Study of HHS Programs Serving Human Trafficking Victims. What are the challenges/barriers to delivering services?

12/15/2009

Given the comprehensive and complex needs of victims of human trafficking and the continuum of services required to address those needs, it is not surprising that respondents reported experiencing many challenges to assisting victims.

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. Many service providers reported their own confusion regarding what services their clients were eligible for and could access, which highlighted the need for effective case management.

There is a general lack of knowledge and understanding of human trafficking and not enough service providers in the healthcare profession, social security administration, department of motor vehicles, and other key agencies are trained on this issue and know they can serve these clients. We are constantly having to take our clients to appointments because they are turned away when they try on their own.

Service provider

Limited availability of services

Even though international and domestic victims may be eligible for services, the availability of those needed services was often limited due to long wait lists and associated fees (even if offered on a sliding scale). As one provider indicated, Free clinics are not always free. You spend a lot of time waiting to be seen and there are often some unexpected charges associated with most services.  According to service providers, this was particularly true for mental health services and substance abuse treatment, especially for domestic child and youth victims.

While accessing basic medical services (physicals, gynecological exams, screenings) was not reported as a problem for most service providers (with the exception of some providers in rural communities), accessing specialized medical treatment was problematic. Specifically, specialized care for acute, long-term needs such as diabetes, cancer, and other illnesses, including prescriptions that were part of the treatment, were often cost prohibitive and in some cases, exhausted program resources.

Similarly, while most service providers were able to find basic dental care for their clients (although sometimes there were long waiting periods), more serious and costly dental procedures, such as root canals and extractions, were difficult to obtain.

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. Transitional and permanent housing was scarce for everyone but in particular for domestic youth with felony convictions and victims with mental health or substance abuse issues.[12] Additionally, domestic victims were known to run from the facilities, often RHY shelters, shortly after placement. Most of these programs have policies that prevented them from allowing these victims to return once they have run. There were only a handful of residential facilities (three specific to victims of domestic trafficking and two others experienced in working with this population) that had changed their policies to accommodate the expected behaviors of these victims (e.g., substance abuse, mental diagnoses, chronic running).

If you just look at what domestic victims are eligible for on paper, it seems impressive. However, trying to access those services is another story.

Service provider

Finally, the availability of services in general for domestic victims was viewed as problematic by some service providers. Several examples included referrals to child welfare agencies by service providers and law enforcement only to find out that the agencies would not see the domestic victims because the abuse did not occur at the hands of a parent or legal guardian.  In these cases, providers and law enforcement reported children falling through the cracks of the mainstream system and not receiving services. In some cases, children have been handed back to their abusers and turned back out on the streets.  Additionally, providers noted that a critical aid to victims of human trafficking, cash assistance, was not available for domestic victims. And there were other problems regarding the presumed availability of services for domestic victims. For example, TANF is only available to adults with children. Under standard victim compensation programs, services are often inadequate and a police report is required to obtain services. For some assistance, the crime needs to be included under domestic violence, which requires the abuser to be a spouse or intimate partner of the victim. This limitation may prompt some victims to lie about their relationship with their trafficker in order to obtain services. 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 of 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. For instance, just having someone from the same culture who spoke the same language did not ensure culturally appropriate services, according to service providers. Speaking the same language as clients can help facilitate service provision, but that is just one piece of ones culture. Service providers gave examples of victims of sex trafficking who were not comfortable talking about their experiences with someone from their same culture due to the associated shame and stigma. Other examples given by service providers were related to the gender and culture of the victim. For example, in some cultures, it is not appropriate for a female to visit a male doctor. 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, service providers noted that providing services to victims who were living in shelters could be difficult and some environments could result in revictimization. In particular, providers shared examples of sex trafficking clients being placed in domestic violence shelters and then facing humiliation and isolation. For international sex trafficking victims, the isolation was usually attributed by service providers to language barriers and cultural differences. But for domestic victims of sex trafficking, the humiliation and isolation, according to service providers and some victims, was attributed to perceptions that domestic victims were prostitutes or willing participants, rather than victims of abuse and crimes. These misperceptions reflected yet again a general lack of understanding and knowledge of human trafficking, not only among service providers but also in the general public.

Access to services

The two greatest barriers to accessing services reported for international victims were language 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 who spoke other languages had difficulty accessing services.

Additionally, transportation was a problem. In large cities, teaching clients how to use the transportation system can be overwhelming and very time consuming. Service providers reported clients missing appointments because they were afraid to use public transportation. In smaller, rural communities, there was often limited or no public transportation, also making it difficult for clients to get to appointments.

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. While they might have been eligible for services because they were U.S. citizens, proving their citizenship could take time. According to some providers, it could take months to obtain documentation for domestic victims. They reported a real need for more assistance in helping these victims obtain their vital records. 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 under the per capita contract is 9 months and the period of services after certification is 4 months. However, according to respondents, the timeline to self-sufficiency varied by client. Some clients may come in, be certified right away, and be ready to work, especially many labor trafficking victims. Other victims, however, may remain pre-certified for a longer period of time, and even after becoming certified they may not be ready to work or move forward with their lives. According to service providers, individual timelines were difficult to predict. However, with close monitoring and anticipation of setbacks (e.g., depositions, appearances at trial, intense counseling sessions, reunification), providers were able to adjust services to meet the changing needs of clients.

There is no cookie-cutter approach to working with this population. Males, females, adults, children, sex trafficking, or labor trafficking. You just dont know how long you will be working with them. Just when you think they are moving forward, something happens with their case or with their family or they see something in the news that triggers the trauma experience and sets them back sometimes months in their progress. A lot of times it is one step forward and two or three steps back. You just have to be prepared for setbacks.

Service provider

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. Even transitional housing was limited to 18 months. When victims were able to stay in the shelters or longer term housing facilities, they often found it difficult to follow the rules and restrictions of the facilities (e.g., no drug/alcohol use, required employment).

When working with a domestic victim, I just need more time. I cant stabilize a client with an extensive trauma history within 90 days or transition them to permanent housing within 18 months. Many of my clients struggle to get clean, get an education (or GED), learn life skills, obtain employable skills, and get employed. This is especially true if they have not begun to work on trauma recovery and this can take years.

Service provider

In addition to the funding restrictions on service periods, health insurance coverage such as Medicaid and others often placed limits on the number of mental health 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. (See discussion of case management for more details.)

This appeared to be especially true in the case of child victims. According to service providers and law enforcement, when working with child victims, in particular international child victims, there were often numerous individuals involved in a case, making coordination and communication difficult. In some cases, providers and law enforcement reported not knowing who to contact or who could make decisions on behalf of the child. This was often because the child was unaccompanied with no guardian in the country, or there were concerns that the alleged caregiver or guardian was involved in trafficking the child. There have been cases where information has not been transferred from one agency to the next, sometimes resulting in children not getting the services they needed. As one provider stated, When the process for [foreign-born] minor victims works, it works well. But when it doesnt, it fails miserably.  There was agreement among providers and law enforcement that there needs to be more information and better communication regarding how international child victims are served. Most providers reported positive experiences with the URM programs, but since there are only 19 such programs in 15 States, communications from these programs and the availability and location of services were sometimes seen as limited.

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, HIPAA privacy regulations,[13] legal concerns (e.g., case notes being subpoenaed), and organizational policies as the reasons for the barriers to sharing information.

View full report

Preview
Download

"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

Preview
Download

"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

Preview
Download

"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

Preview
Download

"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®