1. Domestic Minor Sex Trafficking
Matt Baldock, Deputy Prosecuting Attorney
Paula Skomski, ARNP, SANE-A

2. Objectives Define Domestic Minor Sex Trafficking
State the forms and prevalence of DMST within the U.S.
State the prevalence of DMST locally and regionally
State risk factors for victimization
Identify characteristics of trafficked youth
Describe how to intervene and refer for services

3. What is it?
Commercial Sexual Exploitation of Children (CSEC) generally refers to the sexual abuse of minors for economic gain.
Prostitution
Production of pornography
Drug dependence
“Survival sex”

5. Scope of Problem
100, ,000
American children are victims of Domestic Minor Sex Trafficking (DMST) at any given time annually.
(U. S. Department of Justice, 2010; National Institute of Justice, 2007; Shared Hope International, 2009)
Domestic Minor Sex Trafficking is one form of human trafficking and according to the U. S. Department of Justice (DOJ, 2010), the National Institute of Justice (NIJ, 2007) and Shared Hope International (2009), conservative estimates state there are at least 100,000, and possibly up to 300,000 American children who are victims of Domestic Minor Sex Trafficking (DMST) at any given time annually.

6. Scope of the Problem
Seattle/King County : Estimates 300 – 500 (Boyer, 2008)
Snohomish County: Estimates 30-50
No good empirical data: This is improving with local agencies now tracking victim contacts
Up to 70% of street youth are CSEC victims (Greene, Ennett, and Ringwalt)
Numbers are estimates because girls are frequently moved in and out of the area. These numbers only indicate the numbers of girls on the streets and do not take in to consideration girls being trafficked out of or in their homes, or being trafficked through pornography. The circuit that local girls are frequently moved around includes California, Arizona, Nevada, Oregon, Idaho and Washington.

7. The Victims
13 years old is average age when victims first introduced into to commercial exploitation
Targeted
Runaways or “throwaways”
Prior abuse
Mostly female

8. 48 admitted victims
27 between 15 and 18 years old

9. “The juvenile prostitute is not seen by society as a worthy victim, while the sexually-abused child is. We must realize they are one and the same.”
Identifying and Combating Juvenile Prostitution
Nat’l. Assoc. of Counties, Inc.
1987

10. The Paradigm Shift
Prostitute
VICTIM
Defendant
Runaway
Street Kid

11. The Law in Washington Trafficking Commercial Sexual Abuse of a Minor
Class A Felony, 8-18 years
Commercial Sexual Abuse of a Minor
Class B Felony, 2-10 years
Promoting Commercial Sexual Abuse of a Minor
Class A Felony, 8-26 years

12. The Law Enforcement Approach
Multi-Disciplinary Model
Advocacy
Medical Care
Housing/shelter
Counseling

13. Risk Factors History of sexual abuse Runaways Foster Care
This is the number one risk factor
Runaways
Foster Care
Low Self Esteem
Living in high crime areas
Poverty
Any young person is potentially at risk of being manipulated by a pimp or trafficker but runaway youth are at the highest risk.
Another factor that increases a girls’ risk for being trafficked is a history of childhood sexual abuse, it is estimated that as many as 90% of trafficked girls were sexually abused prior to becoming involved in prostitution (Leitch & Snow, 2010; Lloyd & Orman, 2010; Smith, et al., 2009; HHS, 2007).
Another risk factor is placement in foster care. Familial disruption destroys stability and being placed into foster care significantly increases the likely hood of DMST by some estimates as much as 78% (Coy, 2009; HHS, 2007)
Other risk factors include low self esteem, living in areas of high crime, poverty, lack of education and lack of employment opportunities

14. Additional Risk Factors
Walk to school or to the store alone
Own or have access to a computer
Are attracted to consumer goods
Desire to develop romantic relationships
Feel misunderstood
Fight with their parents
Sometimes feel their parents don’t care
Want more independence
Test boundaries and take risks
(GEMS, 2009)
Shopping malls, parks, and our schools are common areas where girls are targeted. All behaviors common to teens.

15. Entry to DMST Seduction and coercion Peer recruitment
Internet enticement through chat rooms, social networking, or profile-sharing sites
False advertising for “modeling,” “acting,” or “dancing” opportunities
Violence and force
Parents selling children
Kidnapping
(GEMS, 2009)
How do young girls get involved in DMST? There are multiple entry pathways which add to the complexity of this problem as there is no one prevention measure that may be effective. While kidnapping is often thought of the most common cause, it is actually more typical with foreign cases.

16. Recruitment Befriend potential victim Offer gifts, shelter, protection
Develop trust
Isolate from family and friends
Develop sexual relationship
Manipulate into sex with friends
Sells her to others
Gang involvement
Lured in by “The Man, The Money or The Life”
(Shared Hope International, 2010; Smith et al., 2009)
Traffickers hang out where kids hang out; parks, malls, and schools. They target vulnerable young girls/boys and begin conversations to learn their weaknesses then they begin to fill those voids by offering gifts, shelter or protection to gain her trust. They may send one of their girls to do their recruiting because often girls will trust another girl rather than a guy. This behavior quickly moves to isolating the girl from her family and friends.

17. Identifying DMST Youth
Talk of a much older boyfriend
Money, cell phones, make-up, nails, hair that isn’t explained
Tattoos
Visible signs of abuse
Transformation of physical appearance
Lack of ID or false ID
Staying in motels or having motel keys
Travel/Vacations to other areas
Sexually explicit online profile
Language

20. Needs of DMST Youth Safety Housing Health care Counseling Education
Legal Assistance
Re-integration
(Boyer, 2008; Choi, et al., 2009; Clawson, 2010; Leitch & Snow, 2010; Lloyd & Orman, 2010; Logan, et al, 2009; Mukasey, et al., 2007; NCMEC, 2002; Scott & Harper, 2006; HHS, 2011; Zimmerman, et al., 2008)

21. Interacting Provide a safe environment Address immediate needs
Don’t be judgmental
Gain trust and confidence
(GEMS, 2009; Shared Hope International, 2010; Smith et al., 2009)
Now that you have identified a potential trafficking victim, what do you do? First of all make sure that the environment for conversation is safe for the girl and for you. Show an interest in her well being and do not judge her decisions or behaviors. Ask what her immediate needs are and what you can do for her right now. Don’t be offended if she is not cooperative, hostile or is not ready to leave her trafficker. Establish trust by reassuring her that you will be there if she needs anything.

22. I am not a victim!
There is a psychological bond between the pimp and the victim called trauma bonding (Stockholm Syndrome)
The result is
Failure to self-identify as a victim
Repeated returns to pimp
Denial of violence/abuse/exploitation
Two primary physiological states
Hyper-arousal: Anger, panic, tantrums
Hypo-arousal: Flat affect, dissociation, daydreaming, inattention

23. Indicators of Trauma Bonding
Denies violence when it is obvious it is occurring
Believe they have some control over abuse
Self-blame for situation and abuse
Hyper-vigilant to pimps needs
Sees world from the pimps perspective

24. Be prepared to deal with…
Ambivalence
You can’t talk them into changing so don’t try
Difficult behavior
Dishonesty
Recantations
Don’t get frustrated
They have been manipulated by the pimp to act the way they do and to not trust people in roles of authority

25. What is helpful Meet the client where they are and follow their lead
Meet basic needs
Let them know that regardless of their choices you will support them
Validate their strengths and skills
Ask what they would find helpful now

26. Intervening Gather identifying information
Talk with victim about a safety plan
Call the Hotline (Snohomish County)
National Hotline
If you identify a trafficking victim gather as much identifying information as possible about her and the trafficker including street or nick names as law enforcement are often familiar with these names. Talk with the victim about safety issues, convey your concern for her health and safety, ask her how you can help her at this time. Call CPS and law enforcement, make it clear to them that this patient may be a trafficking victim. You can ask to speak to the FBI- Innocence Lost Task Force Officer. Try not to let the victim leave with a potential pimp or trafficker if they are with her. Make sure that everyone involved is safe, pimps and traffickers can be very dangerous people.

27. Summary
Domestic Minor Sex Trafficking is a problem in every community which is complex and requires a coordinated community response.
To combat this problem it is important to know the risk factors, signs of possible victimization, local resources to help and how to safely intervene.
Healthcare providers are in key positions to interact with youth at risk for, or involved in trafficking everyday in various practice settings. Providers have the opportunity to provide prevention education regarding trafficking and to intervene when victims are identified.

28. Contact Information
Matt Baldock Paula Skomski

29. References
Boyer, D. (2008). Who pays the price? Assessment of youth involvement in prostitution in Seattle. Seattle, WA: Boyer Research.
Clawson, H. (2010). Study of HHS programs serving human trafficking victims.
Cole, H. (2008). Human trafficking implications for the role of the advanced practice forensic nurse. Journal of the American Psychiatric Nurses Association , 14 (6),
Coy, M. (2009). Moved around like bags of rubbish nobody wants: How multiple placement moves can make young women vulnerable to sexual exploitation. Child Abuse Review , 18,
Dovydaitis, T. (2010). Human trafficking: The role of the health care provider. Journal of Midwifery & Women's Health , 55 (5),
Girls Educational & Mentoring Services. (2009). GEMS.

30. References
Kalergis, K. (2009). A Passionate practice: Addressing the needs of commercially sexually exploited youth. Journal of Women and Social Work , 24 (3), Kotrla, K. (2010). Domestic minor sex trafficking in the United States. Social Work , 55 (2), Lebloch, E., & King, S. (2006). Child sexual exploitation: A partnership response and model intervention. Child Abuse Review , 15, Leitch, L., & Snow, M. (2010). Intervene: Identifying and Responding to America's Prostituted Youth. Vancouver, WA: Shared Hope International. Lloyd, R., & Orman, A. (2010). Training Manual on the Commercial Sexual Exploitation of Children (CSEC). New York: Girls Educational and Mentoring Services (GEMS). Logan, T., Walker, R., & Hunt, G. (2009). Understanding human trafficking in the United States. Trauma, Violence & Abuse , 10 (1), 3-30.

31. References
Mitchell, K., Finkelhor, D., & Wolak, J. (2010). Conceptualizing juvenile prostitution as child maltreatment: Findings from the national juvenile prostitution study. Child Maltreatment , 15 (1), Moynihan, B. (2006). The high cost of human trafficking. Journal of Forensic Nursing , 2 (2), Mukasey, M., Daley, C., & Hagy, D. (2007). Commercial sexual exploitation of children: What do we know and what do we know about it? Washington DC: U.S. Dept of Justice. National Institute of Justice. (2007, October 25). Human Trafficking. Sabella, D. (2011). The role of the nurse in combating human trafficking. American Journal of Nursing , 111 (2), Scott, S., & Harper, Z. (2006). Meeting the needs of sexually exploited young people: The challenge of conducting policy-relevant research. Child Abuse Review , 15,

32. References
Shared Hope International. (2010). Shared Hope International. Smith, L., Vardaman, S., & Snow, M. (2009). The national report: Domestic minor sex trafficking - America's prostituted youth. Vancouver, WA: Shared Hope International. The Nest Foundation. (2011). Playground. Retrieved February 18, 2011, from The Nest Foundation: U. S. Department of Health and Human Services. (2011, January 31). Administration for Children and Families. U. S. Department of Justice. (2010). Child Exploitation and Obscenity Section.

33. References
U. S. Department of State. (2010). Trafficking in Persons Report. Washington DC: U. S. Department of State.
U.S. Department of Health and Human Services. (2007). Senior policy operating group on trafficking in persons- Subcommittee on domestic trafficking final report. Washington DC: U. S. Department of Health and Human Services.
United Nations Office on Drugs and Crime (UNODC). (2011). Online Edition - Toolkit to Combat Trafficking in Persons.
Zimmerman, C., Hossain, M., Yun, K., Gajdadziev, V., Guzun, N., Tchomarova, M., et al. (2008). The health of trafficked women: A survey of women entering post trafficking services in Europe. American Journal of Public Health , 98 (1), 55-9.