Study of HHS Programs Serving Human Trafficking Victims. Executive Summary

I.        Introduction

Despite increasing attention regarding the problem of human trafficking into, and more recently within, the United States, knowledge and understanding of the issue and how best to serve victims remain fairly limited (Albanese, Donnelly, & Kelegian, 2004; Derks, Henke, & Vanna, 2006). In 2006, the Office of the Assistant Secretary for Planning and Evaluation (ASPE) within the U.S. Department of Health and Human Services (HHS), with involvement from the Office of Refugee Resettlement (ORR), funded an exploratory study to begin filling this research gap. Specifically, the study was intended to examine how HHS programs were currently addressing the needs of international and domestic victims of human trafficking in the United States, with an emphasis on identifying statutory, policy, programmatic, and other barriers to providing effective, comprehensive services to this population and possible promising practices to addressing these challenges. The results of the study summarized below are presented in more detail in a comprehensive review of the literature, several issue briefs, and this final report (

II.       Methodology

This study addressed the following topic areas: defining human trafficking; characteristics of victims; identification of victims, including challenges; outreach strategies; victims’ needs; availability and access to needed services; promising strategies to providing services; and desired outcomes for victims and evidence of achieving those outcomes. There are a number of programs and agencies across the country currently (and previously) funded by HHS and other Federal agencies that are responsible for conducting outreach, identifying victims, providing services, and aiding in the investigation and prosecution of human trafficking cases. Therefore, these programs and agencies were targeted for discussions in order to provide the most comprehensive information addressing the study questions.

Critical to this study was identifying HHS-funded programs working with victims of human trafficking that represented a range of service providers in diverse communities across the country. Ten locations and associated programs were identified, and these locations coincided with 9 of the 10 regions where HHS has regional offices. These study locations were:

  • Boston, Massachusetts (HHS Region I)
  • New York, New York (HHS Region II)
  • Washington, DC, and the surrounding metropolitan area (HHS Region III)
  • Atlanta, Georgia (HHS Region IV)
  • Orlando, Jacksonville, and Tampa, Florida (HHS Region IV)
  • Chicago, Illinois (HHS Region V)
  • Dallas/Ft. Worth and Houston, Texas (HHS Region VI)
  • Kansas City and St. Louis, Missouri (HHS Region VII)
  • Los Angeles and San Diego, California (HHS Region IX)
  • Seattle, Washington (HHS Region X)

Study teams conducted in-person and telephone discussions with direct service providers representing multiple systems of care (domestic violence, runaway and homeless youth, healthcare, mental health, immigration, social services, and trafficking victim services); Federal, State, and local law enforcement; and trafficking survivors. A total of 117 programs and 341 representatives from those programs across 11 States participated in this study.

The information collected for the study was primarily qualitative in nature. Site summaries were prepared to identify common themes, patterns in responses, and issues needing further exploration during subsequent site visits to other locations and programs or in follow-up discussions. Responses were organized by the study questions and coded for similarities and unique differences across respondent groups and locations.

III.      Key Findings and Lessons Learned

1.       Defining Human Trafficking

1.1       Do we know what human trafficking is?

One of the first questions posed to the study participants was, “What does human trafficking mean to you?”  The responses to this question were mixed. The programs receiving Federal funding to serve victims of human trafficking appeared knowledgeable of the definition set forth in the Trafficking Victims Protection Act of 2000 (TVPA). But for some providers, their experiences led them to believe that a determination of a person as a victim of human trafficking often hinged on the ability of law enforcement and prosecutors to “make a case.”  When probing about domestic trafficking, that is the trafficking of U.S. citizens and lawful permanent residents (LPRs), very few programs and providers recognized adult U.S. citizens and LPRs as potential victims despite their inclusion in the definition of victims under the TVPA. For those programs aware of domestic trafficking, respondents equated it with the prostitution of children by a pimp. However, even this was not a common connection that was being made, particularly among programs working with runaway and homeless youth. It is also important to note that for many providers, trafficking was not only equated with primarily foreign-born victims but also with the movement of victims from one country to another. Some providers and even law enforcement also continued to have difficulty making the distinction between smuggling and trafficking, especially in border regions of the country. Lastly, another problem respondents reported was related to the different types of human trafficking. While for most providers, sex trafficking and labor trafficking appeared well understood, victims of domestic servitude were harder for programs to identify and classify as human trafficking.

1.2       Do we know who the victims of this crime are?

While the definition of trafficking was not always understood or consistently applied, it was clear from this study that the victims of human trafficking that were being encountered and served by study respondents included males and females, adults and children. The forms of trafficking seen by the providers and law enforcement in this study included sex and labor trafficking in the food service, agricultural, and garment industries. Victims of domestic servitude also made up some of the trafficking seen by providers and law enforcement. According to respondents, almost all sex trafficking victims they worked with were female and all of the male victims were trafficked for labor. Characteristics that were common to victims served by providers and encountered by law enforcement were those related to poverty; victims tended to come from poor, high-crime communities, with minimal education, lacking family support, and often presented with poor self-image and low self-esteem. Some providers worked with clients with histories of sexual abuse, mental illness, and substance abuse. Interestingly, while many of the programs and law enforcement reported coming into contact with international and domestic victims of human trafficking, very few reported working simultaneously with both victim populations.

2.       Identification of Victims of Human Trafficking

2.1       How are victims identified?

Respondents reported that international victims were mostly being identified by local, State, or Federal law enforcement, either through tips, other investigations, raids, or referrals from nongovernmental organizations. But some victims were being identified by health or social service providers, faith-based organizations or houses of worship, and Good Samaritans. In some cases, such as with medical clinics, immigration service providers, and domestic violence shelters, victims were being identified from among existing clients as the result of improved screening procedures. Similar to the case of international victims, law enforcement appeared to be the primary source of identification of domestic victims. However, in most cases, domestic victims were first arrested and charged with crimes such as solicitation, pandering, or shoplifting before being identified as victims of human trafficking. Some shelters reported the only reason they were aware they were serving (or had served) victims of domestic trafficking was that the children or youth had self-disclosed their victimization during counseling sessions.

2.2       What are challenges to identifying victims?

Challenges to identifying domestic child victims

Hidden nature of the crime. While victims were being identified primarily by those in a position to assist them, this process was not without challenges. The hidden nature of this crime was noted by respondents as the greatest obstacle or challenge to identifying child victims of domestic trafficking.

Lack of awareness and understanding. The next greatest challenge was lack of awareness or understanding of domestic trafficking. Not everyone recognized that the prostitution of children younger than 18 years of age is a form of human trafficking. Respondents reported a lack of resources for outreach and training to address this lack of awareness. Many noted that the majority of outreach materials developed for and by the human trafficking field focused primarily on international victims. Additionally, according to respondents, most media attention related to human trafficking focused specifically on international female victims of sex trafficking.

Lack of self-identification as a victim. Victims often do not self-identify as victims. In particular, respondents working with female child victims of domestic sex trafficking reported that these girls often viewed the pimp or trafficker as their boyfriend and everyone else as the enemy, part of the tactic used by the trafficker to isolate and control the girls.

Contradictory laws and lack of legislation. Other participants noted existing State legislation that allows for the arrest of children for prostitution if sex is exchanged for money, even when other laws on the books indicate a person younger than age 18 cannot consent to having commercial sex. Additionally, the lack of State legislation specifically defining domestic trafficking as a crime is another barrier. Even in States with anti-trafficking legislation, the interpretation and application of the law has not necessarily been included in police training programs, and the average police officer was perceived to be unaware of the law.

Legal and program mandates. Additionally, legal mandates, such as mandatory reporting requiring service providers to report to police and/or child protective services any child abuse, neglect, or sexual exploitation, were seen as hindering the ability of runaway and homeless youth programs to reach domestic victims. Service providers report that youth were often aware of such mandatory reporting requirements of shelters and therefore many avoided contact with these programs and/or figured out ways

to manipulate the system by staying only up until the time period for mandatory reporting elapsed and then proceeding to another shelter, which is commonly known as “shelter hopping.”  Like short stays in general, this prevented many youth from establishing rapport with a clinician or case worker, resulting in them not being identified as trafficking victims and receiving appropriate services, and allowing these youth to remain exposed to exploitation.

Challenges with identifying foreign-born victims

Hidden nature of the crime. Similar to the challenge associated with domestic victims, the hidden nature of the crime of human trafficking continues to be the greatest challenge to identification of international victims and a contributing factor to many of the other reported challenges. While most respondents acknowledged an increase in awareness of the crime of human trafficking as it relates to international victims, it is still a crime that respondents reported needs more attention in the media, both locally and nationally, and more resources devoted to targeted training and ongoing technical assistance for those in positions to identify victims in order for it to become “unhidden.”

Fear of law enforcement and fear of retaliation. Next, respondents noted that fear is a significant deterrent to foreign-born victims coming forward and being identified, specifically fear of law enforcement and fear of retaliation by the trafficker. In most cases, it was reported that victims are taught to fear law enforcement, either as a result of experiences with corrupt governments and law enforcement in their countries of origin or as a result of the traffickers telling the victims that if they are caught, law enforcement will arrest them and deport them.

Feelings of shame and disgrace. In addition to fear, international victims were reported to experience feelings of shame and disgrace for their situation. Once again, the fear that someone will find out what has happened to them, especially in the case of sex trafficking, often keeps victims silent.

Lack of self-identification as a victim. Not unlike domestic victims, respondents indicated that most international victims were not aware that they were victims of a crime. They did not know about human trafficking or the U.S. laws against it. And they did not know that they have rights as victims of this crime. The often successful efforts of traffickers to convince victims that they are criminals and have done something wrong further enforces this problem of victims not identifying themselves as being exploited and eligible for protection and services.

Stereotypes and misperceptions. Again, similar to the case of domestic victims, service providers reported that the initial behavior of an international victim upon contact with law enforcement could influence whether he or she was viewed as a victim of human trafficking. According to both service providers and law enforcement in most communities, those involved in prostitution have historically been viewed and treated as criminals. There was also the perception among some service providers that if victims were unwilling to cooperate with law enforcement and/or if prosecutors were unable to make a legal case for human trafficking, then these law enforcement agencies would not consider these persons as “real” victims, which could negatively affect the ability of providers to secure necessary services or reimbursements for these victims.

Lack of understanding of existing legislation. While a few providers noted the lack of State legislation as a hindrance to identifying international victims, a lack of understanding existing State and Federal legislation is also a problem. For law enforcement, the lack of understanding existing laws translates into a lack of priority and a lack of resources devoted to investigating these crimes at the local level.

3.       Promising Outreach and Identification Strategies

3.1       What is promising in communities across the country to identify victims?

Systemwide outreach and training. One of the most common and perhaps most promising strategies according to service providers was providing direct outreach to entire systems. Specifically, outreach to child welfare agencies, police departments, juvenile detention facilities, healthcare systems, congregations, youth-serving agencies, and schools or school districts was viewed as essential to increasing the identification of victims. These are the types of agencies or systems that often come into contact with potential victims, yet do not usually have the education or training to recognize the role they could play in identifying and assisting victims. Through outreach and training to entire systems, communities created an extended network of providers and organizations educated on the issue of human trafficking and expanded the safety net for victims through increased chances of identification, better referrals, and expanded services.

Collaboration with local law enforcement. With regard to international victims of human trafficking, working directly with local law enforcement was viewed by both service providers and law enforcement as a promising strategy to identify more victims and connect them with services. The approach adopted by many service providers was to work with local law enforcement and have them act as the intermediary to identify a victim and bring the case forward to Federal law enforcement.

Involving ethnic community leaders/members in outreach. Another promising practice to conducting outreach and identifying victims includes involving members of ethnic communities in the outreach efforts. It was noted by service providers that engaging key members and/or representatives from well-known and respected organizations within a community, in particular ethnic communities, was essential to reaching a larger audience.

Involving survivors in outreach efforts. Several of the organizations conducting direct outreach to victims include survivors of human trafficking in the outreach activities as well as in the development of outreach materials. According to respondents, survivors provided credibility and a knowledge and understanding of the issue that was often difficult to translate through training to other staff. They also have unique insight into where to find potential victims and how best to approach them. However, it is important to note that survivors themselves need to make the determination of whether they are comfortable or ready to assist with these efforts.

Conducting direct outreach to potential victims. Despite these promising ideas and strategies, direct outreach to victims was limited; it was viewed as too dangerous for staff and too difficult given the hidden nature of the crime. In those cases where direct outreach to victims did occur, it often followed a crisis response model with staff on call and available 24/7. Additionally, some agencies created dual roles for outreach staff who served as case workers or managers in addition to conducting direct outreach to victims. In this way, the rapport and trust that was established on the street carried over into the service delivery. The link between runaway, homeless, and thrown away youth and human trafficking was not being made by most youth programs and, therefore, potential victims were likely going unidentified.

Targeting populations at risk for human trafficking. An attention to risk factors and the connection with human trafficking was occurring among some law enforcement. A promising strategy to identify more child victims of domestic sex trafficking was employed by two local police departments and involved focusing outreach and investigations on children who present with risk factors for trafficking (e.g., chronic runaway, history of abuse, homeless, previous involvement with child protective services).

4.       Needs of Victims

4.1       What are the needs of victims of human trafficking and how do they differ?

Once victims are identified, determining their needs is a crucial next step for law enforcement and service providers. For all respondents, foremost in the process is assessing the immediate safety needs of the victim. The most common basic or pressing needs beyond safety include emergency housing, basic medical assistance, food/clothing, legal services, and translation services for international victims. Longer term needs include assistance accessing documentation (e.g., birth certificates, passports, Social Security cards, work permits), life skills training, job training, education, mental health services, specialized medical assistance, permanent housing, child care, and in some cases, reunification with family or repatriation. A common need that cuts across both short-term and long-term needs for international and domestic victims was the need for assistance and advocacy to navigate the various systems that victims interacted with (e.g., schools, social service agencies, insurance agencies, legal professionals, courts, child welfare, mental health/counselors, transportation).

5.       Services for Victims of Human Trafficking

5.1       What services are available to victims of human trafficking?

Prior to passage of the TVPA, law enforcement and service providers reported that they struggled with scarce resources to piece together the comprehensive services needed by international victims of human trafficking. Under the TVPA, HHS was designated the agency responsible for helping victims of human trafficking become eligible to receive benefits and services so they might rebuild their lives safely in the United States, and within HHS this authority was delegated to the Office of Refugee Resettlement (ORR).

Eligibility and service availability for international victims

Adult international victims of a severe form of trafficking must become certified in order to be eligible to receive services.  This certification is carried out by ORR.  T-visas were established under the TVPA and allow victims of trafficking to become lawful temporary residents of the United States. Once certified by ORR, international victims are treated the same as refugees for benefits eligibility purposes. International child victims are not required to be certified to receive services; instead, children who are determined to be victims of a severe form of trafficking receive letters of eligibility from ORR for benefits and services to the same extent as refugees, similar to the services available to adults. According to respondents, most of the services for international adult victims, both certified and pre-certified, were being provided through the HHS-funded Per Capita Victim Services contract. While international child victims are also being served under the per capita program, respondents reported that most services for such unaccompanied child victims are provided through the Unaccompanied Refugee Minors program. According to service providers, for some victims certification was not an option. In particular, in those cases where victims decided not to cooperate with law enforcement out of fear of retaliation from the trafficker or for other reasons, service providers sought other options for victims. These included seeking asylum, filing for a U-Visa, and accessing services under the Violence Against Women Act; for some cases, service providers reported tapping into non-Federal or unrestricted funding streams to provide ad hoc services.

Eligibility and service availability for domestic victims

U. S. citizens or LPRs who find themselves victims of trafficking (i.e., domestic victims) do not need to be certified in order to receive benefits. In the case of citizens, they are already eligible for many benefits and services they might need. But in this study, respondents only reported providing services to domestic child victims of human trafficking; none of them reported working with adult U.S. citizens or LPR victims. In most cases, domestic child victims were provided services although not always adequate or appropriate through other HHS-funded or administered programs (e.g., Street Outreach, Basic Center programs, child welfare programs, mental health and substance abuse treatment programs). Additionally, service providers reported many of the domestic youth victims received services through the juvenile justice system as a result of being arrested for prostitution or other unrelated crimes (e.g., curfew violations, pandering), although again these services were not always adequate or appropriate. In a few cases, domestic youth victims had been placed in domestic violence shelters. Whether for an international or domestic victim, adult or child, all respondents agreed that the most important service for all victims was case management. Having a central case manager was viewed by service providers and law enforcement as a critical service not only for victims but also for other service providers and agencies involved in a trafficking case. The importance of this role is evident in the fact that most of the programs in the study reported providing some form of case management as part of their menu of services for trafficking victims.

5.2       What are the challenges/barriers to delivering services?

Lack of knowledge and understanding. One of the most common and frustrating challenges reported by law enforcement and service providers was the lack of knowledge and understanding regarding human trafficking among service providers, law enforcement, and even victims themselves who often did not believe or understand that they were victims of crime. As a result, victims often went unidentified and unserved. Lack of knowledge and understanding of what services were available was an additional barrier for service providers.

Limited availability of services. Even though international and domestic victims may be eligible for various services, the supply or availability of those needed services was often limited due to long wait lists and associated fees (even if offered on a sliding scale). According to service providers, this was particularly true for mental health services and substance abuse treatment, especially for domestic child and youth victims. Housing was another service that law enforcement and service providers reported was limited. While finding emergency shelter for women and girls was not usually a problem, finding the same placements for men and boys was difficult. Finally, the availability of services in general for domestic victims was viewed as problematic by some service providers. As service providers reported, it is important to understand the difference between being eligible for services, the availability of services, and actually being able to access services.

Appropriateness of services. Service providers talked not only about the need for more culturally appropriate services, but also for gender appropriate services. Finding such services could be challenging, particularly in rural communities. Additionally, service providers stressed the importance of understanding what was meant by culturally appropriate services. Recognizing these challenges and the implications for providing appropriate services to clients was seen as critical by providers themselves, since failure to provide such appropriate services could undermine their goal of establishing trust with clients. The appropriateness of services also extends to examining the culture of the environment in which the service is offered. For example, it is important to ensure clients are not placed in a shelter that results in re-victimization, isolation, or humiliation.

Access to services. The two greatest barriers to accessing services reported for international victims were language barriers and transportation. Service providers indicated that the availability of information and access to providers who speak English, Spanish, and in some communities Korean, was not difficult. But their clients that spoke other languages had difficulty accessing services. Additionally, transportation was a problem. For domestic victims, accessing services, including obtaining insurance (e.g., Medicaid) could also be difficult due to a lack of identification. Most domestic victims were not in possession of their birth certificates or other forms of identification. This could also be true for international victims. Providers reported difficulty obtaining proof of identification, birth, and citizenship from consulates, thus often delaying the process of obtaining certification or work authorizations.

Length of services. Another challenge identified by service providers and victims themselves was the length or duration of services available to victims. For example, the standard period for pre-certification services for international victims under the per capita contract is 9 months and the period for services after certification is 4 months. However, according to respondents, the timeline to self-sufficiency varied by client. For domestic youth, shelter stays were often limited to 15, 30, or 60 days and did not allow providers enough time to establish relationships with victims or provide adequate services to meet their longer term needs. In addition to the funding restrictions on service periods, insurance plans such as Medicaid and others often placed limits on the number of counseling sessions that could be covered during a particular period (usually annually). Service providers reported these limits were often insufficient to allow clients to work through their trauma.

Lack of coordination of services. For the most part, service providers acknowledged improved coordination of services for victims over the past several years. However, they saw a need for a single point of contact within each agency working with victims and a central case manager to ensure communication and coordination of services.

Lack of information sharing. Across the board, sharing client information across agencies was seen as a challenge and hindrance to service provision. Providers cited such issues as the protection of client confidentiality, Health Insurance Portability and Accountability Act privacy regulations, legal concerns (e.g., case notes being subpoenaed), and organizational policies as the reasons for the barriers to sharing information.

5.3       What are promising approaches to service delivery?

Offering a one-stop shop for services. While not a common practice, those agencies (primarily refugee service agencies and domestic violence and sexual assault programs) that were able to offer multiple services in a single location were viewed as having a more effective organizational structure. They reported better communication and coordination of services and less confusion for victims.

Mobile services. Another innovation helping to meet the needs of victims in several communities was the use of home visits that provided medical and mental health care, and basic case management. Some service providers mentioned using in-home visits as a way to introduce clients to services, almost as a trial period before transitioning them to in-office treatment.

Trauma-informed and trauma-specific services. One of the most common elements across all forms of human trafficking was the experience of trauma by the victim. While the level of trauma and the victim’s reaction to the trauma may vary, trauma was present in all cases. According to service providers, when victims had access to trauma-informed or trauma-specific services, they recovered from the trafficking experience more quickly and were better able to work on other aspects of their lives, such as obtaining an education or seeking employment.

Use of pro bono services. Several agencies reported using pro bono services, particularly for legal services. This often involved providing training to attorneys on the issue of human trafficking and providing access to victims by allowing legal counsel to interview them. While this resulted in a larger pool of affordable and appropriate services for clients, it did require significant training and monitoring according to service providers.

Volunteer programs. Some agencies established programs where their clients could do volunteer work. For example, because many international victims were unable to do regular work until they received their work authorizations, service providers needed 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.

Consistent case managers. Given the complexity of victims’ needs and the comprehensiveness of the services provided, service providers, law enforcement, and victims reported that having a consistent case manager from identification through case closure was a promising practice. A central case manager with knowledge of all aspects of a victim’s situation can ultimately save time and resources.

Collaboration. The importance of collaboration in meeting the needs of victims of human trafficking cannot be overstated. The establishment of coalitions and task forces, such as the ORR-funded Rescue and Restore coalitions, was viewed as one strategy that has resulted in the increased availability of services for all victims. Several service providers reported establishing formal memoranda of understanding with domestic violence shelters to ensure not only placement of their clients but also placement in a facility with staff trained on human trafficking and sensitive to the needs of victims. For domestic child and youth victims of sex trafficking, it was reported that collaboration among law enforcement, juvenile and family court judges, child protection services, and youth shelters and programs was a promising and necessary practice for identifying and meeting the needs of these child victims.

6.       Anticipated Outcomes for Victims

6.1       What impact are we having on victims and how do we document success?

According to service providers and law enforcement working with victims of human trafficking, the outcomes for victims and the timeline for achieving these outcomes vary. Service providers reported working with each victim to set achievable goals as part of his or her service plan. Based on information provided regarding victim goals, several common short- and more long-term outcomes could be identified. While many of the respondents were able to share stories and provide anecdotal evidence of the positive impact their efforts were having on victims (e.g., cases identified due to outreach activities, direct services provided, number and type of referrals made, and number and type of investigations conducted), very few were able to produce documentation in the form of formal assessments or rigorous (internal or external) evaluations that could establish that their actions, policies, and procedures were the most effective possible.

IV.      Conclusion

While much progress has been made since the passage of the TVPA and the availability of Federal funding to provide effective services to victims of human trafficking, the evidence of this progress remains for the most part anecdotal in nature. Formal assessments and evaluations of these innovative strategies and promising practices from the start are essential to documenting what works (and what does not) and providing other communities across the country with replicable and effective approaches to education, identification, outreach, and service delivery.

View full report


"index.pdf" (pdf, 849.21Kb)

Note: Documents in PDF format require the Adobe Acrobat Reader®. If you experience problems with PDF documents, please download the latest version of the Reader®

View full report


"apa.pdf" (pdf, 99.32Kb)

Note: Documents in PDF format require the Adobe Acrobat Reader®. If you experience problems with PDF documents, please download the latest version of the Reader®

View full report


"apb.pdf" (pdf, 225.34Kb)

Note: Documents in PDF format require the Adobe Acrobat Reader®. If you experience problems with PDF documents, please download the latest version of the Reader®

View full report


"apc.pdf" (pdf, 29.65Kb)

Note: Documents in PDF format require the Adobe Acrobat Reader®. If you experience problems with PDF documents, please download the latest version of the Reader®