Finding a Path to Recovery: Residential Facilities for Minor Victims of Domestic Sex Trafficking. Residential Facilities

The majority of domestically trafficked girls who were not living in their homes during the exploitation were being placed in a variety of settings, including residential treatment centers, child protective services-funded group homes and foster care placements, and juvenile corrections facilities. Additionally, many of these girls were flowing in and out of shelters for runaway and homeless youth and frequenting drop-in centers, often without detection as a victim of domestic sex trafficking by the staff. At the time of the study, we identified only four residential facilities specific to this population in existence across the country. These include Girls Educational and Mentoring Services (GEMS) Transition to Independent Living (TIL) program, Standing Against Global Exploitation (SAGE) Safe House, Children of the Night, and Angelas House (see the table at the end of this issue brief for more details). Despite the limited number of these programs, across sites, street outreach workers, shelter providers, residential facility staff, law enforcement, and child protective services workers spoke of the importance and priority need for more residential programs uniquely tailored to this population.

 

We need an integrated program that doesnt institutionalize.
Service provider

We lack a good quality facility for U.S. kids.
Law enforcement

The girls really have no place to go.
Service provider

There needs to be a whole new model; using the old model is setting these kids up for failure.
Law enforcement

The following are promising components or elements for a residential facility as identified across sites by shelter providers, law enforcement, case workers, and the directors and staff of the four residential facilities serving minor victims of domestic sex trafficking. While there is no research yet validating these shared observations, we believe nonetheless that this information can help provide a guide or road map in the development of new residential facilities or, in some cases, to help others tailor their existing programs to better meet the needs of this population, even if only temporarily until more appropriate placement can occur.

Population Served.  While there was variation in the populations served by existing residential programs, providers and law enforcement agreed that residential facilities should be designed to serve homogeneous populations. While the current focus across sites is on female minor victims of domestic trafficking, there was acknowledgment that the need for similar facilities for males and transgender youth exists. Several of the runaway and homeless youth shelters noted challenges trying to house this population among mixed age and mixed gender populations. In terms of size, the current programs range from 6 beds to 24 beds. Most providers advocate for smaller programs of congregate care settings regardless of the population. It was reported that minor victims of domestic sex trafficking have difficulty navigating relationships and, therefore, need  and are more likely to benefit from  a smaller, more intimate setting. This extends to believing that no more than two girls should share a room; a model similar to domestic violence shelters. Advocates for larger programs believe in the ability to serve a greater number of young people more economically. As described by Children of the Night, The cost of staff for 10 kids is half the cost of staffing for 11, so if you have 11, you might as well have 20.  It was expressed, however, that a larger program must have appropriate space to allow for smaller subgroups to interact. The age of the residents at current facilities for this population ranged from as young as 11 to as old as 21. It was suggested that facilities consider grouping residents by similar age and/or stage of recovery. This could be done through different units within a single residence or through different facilities. Finally, there were some exclusion criteria or conditions under which the existing residential facilities and alternative placements, including runaway and homeless youth shelters and domestic violence shelters, would not serve minors. While these varied by program, the criteria often included the presence of a severe mental disorder (psychotic, suicidal), active and severe substance abuse and addiction, and severe violent behavior (homicidal, threat to others). These girls were determined to need the intensive treatment often available through hospitalization, staff-secured residential treatment facilities for minors with emotional and/or behavioral disorders, or inpatient substance abuse treatment facilities. However, providers remarked on the paucity of beds available for a minor with either no insurance or Medicaid and the lack of in-depth understanding of the experiences of victims of domestic sex trafficking among staff at these other facilities.

Length of Stay.  Providers and law enforcement working with this population advocated for a minimum length of stay at an appropriate facility of at least 18 months. This was also echoed by survivors. While one of the existing programs reported a shorter length of stay (3 to 6 months), they operated under a flexible policy that allowed for longer stays if needed. The 18-month length of stay was recognized as sufficient time to build trust with the girls, provide the necessary therapy to address their trauma, and to begin working their treatment plan and rebuilding their lives. Providers also advocated for continued connection to the program following exit and long-term aftercare services.

Voluntary Stay.  Most providers felt strongly that recovery from the trauma and victimization cannot happen until a victim is ready and willing to work on her recovery. These providers advocated for a voluntary residential program in which participants could opt in once they were invested in exiting The Life. Survivors interviewed universally advocated for voluntary placement, The girls need to make the choice themselves. Furthermore, providers acknowledged that being ready to use the services and support in a residence takes time. For example, providers at SAGE report, Bringing girls into the group home slowly has shown benefits in terms of buy-in.  For Children of the Night, their success rate is reportedly higher among residents who voluntarily enroll in their program compared to court-mandated placements. Whether advocating for a voluntary or mandatory program, everyone recognized that this population is prone to run away or relapse, similar to the phenomenon in substance abuse treatment programs. Unlike some residential treatment programs and group homes funded through the child protection system within the United States and several of the runaway and homeless youth shelters, all of the dedicated programs for minor victims of domestic sex trafficking (and other forms of commercial sexual exploitation) had a policy to allow girls to return after they run away from the facility. One survivor stated, [Programs] need to be able to hold a space open for someone to come back.  Programs also reported having specific protocols in place to work with running as part of each girls treatment plan and provided intensive one-on-one case management during heightened risk periods for running (e.g., initial intake, specific points in therapy, etc.).

Program Location.  There is a great deal of debate among providers as to the appropriate setting for a stand-alone residential program for domestically sex- trafficked girls. Currently, three out of four of the residential programs are sited within urban areas, although all of these programs are away from the track or known areas of street prostitution. Angelas House is located two hours from any urban areas in a rural community. All of the current programs, however, have geographic connections to urban areas from where most of the girls are referred. Those providers that advocate for a program within city limits believe that locating a program within the city allows girls to retain any healthy emotional supports already in place, including any family members, therapists, outreach workers, and school personnel. The girl may also be in a position to better access supports that an urban area can provide, such as a diversity of medical providers, therapists, educational opportunities, recreational opportunities, and job training and employment opportunities. In addition, these providers believe that her real recovery can only occur within the context of her triggers; a victim must learn how to navigate the environment to which she will undoubtedly return.

 

It was nice to be away from urban noise the country is really therapeutic. [It was] nice to be home at night and not worry that I will bump into the pimp. You stay in the mindset of hustling in the city.
Survivor

Providers who advocate for programs sited outside of an urban environment believe that anyone with PTSD is better able to begin recovery away from the daily triggers. For combat veterans, this would be outside of the area of war; for girls who have been the victims of domestic sex trafficking, this would be away from the areas of their exploitation. Furthermore, these providers believe that the distance will provide an added measure of security from traffickers and other predators, and decrease the likelihood that a girl on the run from a program will easily find her way back to the area in which she was trafficked for sex.

In some cases, the decision as to where to locate a residential facility may be driven by availability and cost. Some of these providers found that they were constrained by which neighborhoods would allow their program to be located there and the costs associated with housing in each neighborhood.

Security of Facility.  There was universal agreement that any residential facility needed to be secure in order to establish physical and emotional safety for these girls, which is an essential ingredient for their recovery. Ensuring the safety of the facility and staff themselves was also a priority. Examples of security measures to put in place at a residential facility were identified from the existing residential facilities, domestic violence shelters, and many of the runaway and homeless youth shelters. These measures included: undisclosed location, security cameras and alarm systems, 24-hour staffing and presence of security guards, unannounced room searches and drug screens, limited phone use, supervised or no access to the Internet, locked doors at all times with staff and residents buzzed in and out of the facility, pre-approved/screened contact lists, etc. For some runaway and homeless youth shelter programs currently housing this population, the staff noted that close relationships with local law enforcement and ongoing safety training for staff and residents were key elements to ensuring a safe environment. Not only are these security measures important for programming, they are also important items to consider when developing a program budget.

Additionally, the development of safety plans for each resident, similar to practices employed by domestic violence shelters, was practiced and recommended across the residential programs. Girls are taught to find safety zones for themselves (e.g., within a local convenience store or a fire station) that they can use to flee their trafficker or simply avoid an old acquaintance. These safety plans are put in place to address both the possibility of running and to navigate day-to-day life after exit.

 

These girls require staff to be real, use lots of humor, have street credibility, and be able to compassionately confront their behaviors without judgment.
Case manager

Staff must be culturally competent  knowledgeable about the culture of the street.
Service provider

[Girls] need a person who truly understands where [theyve] been  either by being a survivor themselves or immersing oneself in the culture, language, experience.
Service provider

Program Staffing. Across sites, providers commented that programs for domestically sex-trafficked girls must be run by individuals who live and breathe trafficking in contrast to administrators lacking that expertise and specialization. Because domestically sex-trafficked girls have been exploited primarily by males, programs believe it is important to begin their recovery in an all-female environment and therefore advocate for hiring only female staff. One survivor commented on the need to create a community of women. However, some providers do advocate for the appropriate use of male staff to demonstrate the possibility of a relationship with a male that is nonexploitative. As described by providers, it is of primary importance that staff truly understand minor victims of domestic sex trafficking and the impact of their life experience. All providers agreed that staff need to be able to be consistent, nonjudgmental, and treat victims with the utmost respect.

This need to hire staff with an authentic understanding of The Life and a natural ability to connect with domestically sex-trafficked girls has led to some providers advocating for the hiring of survivors. Both SAGE and GEMS prioritize hiring women who were sexually exploited, including minor victims of domestic sex trafficking and have successfully exited The Life. SAGE explains the rationale for using a peer support model as follows:  Clinicians spend 75% of their time establishing trust, while peers can start from a place of trust.  One provider remarked that someone who has exited can convey hope in a way those of us who havent been there cannot, while another commented that survivors show that people can survive and pull themselves out.  Among the benefits of survivor mentoring is that hearing the life story of someone who has been trafficked for sex often paves the way for girls to open up.

Regardless of whether a program employs survivors or not, it is important for all staff to be well trained in understanding sexual exploitation, the realities of prostitution and sex trafficking, the methods of recruitment, the physical/psychological/spiritual impact of the trauma, potential methods for exit, an overview of youth development programming, and appropriate boundaries and healthy working relationships.

Services Provided.  While not all programs were able to offer all services onsite, there was agreement regarding the range of services that needed to be available to residents. These include:

  • Basic needs.  Each of the programs currently housing domestically sex-trafficked girls meet the basic needs of all residents, similar to runaway and homeless youth programs. That is, each program provides clothes that fit appropriately (including undergarments); food; shelter, including showers; and a safe place to sleep.
  • Intensive case management.  One of the most central services offered by the existing residential facilities is intensive case management. Girls are paired with staff with an emphasis on their relational development  their connection to the staff person builds simultaneously while the services are provided. As described by one provider, this requires lots of time commitment  she needs 24-hour access to her advocate/case manager.  Girls are referred to and supported through the complexity of their life situations by case managers (i.e., legal services, medical services, etc.). The case managers work in collaboration with girls to develop Individual Service Plans. The overall goal of treatment was described by providers in a variety of ways, but all related to the general mental and physical health-related goals of building self-worth, self-respect, and self-efficacy. As described by GEMS, this treatment must be delivered within the context of understanding the developmental hindrances of having been under the control of someone [her trafficker] for so long.

     

    The objective [of the program] is to teach the girl how to value herself.
    Case manager

    To get these girls to like who they are, girls need to know it is OK to take care of yourself.
    Provider

    You are getting these kids back in their bodies.
    Case manager

     

  • Mental health counseling/treatment.  Across sites, providers and law enforcement agreed on the need for trauma-informed ongoing mental health services, with a variety of specific treatments receiving particular emphasis (i.e., cognitive behavioral therapy (CBT), dialectical behavioral therapy (DBT), eye movement desensitization and reprocessing (EMDR)). In addition, programs sought to tailor their program to ensure trauma-informed care. One example is that SAGE provides each resident with a portable CD player and headphones as a means of offering one particular coping and self-soothing tool. In addition, across sites, providers mentioned the need for trained staff to provide crisis management around the clock. As one outreach program described it, vulnerable youth, in general, and sex-trafficked minors, in particular, need someone there all the time to help them stop and process the crisis.
  • Medical screening/routine care.  Given the physical health needs of this population, all programs provided medical screening for STDs, pregnancy, and other health-related problems, often through local medical providers sensitive to this issue or onsite nurse practitioners. Depending on the source of referral to the program, many of the girls receive medical screening (and emergency treatment, if required) prior to entering the facility (e.g., detention facility, child protective services). For more critical or emergency needs while staying at thefacility, programs access local urgent or emergency care facilities. Mobile health clinics and local teen clinics were also utilized by several of the runaway and homeless youth shelters housing this population.

     

    Examples of Innovative Youth Programming

    The Hopes & Ropes Program at Angelas House is a risk-taking program in which residents experience the challenge of a ropes course in the context of their personal recovery. Furthermore, volunteers come on site to offer a variety of group programming, including book groups and a self-confidence building program called Cirque Du Monde.

    The On Track Program at the drop-in center Youth on Fire (developed by the Childrens Trauma Recovery Foundation) encourages youth to write and record music that tells their own narrative.

    At GEMS, girls are offered a variety of educational and recreational opportunities, including Yoga and poetry writing. In addition, girls can choose to be involved in a youth leadership group in which they develop programming for GEMS, speak out about exploitation (their own and in general) to legislators and providers, and conduct public awareness and advocacy campaigns.

    At Children of the Night, residents are able to express their programmatic ideas, concrete needs (i.e., special snacks), and program concerns (i.e., staff who are being disrespectful) through a weekly Residents Council run by the Executive Director.

     

  • Life skills and job training programs.  Across sites, providers agreed that programs serving domestically sex-trafficked girls should integrate some type of life skills, job training, and career development process as part of a girls treatment plan. This may include check writing, bank account management, learning to pay phone bills, and other types of financial literacy. As described by SAGE, a primary goal when working with these girls is to deconstruct their relationship with money.  Within the GEMS program, girls can become involved in a pre-employment and employment program. Girls can apply for hourly work in the office or as part of outreach, building skills they can take with them. Furthermore, girls are offered a stipend in the form of a $5 coupon for attending workshops, classes, or helping out in general. They are then able to cash these coupons with staff once every other week. GEMS seeks to communicate to girls you can do things that arent harmful to yourself and still get compensated and keep the money.
  • Youth development programming.  Many programs, both those serving minor victims of domestic sex trafficking and other forms of commercial sexual exploitation and those serving vulnerable youth in general (runaway and homeless populations), discussed the importance of creative youth development-oriented programming that builds on the strengths of each young person  programming that helps her find her gifts. As described by one resident, a program needs to provide multiple types of educational opportunities for victims to keep her engaged and busy. Another provider described that it cant be boring  it has to be a meaningful alternative [to The Life]. As reported, the most important piece of this creative programming was to involve the young people in its development  the key is that kids are included in determining what they want to do. Several of the runaway and homeless youth programs and drop-in centers provided engaging programming informed by youth and often led by youth, including music production, art and poetry, and sports and recreation.
  • Education.  The educational programming offered by the existing residential facilities varied. Some programs opt for referring girls to mainstream schools, GED programs, or vocational schools. Other programs offer educational programming through a collaborative arrangement with a local day-treatment provider. These models were also similar for the runaway and homeless youth shelter programs. All of the programs agree that it can be difficult to serve all of the girls in the same educational program, given the differences in their cognitive abilities, past school experiences, and interests. Children of the Night offers one example of a successful onsite educational program for residents. Children of the Night has developed their own school, under a different name to avoid the stigma associated with trafficking for sex or sexual exploitation through prostitution. Each child is tested in English, math, and social studies so that they can work according to their ability. Children of the Night is a recipient of the Kumon Math & Reading program where the youth do math problems and reading skills development each night for small monetary rewards. They have had good success with this program, improving math abilities, as well as literacy. The school utilizes an intensive independent-living curriculum and a copyrighted keyboarding program that quickly teaches students to touch type. They offer a lot of one-on-one tutoring and educational support. They have recently developed a relationship with the Los Angeles Unified School District whereby a motivated youth who completes the Children of the Night education program, passes the GED, and completes 10 hours of education on site at the local high school can receive a Los Angeles Unified School District High School Diploma.
  • Family involvement/reunification.  Many of the providers acknowledged the importance of involving biological family members or other appropriate support people in the lives of girls when a healthy relationship is possible. One child protective services official commented that many providers assume that there is no family of origin to whom the girl can return. While the outcome may never be returning home, it was expressed that through counseling and education, there may be an opportunity to maintain some type of family relationship. It was clear, however, that because of the extensive abuse histories of most domestically sex-trafficked girls, programs need to provide structured, safe environments in which families can reconnect. Angelas House has visiting time for one hour, one day per week with authorized family members in a local church. The visits are supervised by Angelas House staff. Family therapy is offered at another time during the week in a more central location. Children of the Night is able to facilitate reunification when appropriate. Staff supervise telephone visits with parents that have not been accused of sexual or physical abuse. If the parent attends five counseling sessions on their own (Children of the Night will help them find a clinic that charges on a sliding scale) and there is a family reunification program on file with child protective services, Children of the Night will fly the parent to Van Nuys, pay for their hotel, and supervise the first day of a reunion, allowing the child to stay in the hotel with the parent. In some cases, when a child incorrectly believes that reunification is possible, Children of the Night will facilitate this process so that the child may have a more realistic view of viable placement options following residential treatment.

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