Social service providers and medical professionals confirm a number of contributing factors can complicate identifying victims of trafficking and providing services to them. A common reason victims of human trafficking are not identified, and therefore do not receive proper care, is because these cases are misclassified. For example, many cases of sex trafficking, especially those in which victims are romantically involved with their traffickers, are identified as sexual or domestic violence cases. Cases of human trafficking are sometimes even processed as domestic violence cases in the court system. Social service providers anecdotally report this is partly due to limited awareness among law enforcement personnel, community service providers, and medical professionals about the scope of the definition of human trafficking. They assert first responders should be adequately trained about this issue so they can properly identify and respond to victims they encounter, including domestic victims.
Symposium attendees described additional barriers to identifying and providing services to international victims of human trafficking. They reported that one of the largest barriers for this population is language. International victims often have limited or no understanding of English. Victims of labor and/or sex trafficking may have signed illegal contracts that they believe legitimize their circumstances. International victims seeking medical and social services usually require the assistance of a translator. Service providers indicate that in order to ensure international victims are properly identified and safe, independent, confidential translators must be available. However, medical and social service providers acknowledge this requirement can be extremely challenging, if not impossible, to meet. Even providers in New York City, which has many multi-lingual communities, noted difficulties in finding appropriate translators when non-English speaking clients present themselves. Additionally, language phone lines can be costly and uncomfortable for both clients and providers, and may not be able to provide translation for all client languages.
Lack of cultural competency by health care providers can also significantly hinder the effectiveness of medical care provided to international victims. Social service providers at the symposium emphasized that an important part of cultural competency is the understanding and use of alternative medicines. They report that international as well as some domestic victims of human trafficking often come from cultures in which folk healing, healing rituals, and secret societies are commonly accepted and used. For example, some African-based therapeutic systems subscribe to the idea that only practitioners belonging to secret societies are able to provide proper psychological treatment. Social service providers also note that cultural competency entails understanding the cultural and religious beliefs surrounding certain medical practices and procedures, such as consuming prescription drugs, using birth control, and undergoing abortions. Successfully working with and treating these clients calls for incorporating into treatment the medical techniques with which victims are familiar and comfortable. Social service providers describe this as being especially true for children who need a comfortable and supportive environment. They suggest that medical practitioners be able to make referrals to specialized providers if they are not familiar or comfortable with medical treatments used by certain populations.
Illiteracy, and specifically health illiteracy, often hinders victim identification and proper medical care. Organizations working with victims of human trafficking point out that many victims, both international and domestic, are illiterate. Therefore, they may be unable to read pamphlets, posters, or other written materials providing important medical information. Additionally, as our culture becomes more dependent on technology to communicate, increasing amounts of information about social services and medical care are being disseminated through the Internet. Individuals who are illiterate, have limited or no understanding of the English language, and/or have no access to the Internet have increasingly less access to crucial information.
The consequences of human trafficking on mental health cannot be overstated. Victims of human trafficking have experienced considerable trauma, some of which does not present itself until years later. According to mental health service providers working with this population, practitioners need to have specialized training to most effectively provide care to clients experiencing trauma. One of the unique aspects of human trafficking that can lead to significant trauma is the fact that these victims have been paid for the harm perpetrated against them. Monetary payment for forced labor and/or sexual services and the social normalization of prostitution often result in victims receiving conflicting and confusing messages regarding their experiences. Treating only physical symptoms without addressing the underlying trauma will not effectively help this population overcome their experiences. Attendees acknowledged that in order to address short- and long-term trauma, adequate health care coverage that includes mental health services is imperative for all victims.
Practitioners from a variety of fields indicated that coordinated service delivery is essential to preventing re-victimization. Victims often experience significant co-morbidity of physical and mental health problems, which cannot be treated as if they exist separately. Health providers and social service agencies recognize the need to develop relationships and systems to better coordinate service delivery, especially for helping victims move from emergency services to long-term rehabilitation and stability. Communities that have successfully developed integrated service delivery systems should be studied and their best practices should be shared.
Working with victims of human trafficking can be extremely draining on service providers. Mental health providers reported that compassion fatigue and vicarious trauma among service providers can dramatically affect services. Organizations and individual practitioners working with this population need to ensure they have the supports necessary to sustain their work on behalf of victims.
Re-traumatizing victims within ostensibly safe institutions is a serious concern. For example, providers working with victims in juvenile detention centers and other public systems pointed out that victims may be re-traumatized within those systems.
Similarly, social service providers reported that some international victims have been re-traumatized by systems that treated them as suspected terrorists. Mental health workers testified that the majority of victims within such public institutions have not had their trafficking experiences recognized as traumatic. They suggested training and education could help these systems learn how to work with victim populations in a way that is not re-traumatizing.
Mental health providers noted the role of resilience, not only in preventing human trafficking but also in helping victims of trafficking deal with and overcome their trafficking experiences. They cited dissociative disorders and other mental health conditions as coping mechanisms victims adopt to survive their trauma. While the importance of resilience in helping victims of human trafficking is anecdotally recognized, the variation in the treatment outcomes of victims indicates the need for further research to better understand its role in victims ability to overcome traumatic experiences.