Executive Summary for the Report of the APA Task Force on Trafficking of Women and Girls

In 2011, the American Psychological Association (APA) established the Task Force on Trafficking of Women and Girls at the recommendation of APA's Committee on Women in Psychology and approval by the Board for the Advancement of Psychology in the Public Interest. The purpose of this report is to (a) raise awareness among psychologists about human trafficking; (b) make recommendations to enhance research, education and training, advocacy and public policy, public awareness and practice as they pertain to the intersections of psychology and this social problem; and (c) urge psychologists to bring scientific rigor and research expertise to bear in informing policy, service provision and understanding of the dynamics of trafficking.

Task Force on Trafficking of Women and Girls

• Co-chair: Nancy M. Sidun, PsyD, ABPP, ATR
• Co-chair: Deborah L. Hume, PhD
• AnnJanette Alejano-Steele, PhD
• Mary C. Burke, PhD
• Michelle Contreras, PsyD
• James O. Finckenauer, PhD
• Marsha B. Liss, PhD, JD
• Terri D. Patterson, PhD
• Alexandra (Sandi) Pierce, PhD

APA Women's Programs Office

• Shari E. Miles-Cohen, PhD
  senior director
• Tanya L. Burrwell
  assistant director
• Wynter K. Oshiberu
  programs assistant

Copyright

Copyright 2014 by the American Psychological Association. This material may be reproduced in whole or in part without fees or permission provided acknowledgment is given to the American Psychological Association. This material may not be reprinted, translated, or distributed electronically without prior permission in writing from the publisher. For permission, contact APA, Rights and Permissions, 750 First Street, Washington, D.C., 20002-4242.

¹  Within the TVPA, coercion is defined as "(a) threats of serious harm to or physical restraint against any person; (b) any scheme, plan or pattern intended to cause a person to believe that failure to perform an act would result in serious harm to or physical restraint against any person; or (c) the abuse or threatened abuse of the legal process" and is distinguished from "force", which involves actual physical violence or harm, restraint or confinement (TVPA, 2000).

Human trafficking is characterized by exploitation of vulnerable populations and is a violation of the basic human right to autonomy and freedom affirmed by the Universal Declaration of Human Rights (United Nations, 1948). In this report, we use the definition of human trafficking from Article 3, paragraph (a) of the U.N. Protocol to Prevent, Suppress and Punish Trafficking in Persons, Especially Women and Children (United Nations, 2000)²:

• "Trafficking in persons" shall mean the recruitment, transportation, transfer, harbouring or receipt of persons, by means of the threat or use of force or other forms of coercion, of abduction, of fraud, of deception, of the abuse of power or of a position of vulnerability or of the giving or receiving of payments or benefits to achieve the consent of a person having control over another person, for the purpose of exploitation. Exploitation shall include, at a minimum, the exploitation of the prostitution of others or other forms of sexual exploitation, forced labour or services, slavery or practices similar to slavery, servitude or the removal of organs.
• The consent of a victim of trafficking in persons to the intended exploitation set forth in subparagraph (a) of this article shall be irrelevant where any of the means set forth in subparagraph (a) have been used.
• The recruitment, transportation, transfer, harbouring or receipt of a child for the purpose of exploitation shall be considered "trafficking in persons" even if this does not involve any of the means set forth in subparagraph (a) of this article.
• "Child" shall mean any person under eighteen years of age.

A social ecological model (McLeroy, Bibeau, Steckler and Glanz, 1988) is used as the framework for this report, highlighting the contributions of individual, interpersonal, institutional, community and societal factors as they pertain to human trafficking. Successful approaches to preventing human trafficking need to take into account more than the vulnerabilities of individual women and girls. Prevention efforts must consider the institutional structures, social norms and policy factors that can empower those individuals or that can constrain individual agency and options. In addition, a focus on reducing demand for commercial sex and for goods produced by exploitative labor is integral to preventing human trafficking.

We identified literature published since 1980 pertaining to the trafficking of women and girls into and within the United States. Because this is a relatively new research area, there are a limited number of empirical studies published. We cast a wide net to capture all relevant research, capitalize on the unique contributions of multiple methodological approaches and determine which findings are supported by converging evidence from multiple approaches. Thus, the review includes studies that used qualitative, quantitative or mixed methodologies, large or small sample sizes, and case studies, ethnography and community-based participatory research, among other approaches. Each methodological approach offers a unique lens and contributes to a more complete picture of human trafficking.

Methodological challenges

Research related to human trafficking is challenging due to its complexity. There is no typical case of human trafficking, which often overlaps with other closely related crimes, such as human smuggling, prostitution, intimate partner violence and child abuse. Trafficked women and girls are frequently victims of multiple crimes. A variety of clinical populations potentially include trafficking victims.

Human trafficking is also extremely difficult to measure. The clandestine nature of the crime, the lack of a comprehensive centralized database of human trafficking cases, the sheer diversity of trafficking situations and experience, and the difficulty in accessing persons with knowledge of the phenomenon, including trafficked women and girls themselves, contribute to the gaps and weaknesses in the empirical research (Farrell et al., 2010, 2012; Hopper, 2004; Weiner and Hala, 2008).

There is currently no reliable estimate of the prevalence or incidence of trafficking of women and girls in the United States (Farrell et al., 2010; Hopper, 2004). Shifts in estimates published in the U.S. Department of State's annual Trafficking in Persons Report (TIP Report) are indicative of the difficulty in determining prevalence and incidence (Miko and Park, 2002; U.S. Department of State, 2003, 2005, 2006).

² The U.N. Protocol to Prevent, Suppress and Punish Trafficking in Persons, Especially Women and Children is often referred to as “the Palermo Protocol” and was one of three protocols to the Transnational Organized Crime Convention, Palermo, Italy, 2000.

Risk factors

Vulnerability to human trafficking results from a nesting of an individual's characteristics and personal history within a complex and dynamic system of external factors. Conditions that permit or condone labor and sexual exploitation, tolerate or fail to regulate unscrupulous business practices, or maintain status inequalities and marginalization all contribute to trafficking (Brennan, 2008; Chacon, 2006; Heyzer, 2002; Van Liemt, 2004). Globalization, poverty, social and political instability, and war and military presence magnify the risk of trafficking (APA Presidential Task Force on Immigration, 2012; Aronowitz, 2009; Danailova-Trainor and Belser, 2006; Farr, 2005; Nikolić-Ristanović, 2002; O'Neill Richard, 2000; Trujillo, 2004; Watts and Zimmerman, 2002).

In addition, factors that undermine the ability for self-protection or that disrupt connections to social and familial support increase susceptibility to psychological coercion (Albanese, 2007; Lloyd, 2011; Norton-Hawk, 2002; Pierce, 2009; Raphael and Ashley, 2008; Reid, 2010). In addition to gender, individual attributes including age, membership in a marginalized group, prior victimization and trauma, developmental, emotional and cognitive factors, disabilities, immigrant or refugee status, and family disruption have been identified as variables contributing to vulnerability to being trafficked (Pierce, 2009; Ugarte, Zarate and Farley, 2003; Van Dorn et al., 2005).

Traffickers

Those who recruit, transport, and exploit women and girls span the continuum from a single individual to organized networks (Bruckert and Parent, 2002; UN Office on Drugs and Crime [UNODC], 2010). The most effective recruiters are those who already have, or who can establish, a trusting relationship with the potential victim or with victims' families (Human Rights Center, 2005). No consistent profile of a trafficker exists: He or she may be a family member, an acquaintance, an intimate partner, a known and trusted member of the victim's community or a stranger (Kingsley and Mark, 2000; Pierce, 2009; Sidun and Rubin, in press; UNODC, 2009).

Means of trafficking

Traffickers use coercion and psychological abuse, deception and fraud, threats, physical and sexual violence, abusive work and living conditions, and coerced substance use to lure, manipulate and control their victims (Bauer, 2007; Hynes, 2002; Kennedy, Klein, Bristowe, Cooper and Yuille, 2007; O'Neill Richard, 2000; Pierce and Koepplinger, 2011). Use of the Internet and communications technology has become an important tool in trafficking as well (Arizona State University, 2012; Blevins and Holt, 2009; Reid, 2010).

Consequences

Trafficked women and girls experience severe and potentially life-threatening physical and mental health consequences, which can be lifelong. They encounter high rates of physical and sexual violence, including homicide and torture, psychological abuse, horrific work and living conditions, and substance abuse (Aronowitz, 2009; Hynes, 2002; Oram, Stöckl, Busza, Howard and Zimmerman, 2012; Pierce, 2009; Potterat et al., 2004; Raymond et al., 2002; Sarkar et al., 2008). Women trafficked into the United States may also encounter extreme deprivation while in transit (Raymond et al., 2002). Serious mental health problems result, including anxiety, depression, self-injurious behavior, suicidal ideation and suicide, drug and alcohol addiction, posttraumatic stress disorder (PTSD), dissociative disorders and complex PTSD (Jung, Song, Chong, Seo and Chae, 2008; McClanahan, McClelland, Abram and Teplin, 1999; Sallman, 2010).³

Physical consequences can include neurological issues, gastrointestinal disturbances, respiratory distress, chronic pain, sexually transmitted diseases (including HIV), urogenital problems, dental problems, fractures and traumatic brain injuries (Burnette et al., 2008; Farley et al., 2003, 2011). The extremely limited research addressing the consequences of labor trafficking reveals that trafficked women and girls in forced labor are at high risk for physical injury, exposure to work hazards and generally deplorable working conditions (Free the Slaves and the Human Rights Center, 2004; Human Rights Center, 2005; Human Rights Watch, 2001, 2012).

³ Herman (1997) coined the term "complex PTSD" to describe a constellation of symptoms that can include impaired cognitive functioning, emotional dysregulation and distorted perceptions of self, others and perpetrators. Complex PTSD is a potential response when individuals experience complex trauma on multiple occasions or on a chronic basis. "Complex trauma" refers to severe harm that is interpersonal in nature. That is, such trauma is purposefully inflicted through the actions of another person, through sexual abuse, relationship violence, exploitation or similar violations (Courtois, 2008; Herman, 1997).

Effective anti-trafficking programming in the United States is in its infancy. As a result of professional training and community awareness programs, early identification of human trafficking should increase the chances that women will receive services and be able to escape or exit the trafficking situation. Prevention, protection, prosecution and partnership currently serve as the "fundamental international framework used by the United States and internationally to combat contemporary forms of slavery" (U.S. Department of State, 2011).

Prevention

Awareness and educational campaigns are intended both for primary prevention (reducing vulnerability to trafficking) and for secondary prevention (early victim identification and intervention):

• Empowerment programs build protective factors, such as education and career counseling, and address risk factors and barriers to exiting, such as homelessness, substance use, history of violent victimization and unavailability of support.
• Demanding reduction targets sex buyers and attempts to change social norms about commercial sex.
• Policy efforts at the local, state, national and international level also address prevention, although most U.S. policy focuses on prosecution of traffickers and services for victims, which may reduce revictimization but does not address primary prevention needs.

Although many prevention approaches seem promising, their impact in terms of reducing victimization is largely unknown, and there is limited reporting on these programs in the peer-reviewed literature. Prevention initiatives may need to be strategically distinct for domestically and internationally trafficked persons.

Protection

Protection measures "ensure that human trafficking victims are provided access to health care and counseling, legal and shelter services in ways that are not prejudicial against victims' rights, dignity or psychological well-being" (Laboratory to Combat Human Trafficking, n.d.). Much of the responsibility for protecting and meeting the needs of survivors of trafficking is assumed by a host of nongovernmental organizations (NGOs). The primary challenges to meeting survivors' needs are (a) lack of sufficient training to identify human trafficking when encountered, (b) inadequate resources (trained staff, funding, etc.) to meet client needs, (c) limited communication and planning between agencies, (d) a shortage of resources to evaluate the effectiveness of service provision and (e) challenges in working with law enforcement agencies (Caliber, 2007; Jones and Yousefzadeh, 2006).

Prosecution and partnership

The complexity of human trafficking investigations makes collaboration and coordination among a variety of entities and jurisdictions necessary (Farrell, McDevitt and Fahy, 2008; Venkatraman, 2003). The most common law enforcement strategy in response to trafficking has been to form and rely on joint task forces made up of state, local and federal agencies, including law enforcement, social service providers and mental health providers, among others (Clawson, Dutch and Cummings, 2006).

Program evaluations

Responses to human trafficking in the United States are not always guided by a comprehensive understanding of the problem. To date there is a notable lack of outcome evaluation (Clawson, Dutch, Salomon and Goldblatt Grace, 2009; Laczko and Danailova-Trainor, 2009; van der Laan, Smit, Busschers and Aarten, 2011). The field is in need of systematic, high-quality research to determine program efficacy in preventing trafficking, in protecting victims and in prosecuting those engaged in the crime of human trafficking.

Psychology can and must address human trafficking in all professional capacities: research, education and training, advocacy and public policy, public awareness and practice. The issue must be addressed at multiple levels of the social ecological model, from individual protective and risk factors to societal and policy factors.

• Psychologists who conduct research have a critical role to play in conceptualizing, designing, conducting, analyzing, and publishing investigations related to human trafficking.
• Psychologists involved in education and training at the undergraduate, graduate and postdoctoral levels can incorporate the topic of human trafficking into their courses, seminars and case conferences.
• By engaging in education and advocacy, psychologists can share their knowledge of psychological science with policymakers to "contribute to the formulation of sound public policy to address health and social issues and improve human welfare" (APA, 2010b, p. 7). Policymakers at all levels — federal, state and local — would benefit from information about populations at risk for trafficking, contributing factors, means of trafficking, identification of trafficked persons and the consequences of exploitation for individuals and for communities.
• Psychologists can inform the public about human trafficking by translating complex research findings into information that is accessible to the general public. Expertise offered by community and social psychologists can also help in developing effective ways to educate specific audiences.

Psychologists practice in many arenas and with thorough training can contribute to human trafficking prevention, protection of trafficked persons and potential victims, and prosecution of traffickers. Clinical and counseling psychologists can provide psychotherapy, forensic evaluation, career counseling and other services. School psychologists can train other school personnel on trafficking issues, develop prevention programming for youth or identify at-risk students. Forensic psychologists can work within law enforcement agencies on investigative and prosecutorial responses to trafficking.

The central challenge of providing psychotherapy services to survivors of human trafficking is the dearth of clinical research identifying best practices for this population. The needs of trafficking survivors are extensive and complex (Shigekane, 2007), and psychologists have an obligation to gain competency regarding this population's unique constellation of mental health problems prior to providing treatment to trafficked women and girls. Multicultural and diversity competency is essential for effective practice; the psychologist needs to attend to the intersections of race, ethnicity, language, sexual orientation, gender, age, ability, class status, education, religion/spirituality, developmental stage and culture (APA, 2008).

In many parts of the United States, survivors have limited access to service providers with specialized training in the unique psychological needs of trafficking victims (Adams, 2010; Chung, Bemak, Ortiz and Sandoval-Perez, 2008; Yakushko, 2009). Because victims of trafficking have likely experienced multiple and persistent traumas, a trauma-informed approach to treatment is essential. A wealth of literature describes effective and empirically based interventions with survivors of trauma (e.g., Cook et al., 2005), and until interventions specific to the needs of trafficked women and girls are developed, it is reasonable to recommend the current guidelines applied to survivors of other abuses. Psychologists should remain aware that trafficking survivors may present with many issues, requiring a holistic approach to services.

Psychologists working on complex trauma and complex PTSD issues can continue to inform and enhance an understanding of best practices and effective interventions (Cloitre et al., 2011; Courtois, 2008). Working in conjunction with women and girls who have been trafficked to develop appropriate and effective therapeutic techniques is essential. Practitioners working to establish therapeutic techniques for trafficked women and girls can develop diagnostic, evaluation and treatment guidelines that describe professional competencies and prescribe ethical and responsible care of the individuals they serve.

Finally, psychologists can play key roles within criminal justice systems by assisting in victim interviews and evaluations. Trafficking survivors who are well advanced in their recovery process can provide invaluable assistance to psychologists and forensic interviewers regarding trafficking dynamics and ways to avoid retraumatizing the client (Pierce, personal communication, April 29, 2013). Social psychologists can help jurors and judges understand the psychological mechanisms by which people can be coerced and manipulated and their freedom constrained, addressing the misperception that trafficking victims "could have left" because they may not have been physically confined, and that the victim is a "bad witness" based on her behavior and demeanor.

Psychologists and organizations providing services to trafficked individuals must proactively prepare for the potential effects of working with traumatized clients. Awareness, education, ongoing self-care and a supportive work culture are essential to the well-being of psychologists and to the responsible and effective treatment of trafficked persons.

Psychologists working with trafficked individuals need to pay special attention to their own well-being (International Organization for Migration [IOM], 2009; Kliner & Stroud, 2012).

Providing trauma-focused treatment is emotionally complex and demanding (Figley, 2002; Meichenbaum, 2007). Distress can fuel burnout, secondary traumatic stress (STS), vicarious traumatization (VT), and compassion fatigue (CF), which can include exhaustion, emotional numbing, a sense of reduced personal effectiveness, PTSD-like symptoms, and a variety of somatic disturbances (IOM, 2009; Jenaro, Flores & Arias, 2007; Kliner & Stroud, 2012; McCann & Pearlman, 1990; Meichenbaum, 2007; Perron & Hiltz, 2006; Smith & Moss, 2009; Yassen, 1995).

Psychologists have an ethical responsibility to (a) be cognizant of the possibility of burnout, STS, VT and CF; (b) understand the impact these conditions have on the therapeutic relationship; and (c) engage in self-care measures to prevent and mitigate impairment in their work (APA Ethical Principles, 2010a; Baker, 2003; Barnett & Cooper, 2009; Carroll, Gilroy, & Murra, 1999; Good, Khairallah & Mintz, 2009; Meichenbaum, 2007; Norcross & Barnett, 2008; Smith & Moss, 2009).

Supervisors, managers and organizations that educate or employ psychologists also have an ethical responsibility to promote "a culture of self-care" (Barnett & Cooper, 2009, p. 16). First and foremost, this includes honest acceptance that STS, VT and CF can occur and that measures should be taken to reduce their likelihood and address them when they arise.

Safety considerations

Psychologists who work with trafficked women and girls need to be mindful of safety for their clients, for themselves and for their places of work, especially if the trafficker is under criminal investigation or prosecution (IOM, 2009). Maintaining absolute confidentiality about clients who have been trafficked is essential for safety (IOM, 2009). For the safety of providers, agency staff and clients, clear guidelines should be developed for confidentiality protocols, employee responsibilities, building security, emergency communication and planning, and staff education and training.

Zimmerman and Watts (2003, p. 4) provided excellent guidelines for interviewing trafficked women and girls that capture the essential need for ethical, respectful and safe interactions. The guidelines are intended for service providers and researchers working with this population as well as for media professionals. A full explication of their recommendations is beyond the scope of this report, but the 10 guiding principles are:

1. Do no harm.
2. Know your subject and assess the risks.
3. Prepare referral information; do not make promises you cannot fulfill.
4. Adequately select and prepare interpreters and coworkers.
5. Ensure anonymity and confidentiality.
6. Get informed consent.
7. Listen to and respect each woman's assessment of her situation and risks to her safety.
8. Do not retraumatize a woman.
9. Be prepared for emergency intervention.
10. Put information collected to good use.

The Task Force on Trafficking of Women and Girls offers specific recommendations in the following topic areas: research, practice, education and training, public policy and public awareness. In addition, we offer general recommendations that transcend the topic areas and are essential to all aspects of work in psychology.

General recommendations

It is recommended that psychologists:

• Examine their assumptions and biases toward at-risk groups as they consider engaging in work on human trafficking issues.
  
  Stereotypes related to immigrants and undocumented migrants, runaway or homeless youth, persons with addictions or individuals in prostitution can impede identification of human trafficking survivors and their unique needs.
  
• Be culturally sensitive in all endeavors related to human trafficking (research, education and training, advocacy and public policy, public awareness and practice).
  
• Remain cognizant that internationally and domestically trafficked persons are a diverse and multicultural group. Psychologists must be able to adapt their professional work accordingly.
  
• Recognize that no "one-size-fits-all" approach exists to comprehensively address the victim/survivor experience.
  
  No single law enforcement or victim services protocol will suffice for every case. Remaining flexible with regard to conceptualization is a critical skill given the many possible intersections of victim characteristics (minor or adult, domestic or foreign national, among others), as well as the multiple labor and commercial sex settings in which trafficking occurs.
  
• Acknowledge that their work occurs within a social ecological system that includes larger community and cultural influences and that changes in one level of the system may have wider implications.
  
  Psychologists should remain aware that psychological approaches do not exist in a vacuum. For example, policy change in the name of anti-trafficking efforts may create unintended consequences for other vulnerable communities (such as clients of child welfare systems or immigrants).
• Support the creation of cultural shifts among law enforcement and service providers in anti-trafficking efforts to create a greater understanding of and respect for all trafficked populations.
  
  One example of cultural shifts: community and social psychologists can address law enforcement and service provider attitudes toward marginalized populations as groups "worthy" of support and access to services by providing specialized training regarding the nature of trafficking and its victims.
  
• Examine the impact of paternalistic attitudes and the "rescue" approach on survivors' outcomes and well-being. This approach must be guarded against in U.S. policy, NGO programs and individual treatment. Paternalistic attitudes toward survivor inclusion in policymaking, program planning and program evaluation sideline expertise and silence essential voices.
  
• Advocate for survivor-centered, survivor-informed and survivor-led efforts guiding policymaking, protocol development, research design, methodology and clinical approaches.
  
  For example, community-based research should be conducted with the input of affected individuals, taking time to build and maintain trusting collaborative relationships.
  
• Increase focus on prevention of human trafficking at all levels of the social ecological system.
  
• Support recommendations of the APA Task Force on the Sexualization of Girls (2010) regarding social norms, attitudes and culture of tolerance for sexual exploitation.

To address the limitations of the current research base as discussed at length in this report, particularly the absence of research on trafficking of women and girls for forced labor and of women and girls into and within the United States, as well as on the efficacy of programs and treatment modalities for survivors, we recommend that:

• The complexity of human trafficking issues be addressed with an interdisciplinary and multisector response.
  
  Transnational and domestic trafficking of women and girls occur within systems of global and domestic trade, voluntary and forced migration, economic disparities and structural inequalities. In addition, legal and governmental factors such as the existence or lack of labor laws, criminal justice procedures and child welfare systems impact trafficking situations. The complexity of the issue requires a multisector response, and interdisciplinary research is necessary for that response to be optimally effective.
• Research methodologies be developed and conducted in collaboration and consultation with survivors and clinicians who have substantial experience providing services to this population.
• Trafficked persons who have experienced powerlessness may experience research settings that are inherently hierarchical as overpowering. Therefore, mixed methodologies (e.g., qualitative and quantitative with an overarching participatory action research lens) may be better suited to concurrently obtain empirically supported results while paying attention to important ethical concerns.
• Community-based participatory research be considered as one promising approach for addressing this topic.

Prevention/demand

It is recommended that research be conducted in the following areas:

• Prevention of human trafficking at all levels of the social ecological model, including examining risk factors such as child sexual abuse, child neglect, parental abandonment, racial and ethnic discrimination, homelessness and marginalization due to sexual identity, sexual orientation, disability or immigrant status.
• The role objectification of women and girls plays in the proliferation of human trafficking and in fueling the demand for commercial sexual exploitation.
• The role of women's empowerment, equity and rights in the prevention of trafficking.
• The potential role of religion and religious practices in relation to trafficking recruitment and recovery.
• Effective cross-disciplinary collaboration and partnerships for prevention.
• Consumer and business models for reducing demand for products made with forced labor and factors impacting consumer attitudes and behavior.
• Effectiveness of primary prevention efforts targeting girls and women.
• The link between pornography and sex trafficking, including trafficking for the purpose of producing pornography, the use of pornography by traffickers and the potential for pornography to fuel trafficking via increased demand.
  
  Anecdotal evidence suggests traffickers may use pornography to "train" women and girls for commercial sex work and also as a coercion method (e.g., threatening to show family the pornographic material involving the victim if she does not comply).
• Demographics, characteristics and motivations of consumers of goods and services that involve trafficking, especially commercial sex.
• Demand and trafficking — Psychologists can collaborate with groups that work on rehabilitating consumers of commercial sex to build methodologies that will help understand demand in the United States.

Identification

• How information processing, social perception, schemas and labeling impact the ability of professionals to identify perpetrators and victims of human trafficking in the field and to respond appropriately.
• Areas that may involve trafficking but have not been examined as such (e.g., survival sex, stripping, pornography). A better understanding of common contributing factors is needed.

Biases

• How depictions of human trafficking impact justice for and empowerment of survivors. Depictions may impact how victims perceive themselves (including whether they identify as victims of a crime) and how the justice system responds (e.g., jury perceptions and decisions, prosecutors' willingness to take cases, assumptions about "good witnesses" and "good victims," and judges' rulings). Failure to represent the diversity of trafficking situations or to recognize the resiliency and agency of trafficking survivors may impact how services are provided.
  
  This could include examination of depictions of trafficking in the media, in government-produced public service announcements, in outreach materials, and in NGO logos and websites. It could also be fruitful to examine the language of policy and rhetoric in the anti-trafficking movement.

Traffickers

• Trafficker coercion tactics, especially psychological tactics.
• A typology of traffickers, including characteristics and contributing factors (e.g., factors that determine whether people become traffickers).
• A comparison of sex traffickers to other types of sex offenders (e.g., rapists, child molesters) to determine whether current criminal justice responses, mental health treatment and rehabilitation and reentry protocols applied to sex offenders are appropriate for sex traffickers.
• The degree to which formerly trafficked persons engage in the trafficking of others and the determinants of this behavior.

Trafficked persons

• Interactions of situational and individual characteristics (e.g., developmental, cultural, demographic) as they apply to human trafficking vulnerability, resistance, resiliency and recovery.
• Post-trafficking social support and relationships. Because traffickers commonly prey on women and girls by establishing a trusting, albeit false, relationship with them, studies on the impact of trafficking on relationships will be especially helpful.
• Long-term impact of the trafficking experience throughout the life course of survivors.
  
  For example, the impact of prolonged exposure to violent pornography or of forced abortions on survivors' sexual and reproductive health warrants investigation.
• Overlap of intimate partner violence and sex trafficking.
• Impact of gender nonconformity and gender fluidity on vulnerability to trafficking.
• The trafficking of men and boys for labor and for commercial sex.
• Religious and spiritual factors pertinent to trafficking (e.g., risk and recruitment), survivor resilience and recovery, and service delivery (e.g., how the faith orientation of groups providing services impacts the well-being of survivors).

Trauma

• Types of trauma exposure during and after trafficking with specific focus on exposure to psychological and physical coercion, resulting sequelae and impacted areas of functioning.
• Trauma's impact on decision making, willingness to cooperate with law enforcement, willingness to receive services and vulnerability to revictimization.
• Traumatic bonding or Stockholm syndrome in cases of human trafficking.
• Resilience of trafficked persons to identify factors that reduce the risk of trauma-related sequelae in affected populations.

Labor

• Risk factors for trafficking into domestic service, agricultural production and meat processing, service industries (e.g., salons, restaurants, hotels) and other locations of labor trafficking.
• The biopsychosocial effects of slave-like and exploitative work environments. A thorough examination of the experiences of persons trafficked for labor, including psychological impact and health consequences, is lacking in the current literature.
• Public attitudes about and media depictions of labor trafficking. It would be informative to examine factors contributing to the relatively low profile of labor trafficking in research, academic writing and public discourse.

Program and treatment evaluation

• Program/practice evaluation using randomized control designs and quasi-experimental designs when appropriate and ethical.
• Strengths, limitations and successes of organizations with survivor leadership and survivors on staff or as peer mentors. It is essential to determine factors that contribute to successful models and identify best practices, as the number of service agencies is growing rapidly.
• Development and evaluation of successful exit programs and support programs.
• Development and evaluation of appropriate individual and group treatments to address the psychological impacts of trafficking.
  
  Group therapy has been used effectively in some programs (Ward and Roe-Sepowitz, 2009), but anecdotal evidence suggests that support groups may be less effective with some populations because of the circumstances of their trafficking (Shigekane, 2007). Further exploration is needed.
• Protocols for meeting needs of trafficking victims (i.e., shelter, health care, trauma-focused counseling, substance use counseling, education, job training, etc.), including guidance on how to prioritize and provide treatment needs in the most efficient and cost-effective way.
• Impact of developmental variables on treatment choice and success.

As practitioners, psychologists perform critical services by providing direct treatment, developing treatment protocols, and consulting with organizations/businesses regarding trafficked women and girls. We recommend that to competently address the unique needs of trafficked persons, psychologists:

• Develop more effective screening tools for therapists, social service providers, law enforcement, health care providers and other professionals who may encounter victims.
• Consider comprehensive and coordinated community-level responses in supporting victims and survivors.
  
  Psychologists are encouraged to develop and maintain partnership protocols with law enforcement, social workers and victim service networks (depending on the needs and request of survivors) to help streamline and support efficient community response.
• Strive for partnership and coordination of efforts between protection, prosecution and prevention sectors.
  
  For example, service providers and law enforcement can coordinate their efforts to more efficiently support survivors.
• Apply psychological theories of healthy personality and identity development, thriving, and psychological growth during the recovery process for survivors of trafficking.
• Educate themselves about developmental factors that impact trafficking risk, response to the trauma of trafficking, and efficacy of treatment with different age groups.
• Assist the companies with which they (i.e., organizational psychologists) consult through technical assistance and training, implementation of prevention strategies and development of business models for monitoring subcontractors, recruiters, supply chains and other practices that may conceal trafficking.
  
  Of special interest are companies that outsource services where trafficking is more prevalent (e.g., hired cleaning crews, subcontracted construction labor, suppliers of manufacturing components). In addition, in settings where traffickers or trafficked persons might be encountered (e.g., airports, hotels, border customs checks, emergency rooms), psychologists are encouraged to consult with personnel to increase identification and awareness of trafficked persons.
• Identify avenues for practitioner self-care and support self-care for other professionals involved in anti-trafficking work (law enforcement, service providers, health care, educators, etc.).
  
  In addition, it is recommended that APA make the "Report of the Task Force on Trafficking of Women and Girls" available to all practitioners to familiarize them with consequences of being trafficked and treatment recommendations relevant to trafficked persons.

To increase knowledge and awareness of trafficking, specifically its prevalence and devastating consequences, within the discipline of psychology and among psychologists, we recommend that:

• Psychological theory and research be used to develop effective communication materials and training curricula to maximize learning among multiple sectors that interface with trafficked persons or are involved in prevention efforts, including service providers, policymakers, law enforcement personnel, health care professionals, businesses, educators and others.
• Research on information processing, social perception, schemas and labeling be used to address misperceptions and failures of identification of trafficked persons. This research should also be incorporated into training curricula.
• APA disseminate the "Report of the Task Force on Trafficking of Women and Girls" to school psychologists, educators and faculty at the elementary, middle-school, high-school and undergraduate levels and to chairs of graduate departments of psychology.
  
  School psychologists and educators need to be informed about (a) identification of students at risk for trafficking, (b) fortifying those at-risk youth with skills to withstand manipulation and advances, (c) empowering youth to recognize and value healthy, noncoercive relationships, (d) helping youth distinguish between legitimate job opportunities and fraudulent "too-good-to-be-true" offers, and (e) encouraging critical discussion of the glorification of pimp culture, sexualization of girls and women, and demand for commercial sex.
• Chairs of graduate departments of psychology, chairs of departments in related disciplines (e.g., law, social work, public health, public policy, human development and family studies, criminal justice), as well as other relevant professionals or community partners, be encouraged to utilize information from the "Report of the Task Force on Trafficking of Women and Girls" in curriculum development and to aid in the dissemination of the report.
• The importance and ethical imperative for self-care be emphasized in course work and training.
• Psychologists who supervise practicum students, interns or postdoctoral residents be well versed and have extensive knowledge regarding human trafficking.
• A continuing education and online program be developed using information from the "Report of the Task Force on Trafficking of Women and Girls," in collaboration with APA's Office of Continuing Education in Psychology.
• All curricula and communication materials be developed by professionals with appropriate background and knowledge on trafficking and be evaluated for effectiveness.

To promote deeper understanding of all aspects of trafficking of women and girls, we recommended that psychologists:

• Support funding of research related to human trafficking.
• Advocate the development and implementation of evidence-based, developmentally appropriate, culturally appropriate and trauma-informed services for survivors of human trafficking.
  
  Promote the integration of behavioral health services in settings where trafficking survivors reside and receive services, including schools, victim services, communities, foster and residential care, juvenile justice, criminal justice and health care.
• Promote and inform the education and training of health, educational, law enforcement, legal, child welfare and social service professionals on the causes, signs and consequences of human trafficking, including mental health aspects, to ensure that individuals are appropriately identified as at-risk for or as survivors of trafficking. Identified individuals should be offered appropriate resources, services and support to ensure safety and optimal medical and mental health outcomes.
• Support evidence-based policies and programs to meet the needs of girls as the fastest growing segment of the juvenile justice system.
  
  Address the substantial overlap between involvement in the justice system and in human trafficking. For example, support investments in competitive grant programs to help states and localities better address the needs of girls in the juvenile and criminal justice systems and to provide specific, targeted support for state efforts to implement best practices for at-risk and system-involved girls.
• Advocate addressing human trafficking in legislation and federal and state initiatives relating to runaway and homeless youth, child welfare services and foster care and adoption assistance programs.
• Advocate inclusion of information about sex trafficking practices and prevention, intimate partner violence prevention, sexualization, objectification and healthy relationships in school health and related programs, including comprehensive sex education and other sexuality education programs.
• Support policy that recognizes trafficked persons coerced into illegal activities (e.g., prostitution) as victims rather than criminals.
• Promote the development and use of empirically supported curriculum models and media literacy programs, including interactive media to prevent trafficking and potentially counteract the effect of sexualization and objectification of girls.
  
  Interventions should be evaluated for effectiveness and potential wide-scale adoption and should assess the impact of sexualization on girls and boys and consider important factors such as race or ethnicity, sexual orientation, religious affiliation, disability status and socioeconomic status, consistent with recommendations from the "Report of the APA Task Force on the Sexualization of Girls" (APA, 2010).
• Advocate for effective behavioral health and educational supports for immigrant-origin children, adolescents and adults who have suffered from or are vulnerable to human trafficking, as consistent with recommendations from the APA Presidential Task Force on Immigration (2012).
• Continue to raise awareness of the behavioral health effects of detention and deportation processes on immigrant trafficking survivors and their families (adapted from the report of the APA Presidential Task Force on Immigration recommendations, 2012).
• Promote immigration policies that support trauma-informed, developmentally appropriate and culturally responsive behavioral health services and that recognize the importance of family reunification in immigration proceedings when appropriate and in the best interest of the trafficking survivor, as consistent with the APA Resolution on Immigrant Children, Youth and Families (1998) (adapted from the APA Presidential Task Force on Immigration recommendations, 2012).
• Advocate review of immigration policy, including examination of the temporary work visas and guest-worker programs, to eliminate abusive labor conditions.
• Promote protection of human rights for all workers in the United States through support for humane and just labor standards, enforcement of labor laws and protection of workers' interests.
• Examine the impact of the current economic climate and policy on the well-being of the workforce. Advocate careful examination of the connection between free-trade policies and trafficking of persons into the United States and to produce goods for U.S. consumption.
• Promote policies that will provide access to life-long health and mental health care to address the long-term and chronic health issues faced by survivors of trafficking.

To raise awareness of trafficking, it is recommended that:

• Public awareness campaigns be used to:
  • Address common misperceptions and myths about trafficking victims.
  • Increase awareness that human trafficking occurs within the United States in all types of communities. As such, awareness campaigns must be adapted for use in diverse and multicultural communities.
  • Increase awareness of both labor and sex trafficking.
  • Educate the public about common signs of human trafficking to help identify potential victims in their communities. Psychologists can be especially helpful in educating about signs of psychological coercion — often subtle and difficult to identify — in trafficking (e.g., grooming, traumatic bonding).
  • Emphasize prevention for parents and youth.
• Public awareness campaigns should include multilevel training created by long-term survivors who are advanced in their own healing and have the necessary experience, professional skills and training to work with economically and culturally diverse stakeholders.
• Public awareness campaigns respect the varied lived experiences of human trafficking survivors. Ensure that images are neither exploitive nor sensationalist in nature to prevent stereotypical images of human trafficking survivors.
  
  When public awareness programs include survivors as speakers, the organizers and other speakers should be mindful to avoid unintentionally presenting survivors as "token" examples, or worse, "specimens" to be examined.
• Public service announcements provide survivor hotline numbers in addition to the Human Trafficking Resource Center hotline number.
  
  Institutions that may serve trafficked persons or that may be locations of trafficking should post public service announcements with hotline numbers.
• Public awareness curricula address intersections and overlaps with other forms of violence (e.g., child abuse, intimate partner violence), exploitation (e.g., labor exploitation and violations) and vulnerable communities (e.g., immigrants, refugee/asylees, homeless youth).

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