Human Trafficking

1. HumanTrafficking • Healthcare Provider Awareness and Intervention Training

2. Objectives • Define Human Trafficking (HT) Labor & Sex • Scope and purpose of IPATH • Recognize statistical significance of crime • Roles & characteristics of those involved • Identify victims for opportunity to intervene • Spread awareness & intervention training

3. What is Human Trafficking? • The fastest growing criminal industry in the world • A crime second only to drug trafficking • Generates $150.2 BILLION annually • Modern day slavery • HUMAN TRAFFICKING HOTLINE: • 1-888-3737-888

4. Labor Trafficking • Labor • Trafficking: • The recruitment, harboring, transportation, provision, or obtaining of a person for labor or services, through the use of force, fraud, or coercion for the purpose of subjection to involuntary servitude, peonage, debt bondage, or slavery.(1)

5. Sex Trafficking • Sex Trafficking: • A commercial sex act induced by force, fraud, or coercion, or in which the person induced to perform such act has not attained 18 years of age.(1)

6. Where are trafficked persons found? • Trafficking is found in many industries including: • The sex industry • Agricultural industry (farmer uses for crop harvest) • Construction industries • Factories, restaurants, hotels • Domestic servitude as servant, • housekeeper or nanny • Health and beauty industries • As a bride • As beggars or peddlers • As a child soldier

7. Indiana’s anti-trafficking task force • Indiana Protection for Abused and Trafficked Humans • www.indianaagainsttrafficking.org • One of 42human trafficking task forces nationwide originally funded by the Department of Justice’s Office of Victims of Crime and the Bureau of Justice Assistance. • Task Force Partnering Agencies & Organizations: • U.S. Attorney’s Office – Northern District and Southern District, Indiana Attorney General’s Office, FBI, Indianapolis Metropolitan Police Department, Marion County Prosecutor's Office, Homeland Security, Indiana State Police, Department of Labor, Department of Child Services, The Julian Center, Neighborhood Christian Legal Clinic and others

8. The Goals of IPATH: • Enhance law enforcement’s • ability to identify and rescue • victims. • 2. Provide resources and training • to identify and rescue victims. • 3. Ensure comprehensive services • are available for victims.

9. LAW ENFORCEMENT Collaborates with agencies on current/future investigations, provides officer trainings, & prevention tactics VICTIM SERVICES Works with identified victims providing legal & social services PROTOCOL Creating and evaluating protocol & procedures for handling human trafficking situations A CollaborativeClient-Centered Approach AWARENESS Community organizations partnering together to provide outreach and education to the community on human trafficking VICTIM SERVICES Works with identified victims providing legal & social services TRAINING Provides trainings to people that might come into contact with victims.

10. Who is involved in trafficking? • The recruiter/spottergains the victim’s trust and then sells them for labor or to a pimp. Sometimes this is a boyfriend, a neighbor, or even a family member. • The trafficker/pimp is the one who controls the victims. By making the victim fearful through abuse, threats, and lies the trafficker gains power over his/her victim. • The trafficked person or victim could be anyone. • The consumer/johnfunds the human trafficking industry by purchasing goods and services. S/he may be unaware that someone is suffering and that there is a victim.

11. Recruiting harboring, moving, or obtaining a person By force, fraud or coercion For the purpose of involuntary servitude, debt bondage, slavery or sex trade Three Elements of Trafficking • In order to be considered trafficking on both federal • and state levels, all three of these elements must be identified: There does not have to have physical abuse.

12. What is Force, Fraud, & Coercion? • Fraud • Promises of valid immigration • Falsified documents • Victim told or pressured to use false travel papers • Contract signed for legitimate work • Promised job differs from actuality • Promises of money or salary • Misrepresentation of work conditions • Wooing into romantic relationship • Coercion • Debt bondage • Threats of harm to victim or family • Control of children • Controlled communication • Photographing in illegal situations • Holding ID/travel documents • Verbal or psychological abuse • Control of victims money • Punishments for misbehavior • Force • Kidnapping • Torture • Battering • Threats with weapons • Sexual abuse • Confinement • Forced use of drugs • Forced abortions • Denial of medical care

13. Indiana Law: IC 35-42-3.5-1(2) • Trafficking: • A person who, by force, threat of force, or fraud engages a person in: • Forced Labor • Involuntary Servitude • Marriage • Prostitution • Participation in Sexual Conduct • Prosecutors don’t have to prove force when a minor under the age of 18 is being trafficked • Any individual can be guilty of committing trafficking of a child; no specific relationship required • Restitution is available to trafficking victims • Trafficking victims may also have a civil cause of action to recover other damages from the trafficker

14. Myths & Statistics • Myth #1: All prostitutes are willing participants. • Children as young as 12 are used in commercial sex and prostitution. (4) • Every year 1 million children are exploited by the commercial sex trade worldwide.(5) • Commercial sex is extremely violent and dangerous. • 34 is the average age of death for those in commercial sex.(6) • http://youtu.be/-NQoaf-2nsE

15. Myths & Statistics • Myth #2: Human trafficking occurs only in foreign countries. • Between 14,500 and 17,500 men, women, and children are trafficked into the United States each year.(7) • Every year 100,000 to 300,000 U.S. children are at risk of being victims of sex trafficking, according to the National Center for Missing and Exploited Children. (8) • Of sex trafficking victims found in the U.S., 83%were U.S. citizens, according to a Justice Department study. (9)

16. Midwest/Indiana statistics Information was obtained from the Bureau of Justice Assistance (BJA). The BJA Task Forces in the Midwestern Region were located in the states of:   Illinois, Indiana, Missouri, Wisconsin,  and Minnesota. OVC is the Office for Victims of Crime

17. Origin & Destination Countries(10) The United States is one of the most popular destinations for human trafficking.

18. Human Trafficking & Sporting Events • Studies have shown that there is an increase in the demand for commercial sex services surrounding large sporting events or conventions such as the Super Bowl, World Series, etc. • According to the Indianapolis Metropolitan Police Department, 68 prostitution arrests were made before and on the day of the 2011 Super Bowl. • 2 human trafficking victims were identified and 2 other potential human trafficking victims were identified. • Reported Rescue of 16 youth ages 13 to 17 during a sting operation by the FBI targeting sex traffickers bringing victims to New Jersey for the Super Bowl weekend (FoxNews.com, February 4, 2014).

19. The Victim or Trafficked Person • Human Trafficking has no socioeconomic or cultural barriers. Regardless • of their demographics, victims are vulnerable in some way, and the • traffickers will use their particular vulnerability to exploit them. • Some risk factors – • Think: “What makes a person vulnerable?” • Youth • Poverty • Unemployment • Desperation • Homes in countries torn by armed conflict, civil unrest, political upheaval, corruption, or natural disasters • Family backgrounds with violence, abuse, conflict • Chronic runaways; involvement in the child welfare system • Homelessness • A need to be loved • Immigration status • Addiction

20. Why Don’t Trafficked Victims Escape? • TRAFFICKED PERSONS HAVE JUSTIFIABLE FEARS! • They may be in danger if they try to leave. • The traffickers have such a strong psychological and physiological hold on them -“Trauma Bonding” (imbalance of power and intermittent violence). • They fear for the safety of their families in their home countries or in the U.S. • They are afraid of being deported or arrested. • They may fear the U.S. legal system because they may not understand the laws that protect them. • They may not be able to support themselves on their own. • IT IS OUR RESPONSIBILITY TO PROTECT AND ASSIST PEOPLE BEING EXPLOITED.

21. How Are People Recruited? • Grooming / “Boyfriend” • Internet and social media • Fake employment agencies • Acquaintances or family • Newspaper ads • Front businesses • Word of mouth • Abduction • Brittany Backpage.com

22. The Trafficker • The trafficker will likely be in a lucrative business enterprise as the heart of human trafficking is exploiting cheap labor. • The trafficker may be part of a larger organized crime ring or gang, or may be profiting independently.

23. The Trafficker • Might be someone who knows the victim and victim’s family. • May be bilingual. • May be an older man with younger women who seems to be controlling, watching their every move, and correcting/instructing them frequently.

24. The Consumer / John • 10% of men in the U.S. buy sex from prostituted or trafficked individuals.(11) • Frequent “Johns” are more likely to be married/older. (12) • Don’t Buy the Lie.(13) • Anyone who unknowingly (or knowingly) purchases goods and services from an organization who uses trafficked victims.

25. Role of Healthcare Providers • As a provider, you are in a unique position to recognize, identify, reach out and rescue victims. • While trafficking is largely a hidden crime, many victims are in plain sight if you know what to look for. • Since pimps and traffickers generally exercise nearly complete control of their victims, these points of contact with healthcare represent rare opportunities for victim identification and intervention.

26. A Critical Role for Healthcare Providers • 87.8% of trafficking victims encounter a health care professional while still captive.(19) • Few if any of these encounters result in the victim being freed because of lack of training to recognize victims.(14) • Lack of training results in misconceptions among healthcare providers, hindering identification of and service provision to victims.(15)

27. Victim Contact with Health CareProvider(19)

28. Victim Contact with Health Care Provider • Pregnancy, miscarriage, and / or abortion was experienced by more than ½ of female survivors.(19) • Obtaining birth control is another reason for victims to interact with a healthcare provider. • 51.7% obtain from doctor or clinic(19) • 65.2% said they went alone to get it(19)

29. Identification of Victims

30. Identification: Underlying Conditions • Victims suffer from host of physical and psychological problems • stemming from: • Inhumane living conditions • Poor sanitation • Inadequate nutrition • Poor personal hygiene • Brutal physical and emotional abuse • Dangerous workplace conditions • General lack of medical care

31. Identification: Common Signs • Most suggestive physical symptoms are injuries from physical violence - signs of being kicked, punched, beaten, forced sex – as nearly all survivors reported these(19) • Reproductive history – STDs, Pregnancies, Abortions • Weight loss, malnutrition, loss of appetite, eating disorders – 71.4% victims reported at least one of these(19) • Drug and/or Alcohol Addiction (control mechanism by trafficker or as a coping mechanism for the abuse) • Psychological Symptoms

32. Identification: Violence & Abuse

33. Identification: Physical Signs • In one study, 57% of victims experienced 12 or more concurrent health symptoms at the time of discovery.(17)

34. Identification: Substance Abuse

35. Identification: Psychological Problems

36. Identification: Social Indicators(16) • Potential victim is accompanied by another person who seems controlling and/or insists on speaking for the victim • Numerous inconsistencies in his or her story • May have signs of neglected healthcare needs • Is not in control of their own money and/or may have an excess amount of cash • False or no legal documentation – i.e., license or state issued identification for U.S. Citizens; passport, Green Card, or other identification for foreign nationals • Uses restricted or scripted communication

37. Identification: Social Indicators(16) • May have hotel room keys in possession • May be a chronic runaway/homeless youth • May describe signs of frequent relocation • May have signs of branding (tattoo, jewelry) • May lie about age • Lack of knowledge of a given community or whereabouts

38. Identification: Behavioral Indicators • Avoids eye contact • Exhibits a loss of sense of time or space • Disorientation, confusion, phobias, or panic attacks caused by daily mental abuse, torture, and culture shock • Exhibits behaviors including hyper-vigilance or paranoia, nervousness, tension, submission, etc.

39. Screening

40. S.A.R.T. – Sexual Assault Response Team • SART models have dramatically enhanced the services provided to victims of sexual assault in communities throughout the United States and should be used for trafficking victims whenever possible.

41. Word choice & conveying appropriate information to victims of trafficking (20)

42. Interview • Conduct all interviews in a private setting away from the person accompanying the patient. • May need an interpreter, but, do not allow the accompanying person to act as the interpreter. • Interview may take significant time as the patient may not recognize himself/herself as a victim. • Be sensitive, every incident of human trafficking is different. • Do not ask if they are a victim of human trafficking as they may not even know what is happening to them or may have been trained to lie about it. They may even feel responsible for their situation.

43. Interview • If the Individual is a female, approach should be made by a female staff member. • Separate the Individual from his/her belongings and escort/interpreter. • The victim may be wearing/carrying some sort of tracking/communication device such as a GPS transmitter, cell phone or other small device – you can separate the victim from these devices by getting him/her into a gown and into an x-ray room. • If possible, choose a comfortable space which is conducive to confidentiality.

44. Interview • Utilize existing culturally sensitive protocols. • Use age-appropriate language when working with minors. • When you ask about sexual history, be sure to distinguish between consensual experiences and non-consensual experiences. • The victim may indeed lie about his/her age. • There may be evidence of sexual trauma, untreated • STDs or frequent pregnancies/abortions.

45. Interview • Individual reports an excessively large number of • sexual partners, especially when it is not age- • appropriate. • Individuals under the age of 18 may express interest • in, or may already be in, relationships with adults or • older men. • Victim may use lingo or slang relating to the • individual’s involvement in prostitution. • There may be evidence of controlling or dominating • relationships. • Victim may not know when or where last medical • examination was done.

46. Key Questions for HT Determination • Can you leave your work or job situation if you want? • When you are not working, can you come and go as you please? • Have you been threatened with harm if you try to quit? • Has anyone threatened your family? • What are your working or living conditions like? • Where do you sleep and eat? • Do you have to ask permission to eat, sleep or go to the bathroom? • Is there a lock on your door or windows so you cannot get out?

47. Physical Assessment

48. Physical Assessment • May or may not be wearing inappropriate clothing. • May have tattoos on the neck and/or lower back • i.e. a man’s name or initials (most often encountered with US citizen victims). • Other types of branding – i.e. cutting or burning.

49. Physical Assessment • Malnourishment or generally poor health • Signs of physical abuse – unexplained injuries or signs of prolonged abuse including injuries / bruises at different stages of healing: • - Bruises • - Black eyes • - Burns • - Cuts • - Broken bones • - Broken teeth • - Multiple scars (including from electric prods)

50. Physical Assessment • Evidence of a prolonged infection that could easily be treated through a routine physical/check up • Addiction to drugs and/or alcohol • Urinary difficulties, pelvic pain, pregnancy, or rectal trauma caused from working in the sex industry • Chronic back, hearing, cardiovascular, or respiratory problems as a result of forced manual labor in unsafe conditions • Poor eyesight and/or eye problems due to dimly lit work sites • Serious dental problems