Resource Limitations. One of the most common challenges reported by service providers is the limited resources available to support case management services. Those working with victims have described case management as a 24/7 responsibility. While case managers admit this is not true of all victims, it does appear to be the case when one first begins working with a victim and during critical points, such as following depositions, appearances in court, application renewals for benefits and services, and reunification. This intensive and sometimes unpredictable need for support and assistance by international victims specifically, limits the size of the case load a case manager can effectively carry. As one case manager stated, "My one trafficking victim requires more of my time than 25 of my domestic violence cases."
Some agencies find it difficult to retain qualified case managers because the compensation is low and the demands of the job are high. Many smaller agencies report struggling with the structure of some funding streams. For example, the per-capita funding available under the ORR Anti-Trafficking Services Subcontracts is based on reimbursement for services and can pose challenges for agencies without diverse funding streams or large infrastructures to support staff during "downtimes" (i.e., low client referrals). Larger agencies are able to support case managers under other funding streams and often have case managers working with different victim populations whereas some of the smaller agencies, often specific to human trafficking, have not been able to diversify their funding. This has resulted in some agencies needing to move to part-time case managers; a challenge given the 24/7 responsibility of their job with some victims.
However, those in the field recognize that the current per-capita funding is intended to be a more efficient use of limited resources than previous funding streams in that it allows for the provision of services to victims "anytime, anywhere" throughout the country, and ensures an efficient use of limited resources. But it may take time for some agencies to figure out how to work within the various reimbursement systems.
Although there are challenges, HHS has recognized some of these limitations and made resources available to fund case management services for international victims. For domestic victims, however, the lack of comprehensive case management has not yet been addressed. According to law enforcement and service providers, this remains a critical problem in need of resources to begin to solve. Domestic victims have to rely on case management services offered through what are described as already overburdened systems, such as the child welfare system and domestic violence and youth shelter programs.
Length of Service Eligibility. Although it is possible to get exceptions from funding agencies, case managers note that time limits associated with some types of services, such as the 8 months for refugee cash and medical assistance, are often not sufficient to move a client from "crisis to thriving." According to service providers, pre-certification can take more than a year and post-certification resources requiring month-to-month approval are limited in duration. There is general recognition in the field that significant time, and thus resources, are needed to build trust with clients, move them into recovery, and help them become self-sufficient. It also often takes time to convince victims to cooperate with investigations and prosecutions, and/or for law enforcement agencies and officials to determine that a trafficking crime has occurred.
Staff Burnout and Turnover. Case managers are characterized as dedicated, committed individuals who are overworked and underpaid. As a result, staff burnout and ultimately staff turnover are significant problems for many agencies. Many case managers' report experiencing secondary or vicarious trauma. Unfortunately, they also acknowledge that they have very little time to take care of themselves. Not only did this affect the case managers, but victims often experience changes in case managers as a result. Given the time needed to establish trust with the victims and the importance of the relationship between the case manager and the victim, these changes in case managers are viewed as setbacks to recovery.
|"This is a major issue. It is more than burnout and compassion fatigue, it's worse. This type of work is hard and the staff get stressed. And what is in place to support the staff? Nothing. We need to find ways to help staff address secondary trauma. For example, I would like to be able to offer my staff a day off or a small token to show how much they are appreciated."
Availability of Services. Regardless of the type of service sought, the role of the case manager in helping victims' access services is viewed as essential for both international and domestic victims. Unfortunately, accessing certain services can be a challenge in many communities. Specifically, service providers report limited availability of emergency and permanent housing (in particular for men and children), mental health services, and dental services. When services are available, there are often long waitlists or significant costs associated with the services.
Additionally, access to culturally-appropriate services, including providers who can communicate with clients in their native languages, are limited. While case managers themselves did not report problems communicating with clients, either directly through multi-lingual staff or indirectly through the use of translation services, other benefit or service agencies that clients were referred to often lacked these capabilities.
Access to Information. Another significant challenge identified by case managers is limitations to information sharing among providers and with other agencies. Specifically, issues of confidentiality are often identified as barriers to keeping clients informed about their legal case and, in some cases, medical diagnoses or results. As the liaison for the client, some case managers report finding themselves in difficult positions where the client expects them to have the information they need and when they cannot provide answers to the client, it is the case manager who is viewed as the "bad guy." This creates issues of distrust, which ultimately can cause setbacks in the client's progress toward self-sufficiency.