Human trafficking is the second largest criminal industry worldwide (second only to drug dealing and tied with illegal arms), and is the fastest growing of all criminal enterprises. One form of human trafficking, the commercial sexual exploitation of children (CSEC), harms thousands of young people in the United States every year. While exact numbers are difficult to estimate given the clandestine nature of the crime and limited reporting, the National Human Trafficking Hotline identified more than 2,600 child trafficking cases in 2020.

Although human trafficking historically has been under the purview of law enforcement, child protection agencies have a legal responsibility to protect young people from CSEC. The 2014 Preventing Sex Trafficking and  Strengthening Families Act specifically requires child protection agencies to develop policies and procedures to identify children who are victims or at risk of commercial sexual exploitation, and to provide appropriate services. Given the high risk of victimization among children who run away from foster care, the act also includes a number of related provisions. Needed improvements  to training, screening, and reporting practices can help ensure data-driven intervention and prevention efforts.

The federal Justice for Victims of Trafficking Act of 2015 changed the legal definition of child abuse to include child sex trafficking. “Children who experience human trafficking often have a history of abuse, neglect, and trauma,” the Administration for Children & Families explains. “Traffickers exploit these adverse childhood experiences to target children through common online and offline schemes.”

CSEC is a complex problem requiring an intensive and unwavering commitment among the wide array of agencies addressing the issue. Developing and implementing compassionate and effective responses requires multi-system collaboration among child welfare, law enforcement, judicial, healthcare, education, and mental health systems, with financial and policy support from local, state, and federal governments.

Risk factors

Perpetrators of CSEC seek out vulnerabilities in youth. As a result, child welfare involvement, running away, and child sexual abuse are among the primary risk factors for sexual exploitation. Studies show that between 70% and 90% of youth who are victims of sex trafficking are survivors of child sexual abuse. One survivor noted that being in foster care was a training  ground for human trafficking, as it taught her that she was attached to a check.

Other risk factors include: emotional or physical abuse; parental substance use; difficulties at school; exposure to domestic violence; history of exploitation in the family or community; and neglect (lack of supervision, care, and basic necessities). LGBTQ youth also are at high risk, in part because in cases where rejected by family, they may have to resort to being victimized in order to meet their basic survival needs. Youth in foster care seeking connection with other adults also can fall prey to the tactics of human traffickers, who target children with minimal social support and low self-esteem.

Of course, many youth in foster care experience several of these risk factors and do not become involved in CSEC. Youth should be appropriately screened for risk and exploitation, rather than assumed to be at risk or exploited. 

Screening

Identification of youth who are victims can be particularly difficult because they often don’t consider themselves victims or are rehearsed in delivering a script with false statements. All screening must be culturally responsive, trauma-informed, and person-centered. Victim-centered interviewing can be helpful, as can employing the language that youth use, such as taking part in “the game” or “working.” Providers may need to spend time building a trusting relationship before youth feel comfortable disclosing their experience.

Several tools have been developed for identifying children who are victims or at risk of CSEC:

• The WestCoast Children’s Clinic integrated feedback from over 100 stakeholders to develop and validate the Commercial Sexual  Exploitation-Identification Tool.
• The Urban Institute developed and tested the Human Trafficking Screening Tool (long and short form), which appears to be effective in identifying children who are victims of CSEC.
• Shared Hope International’s Child Sex Trafficking Warning Signs list potential indicators of children being groomed or trafficked, and the behaviors of pimps and traffickers.
• Seattle-based YouthCare created a one-page guide for the identification of youth at risk of CSEC, including warning signs and guiding principles for engagement.
• The U.S. Department of Health & Human Services’ Office of Planning, Research, & Evaluation created a summary of the various tools that are in use by states for Screening for Human Trafficking in Child Welfare Settings.

Prevention

Child protection agencies and advocates have developed prevention programs, some of which are intended for the general youth population and some of which are intended for youth at risk of CSEC. One program, My Life My Choice, has demonstrated  effectiveness, and offers a curriculum designed to support girls, ages 12 to 18, that includes an in-depth examination of their vulnerabilities and protective behaviors. Survivors of child sexual exploitation developed and reviewed the program, which is designed to be co-facilitated by a survivor. To date, facilitators from 33 different states have been trained in this curriculum.

Love146’s prevention curriculum, Not a Number, raises awareness, teaches about recruitment strategies and vulnerabilities, and how to safely handle potential (or existing) exploitation situations. The curriculum is designed for youth ages of 12 and 18, and has been piloted in Connecticut, Florida, and Texas. The National Advisory Committee on the Sex Trafficking  of Children & Youth in the United States has also released recommendations for states and a state  self-assessment overview tool.

Considerations regarding institutional or group placements

Research indicates that placement in institutional or group settings is associated with poorer outcomes compared to placement in family foster care, and that placing youth in group settings may increase the risk for future CSEC. In particular, traffickers have been known to target group facilities and shelters to find vulnerable children. Specifically, research has found that:

• [Some] exploiters actively seek out vulnerable children at schools, homeless shelters, malls, bus depots, and foster care group homes.
• System decision-making and involvement may increase the risk of exploitation — placing a young girl in an institutional or group setting home near an area known for prostitution, for example, may increase the likelihood that she is recruited by exploiters.
• Sites of increased vulnerability include institutional or group settings, detention facilities, schools in areas known for prostitution, and neighborhoods with challenging community conditions.¹

The relationship between group settings and vulnerability to sex trafficking can become cyclical. Practice experience and available data indicate that youth who run away are more likely to be placed in group settings and youth are more likely to run away from group placements.² “Running away not only places the youth in harm’s way but also frequently jeopardizes current placements and can lead to more restrictive placements once the youth returns.”³ Not only are children placed in group settings more vulnerable to becoming victims of commercial sexual exploitation, but victims of CSEC who enter or return to foster care are often placed in group settings, which can then make them vulnerable to becoming trafficked again.

A comprehensive study of services found that group  facilities in New York state were not able to meet the  needs of youth who are victims of CSEC or keep youth safe from sex traffickers. The study found that group and institutional providers often did not recognize cases of CSEC and, as a result, services were not provided and trauma was not addressed. Group and institutional providers also demonstrated a lack of understanding of human trafficking as a criminal industry, experienced difficulty identifying victims, provided inadequate services to those they did identify, and had concerns about safety for youth and staff (given possible interactions with traffickers).

The 2018 Family First Prevention Services Act generally limits Title IV-E reimbursements for group facility stays longer than two weeks unless the setting is a Qualified Residential Treatment Program (QRTP). But an exemption is made for any setting that “provides high quality residential care and supportive services to children and youth who have been or found to be or are at risk of being sex trafficking victims.” Federal guidance on implementation clarified that the statute does not define high quality residential care, supportive services, or what it means to be “at risk of becoming” a victim of sex trafficking. Title IV-E agencies therefore have the flexibility to define each of these.

As Title IV-E agencies implement the Family First Act’s provisions related to CSEC, taking a broad definition of youth “at risk of trafficking” may lead to too many youth placed in group settings, leading to poorer outcomes and potentially greater risk of CSEC involvement. Therefore, jurisdictions should carefully consider definitions and related policies so that they do not unintentionally expand the role of group facilities in serving youth who are victims or at risk of CSEC. In the absence of set standards, child protection agencies are responsible for developing high standards of practice and ensuring that high-quality services are available for youth in those placement settings.

Ohio⁴ has worked to address human trafficking, forming a task force that includes representatives from 10 state agencies and a commission charged with raising awareness, increasing identification of victims, expanding support services, and developing protocols for responding (such as Ohio’s Child Response Protocol Toolkit). In deciding how to approach the Family First Act’s provisions for youth who are victims or at risk of CSEC, Ohio determined that all youth in residential settings should receive the same high-quality services provided through QRTPs, whether or not they meet the criteria for exemption. As a result, Ohio will require all child-serving residential facilities to adhere to the standards of QRTPs.

Services for young people identified as victims of CSEC

Just as research on CSEC prevention is still emerging, so too is the evidence base for services for young people identified as victims of CSEC. While there are 10 programs for victims of CSEC listed in California’s  Evidence-Based Clearinghouse for Child Welfare (CEBC), all are categorized as “not able to be rated,” meaning more research and evidence are needed.⁵

A promising program (not listed in the CEBC) was developed in Minnesota. Youth participating in the Runaway Intervention Program — an intensive support program encompassing case management, strengths-based home visiting, and group support led by experienced nurses —demonstrated significant decreases in emotional distress and risk factors.

Until more evidence-based interventions are created for survivors of CSEC, modifications of effective interventions for similarly vulnerable youth populations may be helpful, including Trauma-Focused Cognitive-Behavioral Therapy (which has been shown to be effective for survivors of child sexual abuse), Multisystemic Therapy (which engages multiple systems to care for youth), and the Adolescent Community Reinforcement Approach (which has been shown to be effective in increasing social stability and participation in services among youth experiencing homelessness and youth who have run away). The general consensus is that successful efforts require cross-agency collaboration and that interventions should be multi-disciplinary, trauma-informed, and delivered within a system of care.

It also can be helpful to consider harm reduction  principles, as not all youth who are victims of CSEC may be able to successfully exit their situation, but their safety still needs to be ensured through education and resources for safe sex and protection. A harm reduction approach can build a youth’s sense of control, autonomy, and self-determination, helping to move them toward a safe exit from sex trafficking. The Human Trafficking Leadership Academy, which includes survivor leaders, developed a Self-Guided Assessment Tool with recommendations for enhancing services for survivors of human trafficking, using survivor-informed principles.

Resources

The Child Welfare Capacity Building Collaborative assembled Resources to Support Implementation  of the Sex Trafficking Provision of P.L. 113-183, a recorded webinar with background information, descriptions of federal legislation, examples of state policies and programs, guidance on implementation, and resources for service providers. In addition, Identifying Minors and Young People Exploited  through Sex Trafficking: A Resource for Child Welfare  Agencies, provides a list of risk factors for CSEC, considerations when planning to implement a risk assessment or identification tool, “ground rules” for agency staff on how identifying youth who are victims or at risk of CSEC, and information about existing screening and risk assessments.

Child Welfare Information Gateway’s publication, Responding to Child Victims of Human Trafficking, includes a summary of federal legislation, information about the responsibilities of state agencies, and requirements for specialized training. It also includes a summary of state laws (through December 2018). Their publication Human Trafficking and Child Welfare: A Guide for Caseworkers gives tools and resources for caseworkers as well as strategies that caseworkers can use to support victims.

Loyola University Chicago’s Center for the Human Rights for Children’s handbook, Building Child  Welfare Response to Child Trafficking, includes information on identification and investigation, screening tools, case management tools and resources, legal protections and advocacy, and integrating response protocols and services within child welfare.

National Center for Youth Law’s 2014 report, From Abused and Neglected to Abused and  Exploited: The Intersection of the Child Welfare  System with the Commercial Sexual Exploitation  of Children, provides a case study example of a girl in foster care placed in a group setting who subsequently became a victim of sex trafficking. The report highlights several risk factors and makes recommendations for prevention.

The National Conference of State Legislatures’ Human Trafficking Overview webpage compiles information on related federal and state legislative efforts and includes a link to a federal database of state human trafficking laws.

The National Council of Juvenile and Family Court Judges and the National Center for Missing and Exploited Children developed a guide to support a three-branch approach to address child sex trafficking involving legislative, judicial, and executive perspectives: Missing Children, State  Care, and Child Sex Trafficking: Engaging the  Judiciary in Building a Collaborative Response.

The U.S. Department of Health & Human Services offers several resources:

• Identifying and Addressing Human Trafficking in Child Welfare Agencies study, which looks at how 25 state agencies identify and serve young people who are victims or at increased risk of trafficking.
• Recommendations for Child Welfare System Support from Youth Currently and Formerly in Foster Care, which summarizes how the child welfare system can support youth who transition from foster care and are at risk of human trafficking.
• Human Trafficking and Child Welfare: Scope of Agency Authority, which identifies how child protection agencies approach investigations of suspected human trafficking.

• Responding to Human Trafficking among Children and Youth in Foster Care and Missing from Foster Care, is a joint Information Memorandum that compiles resources that help states meet legal requirements intended to protect child-welfare involved children and youth from human trafficking. It includes research, best practices, related federal laws.

• The Office on Trafficking in Persons (OTIP), an Office within the Administration for Children & Families, aims to support systems that work to prevent human trafficking. It holds key resources, promotes National Human Trafficking Prevention Month, and compiles latest news on this topic. The National Human Trafficking Training and Technical Assistance Center delivers training and technical assistance, on behalf of OTIP, to systems that work to prevent human trafficking. They offer an advanced training program SOAR Online, for providers who serve children, youth, and families who may be connected to the child welfare system.

• The national Advisory Committee on the Sex Trafficking of Children and Youth in the United States published the Best Practices and Recommendations for States, a report that contains 127 recommendations for states as they respond to the sex trafficking of children and youth within their jurisdictions.

1 California Child Welfare Council. (n.d.-a). Ending the commercial sexual exploitation of children: A call for multi-system collaboration in California. Retrieved from: www.chhs.ca.gov/wp-content/uploads/2017/06/Committees/California-Child-Welfare-Council/Council-Information-Reports/Ending-CSEC-A-Call-for-Multi-System-Collaboration-in-CA-February-2013.pdf
2 North Carolina Department of Social Services, & Family and Children’s Resource Program. (2014). Preventing and responding to runaways from foster care. Fostering Perspectives,18(2). Retrieved from: http://fosteringperspectives.org/fpv18n2/runaways.htm; Pergamit, M. & Ernst, M. (2011). Running away from foster care: Youths’ knowledge and access of services. Darby, PA: DIANE Publishing.
3 Crosland, K. & Dunlap, G. (2015). Running away from foster care: What do we know and what do we do? Journal of Child and Family Studies, 24(6), 1697-1706, p. 1698.
4 Based on conversation with Bhumika Patel, Anti-Human Trafficking Coordinator, Public Children Services Association of Ohio, December 18, 2019.
5 One of these programs is My Life My Choice, which is both for survivors and youth at risk of CSEC. As mentioned above, this program does have a peer-reviewed study.