Yvonne Rafferty, Ph.D. Fulbright Scholar: ASEAN Research Program

1. Prevention and Protection Practices for the Successful Identification, Recovery and Reintegration of Victims of Child Trafficking in ASEAN Communities Yvonne Rafferty, Ph.D. Fulbright Scholar: ASEAN Research Program Professor, Psychology, Pace University, NYC Pleaseciteas: PaperPresented the FulbrightRegionalEnrichment Conference, Kuala Lumpur 3/15/18

2. “An International Shame” (UNODC) “One of the most egregious violations of human rights which the United Nations now confronts” (Kofi Annan)

3. Magnitude – Unknown • Unreliable data • Clandestine nature • Uncoordinated data collection • No standard definitions

4. Regions… Globally and Locally

5. Trafficked for many reasons --- Forced Marriage…..Begging

6. And Commercial Sexual Exploitation The largest subset is young women and girls for CSE

7. Effective Strategies: The Four P’s • (1) Prosecution • (2) Prevention • (3) Protection • (4) Partnerships

8. Protection:Build a Protective Environment

9. Key Issues - Protection (1) Identification(2) Mental Health Needs(3) Mental Health Services(4) Promising Practices for Psychosocial Recovery

10. Identification of Victims: Barriers & Challenges

11. (1) Most victims not formally identified through official channels(2) Fail to receive the protection services they need(3) Traffickers continue to exploit, and their crimes are neither documented nor prosecuted

12. Barriers to Identification • Situational Factors (7 Factors) • Child Factors (2 Factors)

13. (A) Situational Barriers

14. (1) The Changing Face of Child Trafficking Much of the buying and selling is done in a virtual world.

15. From Brothel-Based to Cyber-Based

16. (2) Underground Locations • Beer Gardens, Karaoke Bars, Hair Salon, Coffee Shops • No Sexual Activity on Premises “Early work release” “Bar fee” • Fewer Young Minors Exploited

17. (3) Non-Compliance with International Definitions of Child/Trafficking Who is a “Child”? • Below age15 in some countries • Age 16 elsewhere What is “Trafficked”? • The role of coercion • CSE vs. other

18. (4) Unequal Attention • Some countries do not recognize domestic trafficking – focus on cross border • Uneven focus on CSE – others overlooked • Little recognition that boys are victims

19. (B) Child Barriers

20. (1) Do not Wish to be Identified/ Rescued • Economic Barriers – driven by economic necessity • Lack of Alternative Options • They do not know or recognize that they are victims • Do not view themselves as having being trafficked

21. (2) Child-Related Psychological Challenges • Trauma Bond: Misguided sense of loyalty to trafficker • Fear/Lack of Trust • Inhibited by Shame/Stigma

22. When Children are Not Identified as Victims, Consequences Can be Devastating • Some Arrested as Criminals & Detained in Inappropriate Facilities • Some Cross-Border Victims are wrongly identified as irregular migrants and deported/pushed back

23. Mental Health Needs

24. The Abuse: Physical, Psychological, Sexual • Experienced violence can include coercive strategies (threats) to extreme abuse or torture-like violence • Physical • Psychological • Sexual

25. Impact: Physical Health • Physical injury (broken bones, burns); • Indirect physical injury (headaches, insomnia, suicide); • Drug/ alcohol dependency; • Sexual & reproductive complications (unsafe abortions, infections; STDs, HIV/AIDS).

26. Psychological Symptoms • Depression • Hopelessness • Anxiety • PTSD • Suicidal Thoughts • Aggressive Behaviors • Complex Trauma

27. Severe and complex psychological & interpersonal problems -- comparable to those identified in: • Victims of Torture • Children Involved w/Armed Conflict • Victims of Sexual Abuse/Assault

28. Additional Challenges • Highly sexualized behaviors of residents in aftercare program and school: • Provocative dress, flirtatious behavior, offering themselves sexually; • Sexual harassment from other girls: • Sexual abuse of younger peers by older girls in the facility; • Acting-out behaviors associated with living in a shelter: • Bullying, fights; • Self-harm behaviors (e.g., cutting).

29. Additional Concerns • Sexual abuse by outside others: • Law enforcement personnel; staff members • Physical and psychological abuse to punish and discipline residents: • Tied to window if make fuss • Lengthy shelter stays: • Particularly for international victims -- awaiting repatriation orders • Locked facilities: • Detain children and prohibit them from leaving.

30. Overall Availability and Quality of Mental Health Services & Supports • Access described as being scarce, inferior in quality, and inadequate to address prevailing needs and repair the psychological damage caused by trafficking.

31. Consistently identified as one of the biggest gaps in aftercare services. “We do relief work. We operate in a crisis mode.” “Mental health care is one of the biggest gaps in aftercare services”

32. Additional Challenges • Children with Severe Mental Health Problems • Children With Severe Trauma • Long Term Mental Health Services • Government Shelter

33. BUT -- The psychological-therapeutic interventions offered in aftercare programs varied substantially across a number of dimensions.

34. Potentially Promising Practices & Challenges (Associated with the Availability and Quality of Mental Health Services and Supports)

35. Two Key Issues • Program Capacity to Provide Quality & Culturally Appropriate Care; • Adequacy of Financial & Human Resources

36. (1) Program Capacity to Provide Quality & Culturally Appropriate Care

37. (a) Trauma Informed Care • Asks “What happened to you?” instead of “What is wrong with you”? • Understands past trauma can be triggered by experiences in the present • Leaves a person feeling educated and informed

38. “..one of the biggest gaps... Staff do not know how to respond to children who have been traumatized… not learned about trauma informed care. Children present with difficult behaviors and staff do not have the capacity to deal with these issues.”

39. (b) Culturally Relevant Mental Health Services • Emphasized transcultural mental health care – • Services that are culturally relevant, cognizant of cultural diversity, consistent with local intervention theory, standards, and best practices; and involving staff who are culturally competent.

40. In other words… • Aware of the limitations of Western approaches and the use of alternative approaches for treating diverse populations, able to incorporate cultural traditions into their practice, and understand cultural variations in the expression of emotion.

41. (c) Incorporate Alternatives to Traditional Therapy • Traditional therapies &holistic healing modalities; • Cultural traditions & community norms, spirituality, traditional healing rituals/ methodologies, massage therapy, acupuncture, relaxation, deep breathing, meditation, mindfulness, and Buddhist/Hindu teachings and healing rituals, herbal gardening, and yoga practice.

42. Highlighted the use of creative non-verbal therapeutic activities/ therapies/healing activities-opportunities/holistic treatment modalities, including art, music, play, and dance movement therapy.

43. (d) Comprehensive Services & Collaborative Care • Acknowledge the transcultural framework (holistic approach – address mental health and social care needs) because psychological wellbeing is influenced by multiple inter-related systems (e.g., physical, emotional, spiritual, social) and requires comprehensive care.

44. In other words, culturally appropriate mental health care as one component of a broad range of interventions needed by children to promote their emotional wellbeing, and address their complex social, emotional, and economic needs.

45. (e) Comprehensive Case Management • Record children’s needs for services, and work collaboratively with other providers as partners to ensure coordination of the various services being delivered.

46. (f) Individualized Care that Recognizes a Hierarchy of Needs • Victims do not have identical experiences (type, degree, duration of their violence/abuse) • Variable mental health needs • Individual differences in resilience

47. Maslow’s Hierarchy of Needs

48. (g) Include Mental Health Assessments to Guide the Delivery of Services • Assess mental health and other psychosocial needs – important but rarely conducted “We notice that she looks sad, doesn’t talk, stays alone, cries a lot”

49. 2. Adequacy of Financial & Human Resources

50. (a) Financial Resources • Some governments have not yet taken full ownership of their responsibilities under international law, leaving the vast share of the responsibility to U.N. agencies, NGOs, and private donors. • Severe understaffing and limited services in government-run public facilities, as opposed to those that are privately funded.