Study of HHS Programs Serving Human Trafficking Victims. What services are available to victims of human trafficking?


Prior to the 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. The HHS anti-trafficking program administered by the Office of Refugee Resettlement (ORR) in the Administration for Children and Families: 1) certifies non-U.S. citizen and non-LPR victims of human trafficking; 2) provides outreach and education to service providers, NGOs, and State and local governments on the phenomenon of human trafficking; 3) awards discretionary grants designed to provide outreach and direct services to victims; 4) awards contracts designed to provide support to intermediary organizations that lead anti-trafficking efforts in localities and regions; 5) administers a public awareness campaign designed to rescue and restore victims of trafficking; and 6) provides services and case management to victims of trafficking through a network of service providers across the United States.

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. To become certified, a victim must: 1) be willing to assist in every reasonable way in the investigation and prosecution of severe forms of trafficking in persons or be unable to cooperate with such a request due to physical or psychological trauma; and 2) have made a bona fide application for a T-visa under section 101(a)(15)(T) of the Immigration and Nationality Act that has not been denied; or 3) be a person whose continued presence in the United States the Attorney General is ensuring in order to effectuate prosecution of traffickers in persons. T-visas were established under the TVPA and allow victims of trafficking to become legal temporary residents of the United States. Once a T-visa is obtained, a victim may remain in the United States for up to 4 years. At the end of 3 years, the victim may apply for LPR status.

Once certified, international victims are treated the same as refugees for benefit eligibility purposes. That is, certification equates to eligibility to apply for benefits and services under Federal or State-funded programs to the same extent as refugees. Some of the services that international victims of trafficking are eligible for through federally funded programs include housing or shelter assistance, food assistance, income assistance, employment assistance, English language training, health care assistance, and mental health services.

Prior to becoming certified, a period referred to as pre-certification, victims can receive limited, often emergency services, through funding available from HHS, the Department of Justice, and to a more limited extent, the Department of Homeland Security. Pre-certification services can meet the emergency needs of victims and include housing, food/clothing, advocacy, medical/dental care, language services (e.g., interpreters/translators), mental health counseling, education, and job training. The Department of Justice also funds legal assistance for potential victims.

International (non-LPR) 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 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. This contract, currently held by the U.S. Conference of Catholic Bishops (USCCB), is designed to centralize and streamline services while maintaining a high level of care for victims of human trafficking through anytime, anywhere case management. Subcontractors are reimbursed for the services actually provided to each human trafficking victim. According to the 2008 Attorney Generals Report to Congress, during 2008, a total of 644 clients received services through the per capita contract. This number included 215 pre-certified victims, 270 certified victims, and 159 family derivatives (spouse, children, or other dependents). During 2008, 16 clients transferred from pre-certified to certified status (U.S. Department of Justice, 2008). Between April 2006 (inception of the program) and May 2009, USCCB reported serving 1,037 victims under the per capita program by approximately 80 subcontractors in 90 locations across the country. An additional 272 family derivatives have also been served. Table 3 shows the demographics of these clients, including the form of trafficking.

While international child victims are also being served under the per capita program, respondents reported that most services for unaccompanied child victims are provided through the Unaccompanied Refugee Minor (URM) program. The URM program establishes legal responsibility, under State law, to ensure that children and youth refugees, entrants, and trafficking victims who do not have a parent or relative available and committed to providing for their long-term care receive the full range of assistance, care, and services that are available to all foster children in the State. The URM program will work with the States courts to establish guardianship of the child, which may entail custody by the State, county, or URM program. Children are placed in foster homes, group homes, or independent living arrangements. Through the URM program, children can receive intensive case management, education, health care, mental health counseling, independent living skills training, assistance with family reunification, and other services until they turn 18 or such higher age, depending on the foster care rules of each State.

Table 3.
Clients Enrolled in Per Capita Program: April 2006-May 2009
  Total Male Female Adult Children
and youth
Sex Labor Both
Pre-certified only 303 120 183 295 8 61 228 14
Certified only 535 109 426 522 13 188 289 58
Clients originally enrolled as pre-certified who became certified 199 103 96 194 5 19 172 8
Total victims enrolled 1037 332 705 1011 26 268 689 80
Family derivative 272 125 147 131 141 N/A N/A N/A
Total clients served 1309 457 852 1142 167 268 689 80

In 2008, a total of 286 certification letters were issued by HHS to adults. While children were not required to be certified, 31children received eligibility letters from HHS. Of the victims who were certified, 45 percent were male. Of the adult victims who were certified, 76 percent were victims of labor trafficking and 17 percent were exploited through sex trafficking, while 5 percent were victims of both labor and sex trafficking. Of the child victims who received eligibility letters, 77 percent were female. Fifty-five percent of the child victims were victims of sex trafficking, 26 percent were victims of labor trafficking, and 6 percent were victims of both labor and sex trafficking. Letters were provided to child victims in 28 States, the District of Columbia, and Saipan. Certified adult victims came from 40 countries; the top 4 countries were Mexico, Thailand, Philippines, and Korea. The graph shows the number of adult victims certified and child victims who received eligibility letters by fiscal year. (U.S. Department of Justice, 2008)

Number of Certified Adult Victims and Eligible Child Victims by Fiscal Year

Number of Certified Adult Victims and Eligible Child Victims by FY. See text for explanation. See table below for data.

Number of Certified Adult Victims and
Eligible Child Victims by Fiscal Year
Fiscal Year Adult Victims Child Victims Total
2001 194 4 198
2002 81 18 99
2003 145 6 151
2004 147 26 173
2005 197 34 231
2006 214 20 234
2007 270 33 303
2008 286 31 317

According to service providers, certification was not an option for some victims. 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, or 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. However LPRs face greater benefit eligibility restrictions than U.S. citizens. For example, LPRs who have been in the United States for less than 5 years are not eligible for Federal means-tested benefits such as Temporary Assistance for Needy Families (TANF), Medicaid, Supplemental Security Income, and food stamps, and beyond this period they may face other eligibility restrictions if they have been sponsored by a relative or friend as a condition of receiving their green card. This results in the anomaly of certified international victims (who are usually considered undocumented immigrants prior to their certification) having greater benefit eligibility than LPRs who have less than 5 years of residence,  For this study, respondents only reported providing services to domestic child victims of human trafficking; none of them reported working with adult U.S. citizen or LPR victims.

In most cases, services for domestic child victims were being provided through other HHS-funded or administered programs, including State child protective services or child welfare agencies, basic youth centers (RHY shelters), youth street outreach programs, and transitional living programs for older youth. Additionally, service providers reported many of the domestic youth victims received services through the juvenile justice system, although these services were not always adequate or appropriate. These youth had been generally arrested for prostitution or other unrelated crimes (e.g., curfew violations, pandering). In a few cases, domestic youth victims had been placed in domestic violence shelters.

Whether an international or domestic victim, adult or child, all respondents agreed that the most important service for all victims was case management.[11] Following are key findings and lessons learned regarding effective case management for victims of human trafficking.

Case Management

Definition of Case Management

Case management is a professional practice in which the service recipient is a partner, to the greatest extent possible, in assessing needs, defining desired outcomes, obtaining services, treatments, and supports, and in preventing and managing crisis.

National Association of Case Management (2008)

Having a central case manager was viewed by service providers and law enforcement alike as a critical service not only for victims but for other service providers and agencies involved in a trafficking case. In fact, the case manager was considered to have a critical role throughout the lifespan of a trafficking case, including at initial contact by law enforcement or others, during depositions, appearances in court, application renewals for benefits and services, and family reunification.

According to respondents, the case manager is responsible for assessing clients needs for service and support; identifying, obtaining, and coordinating those services for clients; coordinating and managing communications across systems involved in a case; and serving as a liaison for the client with other agencies. For some clients, the case manager also serves as translator or obtains translation services for the clients. Other common responsibilities include accompanying clients to appointments, assisting/teaching clients to access public transportation, and teaching clients basic life skills. 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. However, like with other services, providing case management to victims is not without challenges.

Ingredients for Effective Case Management
  • Establishing a hopeful relationship with the client;
  • Assessing client strengths and needs;
  • Developing, in partnership with the client, a service plan to achieve desired outcomes;
  • Locating, linking, and following up with needed services and support;
  • Monitoring, coordinating, and adjusting services and supports to achieve desired outcomes;
  • Providing crisis prevention and intervention services and support; and
  • Advocating for the client.

Extracted from the NACM Web site,

Challenges to case management

One of the greatest challenges respondents reported to providing effective case management was limited resources. Case management for trafficking victims can be a 24/7 responsibility. In fact, providing case management to a single client can be a full-time job; although not true for all clients. This generally limits the amount of time that a case manager is available to other clients and thus necessitates a limited case load for each case manager. In contrast, resources to support full-time case managers are scarce. In particular, smaller agencies without the kind of back-office functions and infrastructure as larger organizations, struggle with funding streams like the per capita program. It is difficult for them to keep up with the reimbursement process and difficult to support case managers during periods when they are not serving any trafficking victims. Large agencies on the other hand are able to support case managers under other funding streams and often have case managers working with different (victim) populations, such as domestic violence victims or refugees. While those in the field, including smaller agencies, recognize that the current per capita funding is intended to be a more efficient use of limited resources than previous funding streams in that it allows for the provision of services to victims anytime, anywhere throughout the country, and only reimburses providers for services actually provided to victims, not all agencies, including those specific to human trafficking, have been able to diversify their funding beyond the per capita program. As a result, some agencies have had to move to part-time case managers which has limited their ability to be available on a 24/7 basis.

When it comes to providing case management services to domestic victims of trafficking, domestic victims have to currently rely on case management services that may be offered through existing systems and programs, such as the child welfare system and domestic violence and youth shelter programs, which are often already overburdened and hence struggle with providing effective case management to their existing caseload. This significant gap in services for domestic trafficking victims is beginning to be addressed. For example, OVC recently released an announcement to fund two demonstration programs to provide comprehensive services, including case management, to domestic child victims of human trafficking, and an evaluation of the demonstrations is being funded by the National Institute of Justice.

Another significant challenge or barrier to effective case management is the length of service eligibility (e.g., 9 months for pre-certification services and 4 months for certification services under the per capita program; 15-, 30-, and 60-day stays in shelters for runaway and homeless youth). Service providers reported that it can take significant time to build trust with clients and get them to begin opening up to their case managers. Until this happens, getting clients to accept and engage in services can be difficult and often times inappropriate. The eligibility time restrictions can limit the ability of case managers to move some clients from crisis to thriving and toward the accomplishment of their service goals.

When working with a domestic victim, I just need more time. I cant stabilize a client with extensive trauma histories within 90 days or transition them to permanent housing within 18-months. Many of my clients struggle to 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

Working with other service providers and law enforcement is acknowledged as a key factor underlying a case managers success in working with victims. Limited access to information regarding details of a clients case can hinder the role of the case manager. For example, several providers reported incidents where case managers were put in difficult situations with their clients because they did not have information that the clients thought they should have about their legal cases, and in some situations, the results of medical tests. When case managers are unable to provide clients with (timely) answers to their questions, respondents reported that this creates feelings of distrust and can cause set-backs in the victims recovery.

While effective case managers were described by respondents as highly committed and dedicated to their work, these same strengths can create another challenge to case management; a high turnover rate. Service providers and law enforcement reported that case managers working with victims of human trafficking are overworked and underpaid, contributing to staff burnout. Additionally, respondents pointed to vicarious or secondary trauma and the lack of resources to address this for staff as another contributing factor to the burnout and high turnover. As one service provider put it, There are few resources devoted to helping the helpers.

Benefits of case management

Service providers and law enforcement were adamant that case management needs to be a core and central service provided to all victims of human trafficking. When effective case management is provided, everyone should benefit. For victims, case manager can help them move toward self-sufficiency by educating them about their rights as victims, helping them understand and navigate through the criminal justice, juvenile justice, immigration, and human services systems, identifying and making appropriate referrals, assisting them in accessing services, advocating on their behalf, and providing ongoing moral and emotional support.

Law enforcement reported that they too benefit from case management to victims. They saw the case manager helping to stabilize victims by providing needed services and support that were beyond the means and expertise of law enforcement. As a result, law enforcement experienced victims that were more likely to share information, and more quickly, with officers that aided in the investigation of their cases, and in some cases aided in the apprehension of traffickers. Law enforcement described case managers as a time saver for officers by freeing them up to focus on the investigation.

Finally, prosecutors also reported benefiting from case management services for victims of human trafficking. According to the few prosecutors that participated in this study, case managers provided an important source of stability for victims that resulted in  more consistent and credible witnesses; an important factor especially in cases dependent on victims for successful prosecutions.

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