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HIDING IN PLAIN SIGHT:
WORKING WITH VICTIMS OF
HUMAN TRAFFICKING
HEATHER R HAYES, M.ED, LPC
HOLLY RYAN, LCSW, LADC, SAP
“If we don't start with a wide humanitarian
view point, how can we ever dream to work
on peoples issues with behavioural,
emotional and mental health problems”
Sam Quinlan, iCAAD Director
CASE STUDIES
Sara- 25 years old
• Grew up in mid-high socioeconomic
house hold
• Parents married
• Appears to be a tight knit family
• Went to college
• Met Trafficker online
• Gradual change in communication
to friends, family and lifestyle
• Psychological Control and
manipulation
• Abuser used local law enforcement
to block intervention attempt
Joe- Now 15 years old
• Taken from home in Guatemala at
age 13 under the guise of making a
better life
• “Sponsored” into US by Traffickers
in 2014
• Forced to work on chicken farms in
Ohio
• Trauma on every level, physical,
emotional, repeated sexual
victimization
• Lived in subhuman conditions, total
neglect, no running water, no
electricity
• Work 6am-8pm
HEATHER HAYES AND HOLLY RYAN - HIDING IN PLAIN SIGHT: WORKING WITH VICTIMS OF HUMAN TRAFFICKING
WHAT DEFINES HUMAN TRAFFICKING?
• The Act
• Recruitment, transporting, harboring or hiding, acquiring
• The Means
• Threat or use force to remove, abduct, coerce, deception, fraud,
abuse of power, paying a person to control the victim
• The Purpose
• EXPLOITATION- sex workers, prostitution, forced labor, slavery,
removal of organs, financial gain
THE NUMBERS
• At any given time in 2016, an estimated 40.3 million people are in
modern slavery, including 24.9 in forced labour and 15.4 million in
forced marriage
• There are 5.4 victims of modern slavery for every 1,000 people in the
world.
• 1 in 4 victims of modern slavery are children
• Out of the 24.9 million people trapped in forced labour, 16
million people are exploited in the private sector such as domestic
work, construction or agriculture; 4.8 million persons in forced sexual
exploitation, and 4 million persons in forced labour imposed by
state authorities
Source: Global Estimates of Modern Slavery: Forced Labour and Forced Marriage , Geneva, September 2017
HEATHER HAYES AND HOLLY RYAN - HIDING IN PLAIN SIGHT: WORKING WITH VICTIMS OF HUMAN TRAFFICKING
HEATHER HAYES AND HOLLY RYAN - HIDING IN PLAIN SIGHT: WORKING WITH VICTIMS OF HUMAN TRAFFICKING
Who is falling victim to
trafficking?
Of the 40.3 million…
HOW MUCH IS A LIFE WORTH?
#NoPriceOnPeople
BILLION DOLLAR INDUSTRY
• 109,081,500,000.00 GBP or $150 Billion Dollar in earnings
• $99 billion from commercial sexual exploitation
• $34 billion in construction, manufacturing, mining and
utilities
• $9 billion in agriculture, including forestry and fishing
• $8 billion dollars is saved annually by private
households that employ domestic workers under
conditions of forced labor
International Labor (ILO) Organization, 2017
HEATHER HAYES AND HOLLY RYAN - HIDING IN PLAIN SIGHT: WORKING WITH VICTIMS OF HUMAN TRAFFICKING
REASONS TRAFFICKING OCCURS
• Globalization
• Poverty
• Political Issues
• Child Soldiers
• Forced Begging
• Forced Labor
• Removal of Organs
• Sexual Exploitation
• Selling Children
• Forced Marriage
• Financial Gain
Trends in the forms of exploitation among detected
trafficking victims, 2007-2014
Understanding Methods Used in
Human Trafficking
WHY?
Reporter: How do you get a girl to do this?
Matthew: It just happens. Like most of
these girls they’re broken. It’s not hard. You
get in there, you find the crack, some are
drugs, they need to hear I love you. I’m
here to take care of you. She’ll do it.
Reporter: Why will she do it.
Matthew: Because you sold her a dream.
Knowing someone cares. It’s an illusion.
Power
and
Control
Using Coercion
and Threats
Threatening Family
Blackmail
Harming another for
another’s disobedience Emotional
Violence
Isolate from social support
Shame
Humiliation
Affection to violence
Physical Violence
Torture
Branding
Forced drug use
Deny food or bathroom
Sexual
Violence
Prostitution
Gang Rape
Sexual Shaming
Purposeful
Manipulation
Exploiting insecurities
Exploiting life gaps (i.e.
absent Father)
Economic
Dependence
Take all assets and money
from victim
Refuse to let them go to
school
Isolation
Inability to access
support resources
Unfamiliar/unaware of
geo location
Total control over the
victim’s movements
(Smith, Healy, Vardaman, & Snow, 2009)
ENTRAPMENT BY ANY MEANS NECESSARY
• Fear: deportation, prosecution or legal problems, causing
or creating harm to ones family and a lack of trust in the
government
• Lack of knowledge about alternatives
• Isolation: to control or mediate the ability to escape.
Isolation may be geographically, physically or through a
language barrier
• Psychological Confinement
• When attained gives way to ultimate compliance
ENTRAPMENT BY ANY MEANS NECESSARY
Psychological entrapment: includes debt
bondage, the use of drugs and alcohol
addiction, and threats of shaming and
humiliation.
ENTRAPMENT BY ANY MEANS NECESSARY
EXAMPLES OF FORCE, FRAUD & COERCION
• Force:
• Physical Abuse
• Kidnapping
• Physical Restraint
• Fraud:
• Illegitimate Contacts
• False Promises
• Fake Businesses
• Fake Visa Documents
EXAMPLES OF FORCE, FRAUD & COERCION
• Coercion:
• Psychological Manipulation
• Threats
• Spoken Threats about victims family or
others
• Implied Threats to create a climate of fear
(electric fences, guns, lies)
• Control of children
• Trafficker has possession of documents
WARNING SIGNS OF DOMESTIC MINOR SEX TRAFFICKING
(Smith, Healy, Vardaman, & Snow, 2009)
THE ULTIMATE GOAL OF TRAFFICKERS
Mental Defeat
• Mental defeat is what follows total
behavioral and cognitive submission
• The perceived loss of all autonomy, a state
of giving up in one’s mind all efforts to
retain one’s identify as human being with a
will of one’s own.
OUTCOME FOR VICTIMS
• PTSD
• Complex Trauma
• Dissociative Disorders
• Anxiety Disorders
• Depressive Disorders
• Attachment Disorders
• Developmental Disorders
• Eating Disorders
• Self-Mutilation
• Substance Use Disorders
Treating Victims of Human Trafficking
PTSD SYMPTOMS REPORTED BY VICTIMS
• Recurrent thoughts/memories of
terrifying events
• Recurrent thoughts/memories of
terrifying events
• Recurrent nightmares
• Feeling detached/withdrawn
• Unable to feel emotion
• Easily Startled
• Difficulty concentrating
• Sudden emotional or physical
reaction when reminded of traumatic
even
• Trouble sleeping
• Feeling on guard
• Feeling irritable , outbursts of anger
• Avoiding activities that remind of the
traumatic even
• Inability to remember part of or most
of traumatic even
• Loss of interest in daily activities
• Feeling hopeless
• Avoiding thoughts or feelings
associated with traumatic events
(Zimmerman et al., 2006)
HEATHER HAYES AND HOLLY RYAN - HIDING IN PLAIN SIGHT: WORKING WITH VICTIMS OF HUMAN TRAFFICKING
COMPLEX TRAUMA
• Associated with chronic, prolonged, repetitive exposure to
traumas
• Sexual trauma, physical beatings, starvation, constant fear,
being trapped and unable to escape and being subject to
subhuman living conditions for a prolonged period of time.
• Sex trafficking incorporates, grooming, pornography and
ritual abuse and prostitution
• Psychological Entrapment
TRAUMA
• Affects those directly exposed and those
around them
• Wives and children of men who suffer
from PTSD tend to become depressed,
insecure, anxious and/or substance
abusers
• Trauma is about perception
• Natural response to an abnormal
situation
INFLOW
(I AM THE VICTIM)
Done to Me Client
Victim
HEATHER HAYES AND HOLLY RYAN - HIDING IN PLAIN SIGHT: WORKING WITH VICTIMS OF HUMAN TRAFFICKING
OUTFLOW
(I AM THE PERP)
Done to Someone Else
Victim Client
HEATHER HAYES AND HOLLY RYAN - HIDING IN PLAIN SIGHT: WORKING WITH VICTIMS OF HUMAN TRAFFICKING
CROSSFLOW
(VICARIOUS TRAUMATIZATION)
(Domestic Violence) Client
HEATHER HAYES AND HOLLY RYAN - HIDING IN PLAIN SIGHT: WORKING WITH VICTIMS OF HUMAN TRAFFICKING
REFLEXIVE
(DONE TO SELF)
(Drinking, Drugs, Self-Mutilation)
Client
HEATHER HAYES AND HOLLY RYAN - HIDING IN PLAIN SIGHT: WORKING WITH VICTIMS OF HUMAN TRAFFICKING
SEXUAL ACTING OUT
(SEX FOR DRUGS)
• Re-traumatization
• Boundary Issues
• Sex confused with love
• Comfort/self-soothing
• Control
• A way to get drugs
• Product of abusive relationships
TRAUMA INFORMED INTERVENTION TM
• Interventionist should be able to work with
PTSD and Dissociative Disorders
• Grounding techniques
• Danger of re-traumatization
• Gender of Clinician
• Eating Disorder assessment
• Self-mutilation assessment
• Appropriate treatment placement
• Dangers of the “Surprise Model”
DISSOCIATION
• A natural response to trauma
• Temporarily escape a trauma or traumatic
memory by walling off and separating the
memory
• The memory is split off, fragmented or
compartmentalized
• These memories are stored in the brain
TRIGGERS
• Visual
• Auditory
• Smell
• Taste
• Physical/Kinesthetic
• Tactile
TRIGGERS
• Pain
• Dates or Seasons
• Stressful events (critical boss)
• Thoughts
• Behaviors
• Defenses down
• Combinations (fireworks)
INDICATORS OF DISSOCIATION
• Stiff or still body
• Slow to respond
• Flat emotions, numb
• Inattention
• Disorientation
• Robotic behavior
• Misses conversation
• Not feeling expected pain
• Memory lapses
• Tuned out
• Dazed look
• Blank stare
• De-realization
• Eyes closed
• Rapid blinking
• Self-soothing
• Because of the nature of trauma, we
often do not see symptoms of trauma
when the person is in a dangerous
place
• Often they will come out when a
person is feeling safe
• Trauma survivors do not like surprises
TRAUMA INFORMED INTERVENTION TM
• Co-therapy
• Transparent vs. Surprise
• Confrontational methodologies are counter
indicated
• Involvement of multi level agencies and
services
• Building of coping skills
COUNTERING TRAUMA BONDS
• Responses to trauma may be automatic or uncontrollable, and are thought to be
wired into us to protect our own survival.
• Often times, involves hormonal fluctuations in the brain
• It is crucial that these responses are understood in the context of an individual’s
experience of abuse and overall environment in which they live
(Smith, Healy, Vardaman, & Snow, 2009)
TRAUMA INFORMED INTERVENTION TM
• Important to help family establish boundaries
• Boundaries will be tested/ usually never held
• Parents must have boundaries they can maintain
• Kicking out of the house often not realistic
• Parents can’t do it
• Psychiatric issues
• Think outside the box
TRAUMA INFORMED INTERVENTION TM
• Bond with the Client/Respect
• Know the lingo
• Be the limit setter for the family
• Family needs a lot of support and guidance
• Importance of case management/staying with the
family
• Emphasize importance of family treatment
(alanon, families anonymous, therapy, etc.)
TRAUMA INFORMED INTERVENTION TM
• Family system must be addressed and
generational issues examined.
• Educate parents about the tip of the iceberg
• Educate parents about drugs and alcohol on
an immature undeveloped brain
• Shift in pediatric paradigm
TRAUMA INFORMED INTERVENTION TM
• Violence
• High tolerance for pain
• Coupled with severe mental health or primary
psych
• Severely disjointed family system
• Need to locate and extract client
• Interfacing with legal i.e. FBI, Scotland Yard,
task forces
TRAUMA INFORMED INTERVENTION TM
Professional’s Role
• Examine whether the behaviors are addiction or
high-risk behaviors.
• Make correct placement
• Look at behavior within the context of the family
system.
• Teach families communication and bonding skills.
• Work within the scope of your practice and
training
DISSOCIATIVE DISORDERS
DISSOCIATIVE DISORDERS ARE CHARACTERIZED BY AN INVOLUNTARY ESCAPE FROM REALITY
CHARACTERIZED BY A DISCONNECTION BETWEEN THOUGHTS, IDENTITY, CONSCIOUSNESS AND MEMORY.
• Dissociative Amnesia
• Depersonalization disorder
• Dissociative identity disorder
ANXIETY, DEPRESSION & MOOD DISORDERS
• Generalized Anxiety Disorder
• Panic Attacks
• Obsessive Compulsive Disorder
SUBSTANCE USE DISORDERS
SUBSTANCE USE DISORDER IS BASED ON EVIDENCE OF IMPAIRED CONTROL,
SOCIAL IMPAIRMENT, RISKY USE, AND PHARMACOLOGICAL CRITERIA.
• Alcohol Use Disorder
• Tobacco Use Disorder
• Cannabis Use Disorder
• Opioid Use Disorder
• Stimulant Use Disorder
• Poly-Substance Use
Disorder
• Human trafficking reports indicate
that substance use issues are
critical health concerns for 1 in 4
trafficking survivors
Trauma-Informed Treatment of Substance Use Disorders in Trafficking Survivors
“Human trafficking victims have
greater needs because they basically
walk away from their situation with
nothing except the clothes on their
back. Thus, they have no way to feed
themselves, nowhere to live, and no
transportation” (Logan et al. (2009) p. 17).
COMPARISON OF PATHOLOGY AND STRENGTHS
PATHOLOGY STRENGTHS
Person is defined as a “case”; symptoms add up to
diagnosis
Person is defined as unique; traits, talents,
resources add up to strengths
Therapy is PROBLEM focused Therapy is POSSIBILITY focused
Personal accounts aid in the evocation of diagnosis
through reinterpretation by an expert
Personal accounts are the essential route to
knowing and appreciating the person
Practitioner is skeptical of personal stories,
rationalizations
Practitioner knows the person from the inside out
Childhood trauma is the precursor or predictor of
adult pathology
Childhood trauma is not predictive, it may weaken
or strengthen the individual
Centerpiece of therapeutic work is the treatment
plan devised by practitioner
Centerpiece of work is the aspirations of the family
and individual
Practitioner is the expert on the victim’s lives Individuals and families are the experts
Choice, control, commitment, and personal
development are limited by pathology
Choice, control, commitment, and personal
development are open
Resources for work are the knowledge and skills of
the professional
Resources for work are the strengths, capacities,
and adaptive skills of the individual, family, and
community.
Help is centered on reducing the effects of
symptoms and the negative personal and social
consequences of actions, emotions, thoughts, or
relationships
Help is centered on getting on with one’s life,
affirming and developing values and commitments,
and making and finding membership in or as a
community
MENTAL HEALTH NEEDS OF A VICTIM
• Foreign-born victims of human trafficking experience many stressors
• Victims initially experience emotional trauma from being deceived by perpetrators
• Often times, these people are someone whom the victim already knew and trusted,
possibly family
• Violation of trust causes the victim to deeply question the motives of others, as
well as their own sense of self
• Traffickers intimidate victims by threatening to harm their families if they try and
escape or talk to law enforcement
• Victims are keenly aware that traffickers have harmed other families, as a result of the
enslaved family members resistance
• International traffickers have a well developed communication network that
crosses borders
• Lack of trust in law enforcement and government officials contributes to mental
health problems
• When government representatives are complicit in human trafficking by participating
or accepting bribes to turn a blind eye.
NEED FOR A CONTINUUM OF CARE
• Trust-building is at the foundation of effective service delivery
when working with victims
• Clinical and medical professionals, law enforcement, social services, and anyone a
part of the extended client care team MUST understand the importance and
value of TRUST
• Victims may be very wary of being revictimized
• Foreign-born victims are especially vulnerable, because they might not know
their rights, local law, or cultural norms.
• Educating foreign-born victims on the United States rights to confidentiality, legal
representation, and self-determination, is a fundamental component in
addressing their immediate and long term needs
BEST PRACTICE IN THE DELIVERY OF SERVICE
• Developments in the field of antitrafficking work have begun to
evaluate efficacy of service deliver and evidence-based
practices
• The President’s “Interagency Task Force” and the “Federal
Strategic Action Plan on Services for Victims of Human
Trafficking” determined that:
• The best practices involve comprehensive client-first,
survivor-first, victim-centered approaches, and trauma-
informed services.
TRUST BUILDING FROM THE VICTIM’S PERSPECTIVE
• Building trust with the client is the foundation in providing best practices
• Victims have been lied to by their captors as fraud, is a key element of initially
gaining trust and maintaining control
• Professionals must acknowledge this; Since their client’s trust has been violated,
they may be reluctant to trust others
• Trust-building process is facilitated by professionals, when they:
• Create an atmosphere where the victim is recognized as the expert of their own
experience
• Create a judgement-free zone
• Are accepting of the decisions and choices their client has and will make
THE NEED FOR CASE MANAGEMENT COLLABORATION
• Interdisciplinary teams, and case collaboration and
coordination, are crucial components to providing best
practices to a victims of human trafficking
• Teams of professionals from different disciples will
synchronize services to be holistic, and avoid possibility of a
second trauma
• Open communication and trust is essential between
professionals and survivors
PUTTING THE VICTIM’S NEEDS FIRST
• Victim-centered approach, is a best practice that specifically
designs programs to meet the specific needs of individual
survivors
• Victim-centered approach is developed through a survivor’s
lens, rather than what might be best for the professional or the
structures in which they typically conduct their work
• Specialized intervention strategies are vitally important:
• Utilize a single point-of-contact service delivery paradigm
• Facilitates wraparound services, while maintaining a
survivor-first and victim-centered approach
• Interventionist also serves and point-of-contact for all other
professionals and groups involved with the case
NEED FOR CULTURAL COMPETENCY
• A survivor-centered approach recognizes and affirms that culturally competent
services for clients are essential when working with victims
• Cultural competence extends beyond ethnicity and race, to encompass learning
specifically about the crime of trafficking and its impact on survivors and their
families
• Specialized intervention services need to be culturally grounded and consider:
• Age and development stage
• Type and length of exploitation
• Relationship with traffickers
• Nationality
• Previous history of victimization
• If language skills of victim are different than the therapist, it is critically important to
utilize a translator
WORKING WITH THE FAMILY SYSTEM FOR
SUSTAINABLE RECOVERY
• De-pathologize the Family
• Educate around the dynamics of mental health
and/or addictions in the family
• Denial as fierce protection
• Begin to look at ways to support health, not
demise
• Difficulty around Re-unification
NEEDS AND CHALLENGES AFTER FAMILY REUNIFICATION
• Time of joy and adjustment
• Expect: ease and turbulence with newly reunited family members
• Mental health resources are frequently needed because of the
stress of acculturation and integration processes for their newly
arrived family members
• Victims exploited who are parents, are often separated from their
children for years. Often times, another family member assumes their
role. At reunification:
• Child: difficultly recognizing biological parent in their parent role =
struggles with being overwhelmed
• Victim parent: sees child struggling = feelings of guilt
WORKING WITH THE FAMILY SYSTEM
FOR SUSTAINABLE RECOVERY
• Initial crisis support
• Information and History Gathering
• Assessment
• Preparation for Intervention
• Treatment Center Options
WORKING WITH THE FAMILY SYSTEM
FOR SUSTAINABLE RECOVERY
• Client enters with clinical information
• Begin Family Health Plan
• Support Health Not Demise
• Plan for Boundaries and Self-care
• Families know what to expect
• Prepare for legal issues and
involvement
WORKING WITH THE FAMILY SYSTEM
FOR SUSTAINABLE RECOVERY
• Support Each Other (Board of Directors)
• Education
• Twelve step support Groups (Alanon,
Naranon, Families Anonymous)
• Decrease Anxiety Once in Treatment
(Paradigm Shift)
WORKING WITH THE FAMILY SYSTEM
FOR SUSTAINABLE RECOVERY
• Continued Support for a year
• Family Alumni Group
• Advocate for the families
• Advocate for the treatment center
• Advocate for the client
WORKING WITH THE FAMILY SYSTEM
FOR SUSTAINABLE RECOVERY
• Interpret clinical updates for the family/
helps manage the family- supporting the
treatment team
• Supports clinical recommendations
• Helps when client calls home complaining
WORKING WITH THE FAMILY SYSTEM
FOR SUSTAINABLE RECOVERY
• Referrals for Treatment
• Therapy
• Family Therapy
• Legal and Advocacy Groups
BARRIERS TO TREATING VICTIMS
• Resulting mental health conditions
• Lack of Resources
• Complexity of the legal cases
• Totality of needs
• Lack of Awareness throughout the country, world and service
providers
• Lack of Treatment
• Survivors may have developed coping strategies that present in
challenging the helping professional: The survivor may be distrusting
or actively defensive or angry toward those in the helping profession
i.e. counselors, social workers, law enforcement
BARRIERS TO TREATING VICTIMS
TRUST
• Trust used to gain access to Victim
• Crucial to remember these responses are
understood in the context of the individuals
experience of abuse and trauma, and overall
environment in which they live. These responses
may be autonomic or uncontrollable linked to the
hormonal and biochemical response in the brain.
TRUST AND TRAFFICKING
• Betrayed by those you should be able to
trust
• Trust is used to groom
• Trust is paramount to healing
TRAUMA INFORMED APPROACH
HEATHER HAYES AND HOLLY RYAN - HIDING IN PLAIN SIGHT: WORKING WITH VICTIMS OF HUMAN TRAFFICKING
GENERAL INDICATORS OF TRAFFICKING VICTIMS
• Be fearful of police/authorities
• Be fearful of the trafficker, believing their lives or family members’
lives are at risk if they escape
• Exhibit signs of physical and psychological trauma e.g. anxiety, lack of
memory of recent events, bruising, untreated conditions
• Be fearful of telling others about their situation
• Be unaware they have been trafficked and believe they are simply in a
bad job
• They May:
GENERAL INDICATORS OF TRAFFICKING VICTIMS
• They May:
• Have limited freedom of movement
• Be unpaid or paid very little
• Have limited access to medical care
• Seem to be in debt to someone
• Have no passport or mention that someone else is holding their
passport
• Be regularly moved to avoid detection
• Be controlled by use of witchcraft e.g. Ju Ju
SEXUAL EXPLOITATION
• Be aware: ordinary residential housing/hotels are being used more
and more for brothels.
• People forced into sexual exploitation may:
• Be moved between brothels, sometimes from city to city
• Sleeping on work premises
• Display a limited amount of clothing, of which a large proportion
is sexual
• Display substance misuse
• Be forced, intimidated or coerced into providing sexual services
• Be subjected to abduction, assault or rape
• Be unable to travel freely e.g. picked up and dropped off at work
location by another person
• Have money for their services provided collected by another
person
FORCED LABOUR
• Where all the work is done under the menace of a penalty
or the person has not offered himself voluntarily and is
now unable to leave. They may experience:
• Threat or actual physical harm
• Restriction of movement or confinement
• Debt bondage i.e. working to pay off a debt or loan, often
the victim is paid very little or nothing at all for their
services because of deductions
• Withholding of wages or excessive wage reductions
• Withholding of documents e.g. passport/security card
• Threat of revealing to authorities an irregular immigration
status
• Their employer is unable to produce documents required
FORCED LABOUR
CONTINUED…
• Poor or non-existent health and safety standards
• Requirement to pay for tools and food
• Imposed place of accommodation (and deductions made
for it)
• Pay that is less than minimum wage
• Dependence on employer for services
• No access to labour contract
• Excessive work hours/few breaks
“An abuse of a child’s vulnerability by a
person’s position of power or trust,
exploiting that position to obtain sexual
services in exchange for some form
of favour such as alcohol, drugs, attention or
gifts” – Engage Team, Blackburn
CHILD ABUSE: HIDING IN PLAIN SIGHT
• You may notice a child that is:
• Often going missing/truanting
• Secretive
• Has unexplained money/presents
• Experimenting with drugs/alcohol
• Associating with/being groomed by older people (not in normal
networks)
• In relationships with significantly older people
• Taking part in social activities with no plausible explanation
• Seen entering or leaving vehicles with unknown adults
• Showing evidence of physical/sexual assault (including STD’s)
• Showing signs of low self image/self harm/eating disorder
CRIMINAL ACTIVITIES
• The person is recruited and forced/deceived into
conducting some form of criminal activity such as pick
pocketing, begging, cannabis cultivation and benefit fraud.
• Same indicators as for forced labour but for cannabis
cultivation you may also notice:
• Windows of property are permanently covered from
the inside
• Visits to property are at unusual times
• Property may be residential
• Unusual noises coming from the property e.g.
machinery
• Pungent smells coming from the property
DOMESTIC SERVITUDE
• They may:
• Be living and working for a family in a private
home
• Not be eating with the rest of the family
• Have no bedroom or proper sleeping place
• Have no private space
• Be forced to work excessive hours; “on call” 24
hours a day
• Never leave the house without the ‘employer’
• Be malnourished
• Be reported as missing or accused of crime by
their ‘employer’ if they try to escape
SHIFTING PERSPECTIVE
We must stop treating the stigma and
begin treating the human.
Addiction
Victim of
Trafficking
Co-Morbidity
WHAT HAVE WE MISSED?
QUESTIONS
Heather R. Hayes, M.Ed., LPC, CAI, CIP
www.heatherhayes.com
Heather@heatherhayes.com
(770) 335-5004
Holly Ryan, LCSW, LADC, SAP
Holly@heatherhayes.com
470-505-9939

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HEATHER HAYES AND HOLLY RYAN - HIDING IN PLAIN SIGHT: WORKING WITH VICTIMS OF HUMAN TRAFFICKING

  • 1. HIDING IN PLAIN SIGHT: WORKING WITH VICTIMS OF HUMAN TRAFFICKING HEATHER R HAYES, M.ED, LPC HOLLY RYAN, LCSW, LADC, SAP
  • 2. “If we don't start with a wide humanitarian view point, how can we ever dream to work on peoples issues with behavioural, emotional and mental health problems” Sam Quinlan, iCAAD Director
  • 3. CASE STUDIES Sara- 25 years old • Grew up in mid-high socioeconomic house hold • Parents married • Appears to be a tight knit family • Went to college • Met Trafficker online • Gradual change in communication to friends, family and lifestyle • Psychological Control and manipulation • Abuser used local law enforcement to block intervention attempt Joe- Now 15 years old • Taken from home in Guatemala at age 13 under the guise of making a better life • “Sponsored” into US by Traffickers in 2014 • Forced to work on chicken farms in Ohio • Trauma on every level, physical, emotional, repeated sexual victimization • Lived in subhuman conditions, total neglect, no running water, no electricity • Work 6am-8pm
  • 5. WHAT DEFINES HUMAN TRAFFICKING? • The Act • Recruitment, transporting, harboring or hiding, acquiring • The Means • Threat or use force to remove, abduct, coerce, deception, fraud, abuse of power, paying a person to control the victim • The Purpose • EXPLOITATION- sex workers, prostitution, forced labor, slavery, removal of organs, financial gain
  • 6. THE NUMBERS • At any given time in 2016, an estimated 40.3 million people are in modern slavery, including 24.9 in forced labour and 15.4 million in forced marriage • There are 5.4 victims of modern slavery for every 1,000 people in the world. • 1 in 4 victims of modern slavery are children • Out of the 24.9 million people trapped in forced labour, 16 million people are exploited in the private sector such as domestic work, construction or agriculture; 4.8 million persons in forced sexual exploitation, and 4 million persons in forced labour imposed by state authorities Source: Global Estimates of Modern Slavery: Forced Labour and Forced Marriage , Geneva, September 2017
  • 9. Who is falling victim to trafficking? Of the 40.3 million…
  • 10. HOW MUCH IS A LIFE WORTH? #NoPriceOnPeople
  • 11. BILLION DOLLAR INDUSTRY • 109,081,500,000.00 GBP or $150 Billion Dollar in earnings • $99 billion from commercial sexual exploitation • $34 billion in construction, manufacturing, mining and utilities • $9 billion in agriculture, including forestry and fishing • $8 billion dollars is saved annually by private households that employ domestic workers under conditions of forced labor International Labor (ILO) Organization, 2017
  • 13. REASONS TRAFFICKING OCCURS • Globalization • Poverty • Political Issues • Child Soldiers • Forced Begging • Forced Labor • Removal of Organs • Sexual Exploitation • Selling Children • Forced Marriage • Financial Gain
  • 14. Trends in the forms of exploitation among detected trafficking victims, 2007-2014
  • 15. Understanding Methods Used in Human Trafficking
  • 16. WHY? Reporter: How do you get a girl to do this? Matthew: It just happens. Like most of these girls they’re broken. It’s not hard. You get in there, you find the crack, some are drugs, they need to hear I love you. I’m here to take care of you. She’ll do it. Reporter: Why will she do it. Matthew: Because you sold her a dream. Knowing someone cares. It’s an illusion.
  • 17. Power and Control Using Coercion and Threats Threatening Family Blackmail Harming another for another’s disobedience Emotional Violence Isolate from social support Shame Humiliation Affection to violence Physical Violence Torture Branding Forced drug use Deny food or bathroom Sexual Violence Prostitution Gang Rape Sexual Shaming Purposeful Manipulation Exploiting insecurities Exploiting life gaps (i.e. absent Father) Economic Dependence Take all assets and money from victim Refuse to let them go to school Isolation Inability to access support resources Unfamiliar/unaware of geo location Total control over the victim’s movements (Smith, Healy, Vardaman, & Snow, 2009)
  • 18. ENTRAPMENT BY ANY MEANS NECESSARY • Fear: deportation, prosecution or legal problems, causing or creating harm to ones family and a lack of trust in the government • Lack of knowledge about alternatives • Isolation: to control or mediate the ability to escape. Isolation may be geographically, physically or through a language barrier • Psychological Confinement • When attained gives way to ultimate compliance
  • 19. ENTRAPMENT BY ANY MEANS NECESSARY Psychological entrapment: includes debt bondage, the use of drugs and alcohol addiction, and threats of shaming and humiliation.
  • 20. ENTRAPMENT BY ANY MEANS NECESSARY
  • 21. EXAMPLES OF FORCE, FRAUD & COERCION • Force: • Physical Abuse • Kidnapping • Physical Restraint • Fraud: • Illegitimate Contacts • False Promises • Fake Businesses • Fake Visa Documents
  • 22. EXAMPLES OF FORCE, FRAUD & COERCION • Coercion: • Psychological Manipulation • Threats • Spoken Threats about victims family or others • Implied Threats to create a climate of fear (electric fences, guns, lies) • Control of children • Trafficker has possession of documents
  • 23. WARNING SIGNS OF DOMESTIC MINOR SEX TRAFFICKING (Smith, Healy, Vardaman, & Snow, 2009)
  • 24. THE ULTIMATE GOAL OF TRAFFICKERS Mental Defeat • Mental defeat is what follows total behavioral and cognitive submission • The perceived loss of all autonomy, a state of giving up in one’s mind all efforts to retain one’s identify as human being with a will of one’s own.
  • 25. OUTCOME FOR VICTIMS • PTSD • Complex Trauma • Dissociative Disorders • Anxiety Disorders • Depressive Disorders • Attachment Disorders • Developmental Disorders • Eating Disorders • Self-Mutilation • Substance Use Disorders
  • 26. Treating Victims of Human Trafficking
  • 27. PTSD SYMPTOMS REPORTED BY VICTIMS • Recurrent thoughts/memories of terrifying events • Recurrent thoughts/memories of terrifying events • Recurrent nightmares • Feeling detached/withdrawn • Unable to feel emotion • Easily Startled • Difficulty concentrating • Sudden emotional or physical reaction when reminded of traumatic even • Trouble sleeping • Feeling on guard • Feeling irritable , outbursts of anger • Avoiding activities that remind of the traumatic even • Inability to remember part of or most of traumatic even • Loss of interest in daily activities • Feeling hopeless • Avoiding thoughts or feelings associated with traumatic events (Zimmerman et al., 2006)
  • 29. COMPLEX TRAUMA • Associated with chronic, prolonged, repetitive exposure to traumas • Sexual trauma, physical beatings, starvation, constant fear, being trapped and unable to escape and being subject to subhuman living conditions for a prolonged period of time. • Sex trafficking incorporates, grooming, pornography and ritual abuse and prostitution • Psychological Entrapment
  • 30. TRAUMA • Affects those directly exposed and those around them • Wives and children of men who suffer from PTSD tend to become depressed, insecure, anxious and/or substance abusers • Trauma is about perception • Natural response to an abnormal situation
  • 31. INFLOW (I AM THE VICTIM) Done to Me Client Victim
  • 33. OUTFLOW (I AM THE PERP) Done to Someone Else Victim Client
  • 37. REFLEXIVE (DONE TO SELF) (Drinking, Drugs, Self-Mutilation) Client
  • 39. SEXUAL ACTING OUT (SEX FOR DRUGS) • Re-traumatization • Boundary Issues • Sex confused with love • Comfort/self-soothing • Control • A way to get drugs • Product of abusive relationships
  • 40. TRAUMA INFORMED INTERVENTION TM • Interventionist should be able to work with PTSD and Dissociative Disorders • Grounding techniques • Danger of re-traumatization • Gender of Clinician • Eating Disorder assessment • Self-mutilation assessment • Appropriate treatment placement • Dangers of the “Surprise Model”
  • 41. DISSOCIATION • A natural response to trauma • Temporarily escape a trauma or traumatic memory by walling off and separating the memory • The memory is split off, fragmented or compartmentalized • These memories are stored in the brain
  • 42. TRIGGERS • Visual • Auditory • Smell • Taste • Physical/Kinesthetic • Tactile
  • 43. TRIGGERS • Pain • Dates or Seasons • Stressful events (critical boss) • Thoughts • Behaviors • Defenses down • Combinations (fireworks)
  • 44. INDICATORS OF DISSOCIATION • Stiff or still body • Slow to respond • Flat emotions, numb • Inattention • Disorientation • Robotic behavior • Misses conversation • Not feeling expected pain • Memory lapses • Tuned out • Dazed look • Blank stare • De-realization • Eyes closed • Rapid blinking • Self-soothing
  • 45. • Because of the nature of trauma, we often do not see symptoms of trauma when the person is in a dangerous place • Often they will come out when a person is feeling safe • Trauma survivors do not like surprises
  • 46. TRAUMA INFORMED INTERVENTION TM • Co-therapy • Transparent vs. Surprise • Confrontational methodologies are counter indicated • Involvement of multi level agencies and services • Building of coping skills
  • 47. COUNTERING TRAUMA BONDS • Responses to trauma may be automatic or uncontrollable, and are thought to be wired into us to protect our own survival. • Often times, involves hormonal fluctuations in the brain • It is crucial that these responses are understood in the context of an individual’s experience of abuse and overall environment in which they live (Smith, Healy, Vardaman, & Snow, 2009)
  • 48. TRAUMA INFORMED INTERVENTION TM • Important to help family establish boundaries • Boundaries will be tested/ usually never held • Parents must have boundaries they can maintain • Kicking out of the house often not realistic • Parents can’t do it • Psychiatric issues • Think outside the box
  • 49. TRAUMA INFORMED INTERVENTION TM • Bond with the Client/Respect • Know the lingo • Be the limit setter for the family • Family needs a lot of support and guidance • Importance of case management/staying with the family • Emphasize importance of family treatment (alanon, families anonymous, therapy, etc.)
  • 50. TRAUMA INFORMED INTERVENTION TM • Family system must be addressed and generational issues examined. • Educate parents about the tip of the iceberg • Educate parents about drugs and alcohol on an immature undeveloped brain • Shift in pediatric paradigm
  • 51. TRAUMA INFORMED INTERVENTION TM • Violence • High tolerance for pain • Coupled with severe mental health or primary psych • Severely disjointed family system • Need to locate and extract client • Interfacing with legal i.e. FBI, Scotland Yard, task forces
  • 52. TRAUMA INFORMED INTERVENTION TM Professional’s Role • Examine whether the behaviors are addiction or high-risk behaviors. • Make correct placement • Look at behavior within the context of the family system. • Teach families communication and bonding skills. • Work within the scope of your practice and training
  • 53. DISSOCIATIVE DISORDERS DISSOCIATIVE DISORDERS ARE CHARACTERIZED BY AN INVOLUNTARY ESCAPE FROM REALITY CHARACTERIZED BY A DISCONNECTION BETWEEN THOUGHTS, IDENTITY, CONSCIOUSNESS AND MEMORY. • Dissociative Amnesia • Depersonalization disorder • Dissociative identity disorder
  • 54. ANXIETY, DEPRESSION & MOOD DISORDERS • Generalized Anxiety Disorder • Panic Attacks • Obsessive Compulsive Disorder
  • 55. SUBSTANCE USE DISORDERS SUBSTANCE USE DISORDER IS BASED ON EVIDENCE OF IMPAIRED CONTROL, SOCIAL IMPAIRMENT, RISKY USE, AND PHARMACOLOGICAL CRITERIA. • Alcohol Use Disorder • Tobacco Use Disorder • Cannabis Use Disorder • Opioid Use Disorder • Stimulant Use Disorder • Poly-Substance Use Disorder • Human trafficking reports indicate that substance use issues are critical health concerns for 1 in 4 trafficking survivors Trauma-Informed Treatment of Substance Use Disorders in Trafficking Survivors
  • 56. “Human trafficking victims have greater needs because they basically walk away from their situation with nothing except the clothes on their back. Thus, they have no way to feed themselves, nowhere to live, and no transportation” (Logan et al. (2009) p. 17).
  • 57. COMPARISON OF PATHOLOGY AND STRENGTHS PATHOLOGY STRENGTHS Person is defined as a “case”; symptoms add up to diagnosis Person is defined as unique; traits, talents, resources add up to strengths Therapy is PROBLEM focused Therapy is POSSIBILITY focused Personal accounts aid in the evocation of diagnosis through reinterpretation by an expert Personal accounts are the essential route to knowing and appreciating the person Practitioner is skeptical of personal stories, rationalizations Practitioner knows the person from the inside out Childhood trauma is the precursor or predictor of adult pathology Childhood trauma is not predictive, it may weaken or strengthen the individual Centerpiece of therapeutic work is the treatment plan devised by practitioner Centerpiece of work is the aspirations of the family and individual Practitioner is the expert on the victim’s lives Individuals and families are the experts Choice, control, commitment, and personal development are limited by pathology Choice, control, commitment, and personal development are open Resources for work are the knowledge and skills of the professional Resources for work are the strengths, capacities, and adaptive skills of the individual, family, and community. Help is centered on reducing the effects of symptoms and the negative personal and social consequences of actions, emotions, thoughts, or relationships Help is centered on getting on with one’s life, affirming and developing values and commitments, and making and finding membership in or as a community
  • 58. MENTAL HEALTH NEEDS OF A VICTIM • Foreign-born victims of human trafficking experience many stressors • Victims initially experience emotional trauma from being deceived by perpetrators • Often times, these people are someone whom the victim already knew and trusted, possibly family • Violation of trust causes the victim to deeply question the motives of others, as well as their own sense of self • Traffickers intimidate victims by threatening to harm their families if they try and escape or talk to law enforcement • Victims are keenly aware that traffickers have harmed other families, as a result of the enslaved family members resistance • International traffickers have a well developed communication network that crosses borders • Lack of trust in law enforcement and government officials contributes to mental health problems • When government representatives are complicit in human trafficking by participating or accepting bribes to turn a blind eye.
  • 59. NEED FOR A CONTINUUM OF CARE • Trust-building is at the foundation of effective service delivery when working with victims • Clinical and medical professionals, law enforcement, social services, and anyone a part of the extended client care team MUST understand the importance and value of TRUST • Victims may be very wary of being revictimized • Foreign-born victims are especially vulnerable, because they might not know their rights, local law, or cultural norms. • Educating foreign-born victims on the United States rights to confidentiality, legal representation, and self-determination, is a fundamental component in addressing their immediate and long term needs
  • 60. BEST PRACTICE IN THE DELIVERY OF SERVICE • Developments in the field of antitrafficking work have begun to evaluate efficacy of service deliver and evidence-based practices • The President’s “Interagency Task Force” and the “Federal Strategic Action Plan on Services for Victims of Human Trafficking” determined that: • The best practices involve comprehensive client-first, survivor-first, victim-centered approaches, and trauma- informed services.
  • 61. TRUST BUILDING FROM THE VICTIM’S PERSPECTIVE • Building trust with the client is the foundation in providing best practices • Victims have been lied to by their captors as fraud, is a key element of initially gaining trust and maintaining control • Professionals must acknowledge this; Since their client’s trust has been violated, they may be reluctant to trust others • Trust-building process is facilitated by professionals, when they: • Create an atmosphere where the victim is recognized as the expert of their own experience • Create a judgement-free zone • Are accepting of the decisions and choices their client has and will make
  • 62. THE NEED FOR CASE MANAGEMENT COLLABORATION • Interdisciplinary teams, and case collaboration and coordination, are crucial components to providing best practices to a victims of human trafficking • Teams of professionals from different disciples will synchronize services to be holistic, and avoid possibility of a second trauma • Open communication and trust is essential between professionals and survivors
  • 63. PUTTING THE VICTIM’S NEEDS FIRST • Victim-centered approach, is a best practice that specifically designs programs to meet the specific needs of individual survivors • Victim-centered approach is developed through a survivor’s lens, rather than what might be best for the professional or the structures in which they typically conduct their work • Specialized intervention strategies are vitally important: • Utilize a single point-of-contact service delivery paradigm • Facilitates wraparound services, while maintaining a survivor-first and victim-centered approach • Interventionist also serves and point-of-contact for all other professionals and groups involved with the case
  • 64. NEED FOR CULTURAL COMPETENCY • A survivor-centered approach recognizes and affirms that culturally competent services for clients are essential when working with victims • Cultural competence extends beyond ethnicity and race, to encompass learning specifically about the crime of trafficking and its impact on survivors and their families • Specialized intervention services need to be culturally grounded and consider: • Age and development stage • Type and length of exploitation • Relationship with traffickers • Nationality • Previous history of victimization • If language skills of victim are different than the therapist, it is critically important to utilize a translator
  • 65. WORKING WITH THE FAMILY SYSTEM FOR SUSTAINABLE RECOVERY • De-pathologize the Family • Educate around the dynamics of mental health and/or addictions in the family • Denial as fierce protection • Begin to look at ways to support health, not demise • Difficulty around Re-unification
  • 66. NEEDS AND CHALLENGES AFTER FAMILY REUNIFICATION • Time of joy and adjustment • Expect: ease and turbulence with newly reunited family members • Mental health resources are frequently needed because of the stress of acculturation and integration processes for their newly arrived family members • Victims exploited who are parents, are often separated from their children for years. Often times, another family member assumes their role. At reunification: • Child: difficultly recognizing biological parent in their parent role = struggles with being overwhelmed • Victim parent: sees child struggling = feelings of guilt
  • 67. WORKING WITH THE FAMILY SYSTEM FOR SUSTAINABLE RECOVERY • Initial crisis support • Information and History Gathering • Assessment • Preparation for Intervention • Treatment Center Options
  • 68. WORKING WITH THE FAMILY SYSTEM FOR SUSTAINABLE RECOVERY • Client enters with clinical information • Begin Family Health Plan • Support Health Not Demise • Plan for Boundaries and Self-care • Families know what to expect • Prepare for legal issues and involvement
  • 69. WORKING WITH THE FAMILY SYSTEM FOR SUSTAINABLE RECOVERY • Support Each Other (Board of Directors) • Education • Twelve step support Groups (Alanon, Naranon, Families Anonymous) • Decrease Anxiety Once in Treatment (Paradigm Shift)
  • 70. WORKING WITH THE FAMILY SYSTEM FOR SUSTAINABLE RECOVERY • Continued Support for a year • Family Alumni Group • Advocate for the families • Advocate for the treatment center • Advocate for the client
  • 71. WORKING WITH THE FAMILY SYSTEM FOR SUSTAINABLE RECOVERY • Interpret clinical updates for the family/ helps manage the family- supporting the treatment team • Supports clinical recommendations • Helps when client calls home complaining
  • 72. WORKING WITH THE FAMILY SYSTEM FOR SUSTAINABLE RECOVERY • Referrals for Treatment • Therapy • Family Therapy • Legal and Advocacy Groups
  • 73. BARRIERS TO TREATING VICTIMS • Resulting mental health conditions • Lack of Resources • Complexity of the legal cases • Totality of needs • Lack of Awareness throughout the country, world and service providers • Lack of Treatment • Survivors may have developed coping strategies that present in challenging the helping professional: The survivor may be distrusting or actively defensive or angry toward those in the helping profession i.e. counselors, social workers, law enforcement
  • 74. BARRIERS TO TREATING VICTIMS TRUST • Trust used to gain access to Victim • Crucial to remember these responses are understood in the context of the individuals experience of abuse and trauma, and overall environment in which they live. These responses may be autonomic or uncontrollable linked to the hormonal and biochemical response in the brain.
  • 75. TRUST AND TRAFFICKING • Betrayed by those you should be able to trust • Trust is used to groom • Trust is paramount to healing
  • 78. GENERAL INDICATORS OF TRAFFICKING VICTIMS • Be fearful of police/authorities • Be fearful of the trafficker, believing their lives or family members’ lives are at risk if they escape • Exhibit signs of physical and psychological trauma e.g. anxiety, lack of memory of recent events, bruising, untreated conditions • Be fearful of telling others about their situation • Be unaware they have been trafficked and believe they are simply in a bad job • They May:
  • 79. GENERAL INDICATORS OF TRAFFICKING VICTIMS • They May: • Have limited freedom of movement • Be unpaid or paid very little • Have limited access to medical care • Seem to be in debt to someone • Have no passport or mention that someone else is holding their passport • Be regularly moved to avoid detection • Be controlled by use of witchcraft e.g. Ju Ju
  • 80. SEXUAL EXPLOITATION • Be aware: ordinary residential housing/hotels are being used more and more for brothels. • People forced into sexual exploitation may: • Be moved between brothels, sometimes from city to city • Sleeping on work premises • Display a limited amount of clothing, of which a large proportion is sexual • Display substance misuse • Be forced, intimidated or coerced into providing sexual services • Be subjected to abduction, assault or rape • Be unable to travel freely e.g. picked up and dropped off at work location by another person • Have money for their services provided collected by another person
  • 81. FORCED LABOUR • Where all the work is done under the menace of a penalty or the person has not offered himself voluntarily and is now unable to leave. They may experience: • Threat or actual physical harm • Restriction of movement or confinement • Debt bondage i.e. working to pay off a debt or loan, often the victim is paid very little or nothing at all for their services because of deductions • Withholding of wages or excessive wage reductions • Withholding of documents e.g. passport/security card • Threat of revealing to authorities an irregular immigration status • Their employer is unable to produce documents required
  • 82. FORCED LABOUR CONTINUED… • Poor or non-existent health and safety standards • Requirement to pay for tools and food • Imposed place of accommodation (and deductions made for it) • Pay that is less than minimum wage • Dependence on employer for services • No access to labour contract • Excessive work hours/few breaks
  • 83. “An abuse of a child’s vulnerability by a person’s position of power or trust, exploiting that position to obtain sexual services in exchange for some form of favour such as alcohol, drugs, attention or gifts” – Engage Team, Blackburn
  • 84. CHILD ABUSE: HIDING IN PLAIN SIGHT • You may notice a child that is: • Often going missing/truanting • Secretive • Has unexplained money/presents • Experimenting with drugs/alcohol • Associating with/being groomed by older people (not in normal networks) • In relationships with significantly older people • Taking part in social activities with no plausible explanation • Seen entering or leaving vehicles with unknown adults • Showing evidence of physical/sexual assault (including STD’s) • Showing signs of low self image/self harm/eating disorder
  • 85. CRIMINAL ACTIVITIES • The person is recruited and forced/deceived into conducting some form of criminal activity such as pick pocketing, begging, cannabis cultivation and benefit fraud. • Same indicators as for forced labour but for cannabis cultivation you may also notice: • Windows of property are permanently covered from the inside • Visits to property are at unusual times • Property may be residential • Unusual noises coming from the property e.g. machinery • Pungent smells coming from the property
  • 86. DOMESTIC SERVITUDE • They may: • Be living and working for a family in a private home • Not be eating with the rest of the family • Have no bedroom or proper sleeping place • Have no private space • Be forced to work excessive hours; “on call” 24 hours a day • Never leave the house without the ‘employer’ • Be malnourished • Be reported as missing or accused of crime by their ‘employer’ if they try to escape
  • 87. SHIFTING PERSPECTIVE We must stop treating the stigma and begin treating the human.
  • 89. QUESTIONS Heather R. Hayes, M.Ed., LPC, CAI, CIP www.heatherhayes.com Heather@heatherhayes.com (770) 335-5004 Holly Ryan, LCSW, LADC, SAP Holly@heatherhayes.com 470-505-9939