Upon identification, victims of human trafficking often present with a number of complex needs, requiring comprehensive services and treatment representing a continuum of care (from emergency, to short-term, and long-term assistance). Providers have conceptualized this continuum of care as having three phases: crisis intervention and assessment, comprehensive assessment and case management, and social reintegration (Bales & Lize, 2004). The goal is to help the victim progress along the continuum that begins at crisis or the need for emergency assistance and moves to a position of safety (all within phase 1). With ongoing assessment and intervention to address existing and emerging needs, the victim can move to stability in phase 2. Finally, victims (now often referred to as survivors) can integrate into their environment and begin to thrive. This continuum echoes the Exit Counseling Model developed by MacInness (1998), which illustrates the importance of beginning trust building and engagement with prostituted youth and moving toward stabilization and support.
The specific needs of victims include safe emergency, transitional, and permanent housing; legal services; medical services (including dental care); substance abuse treatment; trauma therapy; and case management and social services.
Few shelters across the country exclusively serve victims of trafficking and those that do tend to exclusively serve female adolescent victims of sex trafficking. Due to the limited availability of housing options for trafficking victims, most female victims are placed in shelter or housing programs that traditionally serve victims of domestic violence and sexual assault. In emergencies, domestic violence shelters may provide shelter for female child victims. The availability of shelter options is even more restricted for male victims who often are referred to homeless shelters, housed in shelters run by NGOs or faith-based organizations, or placed in hotels or temporary housing paid for by service providers, if available (Salvation Army, 2006).
Victims of trafficking often need immediate legal assistance to handle issues related to immigration status, a trafficking investigation and prosecution, a civil lawsuit against a trafficker, juvenile delinquency proceedings, or issues about having dependency or guardianship established (Caliber Associates, 2007; Florida University Center for Advancement of Human Rights, 2003). Attorneys are needed to let victims know about their legal options and rights; educate them about the legal system; represent them in hearings; help them receive certification and complete applications for a T-visa, U-visa, Special Immigrant Juvenile status, or derivative visas for family members; and assist them with gaining lawful permanent resident status and the repatriation process, if appropriate (Florida Immigrant Advocacy Center, n.d.; Salvation Army, 2006). Additionally, attorneys may also need to assist victims of trafficking with housing, employment, medical problems, transportation issues, and obtaining other services if they are not receiving social service support or case management through a partnering agency (Caliber Associates, 2007).
Victims can have both emergency and long-term medical problems as a result of the abuse and/or harsh labor conditions they experienced (Bales, 2004; Caliber Associates, 2007). Service providers have reported the following needs for medical services: basic physical exams; gynecological exams; tests for infectious diseases; treatment for stomach problems and headaches (often symptomatic of an emotional problem); chronic back, hearing, cardiovascular, or respiratory problems; and eye and dental care (Caliber Associates, 2007). Work with torture victims indicates that medical treatment is essential to physical and psychological healing, as lingering body pains and symptoms create daily reminders of past torture.
Substance abuse treatment
Limited information is available regarding substance abuse treatment for adult victims of human trafficking. One explanation given by a service provider for this absence is the belief that victims are reluctant to divulge this problem for cultural reasons as well as concern that by acknowledging they have a problem, they may be jeopardizing their credibility as a witness in their trafficking case, their immigration case, or a future custody case (Caliber Associates, 2007). Likewise, research specific to substance abuse in minor trafficking victims is also extremely limited. However, there is some general research on adolescent treatment programs that might provide some guidance about effective substance abuse services for minor trafficking victims. Most important, research suggests that adolescent treatment for substance abuse must be tailored to the unique challenges and developmental needs of the population served (Hser et al., 2001; Physician Leadership on National Drug Policy, 2002). Additionally, the earlier treatment is received, the shorter the course of substance abuse. While encouraging, the problem is that fewer than 1 in 10 adolescents with substance abuse or dependence problems receives treatment (Dennis, 2006).
Like torture victims, trafficking victims often experience posttraumatic stress disorder (PTSD), depressive disorder, other anxiety disorders, or substance abuse, and some may display symptoms of Stockholm syndrome (Center for the Survivors of Torture, n.d.; De Jong et al., 2001; Graham & Wish, 1994; Shrestha et al., 1998). Specific symptoms can include sleep disorders, nightmares, difficulty concentrating or relaxing, experiencing feelings of hopelessness, and physical symptoms such as headaches, chest pain, shaking, sweating, and dizziness (Center for Victims of Torture, n.d.). The recognition of co-occurring disorders and the need for integrated treatment approaches, specifically for trauma, substance use, and mental health disorders, has gained momentum over the past 5-10 years (Austin, Macgowan, & Wagner, 2005; Battjes et al., 2004; Dasinger, Shane, & Martinovich, 2004; Dennis et al., 2002, 2004; Godley, Jones, Funk, Ives, & Passetti, 2004; Robbins, Bachrach, & Scapocznik, 2002). Trauma therapy is often a critical component to this integrated treatment approach. Trauma recovery models begin with pretreatment assessment and an understanding of a victims current safety risk. Once the victims immediate safety is established, a clinician can begin to address the trauma issues and their related symptoms, including any appropriate family work, and treat any co-occurring disorders (Mahoney, Ford, Ko, & Siegfried, 2004). Literature on adults shows that comprehensive treatment systems that provide both trauma-informed and trauma-specific services are most effective in identifying and responding to victims multiple needs. Effective systems include culturally competent approaches with basic supports and services, peer support, and coordinated treatment across multiple systems of care (Finkelstein et al., 2004; Harris & Fallot, 2001; Herman, 2003; Pearlman & Courtois, 2005; Hoshmand, 2007; Ugarte, Zarate, & Farley, 2003).
Case management and social services
Given their complex needs, victims of human trafficking typically encounter a range of law enforcement, and health and human service providers and agencies, which can be a daunting experience, especially for international and child victims. In response, providers have adopted intensive case management approaches. A case manager works with other service providers and is responsible for assessing service needs, providing victims with information about their rights to services, establishing comprehensive service plans with victims, identifying and making service referrals, coordinating services, accompanying victims to appointments, advocating on behalf of victims to other providers and agencies, providing emotional and moral support, and often keeping victims informed of progress on their legal cases and T-visa and other applications (e.g., Social Security card, work permit) (Caliber Associates, 2007; Salvation Army, 2006). Case managers help stabilize victims by offering opportunities to obtain an education, develop life/social skills, learn a new language, gain job skills, and obtain employment, all essential in order for victims to reintegrate into society (Caliber Associates, 2007). Coordinated care that takes a holistic approach to treatment, while often challenging, is essential to meeting the medical, psychological, and social needs of victims (Center for Victims of Torture, n.d.; Program for Torture Victims, n.d.).