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Child human trafficking victims: Challenges for the child welfare system
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Child human trafficking victims: Challenges for the child welfare system
Rowena Fong *, Jodi Berger Cardoso
The University of Texas at Austin, School of Social Work, 1 University Station D3500, Austin, TX 78712, United States
Since the passing of the Victims of Trafficking and Violence
Protection Act in 2000, also known as the Trafficking Victims
Protection Act (TVPA), and its reauthorization as the Trafficking
Victims Protection Reauthorization Act by President George Bush
in 2008, federal, state and community efforts in identifying and
providing services for victims of human trafficking have
significantly improved. However, most of the research and
resources for trafficking victims have been directed towards
adults rather than children. Researchers agree that there is a
growing number of sexually exploited and trafficked children in
the United States (Boxill & Richardson, 2007; Estes & Weiner,
2002; Spangenberg, 2001), yet few programs emphasize the
unique experiences and special needs of this population. Public
child welfare systems make referrals to licensed private therapists
and providers who have experience treating sexual abuse, but the
issues and treatment goals of children sexually abused by single
perpetrators are different than those for sexually exploited
children. Public child welfare program assessment practices
and treatment policies should be changed to reflect the distinctive
problems of the human trafficking population, which has been
subjected to sex slavery.
1. International human trafficking
The secretive nature of human trafficking prevents a precise
count of the number of people victimized by the industry each year
(U.S. Department of State, 2008), but a conservative estimate by
the United Nations Children’s Fund (UNICEF) suggests approximately 1.2 million children are trafficked for sexual exploitation
worldwide (2007). In the Trafficking in Persons Report-June 2008,
the Department of State stated that at least two million children
are exploited in the international commercial sex trade. Most
victims of international trafficking come from Southeast Asia, Latin
America, Eastern Europe and Newly Independent States and the
average age of child victims of trafficking is about 13 or 14 (Barnitz,
2001; Boxill & Richardson, 2007). Although the trafficking of boys
for commercial sexual purposes is typically unreported, the
International Labor Organization (ILO) and UNICEF estimate that
2% of all commercial sexual exploitation is with boys (U.S.
Department of State, 2008).
The commercial sexual exploitation of children (CSEC) is
defined as the ‘‘exploitation of children entirely, or at least in
part, for financial or other economic reason. The economic
exchanges involved may be monetary or nonmonetary. . .’’ (Estes
& Weiner, 2002, p. 10).
2. Domestic human trafficking
In the United States, runaway, homeless, kidnapped children or
children in or leaving foster care are at elevated risk of forced
prostitution and trafficking. Trafficking of persons occurs domestically and vulnerable children within the United States are at-risk
for sexual exploitation. Although most research has focused on
children involved in international sex trafficking (Fong & Berger,
2008; Miko & Park, 2002), there is a growing concern about child
prostitution and its link to children who have been trafficked in the
United States (United States Department of Health and Human
Services & Administration for Children and Families, 2009a).
Evaluation and Program Planning 33 (2010) 311–316
A R T I C L E I N F O
Article history:
Received 16 December 2008
Received in revised form 16 June 2009
Accepted 16 June 2009
Keywords:
Child victims of human trafficking
Human trafficking victims and child welfare
A B S T R A C T
Since the passing of the Victims of Trafficking and Violence Protection Act in 2000 and its reauthorization
by President George Bush in 2008, federal, state and community efforts in identifying and providing
services for victims of human trafficking have significantly improved. However, most of the research and
resources for trafficking victims have been directed towards adults rather than children. Researchers
agree that there is a growing number of sexually exploited and trafficked children in the United States
yet few programs emphasize the unique experiences and special needs of this population. This article
examines commercial sexual exploitation of children; differentiates the needs and problems between
child prostitution and victims of human trafficking; reviews and critiques current treatment practices;
and summarizes challenges and successes in working with child victims of human trafficking, offering
practice and policy recommendations.
Published by Elsevier Ltd.
* Corresponding author. Tel.: +1 512 471 1393; fax: +1 512 471 9600.
E-mail address: [email protected] (R. Fong).
Contents lists available at ScienceDirect
Evaluation and Program Planning
journal homepage: www.elsevier.com/locate/evalprogplan
0149-7189/$ – see front matter. Published by Elsevier Ltd.
doi:10.1016/j.evalprogplan.2009.06.018
In the 2004 U.S. Department of Justice Annual Report, the FBI
identified 14 field offices located in areas where there was a high
incidence of prostituted children and asked each of these offices to
establish a task force to address the problem. The original 14 cities
identified as part of the initiative were Atlanta, Chicago, Dallas,
Detroit, Las Vegas, Los Angeles, Miami, Minneapolis, New York, San
Diego, San Francisco, St. Louis, Tampa, and Washington, DC.
Children and youth who have been prostituted typically lack
parental support and, if under the age of 18 years, usually become
clients in the public child welfare system when they are finally able
to leave the oppressive situation and seek help. Children and youth
who have been forced into sex slavery have similar, but nevertheless different, clinical issues from children subjected to sex
abuse within their family or social service systems. This article
examines commercial sexual exploitation of children; differentiates the needs and problems between child sexual abuse and
victims of human trafficking; reviews and critiques current
treatment practices; and summarizes challenges and successes
in working with child victims of human trafficking, offering
practice and policy recommendations.
3. Commercial sexual exploitation of children and
international human trafficking
To address the growing number of international trafficking
cases, the United States in 2000 passed The Trafficking Victims
Protection Act (TVPA), a national policy addressing human
trafficking which defines ‘‘severe forms’’ of human trafficking as
sex trafficking in which commercial sex is induced by force,
fraud, or coercion, or in which a person induced to perform such
an act has not attained 18 years of age; or the recruitment,
harboring, transportation, provision, or obtaining of a person for
labor services, through use of coercion, for the purpose of
subjection to involuntary servitude, peonage, debt bondage and
slavery (U.S. Department of State, 2008, p. 6).
TVPA has three main objectives: to prevent human trafficking,
protect victims, and prosecute traffickers. Although funding to
implement TVPA was reauthorized in 2003, 2005 and 2008, most of
the services are aimed towards adults rather than children.
Most children fall victims of trafficking through the process of
migration (U.S. Department of State, 2008). Desiring better
alternatives for their children, parents in overseas countries are
tricked by traffickers promising education, employment and
financial prosperity. Other vulnerable children include street
workers, the homeless, and unaccompanied minors crossing
international borders illegally and without adult supervision.
The Division of Unaccompanied Children Services (DUCS) in the
Office of Refugee Resettlement (ORR) in Washington, DC handles
the Unaccompanied Alien Children (UAC) and finds ORR-funded
facilities where they receive services related to mental health and
trafficking issues.
Traffickers may have isolated children from their parents, using
control, violence, coercion, narcotics and social isolation to force
children into debt bondage, involuntary servitude and commercial
sexual exploitation.
The violence inflicted on children in the sex industry is severe.
The few children rescued by law enforcement have acute physical
and sexual trauma and adverse health effects including mental
illness, substance abuse, sexually transmitted diseases, HIV
infection, pregnancy and abortion-related complications (Willis
& Levy, 2002). Although non-governmental organizations, like End
Child Prostitution, Child Pornography, and Trafficking Children for
Sexual Purposes (ECPAT) have proposed intervention and prevention models to mitigate the long-term health consequences of child
prostitution, the implementation of such strategies are not
uniform and are under-utilized in many countries (O’Brian, Van
de Borne, & Noten (2006); Willis & Levy, 2002).
In addition to medical and mental health services, children
trafficked across international borders may need to be repatriated to
their country of origin. However, prior to repatriation, a needs
assessment should be conducted with child welfare and law
enforcement to ensure the safety of the child. If family reunification
or repatriation is unsafe, child welfare agencies must work to create
a permanency plan that is in the best interest of the child (O’Neill
Richard, 1999). While child welfare agencies in the United States
may have some of these steps in place for abused and neglected kids,
these safeguards tend to disappear for sexually exploited children
and for victims of human trafficking, particularly.
4. Commercial sexual exploitation of children and child
prostitution in the United States
A growing number of American children are trafficked into the
national and international sex industry. In 1995, the United States
government created a task force with representatives from federal
agencies and the National Center for Missing and Exploited
Children. The task force was responsible for initiating research
about the commercial and sexual exploitation of children (CSEC),
and was instrumental in enhancing and amending legislation to
include harsher penalties for perpetrators, culminating in 2000
with the passing of TVPA (Barnitz, 2001).
Many of the domestic victims of sexual exploitation are
vulnerable youth on the street or from the foster care system. In
2003, the Federal Bureau of Investigation (FBI), Department of
Justice Child Exploitation and Obscenity Section and the National
Center for Missing and Exploited Children joined forces to create
the Innocence Lost Initiative. The purpose of this initiative was to
develop specialized task forces across the country to address the
growing number of children victimized by domestic sex trafficking
in the United States. These coalitions were established in sixteen
cities, which were selected because of high incidences of child
sexual exploitation and prostitution (Federal Bureau of Investigation, 2009; Shared Hope International, End Child Prostitution Child
Pornography and Trafficking of Children for Sexual Purposes
(ECPAT-USA), & The Protection Project of the Johns Hopkins
University School of Advanced International Studies, 2006). In
2008, the FBI reported a total of 577 rescued children. Since the
inception of the Innocence Lost Initiative, more than 300 pimps,
madams and associates have been convicted of crimes against
children, resulting in more than 3 million dollars seized from these
operations (Federal Bureau of Investigation, 2009).
Although child prostitution is often associated with international trafficking, Estes and Weiner (2002) showed that this is only
one aspect of child prostitution. Estes and Weiner (2002) suggest
that as many as 244,000 American youth are at-risk of commercial
sexual exploitation each year. In a national survey of nongovernmental and governmental organizations conducted in
1999, 3171 cases of child sexual exploitation were identified
and 901 of these cases were CSEC prostitution. In this subsample,
approximately 25% (224) of prostitution cases occurred while the
child was living at home, 59% (532) of the children participated in
local sex rings run by pimps and 16% (145) engaged in national sex
prostitution rings (Estes & Weiner, 2002). Estes and Weiner (2002)
identified 17 U.S. cities known for the presence of high child sexual
exploitation and prostitution. These cities included Chicago,
Dallas-Fort Worth, Detroit, El Paso, Honolulu, Las Vegas, Los
Angeles, Miami, New York, New Orleans, Oakland, Philadelphia,
San Antonio, San Diego, San Jose, San Francisco and Seattle.
Because very little is known about child prostitution in the
United States, reporting inconsistencies have prevented accurate
312 R. Fong, J. Berger Cardoso / Evaluation and Program Planning 33 (2010) 311–316
national estimates of commercial sexual exploitation and trafficking of children domestically. However, conservative measures
indicate that between 300,000 and 400,000 children are exploited
through prostitution in the United States each year (Spangenberg,
2001; Willis & Levy, 2002).
Children who live close to international borders have an
increased risk of being trafficked across international boundaries.
Estes and Weiner (2002) estimate that between 10 and 15% of
homeless and street children are trafficked through national and
international networks; this estimate includes both U.S. born and
foreign born children. Small groups of organized criminals and
large national and international trafficking networks are responsible for transporting children across state and international
boundaries. They use well developed networks of people that
recruit, transport, enforce and organize sex rings involving
children (Estes & Weiner, 2002).
Although previous studies of international victims of human
trafficking indicate similar patterns between male and female
victims, studies conducted with prostituted youth in the United
States show patterns that differ by gender. Previous studies have
shown that female youth in the United States experience a greater
risk of commercial sexual exploitation than males (Boxill &
Richardson, 2007; Estes & Weiner, 2002). Male prostitutes are
often older, act independently of pimps and organized crime
leaders, and prostitute in public areas (Boxill & Richardson, 2007).
These differences are likely to decrease the incidences of violence
inflicted on male prostitutes.
In contrast to the typical picture of at-risk youth, a study in
Atlanta found that not all children forced into prostitution were
runaway, homeless or delinquent youth. In a study using Fulton
County Juvenile Court Records, Boxill and Richardson (2007) found
many of the girls forced into prostitution in Atlanta were
kidnapped or lured from public places, such as movie theaters,
schools, bus stops and shopping malls. After years of victimization,
many of these girls looked similar to child prostitutes from abusive
backgrounds despite their circumstances and different means of
entry into prostitution. Boxill and Richardson (2007) found that
these children were frequently involved in the juvenile justice
system and their behavior criminalized. As a result, their
abductions and long histories of physical and sexual abuse were
ignored (2007).
Many juvenile victims of sexual exploitation are funneled
through the juvenile justice system. They are often arrested on
charges of prostitution or illegal work. Similarly, as many as 38,000
children are deported from the United States each year, some of
whom may be victims of human trafficking (Shared Hope
International et al., 2006). In part, this is a function of the
insufficient cooperation between non-profit organizations and
governmental organizations.
5. Child sexual abuse
International studies estimate that 25% of children around the
world experience sexual abuse, physical abuse or domestic
violence (Cohen & Mannarino, 2008). Rates of sexual abuse in
the United States are higher than international estimates of abuse.
In North America several studies show that 30–40% of female
children and 13% of male children experience sexual abuse (Bolen
& Scannapieco, 1999; Briere & Elliott, 2003; Corcoran & Pillai,
2008). Moreover, the U.S. Department of Justice estimates that
juvenile victims comprise 12% of crimes and 71% of all sexual
crimes reported to police (Finkelhor & Ormrod, 2000). While there
is an abundance of literature on the short- and long-term impact of
child sexual abuse, there is less information about evidencedbased treatment modalities that successfully decrease the impact
of this trauma (Lev-Wiesel, 2008). Due to the growing prevalence
of child sexual abuse in the United States, there is a dire need for
effective treatments that reduce the consequences of sexual
trauma on children and families.
In the aftermath of child sexual abuse, children with exposure
to trauma typically experience affective, behavioral and cognitive
problems (Cohen & Mannarino, 2008). Previous research consistently demonstrates the negative impact of child sexual abuse on
child and adult mental health outcomes. In a recent study of such
abuse victims, Spatato, Mullen, Burgess, Wells, & Moss (2004)
found increased incidences of acute anxiety and stress disorders,
affective disorders, conduct disorders and personality disorders.
Other mental health problems may include acute post-traumatic
stress symptoms, low self-esteem, suicidality, poor academic
achievement, substance abuse, disassociation and poor interpersonal relationship quality (Cohen & Mannarino, 2008; Corcoran &
Pillai, 2008).
6. Child sexual abuse and child welfare
Child sexual abuse is an umbrella term for children or youth
who are domestic or international victims of commercial sexual
exploitation, child prostitution, or sexual abuse done by a single
perpetrator who was a family member, familiar adult, or stranger.
However, due to eligibility restrictions not all of these forms of
sexual abuse fall under the jurisdiction of the public child welfare
system. For child protective services to become involved with the
case, the perpetrator of sexual abuse needs to be responsible for
the care and custody of the child.
In 2006, the United States Department of Health and Human
Services Administration on Children, Youth, and Families (ACYF)
reported 8.8% of children in ACYF custody were removed from their
original homes because of sexual abuse. The percentage of children
sexually abused varied by age (U.S. Department of Health and
Human Services, 2006). For child victims ages 4–7, approximately
8.2% of children were in care because of sexual abuse. This
percentage dramatically increased for older children ages 12–15.
ACYF (2006) reports 16.5% of children in this age group were
removed because of sexual abuse (U.S. Department of Health and
Human Services, 2006).
The determination of abuse following a CPS investigation was
determined by multiple factors. In 2006, ACYF published the Child
Maltreatment Report. Findings from this report suggest that
children who were alleged to have experienced multiple forms
of abuse (combination of neglect, sexual and physical abuse) were
four times more likely to be considered a victim of abuse than
children who were alleged to have experienced physical abuse.
Similarly, children who experienced sexual abuse were twice as
likely to be considered a victim of abuse as children who
experienced physical abuse. The likelihood of being considered a
victim declined the older the child was at the time of the crime
(U.S. Department of Health and Human Services, 2006). Finally,
data from 36 states indicated that children who were prior victims
of maltreatment with 96% more likely to experience a future
incidence of abuse than children who were not prior victims.
The federal government directs money to the state and local
communities through several funding sources. While the federal
government provides most of the funding for preventative and
post-investigative services, state and local governments determine
who will receive the resources. Nationally, nearly 60% of child
victims received post-investigative services (U.S. Department of
Health and Human Services, 2006). Children who were victims of
multiple forms of maltreatment and neglect were more likely to
receive treatment than children who were physically abused.
Similarly, children who were sexually abused were less likely to
receive services. Moreover, younger children and children abused
by at least one parent were more likely to receive services than
R. Fong, J. Berger Cardoso / Evaluation and Program Planning 33 (2010) 311–316 313
older children and children not abused by a parent (U.S.
Department of Health and Human Services, 2006).
Recent studies using a national sample of children in child
welfare yielded similar results when examining mental health
services. Children who come into contact with the child welfare
system are more likely to receive mental health treatment than
children in the general population (Burns et al., 2004; Farmer et al.,
2001). Burns et al. (2004) estimated that over one half of children
in the child welfare system have emotional or behavioral
problems. Despite the large demand for mental health services,
only about one-fourth of children with severe mental health needs
received services (Burns et al., 2004). For children who did receive
services, in-patient hospitalization was the least common treatment approach (3.1%) compared to out-patient mental health use
(15.1%). Finally most out-patient services occurred in clinic or
office settings. However, in-home treatment was still a popular
treatment option for these youth (Burns et al., 2004).
Although information about sexual abuse and child maltreatment is available in national publications from the Administration
on Children, Youth, and Families, the publications lack information
about child victims of human trafficking and commercial sexual
exploitation. To collect this information and fill the gap, public
child welfare administrators need to change their practices to
include assessment categories on intake and investigation forms.
More information is also needed about the circumstances under
which the sexual abuse occurred. Child victims of human
trafficking have experienced a form of sex slavery and assessment
tools need to be able to reflect this trauma. Program planning
should include mandatory out-patient mental health services, with
public child protective services case managers collaborating with
private agencies equipped to work with human trafficking victims.
7. Treatment and services for domestic and international child
human trafficking
Domestic and international victims of human trafficking are
typically not eligible for services until they have been officially
classified as victims of trafficking. This has often been a hardship
for governmental and non-governmental agencies, who do receive
funding for services until this classification status is achieved. Once
sexually exploited youth have been identified, there are few secure
shelters and treatment programs that can aid in rehabilitation and
reintegration. Moreover, many shelters and treatment programs
do not provide services specific to sexually exploited youth.
Although there are few safe shelters for international victims of
human trafficking, there are even fewer places for domestic victims.
In part, this is becausefunding oftenfocuses on international victims
(Shared Hope International et al., 2006). As a result, many youth are
housed in juvenile detention centers and in cases of domestic
trafficking, victims can be placed in the custody of state child
protective service (CPS) agencies (Shared Hope International et al.,
2006). Some state CPS agencies, like in the case of Florida, have
contributed to the identification of child victims by training intake
and emergency workers to screen for child sexual exploitation.
However, this process has not been adopted by all state child welfare
agencies. In the case of Florida, involvement for CPS has led to an
increase in the number of identified victims of trafficking (Shared
Hope International et al., 2006).
Child and adult victims of human trafficking qualify for a wide
range of services under the Trafficking Victims Protection Act and
are eligible for the T-visa. Under the T-visa, a victim can remain in
the United States, obtain legal work authorization and qualify for
public assistance programs. After three years, victims are eligible
to become a permanent legal resident (United States Department
of Health and Human Services & Administration for Children and
Families, 2009b). Although child and adult victims of human
trafficking receive similar benefits under TPVA, there are several
differences in how services are provided to these two populations.
The primary difference between adult and child victims of
trafficking is that children are not obligated to work with federal
law enforcement and prosecution in order qualify for public
benefits and immigration relief provided under the T-visa
(Bridging Refugee Youth and Children’s Services & U.S. Conference
of Catholic Bishops/Migration and Refugee Services, 2009).
Since child victims of trafficking are often present in the United
States without parental or legal guardianship, these children are
classified by the Office of Refugee Resettlement as Unaccompanied
Refugee Minors (URM). Children who enter the URM program are
placed in federal foster care and are eligible for a wide range of
benefits, including mental health treatment, medical care, educational services, legal representation, intensive case management,
and independent living. Lutheran Immigrant and Refugee Service
(LIRS) and the United States Conference of Catholic Bishops
(USCCB) are two voluntary agencies that assist the ORR and URM
program with victim identification, foster care placements and
training, research and evaluation in the area of child trafficking
(United States Department of Health and Human Services &
Administration for Children and Families, 2009c). These programs
are located in cities across the United States, including Phoenix,
San Jose, Denver, Washington, DC, Miami, Boston/Worchester,
Lansing, Grand Rapids, Jackson, Fargo, Rochester, Syracuse,
Philadelphia, Dallas, Houston, Salt Lake City, Richmond, Tacoma
and Seattle.
In the American child welfare system, public child welfare
workers depend on licensed private therapists and providers who
are knowledgeable in treating child sexual abuse but who struggle
with the treatment modalities available for child victims of human
trafficking because of the poor ‘‘best practice’’ fit. Despite the
existing knowledge about the short- and long-term impacts of
child sexual abuse, few treatment modalities for this population
have been rooted in evidenced-based practice. Lev-Wiesel (2008)
argues that many of the treatment models used with child sexual
abuse survivors were actually developed for individuals with PTSD.
Individual, family and group therapy are the most common
treatment modalities. For child victims of human trafficking and
prostitution, family and group therapy treatment would be
problematic. These children seldom have family members who
can attend therapy with them. Human trafficking victims often
have extra needs for anonymity in group therapy and fear that
family members may be harmed because traffickers use death
threats to enforce compliance.
Private practitioners and public child welfare workers need to
determine if the treatment modalities are appropriate for this
different population of child sexual abuse cases. Within individual,
family, and group therapy are several different types of therapeutic
models. Many models aim to accomplish at least one of four goals:
symptom reduction, destigmatization, increasing self-esteem and
self-concept and prevention of future abuse (Lev-Wiesel, 2008).
Trauma-focused cognitive behavioral therapy (TF-CBT) is one of
the few treatment models that have been tested in random-control
trials with child sexual abuse survivors. It was developed to treat
symptoms of PTSD, depression, anxiety and/or behavioral problems (Cohen & Mannarino, 2008). This model conducts individual
treatment and joint parent–child therapy sessions. The model is
centered on building client education about sexual abuse and
trauma, parental involvement, relaxation skills, affective and
emotional regulation, coping skills, trauma-based narratives,
desensitization and gradual exposure and safety planning. This
is an example of a treatment model that needs to be modified by
program planners in child welfare, mental health, and education
who work with child victims of human trafficking. Because
parental involvement, trauma-based narratives, and gradual
314 R. Fong, J. Berger Cardoso / Evaluation and Program Planning 33 (2010) 311–316
exposure may prove to be problematic for this clientele,
modifications need to be made to assure that practices allow
victims to be empowered and to receive supportive and culturally
appropriate treatments.
8. Challenges and successes
A plethora of barriers in child welfare and other public systems
impede the identification of children who have been sexually
abused. To tackle victim identification, public child welfare
workers and social service providers need to work closely with
juvenile detention facilities, court system, emergency shelters, and
school social workers (Boxill & Richardson, 2005). Until recently,
these entities were completely unaware that U.S. children were
being exploited for commercial sex. While awareness of the issue is
still lacking, successful programs in New York and Atlanta have
helped draw national attention.
Few treatment and social service programs are equipped to
address the complex needs of children who may have experienced
torture, rape, drug abuse, trafficking and physical abuse. In
addition, many of these young women and men must grapple
with the stigma and shame surrounding their experience. In 2007,
Boxill and Richardson published an article about their experience
with a treatment program for women of commercial sexual
exploitation and prostitution in Atlanta, Georgia. Angela’s House is
a therapeutic treatment community for young girls leaving
prostitution. During the initial assessment period, each girl
receives in-depth psychological, cognitive, social, physical and
familial assessments. Girls receive home schooling and medical
and mental health services while in the program.
Angela’s House implements a therapeutic treatment model
called Multisystemic Therapy (MST). Research on MST has been
conducted by the National Institute of Health and has been
validated as an effective treatment model for decreasing recidivism and psychiatric hospitalization (Henggeler, Melton, Brindino,
& Schere, 1997; Henggeler, Melton, & Smith, 1992; Littell, 2005).
Using a socio-ecological framework (Multisystem Treatment
Services, 2007), this therapeutic model uses intervention components from strategic and structural family therapy, problemfocused therapy, and cognitive behavioral therapy (Littell, 2005).
The emphasis in on the relationship between the individual youth
and the family, peer group, school, community and juvenile justice
systems (Multisystem Treatment Services, 2007). The goal of MST
is to build social assets by improving strength and protective
factors through healthy and strong relationships and supports
(Multisystem Treatment Services, 2007). This treatment model is
usually disseminated using a team of therapist, clinical psychologists and psychiatrists (Littell, 2005). The treatment is also
typically provided in an environment natural to the youth (home,
school, community, etc.) and usually lasts for approximately four
months. Although successful with domestic victims of sexual
prostitution, using MST with international victims of sexual
human trafficking warrants caution because of the need to assure
the understanding of cultural equivalents in therapeutic modalities.
The Girls Educational and Mentoring Services (GEMS) is another
successful program. GEMS is one of a very few programs in New
York City that focuses on the needs of sexually exploited youth and
children (Girls Education & Mentoring Services, 2008). GEMS
provides prevention and outreach to youth on the streets of New
York, intervention services through case management, independent living, court advocacy and individual and group counseling,
and youth development. In addition to providing services to
children and youth exploited in sexual commerce, GEMS offers
training to other organizations serving this population (Girls
Education & Mentoring Services, 2008).
9. Practice and policy recommendations
Administrators, program planners, and evaluators need to
recognize that there is a population within the domain of the
public child welfare sexual abuse caseload, that warrants special
attention. Child victims of human trafficking are survivors of sex
slavery and have been through experiences similar to other
children in prostitution. Both have experienced coercion and a
large number of abusers. Human trafficking victims, however, may
experience a greater variety of traumas because they may come
from international backgrounds. Child protective service workers
and social service providers who neglect the cultural component
may aggravate, rather than relieve, the emotional and psychological damage done.
Organizational practices and polices need to be examined for
child welfare assessments to appropriately capture the enormity
of trauma child victims of human trafficking have experienced and
accurately identify the treatment needed. Standard treatments of
individual, family, and group therapy for child sexual abuse,
which child protective workers use for referrals, may not be
appropriate. Family members may not be available and group
work may require extra sensitivity to the victims’ fear of exposure,
lack of anonymity, and fear of deadly harm to family members
abroad.
Child welfare agencies need to partner with successful
treatment programs in private agencies that work with the
commercial sexual exploitation of children. Together, they need to
identify successful program components and adapt the practices to
their systems. Because of the diverse backgrounds of child human
trafficking victims, culturally competent practices, such as
respecting cultural norms and tradition, and policies that dignify
the victims also need to be established in public child welfare
agencies to enhance well-being and empower the victims.
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Dr. Rowena Fong is the Ruby Lee Piester Centennial Professor in Services to Children
and Families at The University of Texas at Austin. Author of over 100 publications,
including 5 books, Dr. Fong’s areas of research and scholarship are victims of human
trafficking, child welfare, international adoptions, and culturally competent practice.
She is the President -elect for the Society for Social Work and Research and the
recipient of the Council on Social Work Education 2008 Distinguished Recent Contributions Award. Dr. Fong has conducted trainings nationally and internationally and
has worked with immigrant and refugee populations in Boston, Massachusetts;
Honolulu, Hawaii; San Francisco, CA; and Austin, Texas.
Jodi Berger Cardoso is a third year doctoral student at the University of Texas at
Austin, School of Social Work. She has international practice experience with Latinos
and has co-authored an article on ‘‘Mexican American Youth: The impact of Generation
and Gender on Outcomes in Young Adulthood’’ to be published with the Journal of
Immigrant and Refugee Studies.
316 R. Fong, J. Berger Cardoso / Evaluation and Program Planning 33 (2010) 311–316
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