal law enforcement. T visas were U. S. citizens or LPRs who find themselves established under the TVPA and allow victims of trafficking (i.e., domestic victims) victims of trafficking to become legal do not need to be certified in order to temporary residents of the United States. receive benefits. In the case of citizens, they Once a T visa is obtained, a victim may are already eligible for many benefits and remain in the U.S. for up to three years. At services they might need. And although the end of this time period the victim may be LPRs face greater benefit restrictions than eligible for legal permanent residence status. U.S. citizens, they do not face the same eligibility restrictions as undocumented Certified adult victims are eligible to receive immigrants, which is usually the status of federally funded services and benefits international adult victims when they are similar to refugees. Some of the services that first identified. International minor victims victims of trafficking are eligible for through of trafficking (under the age of 18) do not federally funded programs, such as the Per- need to be certified but instead receive a Capita Victim Services Contract include letter of eligibility from HHS and are then housing or shelter assistance, food eligible to apply for a similar range of assistance, income assistance, employment services as refuges, including the assistance, English language training, health Unaccompanied Refugee Minor (URM) care assistance, and mental health services. Program. In order for an international adult victim of Per-Capita Victim Services Contract

The Unaccompanied Refugee Minor (URM) The Per-Capita Victim Services contract is Program for designed to centralize services while International Minor Victims maintaining a high level of care for victims of human trafficking through “anytime, International minors who are determined to be anywhere” case management. Working in victims of human trafficking by law enforcement concert with HHS’ ongoing Rescue & Restore officials are eligible for the T visa, which allows public awareness campaign, subcontractors are victims of trafficking to remain in the U.S. and reimbursed for the services actually provided to become eligible for work authorization. each human trafficking victim. The contract Additionally, international minor victims without also streamlines support services in order to help a parent or legal guardian in the U.S. are eligible victims gain timely access to shelter, job for services under the Unaccompanied Refugee training, and health care. Minors (URM) program. The URM serves as a legal authority designated to act in place of the For more information, please contact child’s unavailable parents. Children are placed [email protected] in foster homes, group homes, or independent living arrangements. Through the URM, children can receive intensive case management, Prior to becoming certified, a period referred education, health care, mental health counseling, to as pre-certification, victims pursuing independent living skills training, assistance with ______family reunification and repatriation, and other services until they turn 18 or such higher age, depending on the foster care rules of each state. 4

______certification and cooperating with law enforcement can receive limited, often Lack of Knowledge and Understanding. emergency services, which parallel most One of the most common and frustrating certification services as a result of funding challenges reported by law enforcement and available from HHS and other federal service providers is the lack of knowledge agencies. Pre-certification services include and understanding regarding human housing, food/clothing, advocacy, legal trafficking among service providers, law assistance, medical/dental care, language enforcement, and even victims themselves services (e.g., interpreters/translators), who often do not believe or understand that mental health counseling, education, and job they are a victim of crime. As a result, training. victims often go unidentified and unserved.4

In addition, service providers report seeking Lack of knowledge and understanding of other assistance for victims who may decide what services are available is a barrier for not to cooperate with law enforcement out service providers as well. Many service of fear of retaliation from the traffickers, or providers report their own confusion for other reasons. The strategies to assist regarding what services their clients are these victims may include seeking asylum eligible for and can access, which highlights for the victim or filing for a U-Visa3 and the need for effective case management as accessing services under the Violence identified in a previous Issue Brief.5 Against Women Act, or for some agencies, tapping into non-federal or unrestricted “There is a general lack of knowledge and funding streams to provide ad hoc services understanding of human trafficking and not (for example, from state or local government enough service providers in the healthcare programs, foundation-funded programs, profession, local Social Security etc.). Administration offices, department of motor vehicles, and other key agencies are trained IV. CHALLENGES AND BARRIERS on this issue and know they can serve these TO MEETING THE NEEDS OF clients. We are constantly having to take our VICTIMS clients to appointments because they are turned away when they try on their own.” While there seems to be consistency Service Provider between the needs of trafficking victims and the services for which they are eligible and the programs in place to provide these Availability of Services. Even though services, there are many challenges and victims, international or domestic, may be barriers to getting victims into service. eligible for services, the availability of those

3 A U visa is set aside for victims of crimes, such as domestic violence, rape, assault, 4 For more information on the challenges abduction, and other violent crimes who identifying victims of human trafficking, see have suffered mental or physical abuse “Identifying victims of human trafficking: because of the crime and who not only have Inherent challenges and promising strategies information regarding the activity, but also from the field” at are willing to assist government officials in http://aspe.hhs.gov/hsp/07/HumanTrafficking/ or the investigation of the criminal activity. http://www.icfi.com/markets/social-programs/ U.S. Citizenship and Immigration services 5 For more information on the case management can grant up to 10,000 U visas each year needs of victims of human trafficking, see “Case authorizing the holder to remain and work management and the victim of human legally in the U.S. for up to three years, at trafficking: A critical service for client success” which time the victim can apply for a green at http://aspe.hhs.gov/hsp/07/HumanTrafficking/ card. or http://www.icfi.com/markets/social-programs/ ______

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______needed services is often limited due to long for women and girls is not usually a wait lists and associated fees (even if offered problem, finding the same placements for on a sliding scale). As one provider men and boys is difficult. Transitional and indicates, “Free clinics are not always free. permanent housing is scarce for everyone You spend a lot of time waiting to be seen but in particular for domestic minors with and there are often some unexpected charges felony convictions and victims with mental associated with most services.” According health or substance abuse issues.6 to service providers, this is particularly true for mental health services and substance ‘There just isn’t affordable housing in our abuse treatment. community for anyone. We often end up placing groups of victims together in While accessing basic medical services apartments or houses. Sometimes this works (physicals, gynecological exams, screenings, but sometimes the only areas where they can etc.) is not reported as a problem for most afford housing are high crime areas. We’ve service providers (with the exception of actually had clients become the victims of some providers in rural communities), other crimes (burglary) because they could only afford to live in unsafe neighborhoods.” accessing specialized medical treatment was problematic. Specifically, specialized care Service Provider for acute, long-term needs, such as diabetes, cancer, and other illnesses, including prescriptions that are part of the treatment, Finally, the availability of services in were often cost prohibitive and in some general for domestic victims is viewed as cases, exhaust program resources. problematic by some service providers. As one provider states, “If you just look at what domestic victims are eligible for on paper, it “As a service provider, I find it confusing trying to figure out what services are available for looks promising. However, trying to access which clients [international or domestic]. Most those services is another story.” Several of my time is spent making calls or running examples include referrals to child welfare around to agencies. We [service providers] agencies by service providers and law need a road map that helps explain not only enforcement only to find out that the what services our clients are eligible for but agencies would not see the domestic victims how we go about accessing these services. because the abuse did not occur at the What documentation does my client need? “hands of a parent or legal guardian.” In What paperwork do they need to fill out? What these cases, providers and law enforcement would make my client ineligible for services? I report minors falling through the cracks of can barely navigate through all of these systems myself, so how can we expect our clients to take the mainstream system and not receiving this on?” services. In some cases, minors were handed back to their abusers and “turned Service Provider back out on the streets.”

Appropriateness of Services. Service Similarly, while most service providers are providers talk not only of the need for more able to find basic dental care for their clients culturally appropriate services, but also for (although sometimes there are long waiting periods), more serious and costly dental 6 procedures, such as root canals and For more information on the housing needs of extractions, are difficult to obtain. domestic minor victims, see “Finding a path to recovery: Residential facilities for minor victims

of domestic sex trafficking” at Housing is another service that law http://aspe.hhs.gov/hsp/07/HumanTrafficking/ or enforcement and service providers report is http://www.icfi.com/markets/social-programs/ limited. While finding emergency shelter ______

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______gender appropriate services. Finding such knowledge of the issue, not only among services can be challenging, particularly in service providers but in the general public. rural communities. Additionally, service providers stress the importance of Access to Services. The two greatest understanding what is meant by culturally barriers to accessing services for appropriate services. For instance, just international victims include language having someone from the same culture who barriers and transportation. Service speaks the same language does not translate providers indicate that the availability of into culturally appropriate services information and access to providers that according to service providers. Speaking speak English, Spanish, and in some the same language as clients can help communities Korean, is not difficult. It is facilitate service provision but that is just their clients that speak other languages that one piece of one’s culture. Service have difficulty accessing services. providers gave examples of victims of sex trafficking who were not comfortable Additionally, transportation is a problem. In talking about their experiences with large cities, teaching clients how to use the someone from their same culture out of the transportation system can be overwhelming associated shame and stigma. Other and very time consuming. Service providers examples given by service providers were report clients missing appointments because related to the gender and culture of the they were afraid to use public transportation. victim. For example, in some cultures, it is In smaller communities, there is often not appropriate for a female to visit a male limited or no public transportation, also doctor. Recognizing these challenges and making it difficult for clients to get to the implications for providing appropriate appointments. services to clients is seen as critical by providers themselves. “There is no cookie-cutter approach to working with this population. Males, females, adults, The appropriateness of services also extends children, sex trafficking, or labor trafficking. to examining the culture of the environment You just don’t know how long you will be in which the service is offered. For working with them. Just when you think they example, service providers note that are moving forward, something happens with providing services to victims who are living their case or with their family or they see in shelters can be difficult and some something in the news that triggers the trauma experience and sets them back sometimes environments can result in months in their progress. A lot of times it is one “revictimization.” In particular, providers step forward and two or three steps back. You share examples of sex trafficking clients just have to be prepared for setbacks.” being placed in domestic violence shelters and then facing humiliation and isolation. Service Provider For international sex trafficking victims, the isolation is usually attributed by service providers to language barriers and cultural Length of Services. Another challenge differences. But for domestic victims of sex identified by service providers and victims trafficking, the humiliation and isolation, themselves is the length or duration of the according to service providers and some services available to victims. Service victims, is attributed to perceptions that providers note that the timeline to self- domestic victims are “prostitutes,” or willing sufficiency varies by client. Some clients participants, rather than victims of abuse and may come in, get certified right away and be crimes. These misperceptions reflect again, ready to work, especially among many labor a general lack of understanding and trafficking victims. Other victims, however, may remain pre-certified for a longer period of time and even after becoming certified, ______

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______they may not be ready to work or move international minor victims, there are often forward with their lives. According to numerous individuals involved in a case, service providers, individual timelines are making coordination and communication difficult to predict. However, with close difficult. In some cases, providers and law monitoring and anticipation of set-backs enforcement report not knowing who to (e.g., depositions, appearances at trial, contact on behalf of the minor or who could intense counseling sessions, reunification, make decisions on behalf of the minor. etc.), providers are able to adjust services to There were cases of information not getting meet the changing needs of clients. transferred from one agency to the next, sometimes resulting in minors not getting For domestic minors, shelter stays are often the services they needed. As one provider limited to 15-, 30- or 90-days and do not states, “When the process for [international] allow providers enough time to establish minor victims works, it works well. But relationships with victims or provide when it doesn’t, it fails miserably.” There is adequate services to meet their longer-term agreement among providers and law needs. Transitional housing for domestic enforcement alike that there needs to be minors and domestic victims is often more information and communication limited, and when available victims often regarding how international minor victims find it difficult to follow the are served. Most providers report positive rules/restrictions of the facilities (e.g., no experiences with the URM programs but drug/alcohol use, required employment). communications from these programs, as well as the availability and location of “When working with a domestic victim, I just services are seen as limited. need more time. I can’t stabilize a client with an extensive trauma history within 90 days or V. INNOVATIONS AND PROMISING transition them to permanent housing within PRACTICES TO SERVING VICTIMS 18-months. Many of my clients struggle to get clean, get an education (or GED), learn life To address the many challenges and barriers skills, obtain employable skills, and get to providing services to victims of human employed. This is especially true if they have not begun to work on trauma recovery and this trafficking, many service providers have can take years.” developed innovative strategies and promising practices for their agencies and Service Provider their clients.

Collaboration. The importance of Lack of Coordination of Services. For the collaboration in meeting the needs of most part, service providers acknowledge victims of human trafficking cannot be improved coordination of services for clients overstated. Law enforcement and service over the past several years. However, they providers stress the importance of working see the need for a single point of contact together to meet the diverse and complex within each agency working with victims needs of this population. The establishment and a central case manager to ensure of coalitions and task forces, such as the communication and coordination of ORR-funded Rescue and Restore coalitions, services. is viewed as one strategy that has resulted in the increased availability of services for all This appears to be especially true in the case victims. of minor victims. According to service providers and law enforcement, when working with minor victims, in particular

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______and the lack of funding for case managers “We have partnered with Goodwill and other similar organizations to obtain vouchers for for domestic victims, having this our clients. They are able to use these to consistency benefits the victim, service shop for necessities. It provides them with providers, and law enforcement (including what they need as well as gives them some prosecutors). A central case manager with level of independence.” knowledge of all aspects of the victim’s situation can ultimately save time and Service Provider resources.

Several service providers report establishing “Victims need to be assigned a case formal memoranda of understanding manager from point of identification (MOUs) with domestic violence shelters to throughout the criminal justice process. ensure not only placement of their clients This person does not need to be a victim but placement in a facility with a staff witness coordinator from law enforcement trained on human trafficking and sensitive to (although they could) but the person needs to the needs of victims. These MOUs are also be consistent.” important because some domestic violence Law Enforcement shelters will not (or cannot) accept victims if they are not victims of domestic violence, defined as involving a boyfriend or spouse. Mobile Services. In some communities, But with MOUs, exceptions to this home visits that provide medical and mental definition have been made with some health care, and basic case management, is agencies. Service providers also report an innovation helping to meet the needs of success in reaching out to domestic violence victims. This approach is especially valued shelters that traditionally serve battered by agencies serving clients in large immigrant women. geographically dispersed areas, as well as rural areas. In both of these cases, clients In several communities across the country, can find it difficult to get to their collaboration among local law enforcement, appointments. Some service providers juvenile and family court judges, child mention using in-home visits as a way to protection services, and youth shelters and introduce clients to services; it is almost a programs has proven to be a promising and trial period before transitioning them to in- necessary practice for identifying and office treatment. meeting the needs of domestic minor victims of sex trafficking. Additionally, linking clients to existing mobile health clinics is a common practice Consistent Case Managers. Given the for many agencies, including shelters complexity of victims’ needs and the working with domestic victims. comprehensiveness of the services provided, service providers, law enforcement, and Use of Pro Bono Services. Several victims report that having a consistent case agencies report using pro bono services, manager all the way from identification to particularly for legal services. This often case closure is a promising practice.7 While involves providing training to attorneys on not possible in all cases due to staff turnover the issue of human trafficking and providing access in order to interview clients. While 7 For more information on the case management this results in a larger pool of affordable and needs of victims of human trafficking, see “Case appropriate service providers for clients, it management and the victim of human does require significant training and trafficking: A critical service for client success” monitoring according to providers. One at http://aspe.hhs.gov/hsp/07/HumanTrafficking/ example of where this approach has worked or http://www.icfi.com/markets/social-programs/ ______

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______well is Project Liberty, highlighted in the and appropriate services for victims are box below. ongoing. But through collaboration among agencies, including non-governmental Project Liberty organizations, shelter providers, health care providers, law enforcement and others in In Atlanta, Tapestri, Inc., a non-profit communities across the country, and through organization dedicated to ending violence and innovative strategies and promising oppression in refugee and immigrant practices, there are more services available communities, and using culturally competent today for victims of human trafficking than and appropriate methods, has established at any time in the past. And while there Project Liberty. This is a program where a pool of immigration attorneys (public and remains room for improvement, particularly private) receive annual training from Tapestri regarding adult domestic victims, the on human trafficking as part of their services available to victims of human professional development. In exchange, the trafficking appear to be better tailored to attorneys provide pro-bono services to their needs than they have been in the past. Tapestri’s trafficking clients. Tapestri has recently replicated this model with psychologists to provide mental health services The issue briefs in this series and the final for its clients. study report can be downloaded from the following Web sites: For more information on this model, please call 404.299.2185 or email Tapestri at tapestri.org. http://aspe.hhs.gov/hsp/07/HumanTrafficki

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Volunteer Programs. Some agencies http://www.icfi.com/markets/social- establish programs where their clients can programs/ do volunteer work. Because many victims are unable to do regular work until they receive their work authorizations, service providers need to find ways to use this “waiting period” to help engage their clients in the community and workplaces, when appropriate. Several providers have in place volunteer programs where clients gain valuable on-the-job training that can then result in quick placement in a job with the same or similar agencies.

VI. SUMMARY

The needs of victims of human trafficking, whether international or domestic, can be characterized as complex, requiring comprehensive services and treatment that span a continuum of care from emergency to short-term to longer-term assistance. Providing these services can take months or years; the timeline for serving each victim is different and often unpredictable. The challenges associated with accessing timely

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