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__________________. Presentation- Brief Overview Overview and Definitions Background- International and U.S. Recovery and Care of Survivors Good practices.

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Presentation on theme: "__________________. Presentation- Brief Overview Overview and Definitions Background- International and U.S. Recovery and Care of Survivors Good practices."— Presentation transcript:

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2 Presentation- Brief Overview Overview and Definitions Background- International and U.S. Recovery and Care of Survivors Good practices around the world Clinical approach in the public health setting Ongoing initiatives for prevention

3 T RAFFICKING Trafficking is the illegal trade in human beings for the purposes of commercial sexual exploitation and forced labor Trafficking is consistent with international definitions and protocols with slavery

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5 UN TRAFFICKING PROTOCOL DEFINES HUMAN TRAFFICKING AS: Recruitment, transportation, transfer, harboring, or receipt of person by means of threat, force, or other forms of coercion, fraud, or deception

6 The consent of the victim is irrelevant whenever any of the “means” of trafficking are used. A child cannot consent. Abuse of a position of vulnerability refers to any situation where the person involved has no reasonable or acceptable alternative but to submit to the person involved. TRAFFICKING DEFINITIONS and BACKGROUND

7 Fastest growing criminal industry in the world, tied with illegal arms trade and following the drug trade Revenue may be between USD $5 billion and $9 billion

8 Council of Europe says trafficking has reached epidemic proportions over the last decade UN estimates 2.5 billion people are now trafficked in 127 different countries Statistics may be misleading, total unknown

9 Trafficking for sexual purposes May be found in dire circumstances and easily targeted Majority of trafficking is for sexual purposes Homeless, refugees, substance addicted, runaway teens, displaced homemakers, those in conflict areas, but victims are exploited from any ethnic and social background Close connection with pornography, sex tourism

10 Gender of trafficking for sexual purposes Girls 80% Boys 20% Research into gender - based differences in consequences is incomplete. Preliminary data has suggested notable differences.

11 Mongolia : Trafficking is an emerging phenomenon. Primary targets of trafficking schemes are young middle class girls and women, ranging in age from 14 years to the mid-20s. They are often lured abroad by offers to study or work. Transit country for trafficking between China & Russia. Thailand : Much of cross-border trafficking in SEA involves Thailand. Burmese children make up the largest number of trafficked children into Thailand. Trafficking of boys into the fishing industry in the South is rife and unchecked.

12 China Women from Myanmar, Lao PDR, North Korea, Vietnam and Russia are trafficked to China for the purposes of prostitution or are forcibly married to Chinese men. Chinese women are also trafficked to other countries such as Malaysia, Burma, Taiwan, and Australia. Japan Many women are trafficked to Japan for work in the sex industry, from countries as varied as the Philippines, Taiwan, Cambodia, Hong Kong, Thailand, Costa Rica, Sri Lanka, Ukraine and Russia. Reported that a significant number are under 18 years of age

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17 Trafficking Patterns in the U.S.

18 ECPAT International U.S. one of largest producers, distributors, and consumers of child pornography Source country for child sex tourism Vast majority of sexually exploited children are stigmatized and trivialized by law enforcement system. Victims often treated as offenders and not victims Convention on the Rights of the Child (CRC) not yet ratified in U.S.- only one of two countries who have not done so (other country- Somalia)

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20 Of the 45,000 to 50,000 victims that are brought to the U.S.A.: 30,000 come from Asia- primary countries are China, Thailand, and Vietnam 10,000 from Latin America 5,000 from other countries, including the former Soviet Union, Romania, Africa 14,500 to 17,500 are children

21 TRAFFICKING Children- Commercial Sexual Exploitation of Children (CSEC) “… as many as 300,000 American youth may be at risk of commercial sexual exploitation at any time. Especially vulnerable are homeless and runaways.” Univ. of Pennsylvania, 2001, School of Social Work Study

22 Nationally 450,000 children run away from home each year. 1 out of every 3 teens on the street will be lured toward prostitution within 48 hours of leaving home. Statistically, this means at least 150,000 children lured into prostitution each year.

23 TRAFFICKING USA Miami Fl Portland OR Las Vegas NV Toledo OH Houston, TX

24 Federal Crime- penalties up to life Cases of human trafficking in all 50 states Children, adults, U.S. or foreign nationals, male or female Advocacy and specialized agencies to care for victims is increasing

25 AFTERMATH OF HUMAN TRAFFICKING FOR SEXUAL PURPOSES ON VICTIMS AND THEIR FAMILIES

26 Common experiences of victims Physical and emotional trauma Prolonged Humiliation Violence Degradation Unrelenting fear and abuse Profound violation of human rights

27 Consequences: Commercial sexual exploitation is the most damaging form of abuse because it includes almost all forms of abuse-  Physical  Sexual  Psychological Incorporates elements of many crimes including kidnapping, assault, battery, and others on a daily basis

28 Associated factors that may increase vulnerability: Relationship with early environment Child and family risk factors- dysfunction, etc. Extreme poverty Gender inequality Substance abuse Myths Community attitudes All contribute to vulnerability

29 Consequences Educational deprivation and deficits Physical health problems- health, diet, beatings, lack of.. inter alia.. health care, hearing, vision, HIV/AIDs, tuberculosis, STD’s, skin infections, dental, etc.

30 Emotional Relationship with families Depression, hopelessness Guilt, shame, flashbacks Nightmares, loss of confidence, self-esteem Anxiety, relationships, behavioral problems, assertiveness

31 Consequences Behavioral  attachment  mistrust of adults  sexualized behaviors  antisocial behaviors

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33 Essential Components of Comprehensive Care Access to appropriate referrals - law enforcement, medical, psychiatric, etc. Trained staff - essential element, often requires outside training opportunities Establish basic trust

34 Essential Components of Care – International Emergency shelters Transit Centers Short term shelters Long term shelters

35 Caring for Victims Medical Care Appropriate physical exams Basic blood work HIV/AIDS and STD Treatment for substance abuse GYN exams as appropriate Nutrition, hygiene, dental Referrals for complex medical needs

36 Vocational Training Basic reading, writing, and numeracy Business skills Formal primary, secondary, and post- secondary education Collectives, self-generating incomes

37 Caring for Victims Educational Services Preparation and attainment of competency skills to integrate into educational system Remedial education and Accelerated Learning Programs (ALP) Inclusive learning for physical or intellectually challenged

38 Caring for Victims Educational Services Preparation for state examinations, high school and college entry exams, or skills required for trade schools Ability to detect learning disorders and provide available referrals and resources

39 Caring for Victims Psychosocial care Controversy exists about individualized therapy Family and community liaison where possible Integration of community-centered approaches Group supportive, solution - oriented therapy

40 Essential Components of Caring for Victims Psychosocial care Preparation for re-integration Cognitive restructuring and reframing- move to multi-dimensional self identification Opportunities for accessing local traditions, customs, and beliefs

41 Caring for Victims Psychosocial care Mental health referrals available for severe pathology Life Skills training – now seen as an integral component

42 Caring for Victims Psychosocial care Support healthy defenses, explore and support hidden skills and talents Integrate spiritual beliefs and traditional healing practices Problem – solving skills Family counseling and therapy

43 Caring for Victims Barriers Community attitudes and beliefs Pre-existing family dysfunction Relapse common Weak law enforcement Blaming the victim Severe emotional trauma (often dependent on age and duration of abuse)

44 Good Practices and Programs International

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46 Founded in 1987 and formally registered in 1989, SANLAAP is a non-government development organization SANLAAP works to prevent human trafficking and to prevent second- generation prostitution.

47 Founded by Indrani Sinha, Sanlaap means “dialogue” Runs four shelters around Kolkata, caring for an average 200 girls Most girls are victims of sexual abuse and trafficking. Large HIV+ population Comprehensive program, including self defense training, textile shop, bakery, and small contracts for hand-woven stationery products. This has provided some self- generating income

48 Examples Sanlaap-India

49 Examples Sanlaap-India Integrated into residential communities with no demarcating signs Counselors trained by volunteers, local NGOs, and international agencies Teaches girls how to navigate “systems”, including legal actions, police, social welfare, and health Encourages advocacy, involved in research

50 Examples Outreaches to red-light districts to offer rescue and services Outreaches also are made with the purpose of learning from sex workers to plan future interventions based on current grooming or trafficking trends

51 Examples Dhaka Ahsania Mission (Bangladesh) Operates a long term shelter whose primary objective is to return the victim to social and family life Offers trained psychosocial counseling, along with mandatory literacy and vocational programs Has local linkages that allow access to micro- credit opportunities Requires an adequate period of family reintegration counseling before a girl can return to her community

52 Examples Good Samaritan Association (Addis Ababa, Ethiopia) Long term shelter “Center for Trafficked Women” for Ethiopian women trafficked abroad Offers psychosocial and vocational counseling and programming Teaches victims to drive, perform intricate leather work, and photography

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54 Examples MAIS DOMINICAN REPUBLIC Priorities are to help children stay in school, promote child participation in issues that concern them, and prevent the abuse and mistreatment of children, including commercial sexual exploitation. Movimiento Para el Autodesarrollo Internacional de la Solidaridad (MAIS) de Puerto Plata

55 Examples MAIS DOMINICAN REPUBLIC Provides skills training for heads of families to improve income Reduce vulnerability of recruitment Decrease children’s need to work and that impacts on school performance Learning Deficits- ADHD Movimiento Para el Autodesarrollo Internacional de la Solidaridad (MAIS) de Puerto Plata

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57 Examples Swift Wash: An industrial laundry as an economic alternative for victims of prostitution

58 Examples Swift Wash- Goa, India The goal of the Swift Wash laundry, launched in 2006, is to provide support and guidance to former victims for social integration.

59 l Swift Wash- Goa, India Group of former sex workers united to create self- generating business Raised funds for laundry machines, dryers, ironing, steaming, and dry cleaning, vehicles to pick up and deliver, and advertising Initial group of 200 women obtained support from local and international NGOs, and now run the company Former sex workers and trafficking victims are hired as employees Laundry now works 24/7, picks up at home, cleans and irons at workshop, and delivers clothes back within 24 hours

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61 Examples Youth Partnership Project Nepal, Bangladesh, India

62 Survivors of commercial sexual exploitation that empowers and builds capacity of experiential youth to take the lead in the fight against CSEC Bangladesh, India, Nepal Peer support projects in high risk areas Trained in media and advocacy skills Peer psychosocial care

63 Established for the large numbers of children trafficked in South Asia Estimates India 350,000 Nepal 40,000 Bangladesh 29,000

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65 Caring for Victims of Sexual Trafficking Clinical and Public Health Settings

66 Awareness Raising Briefings and sharing information on sexual trafficking for staff Identification of “red flags” to identify potential victims Available resources including government and state agencies Identification of possible referrals

67 Potential Red Flags : Severe indebtedness with no out Unable to leave a job Inability to leave a situation Isolation from support systems Unaccounted for history, especially if from a known conflict zone No ID, driver’s license, passport

68 Potential Red Flags: Adolescents not in school Expensive jewelry or large amounts of cash Cell phones or other items not paid for by parents or family Has hotel keys Multiple unaccounted for STD’s Inconsistent stories

69 Potentially More vulnerable (reasonable and balanced approach) : From developing countries where jobs are scarce Children/teens involved with CPS, foster care, or criminal justice Severe impoverishment Sudden change in financial status

70 Management of Victims in Health and Mental Health Settings Consider links to trafficking agencies Victims often do not disclose, or may be very reluctant to provide details. Often great shame and guilt Balancing act between clinical symptoms and respect for privacy Awareness of cultural sensitivities and meanings

71 Management of Victims in Health and Mental Health Settings Comprehensive International programs may be instructive: Trust- be aware of own judgments Psychosocial integration with a community Survivor groups, family counseling, individual counseling, education and skills training, advocacy, cognitive reshaping, substance abuse treatment

72 Management of Victims in Health and Mental Health Settings Evidence based practices for victims rest on common components such including PTSD, non-commercial sexual abuse treatment, and establishment of an effective and trusting therapeutic alliance

73 Management of Victims in Health and Mental Health Settings PTSD SYMPTOMS Percentage of PTSD symptoms endorsed by trafficked women : Recurrent thoughts/memories of terrifying events75% Feeling as though the event is happening again52% Recurrent nightmares54% Feeling detached/withdrawn60% Unable to feel emotion44% Jumpy, easily startled 67%

74 Management of Victims in Health and Mental Health Settings PTSD SYMPTOMS Percentage of PTSD symptoms endorsed by trafficked women: Difficulty concentrating 52% Trouble sleeping67% Feeling on guard64% Feeling irritable, having outbursts of anger 53% Avoiding activities that remind them of the traumatic or hurtful event 61% Inability to remember part or most of traumatic or hurtful event 36% Less interest in daily activities 46% Feeling as if you didn’t have a future 65% Avoiding thoughts or feelings associated with the traumatic events 58% Sudden emotional or physical reaction when reminded of the most hurtful or traumatic events (Zimmerman et al., 2006) 65%

75 Management of Victims in Health and Mental Health Settings “Complex Trauma” “ a type of trauma that occurs repeatedly and cumulatively, usually over a period of time and within specific relationships and contexts”

76 Management of Victims in Health and Mental Health Settings “Complex Trauma” Victims suffering from complex trauma often experience depression, anxiety, self-hatred, dissociation, substance abuse, despair, and somatic ailments. Individuals exposed to this type of trauma are also at heightened risk for self-destructive and risk-taking behaviors as well as re-victimization, and tend to experience difficulty with interpersonal and intimate relationships

77 Management of Victims in Health and Mental Health Settings Most commonly seen disorders in trafficking victims: Anxiety disorders (including PTSD) Mood disorders Dissociative disorders Substance related disorders

78 Management of Victims in Health and Mental Health Settings Cognitive Behavioral Therapy Restructuring, guilt, shame, being responsible for events Realistic assessment of talents, capacities, and human value

79 Management of Victims in Health and Mental Health Settings Group Therapy Provides support, peer influence, and focuses on relationships Group focuses on relationships, common issues, and coping skills

80 Management of Victims in Health and Mental Health Settings Family Therapy When possible, family therapy would be the “therapy of choice” Family therapy is more effective when approached in a traditional social work framework, meeting many needs

81 Management of Victims in Health and Mental Health Settings EMDR Because of research from PTSD Substance abuse- needs to tie event and consequences, rather than just consequences Mood and anxiety disorders- standard treatment approaches, but meds and therapy combined

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83 Please see handout for detailed list of resources REPORTING: - Local police - 24/7 toll free Human Trafficking Resource Center Children- National Center for Missing and Exploited Children hotline THE-LOST

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85 Thank you Thomas G. Shafer, RN, MA Psychiatric Counselor College of Brockport State University of New York

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