Working With Survivors of Human Trafficking: Results From a Needs Assessment in a Midwestern State, 2019.

OBJECTIVES: While the needs of human trafficking survivors have been documented in the academic discourse, the saliency of such needs is understudied. This study aimed to reveal the critical needs of service provision for human trafficking survivors in a Midwestern state as perceived by multidisciplinary service providers. METHODS: Targeting health care, social service, law enforcement, public health, and other service providers involved in anti-human trafficking service delivery, we disseminated a survey using purposive and snowball sampling. Drawing from survey responses collected in 2019 from 107 service providers working with 422 survivors of human trafficking in the previous 12 months in a Midwestern state, we examined the saliency of needs from the perspective of service providers in the health care, criminal justice, and social service sectors. RESULTS: Respondents indicated on a Likert scale (1-5) the level of need for 37 social, health care, and legal services in their communities. The top-indicated needs statewide were mental health care, shelter/housing, peer mentorship programs, legal services, transportation, and provider training in juvenile courts, schools, law enforcement, and health care settings on human trafficking. CONCLUSION: The results suggest the need for statewide responses, such as legal assistance networks, telemental health options, and enhanced training collaborations between interpersonal violence and anti-human trafficking service providers. The study findings are generalizable beyond the study site in 3 ways that can guide strategic action: (1) they provide a framework for state-level analysis and strategic planning that parallels the results; (2) they show that regional variation is possible and should be accounted for in state-level study design, analysis, and strategic planning; and (3) the implications for housing assistance, legal assistance, mental health/substance use disorder-related health care, and training are scalable.

Provider challenges in responding to retrafficking of juvenile justice-involved domestic minor sex trafficking survivors.

BACKGROUND: Domestic minor sex trafficking (DMST) survivors are disproportionately involved in the juvenile justice system, but frequently run away and experience retrafficking. However, little research explores how practitioners who work with juvenile justice-involved DMST survivors address such dynamics. OBJECTIVE: This study examines challenges related to chronic runaway behaviors and related retrafficking of juvenile justice-involved DMST survivors from the perspective of practitioners. PARTICIPANTS AND SETTING: 35 in-depth interviews were conducted with social service and justice system practitioners working with DMST survivors in a Midwestern metropolitan area. METHODS: Inductive analysis of the transcribed interviews involved a multi-phase, independent co-coding process conducted by three members of the research team, including selective coding, open coding, and taxonomic analysis to identify recurring themes and subthemes. Core themes that focused on challenges experienced by practitioners working with minors who chronically ran away and returned to a trafficking situation were further developed. RESULTS: Practitioners reported that their ability to provide care to minors returning to trafficking situations was limited because of their informal authority in the juvenile justice system, inaccessibility of residential therapeutic care and drug treatment, and punitive measures directed toward parents seeking assistance from Children's Division. Provider narratives indicated that without effective interventions, minors typically exit a retrafficking situation only after experiencing emotional distress, extreme violence, pregnancy or birth, or contracting an STI. CONCLUSIONS: Non-punitive responses to address chronic runaway behaviors and retrafficking of minors in the justice system include: placement with foster families trained in dynamics of sex trafficking, trauma, and runaway behaviors; safety planning including risk assessments and providing resource information about drop in centers and healthcare; revising hotlining procedures for concerned parents; and increasing minors' access to trauma-informed residential care, therapeutic care, and substance use treatment by legislatively expanding healthcare coverage under Safe Harbor laws.

Disclosing Sex Trading Histories to Providers: Barriers and Facilitators to Navigation of Social Services Among Women Impacted by Commercial Sexual Exploitation.

Sex trafficking and commercial sexual exploitation (CSE) can lead to devastating health and mental health consequences for women, such as elevated rates of substance use, trauma, posttraumatic stress disorder, depression, sexually transmitted infections (STIs), and HIV. Consequently, engagement with services that address addiction, mental health, and housing, and provide general advocacy is critically important to women's increased safety, stabilization, and quality of life. The purpose of this study is to identify perceived barriers and facilitators to service access and engagement with social services among women involved in CSE. Drawing from a larger grounded theory study that partnered with an anti-trafficking coalition and a substance use treatment center for women, in-depth, semistructured interviews were conducted with 30 adult women who traded sex as adults and 20 service providers who come into contact with this population. Women engaging in services were sampled through maximum variation sampling (n = 24) and women not engaged with services (n = 6) were recruited through snowball sampling. Providers were recruited through purposive sampling through the coalition (n = 10) and nominations sampling (n = 10). Open and focused coding were conducted. Multiple enhancements to methodological and analytic rigor were taken, including collaboration with multiple key stakeholders, use of nonstigmatizing language, self-reflexivity processes, analytic memo-writing, and member checking. Findings suggest that women experienced judgment when disclosing sex trading in social service intakes, and individual and group sessions from providers and other women in the groups. Although some women saw disclosure as helpful in addressing the complex feelings stemming from sex trading, as well as the desire to help or relate to other women in similar situations, they also identified risk of harm and multiple barriers to disclosing during intake meetings and individual sessions with providers as well as group sessions with providers and other clients. Implications for individual and group practice are discussed.

Examining Commonly Reported Sex Trafficking Indicators From Practitioners' Perspectives: Findings From a Pilot Study.

Commonly reported sex trafficking indicators have been disseminated widely by government and non-governmental organizations in trainings aimed to increase identification and referral to resources. However, very little research evaluates such indicators. Drawing from survey responses of 86 social service providers, health care practitioners, and justice system officials in a Midwestern City, this pilot study aimed to examine: (a) the pervasiveness of the commonly reported indicators, (b) the salience of domains of indicators, and (c) the extent to which indicators differ across service populations (U.S.-born minors, U.S.-born adults, foreign born minors, and foreign born adults). The most commonly identified indicators included mental health symptoms of depression (M = 3.82); low self-esteem (M = 3.59); anxiety (M = 3.55); low levels of interpersonal trust (M = 3.52); sense of fear (M = 3.36); feelings of shame or guilt (M =3.34); isolation from family, friends, and communities (M = 3.3); and fear/distrust of law enforcement (M = 3.80). The least commonly identified indicators included exhibiting low English proficiency (M = 1.62), previous history of loitering charges (M = 1.74), presenting false documents (M = 1.85), presence of tattoos or branding (M = 1.89), presenting delayed cognitive development (M = 1.91), being unaware of one's location (M = 1.94), owing large debt (M = 1.95), previous history of prostitution or drug charges (M = 1.98, M = 2.01), and physical evidence of torture (M = 2.07). The mental health domain was identified as especially common among U.S.-born adults (M = 3.07). Criminal justice involvement was identified as less common among foreign-born minors (M = 1.82) and foreign-born adults (M = 1.96). The most commonly identified indicators, according to the service providers, health care workers, and justice system officials who work with them, are inconsistent with many of the indicators that are used frequently across governmental and community trainings. Trainings focusing on diverse case examples of trafficking may be important in strengthening identification of sex trafficked individuals, as well as accounting for regional contexts.

Design strategies from sexual exploitation and sex work studies among women and girls: Methodological considerations in a hidden and vulnerable population.

The study of sex trafficking, prostitution, sex work, and sexual exploitation is associated with many methodological issues and challenges. Researchers' study designs must consider the many safety issues related to this vulnerable and hidden population. Community advisory boards and key stakeholder involvement are essential to study design to increase safety of participants, usefulness of study aims, and meaningfulness of conclusions. Nonrandomized sampling strategies are most often utilized when studying exploited women and girls, which have the capacity to provide rich data and require complex sampling and recruitment methods. This article reviews the current methodological issues when studying this marginalized population as well as strategies to address challenges while working with the community in order to bring about social change. The authors also discuss their own experiences in collaborating with community organizations to conduct research in this field.

No-Drop Prosecution in Domestic Violence Cases: Survivor-Defined and Social Change Approaches to Victim Advocacy.

The feminist debate on no-drop prosecution is long-standing. However, the ways liberal and radical feminist perspectives inform advocacy in applied settings are limited in the extant research. Drawing from interviews with 26 domestic violence (DV) victim advocates, the current study examines perspectives and practices of victim advocates in no-drop prosecution cases. Two predominate themes emerged-a survivor-defined approach to advocacy emphasizing the individual situations and choices of battered women, and a social change approach focusing on changing the social structures that tolerate violence against women. Findings indicated the relationship between such practices was complex, overlapping, and at times contradictory. While advocates generally supported no-drop prosecution with the goal of social change, survivor-defined approaches superseded social change efforts for a majority of advocates. Survivor-centered advocacy and no-drop prosecution at times conflicted with one another. Advocates described victims' concerns about safety, livelihood, and trauma testifying in court as challenges to the policy, as well as the practice of holding victims in contempt of court and jailing them for not testifying. At the same time, advocates illustrated how survivor-defined advocacy complimented prosecution by addressing women's myriad of needs and concerns related to prosecution. Advocates indicated that victims were more likely to safely participate in prosecution when their individual needs were addressed. Implications for DV victim advocacy are presented.

Frizzled receptors signal through G proteins.

Frizzled receptors have long been thought to couple to G proteins but biochemical evidence supporting such an interaction has been lacking. Here we expressed mammalian Wnt-Frizzled fusion proteins in Saccharomyces cerevisiae and tested the receptors' ability to activate the yeast mitogen-activated protein kinase (MAPK) pathway via heterotrimeric G proteins. Our results show that Frizzled receptors can interact with Gαi, Gαq, and Gαs proteins, thus confirming that Frizzled functions as a G protein coupled receptor (GPCR). However, the activity level of Frizzled-mediated G protein signaling was much lower than that of a typical GPCR and, surprisingly, was highest when coupled to Gαs. The Frizzled/Gαs interaction was further established in vivo as Drosophila expressing a loss-of-function Gαs allele rescued the photoreceptor differentiation phenotype of Frizzled mutant flies. Together, these data point to an important role for Frizzled as a nontraditional GPCR that preferentially couples to Gαs heterotrimeric G proteins.

Survivor-defined practices to mitigate revictimization of battered women in the protective order process.

A growing body of research finds that instead of a one-size-fits-all response, community-based responses that include survivor-defined advocacy may prevent further abuse through customized, individualized safety planning and provision of resources. Extant literature related to survivor-defined approaches highlights outcomes, but the work illustrating specifically how these practices work in applied settings is limited. Drawing from interviews with 26 domestic violence victim advocates, the author examines how advocates mitigate revictimization of battered women through survivor-defined practices in the protective order process to provide additional context for this emerging body of work. Findings illustrate that the effectiveness and benefits that an order of protection offered varied from case to case; consequently advocates used survivor-defined approaches to address the specific needs of each woman to better ensure safety.