OVC Provider Forum Transcript

Human Trafficking in Rural Communities
Kimber Nicoletti, Kiricka Yarbough Smith  -  2016/1/20
What service gaps currently exist for this population?
1.  Kimber
 I know that Kiricka has done fabulous work in her state. I would also recommend reaching out to the Polaris Project who offers incredible resources for working with human trafficking victims.
2.  Kiricka
 Polaris Project does great resources on their website. We also have created law enforcement specific training through our NC Justice Academy, our USAO-Eastern District, and the Conference of District Attorneys. We created a training for Child Advocacy Centers, Case Managers, Mental Health, etc as well. As a part of the NC Coalition Against Human Trafficking, we have a training and education committee and we often work together to offer multidisciplinary trainings to all professionals, including law enforcement
3.  Hannah
 Do you know of any existing educational programs that have been pioneered in rural (or non-rural) areas to train healthcare providers, law enforcement, and other service providers
4.  Kimber
 While it may not be feasible to develop specific services for human trafficking victims in rural communities such as community rehabilitation and housing. It is possible to strengthen the capacity for local service providers to meet the needs of victims of human trafficking. It often starts with educating local service providers that victims exist within their community.
5.  Mike O'Connor
 Thank you. Obviously large gaps in services. What servcies exists in non-rural areas that can be reasonably duplicated in rural areas?
6.  Kiricka
 Rural communities traditionally have limited mental health and medical service providers who are trained on working with survivors of human trafficking. Also often sexual assault, domestic violence, and human trafficking agencies in rural communities have large service areas that they cover with limited staff and funding. Even if a community has service providers that understand some of the unique needs of human trafficking survivors, they often do not have access to bilingual or multilingual advocates or staff in order to serve all survivors. Appropriate shelter and transportation are two other key issues in rural communities. Adequate services for male survivors are extremely hard to find.
7.  Kimber
 There are so many gaps in services for this population currently. There is a need for coordinated community response. However the needs of trafficking victims vary greatly. There is a need for culturally/linguistically relevant mental health services, housing, vocational rehabilitation, child welfare. This is all intensified when talking about service gaps in rural communities where there is generally more limited knowledge or recognition of human trafficking victims.
Are there funding streams available for victims who need MH Treatment? If so, what are those?
1.  Estefania Pina
 Where can I find information about the services available for this population?
2.  Kimber
 There are immigrant-specific services and resources that would be available to a Human trafficking victim who is also an immigrant that would not be available to a domestic victim. For example: U-Visa and the services related to the processing of a U-visa would not be appropriate for a person who was not an immigrant.
3.  Sarah
 I recently took an online continuing education course entitled, Sex Trafficking: A Gender Based Civil Rights Violation, via quantum units education. It was helpful to explain "rights" in several different ways. It is a complex topic.
4.  Estefania Pina
 You mentioned in your reply that immigration status can affect what services may be available to help human trafficking victims. Could you please elaborate on how exactly immigration status can impact what help and services may be available for human trafficking victims? Does age (minor v. adult) also impact the type of services that are available for undocumented immigrants in the United States who are found to be victims of human trafficking?
5.  Kiricka
 There are funding streams that will assist with MH services, in particular Medicaid. Often you can go through your local managed care organization to get a list of mental health providers that accept Medicaid or Integrated Payment & Reimbursement System (IPRS) funding. In NC we have also been able to partner with local faith based groups and churches who can offer stipends to assist with medication and mental health services for survivors.
6.  Kimber
 At the local level, there can be a variety of funding available for MH treatment from local community organizations that serve victims of human trafficking that include faith-based organizations. At the federal grant level, the main sources for grant funding come from HHS Office of Refugee and Resettlement, DOJ office for victims of crime but there is also some funding available through the office on violence against women. It really depends how services are coordinated in the specific area and a number of other factors regarding the victim: immigration status, type of trafficking, location, type of services available in the area, etc.
Do NC LME/MCO’s participate in the strategic planning for these victims?
1.  Kiricka
 In NC we have Rapid Response Teams that are in place for the first 24-72 hours that a victim of trafficking is identified and we have 11 in various stages across our state. With those team we try to have a representative from the local department of social services and the mental health management entity as well. We also have Project NO Rest that was funded through ACF to address Child Trafficking in the Child Welfare System. With this project we are working closely with DHHS and the MCOs to ensure they are at the table and a large part of the strategic planning for victims.
Please describe some of the barriers service providers and advocates may encounter while working in collaboration with law enforcement in rural areas? What are some potential solutions, methods, etc to overcome these barriers?
1.  Kiricka
 Also after a case happens, it is important to have case reviews and talk through what worked and what didn't work. Hopefully this will help with building trust amongst both groups.
2.  Kiricka
 I think there are three main barriers to LEO and advocates collaborating on these cases. One is the need for LE to identify and respond to human trafficking as Kimber mentioned. It is important to educate our law enforcement on human trafficking and in NC we now have mandatory training for all LEOs through our NC Justice Academy's basic law enforcement training. We also need to work on the attitudes and biases that both professions often have about the roles and responsibilities that each have. I think one of the best ways to address this is to have both groups come to the table to share common goals and any concerns that they have up front.
3.  Kimber
 One of the main barriers that I have seen in working with law enforcement in rural areas is understanding the needs of human trafficking victims, the need for training on culturally relevant forensic interviews and more education on human trafficking. Education is key. It is important to develop the capacity of law enforcement to serve human trafficking victims and to address human trafficking in their communities. It is helpful to host specific training, to partner with other organizations that serve human trafficking victims.
Can you offer best practice tips for rural hospitals concerned about safe and effective Human Trafficking screening and interventions. In particular, when a provider suspects their patient is a victim, and when adult victims do not want to report.
1.  Jody
 This sounds similar to the SART kits that are provided to some hospitals for Sexual Assault victims or could be use the same.
2.  Kimber
 When screening victims for human trafficking it is very important: 1. All staff involved are trained. 2. Provide a comfortable, safe private space. 3. Don't push victims for disclosure but provide offer to help. 4. Victims are often concerned about well-being and safety of children or extended family and may have been threatened by traffickers. 5. Staff should also exercise precautions about their own safety when working with victims of human trafficking.
3.  Kiricka
 Also ECPAT has a great video for hospital workers on HT and Polaris has fact sheets on their website that are geared toward medical professionals and how to identify trafficking.
4.  Kiricka
 In rural communities in particular it is often vital to remind providers and hospital staff of dangers of human trafficking and that the perpetrator may be known in the community because it is so small and that the survivors confidentially is key. Also if they suspect something, to report it immediately and take any opportunity that they are alone with the patient to ask questions such as do you feel safe.
What are some of the warning signs we should be looking for that might indicate a person is being trafficked?
1.  Kimber
 #2 Common warning signs: a person is not free to come/go. Under-age doing sex work. Extremely low or no wages. Large debt owed to trafficker. Is charged a high rate for food/housing or anything. Maintained in highly secure living situations (a basement with no windows or boarded up houses). fearful/anxious or excessively submissive. lacks health care. Avoid eye contact or sharing any personal information.
2.  Kimber
 Warning signs can vary depending on the type of trafficking. Ten years ago I worked on a rescue operation with a group of victims of labor trafficking victims. They were discouraged from having contact with outsiders. There were two groups of men. One group was Mexican and the other were Chinese. They were not allowed to seek medical treatment even if they were injured on the job. They were taken to the store once a month and given 15 minutes to make any purchases they needed.
My dissertation topic is human trafficking and my area of focus is central Virginia. I found it very difficult to access local organizations that can assist me with my research. Do you provide assistance in this area? If not can you recommend someone I can speak with?
1.  Bethany
 Shared Hope International has a field assessment called Rapid Assessment on Domestic Minor Sex Trafficking in Virginia that may be useful. It discusses issues regionally and on a state level
2.  Kiricka
 #2 It is often better to work with coalitions or organizations that serve as clearing houses for these groups at a state level so they can send your request out to multiple players and also assist with answering some of your questions directly
3.  Kiricka
 Hannah, I do not know of specific listservs or groups for students that are working on research related to HT but their is a group called NEST (National Educator on Sex Trafficking) and you may be able to contact them. I think its easy to get discouraged by the lack of response but remember that the number of service providers working on this issue is limited and sometimes the advocates are working with limited resources. They often feel that their time needs to be dedicated to mainly serving survivors, it does mean that the work you are doing is not important
4.  Oludele Doherty
 I will be grateful. I can provide you with my phone number if you so desire.
5.  Oludele Doherty
 That is an excellent question. I think the Polaris project may be a good start. Would you be interested in collaborating after I complete my dissertation. Web administrator can give you my email.
6.  Kiricka
 I know of organizations in Virginia that work with survivors and I can connect you to those agencies. Also, I chair the NC Coalition Against Human Trafficking and I would be happy to send your request out on our listserv. We can communicate off line after the web forum ends
7.  Hannah
 I am looking into similar research (also in Central Virginia) for a Distinguished Majors project. I know that it can be difficult to do research in this area due to the need for high levels of confidentiality. On another note, I wonder if there are any online networks that link like-minded organizations and resources specifically in relation to trafficking
Up to half of the victims identified in sex trafficking cases in our state are Native Americans. Poverty and family dysfunction are acknowledged as contributing factors to vulnerability. What insight can you suggest to help promote provider competency and consistency of services for victims of sex trafficking in our small, very rural Tribal communities? Thank-you.
1.  Gayle
 part 3 of 3 We have attained some of the harshest sentences in the nation for HT crimes. We have had 3 separate defendants receive life sentences for sex trafficking offenses; one of them was sentenced to 3 life terms+ two 20 year terms.
2.  Gayle
 part 2 Sex trafficking victims are all female, ages range from 13 years old to 30. Backgrounds vary, but they are predominately from low-income homes, often with one or both parents absent. Several have endured childhoods of abuse and neglect. Many were encountered by their traffickers during periods of drug addiction and or homelessness, and many were struggling to care for family members, including their own young children. Sadly, several have been identified as victims in more than one case. It is estimated that up to half of the victims are Native American
3.  Gayle
 PART 1 We are actually very active here in South Dakota investigating & prosecuting sex trafficking cases. We definitely have a need for more long-term resources to assist victims to become survivors and we are constantly striving for those resources. Awareness/education are two primary areas of focus as well, for the general public and for all allied professionals. We have two HT task forces in the state. I am privileged to lead the Native Affairs committee for the West River HTTF. Thankfully, law enforcement and service providers at all levels collaborate pretty well on these cases. We have had labor trafficking cases as well as the majority of victims being trafficked for sex.
4.  Kiricka
 I would love to know what state you are in because I would love to connect with a couple of the agencies that are doing great work around Native Americans and HT. I think you have to keep educating your service providers and law enforcement on how to identify trafficking but you also need to provide training and outreach to the tribal groups that are specific for your communities. Depending on the community, human trafficking trends can look very different. Reach out to some of the tribal leaders and organizations in your community to talk about human trafficking and ways that it may intersect with other crimes they are seeing. Open communication and collaboration are both key.
What are the statistics nationally?
1.  Kiricka
 I agree with Kimber, the UN has a lot of statistics and so does Polaris Project but the numbers vary greatly. Also, remember that the numbers that Polaris has are just the calls, emails, and texts that they receive. There are much larger portion of human trafficking cases that probably never reach the National Human Trafficking Hotline. Looking at these websites will at least give you a snapshot of what is happening in your state and nationally.
2.  Kimber
 The International Labour Organization estimates that there are 20.9 million victims of human trafficking. 21,000 cases of human trafficking have been reported via the National Human Trafficking Resource Center Hotline. I would caution that most of the statistics available do not give a clear picture of the problem due to lack of reporting, limited knowledge about the extent of the problem and so much trafficking that goes on undetected. Back in 2002, I worked with scholar out of Mexico City on a child sexual abuse project who told me that men in the United States were the largest consumers of children who had been trafficked. I remember at the time being in a state of shock and disbelief. It was so difficult to comprehend that children were being sold.
What is the evidence - if known- regarding the impact of decriminalization and/or legalization of sex work ON human trafficking? (e.g. increases? decreases? no impacts?) I am part of a national group that is looking at some of these issues.
1.  Kimber
 I have read some scholarly articles about the legalization of sex work and its impact on human trafficking. I think that there is still much that needs to be learned especially knowing that many sex workers are introduced into the trade when they are under-age.
How are multi-disciplinary teams ensuring victim confidentiality in smaller communities where "everyone knows everyone"?
1.  Estefania Pina
 As mandated reporters, my understanding is that it can be difficult to totally ensure confidentiality to a client/patient. Part of working in the human services field is reporting the threats to the well-being of a person or group of persons that we have encountered. When victims disclose this information, we understand that they are in imminent danger. How do we go about reporting and seeking the appropriate assistance with the least amount of damage to the safety of the victim?
2.  Kimber
 Confidentiality can be very challenging in rural communities in any type of services. I think that it is important to educate service providers about the "imminent danger" for victims of human trafficking and that confidentiality is about their rights to privacy but also about their personal safety. In community trainings, we often talk about human trafficking victims but many not talk about the very dangerous world of human trafficking.
I am a nurse in a hospital. What should we do when an adult patient discloses that they are a victim but they do not want it reported?
For juvenile victims of sex trafficking, how are rural communities dealing with the issue of housing/shelter vs. juvenile detention (if there's a shortage of appropriate shelter)?
1.  Kiricka
 In 2013 NC passed the Safe Harbor Law that helps us with the efforts to stop criminalizing minor victims of trafficking. This law requires our Law enforcement to work with department of social services on these cases so that we will not be using juvenile detention as an option for housing. We also have another project with our state DHHS to address child trafficking in the welfare system so that the workers are trained on how to identify and respond to human trafficking as well. We don't have all the answers when it comes to this but I just know that criminalizing victims is not.
Are there resources available to train healthcare professionals, especially those working in rural areas, to identify victims and provide trauma care specific to their needs?
1.  Kiricka
 DHHS created a program called SOAR which is geared towards training healthcare workers, DHS Blue Campaign also has great training resources for healthcare workers that incorporates more on labor trafficking.
How are communities sharing resources across jurisdictions (eg: when there's a service gap, or when the crime took place in multiple jurisdictions)? Do they have inter-agency agreements in place? Shared protocols?
1.  Kimber
 Working with victims of human trafficking across jurisdictions can be challenging. Most of our work has been across state lines. We work to develop relationships with service providers in other states. I do know that some will have an MOU to provide specific services that their agency does not provide. However each case is so different and so specific that it requires a lot of communication and coordination. In larger urban communities that might see human trafficking victims more frequently, the services can look very differently.
2.  Kiricka
 Our rapid response teams usually cover multiple counties so it is definitely necessary to have MOUs in place for information and resource sharing. Each of our rapid response teams create a multidisciplinary team protocol and intake protocol for all cases of trafficking. We have a step by step guide to this in our rapid response team toolkit for NC.
Since starting new agencies in rural areas is a challenge, what are the funding streams for adding services specific to trafficking survivors to existing agencies such as domestic violence shelters?
1.  Kiricka
 Also you can look at applying for state funds that address violence against women or children as well. Although we know that a large percentage of victims are male, since the majority of sex trafficking victims are female or children then you can use those funding streams that I mentioned. Its also important in rural communities to be creative. Partner with faith based groups, local businesses, and community foundations to receive smaller grants and donations as well.
2.  Kimber
 HHS Office of Refugee and Resettlement, DOJ office for victims of crime provide grant opportunities to develop services for the victims of human trafficking. Depending on your application, there is also some funding available through the office on violence against women that could be used with victims of human trafficking.
Often, rural communities are closed systems. What have you found to be effective in identifying victims in such communities and getting resources for them?
1.  Kimber
 I think an important first step is about developing and strengthening relationships in the community. We started regularly visiting some venues that we suspected might have some trafficking victims employed. We went there for services, offered some linguistically appropriate general health education and worked to establish some community trust. Trust and invested relationship are the foundation to identifying trafficking victims.
For a locality that wants to better serve victims of human trafficking ,where do we begin?
1.  Kiricka
 I think the best thing to do is figure out the key players in your community that address issues that intersect with human trafficking such as immigrant services, child abuse, domestic violence, and sexual assault figure out what you already have in place to begin working on this issue. Its not always necessary to create a new taskforce or team if you already have the main players at the table. We created a Rapid response Team toolkit that tells you all of the steps you need to take to address human trafficking in your community and some of the key groups that should be at the table if you want to do this work.
2.  Kimber
 I think that it really begins by prioritizing addressing the needs of human trafficking victims in your community by having the conversation with service providers, stakeholders and community collaborators. You can conduct community education, assessment, capacity-building, networking with other service providers. However it all really begins by creating a leadership team that is dedicated to ensuring these processes happen.
Are there evidenced based approaches to working with this population? How does trauma come into play when working with a victim?
1.  Kiricka
 There is very limited information on evidenced based approaches to working with victims of trafficking. Mostly what I have found are promising practices at best. HHS has some information on EBP for mental health and human trafficking here: https://aspe.hhs.gov/basic-report/evidence-based-mental-health-treatment-victims-human-trafficking Also, the National Institute on Justice has a fee studies that have been completed on human trafficking and the a
What can a rural domestic violence/sexual assault program do to better serve victims of trafficking?
1.  Kimber
 Education, Training and Communication. I believe those are the three key areas for a Rural DV/SA program to start to better serve victims of human trafficking. It is imperative to start by having the conversation with your staff!!! If you want to start screening for human trafficking victims then you need to develop a plan. The second step would really be to educate everyone in your organization to strengthen your capacity. you can build on your organizational strengths. you will also want to develop your capacity to work cross-culturally to provide culturally relevant services for victims. Then lastly it would be helpful to start training the community and other service providers.
Do you have any suggestions for how we might want to proceed with measuring CSEC in our community and/or the formation of a Task Force/Committee?
1.  Kimber
 Part 2: However it all really begins by creating a leadership team that is dedicated to ensuring these processes happen. In rural communities, there are often limited resources and competing needs. A group that will spearhead efforts will be vital in the creation of an effective task force.
2.  Kimber
 Part One: If you want to measure CSEC in your community by looking at existing data from police reports/hospitals and rape crisis centers. However I think that data may be very inaccurate if providers have not been educated on identifying victims. As I mentioned in another question: I think that it really begins by prioritizing addressing the needs of human trafficking victims in your community by having the conversation with service providers, stakeholders and community collaborators. You can conduct community education, assessment, capacity-building, networking with other service providers.
3.  NVolin
 Commercial sexual exploitation of children (encompasses more than just juvenile sex trafficking)
4.  Matt
 What does CSEC stand for?
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