Health and Social Service-Based Human Trafficking Response Models

Abstract

Drawing on a comprehensive review of the international literature, this chapter will examine health and social service-based human trafficking response models, with focus on those developed in the industrialized countries. It will discuss the four main building blocks of a service-based response model; will highlight key elements to successful service delivery, as well as the primary challenges and barriers associated with service provision to trafficked persons; and will offer suggestions for ongoing and future initiatives.

Appendix A. Examples of human trafficking identification tools

Source	Focus	Target audience	Description
Lists and inventories of TIP indicators
The United Nations Office on Drugs and Crime ([UNODC] n.d.)	Generalist	Any	A two-page information sheet that lists, in a bullet-point format, six sets of mainly situational/circumstantial TIP indicators:  • General indicators  • Child trafficking  • Sexual exploitation  • Labor exploitation  • Domestic servitude  • Begging and petty crime
B.C.’s Office to Combat Trafficking in Persons ([OCTIP] 2014)	Generalist	Any	A five-page information sheet, which provides bulleted lists of primarily situational/circumstantial human trafficking indicators/red flags, as well as some behavioral, physical appearance and language indicators. The indicators are divided into six sets:  • Abuse and control  • Sexual exploitation  • Domestic servitude  • Child trafficking  • Child recruitment for sexual exploitation  • International trafficking The presence of one or more of these indicators suggests it is worth looking further into the situation.
MCIS Language Solutions (2014)	Generalist	Service providers	A one-page information sheet that lists, in a bullet-point format, five sets of mainly situational/circumstantial TIP red flags, with several key physical appearance and behavioral indicators:  • General signs  • Signs of commercial sexual exploitation  • Signs of child trafficking  • Signs of forced labor  • Signs of domestic servitude
UNODC (2009)	Generalist	Criminal justice practitioners	Embedded in a comprehensive anti-TIP manual is a general inventory of situational/circumstantial human trafficking indicators, as well as select demographic, physical appearance, and behavioral indicators. These indicators are first described in nine narrative sections:  • Age  • Gender  • Location of origin  • Documentation  • Last location  • Transport  • Circumstances of referral  • Evidence of abuse  • Assessment of the referring agency These sections are supported by bulleted lists of indicators for:  • General human trafficking  • Child trafficking  • Trafficking for the purpose of domestic servitude  • Trafficking for the purpose of sexual exploitation  • Trafficking for the purpose of labor exploitation  • Trafficking for the purposes of begging and committing petty crimes
Purchased (n.d.)	Generalist	Service providers General public	Web-posted list of mainly situational/circumstantial TIP indicators, combined with a few physical appearance and behavioral indicators. Indicators are divided into two sets – social and health – and presented in a bullet-point format. These indicators are complemented by the “Questions to Keep in Mind” section.
Sarnia-Lambton Committee Against the Trafficking of Women and Children ([SLCATWC] 2015: 15–16)	Generalist	Service providers Community members	Embedded in a community TIP response guide, a two-page section “Recognizing Signs of Human Trafficking” lists, in a bullet-point format, two sets of situational/circumstantial indicators: health characteristics of trafficked persons and “other” indicators. These indicators are complemented by the “Questions to Ask Yourself” section (not for self-screening).
Stoklosa et al. (2017b: 192)	Generalist	Health care workers	“HT Assessment” pocket tool lists, in a bullet-point format, core physical appearance, and situational/circumstantial TIP indicators, which are divided into three sets:  • Eight physical indicators (e.g., signs of physical trauma)  • Nine red flags/warning signs (e.g., inconsistent or scripted history)  • Seven control indicators (e.g., controlling person doesn’t allow patient to answer questions) If at least one indicator is present, action needs to be taken. Four action steps are outlined in a clear, succinct manner.
Fraser Health Authority (2014)	Generalist	Health care workers General public	An online training program, designed to help identify and respond to potential victims of human trafficking who present in a hospital emergency department, offers a list of primarily situational/circumstantial and language indicators divided into three sets:  • Social indicators  • Inconsistent explanations  • Presence of a controlling companion  • Lack of personal documents  • Language
Women’s Support Network of York Region ([WSN] 2017)	Sex trafficking of women and girls	Service providers General public	Web-posted list “Indicators of Trafficking” provides three sets of observable indicators:  • Attitudes indicators  • Behaviors indicators  • Physical indicators
WSN (2013: 9–11)	Sex trafficking	Educators School guidance counselors	Embedded in a comprehensive TIP prevention manual, several categories of indicators of trafficking for the purpose of commercial sexual exploitation are listed in a bulleted format:  • Demographic risk factors  • Three sets of sex trafficking indicators:   - Appearance (physical and emotional)   - External control and isolation of the victim   - The victim’s involvement in sex trade
Washington Coalition of Sexual Assault Programs ([2015]: 8–9)	Sex trafficking of children and youth	Educators Parents Community members	Embedded in a brief TIP prevention and intervention resource guide, a two-page section “Warning Signs to Help Identify Victims” lists, in a bullet-point format, a combination of behavioral, physical appearance, language, and health indicators specific to sexual exploitation of children and youth.
Children of the Street Society (n.d.)	Sex trafficking of children and youth	Parents	This comprehensive prevention and early intervention toolkit for parents provides three sets of warning signs:  • Attitudes  • Behaviors  • Physical abuse Highlighted are risk factors specific to the most vulnerable population groups:  • Indigenous people  • LGBTQ+  • New immigrants  • Adopted youth and youth in care
SAFE Action Project (2016)	Child sex trafficking	Hotel staff Airport staff	Online training toolkit, available in English and Spanish. Offers several information sheets listing primarily visual child sex trafficking warning signs for:  • General hotel staff  • Housekeeping and maintenance staff  • Front desk and reservations staff  • Guest services staff (concierge, bellman, valet)  • Food and beverage staff  • Security staff Downloadable posters and “bystander” cards listing general warning signs for child sex trafficking in hotels are provided for airport staff.
Native Women’s Association of Canada ([NWAC] 2015: 5–6)	Sex trafficking of women and girls	Presumed trafficked persons	A one-page “Warning Signs” section, embedded in a comprehensive handbook on helping sexually exploited indigenous women and girls, provides a short list, in a bullet-point format, of situational/circumstantial sex trafficking indicators for self-screening.
MOSAIC, West Coast Domestic Workers’ Association (n.d.)	Labor trafficking of foreign workers	Presumed trafficked persons	A two-page pamphlet aimed to raise awareness and assist foreign workers who may be trafficked. Provides a short bulleted list of situational/circumstantial TIP indicators for self-screening. Is available in five languages: English, Chinese, Filipino, Punjabi, and Spanish.
OCTIP (n.d.)	Domestic servitude	Presumed trafficked persons	Awareness poster about help available for victims of domestic servitude. Focuses on situational/circumstantial indicators aligned with the UN (2000) definition of TIP. Lists six questions for self-screening. Available in five languages: English, Chinese, Filipino, Punjabi, and Spanish.
Open-ended interview guides
National Human Trafficking Resource Center ([NHTRC] 2011)	Generalist	Service providers	A comprehensive tool designed for assessing clients for potential signs of TIP. Outlines general TIP assessment tips and safety check guidelines. Focus on situational/circumstantial indicators aligned with the terminology of the UN (2000) definition of TIP. Provides several types of open-ended assessment interview guides aimed to elicit narrative answers:  • General trafficking assessment questions   - Fraud questions   - Coercion questions   - Debt-monetary questions   - Force questions  • Sex trafficking assessment questions  • Labor trafficking assessment questions  • Network/controller-specific assessment questions, including questions related to:   - Domestic servitude   - Pimp-controlled sex trafficking (street, truck stops, online escorts, etc.)  • Intimate partner and inter-familial trafficking, with questions related to:   - Sex trafficking   - Labor trafficking  • Questions for workers in commercial front brothels (fake massage businesses, nail salons, bars, strip clubs)  • Questions for workers of residential brothels  • Labor trafficking in agriculture assessment questions  • Labor trafficking in the service industry (hotels, restaurants, resorts) assessment questions  • Labor trafficking in sales crews assessment questions
Anti-Slavery International (2005)	Generalist	Front-line responders: Police officers Immigration officers Detention center workers Service providers	This comprehensive protocol and training kit for identification and assistance to trafficked persons offers open-ended interview guides, with questions structured around situational/ circumstantial indicators and aligned with the terminology of the UN (2000) definition of TIP The questions are divided into eight key areas:  • The situation prior to and on entry into the country or situation (if internal trafficking), and the individual’s expectations.  • Their working conditions.  • Their living conditions.  • How the person got out of the situation (if he/she did) and what help is needed now.  • Threats and coercion.  • How the person concerned sees his/her situation.  • What his/her plans and expectations are for the future. If assistance/help/services were provided, what was useful and what was not? Why?  • Risk assessment. Immediate and long-term risks and needs. How to meet them. Additional tips for gathering information and forensic evidence are offered, including observation of persons’ behavioral indicators.
Indiana Protection for Abused and Trafficked Humans Task Force ([IPATH] 2015)	Sex and labor trafficking	Law enforcement Service providers	A basic screening tool to be utilized by entities likely to encounter human trafficking victims. Contains three open-ended interview guides:  • Initial screening questions  • Sex trafficking assessment questions  • Labor trafficking assessment questions Provides a “Human Trafficking Report” template.
Checklists
The Civil Society Anti-Human Trafficking Task Force Hong Kong (2018)	Generalist	Service providers Other professionals who may encounter trafficking victims	This comprehensive handbook on initial victim identification and assistance to trafficked persons offers an interview guide with questions structured around situational/circumstantial indicators aligned with the three inter-related elements of TIP as defined by the UN (2000):  • Acts  • Means  • Purpose For an adult to be considered trafficked, the answer should be “Yes” for at least one key question in each section. For a minor to be considered trafficked, the “Yes” answer is required for at least one key question only in two sections - “Acts” and “Purpose.” In addition to the interview guide, the handbook provides:  • A list of basic principles and standards that should be followed to ensure effective direct assistance process for trafficked persons.  • Pre-interview assessment indicators (age, gender, nationality, language, documentation, movement, location, behavior, signs of abuse, and assessment of any referring agency) to be considered cumulatively.  • A one-page, multicolor scheme of a six-step victim identification process.
Canadian Council for Refugees ([CCR] 2015)	Generalist	Service providers	This Canadian National Human Trafficking Assessment Tool, available online in English and French, offers an extensive Yes/No checklist of situational/circumstantial indicators aligned with the terminology of the UN (2000) definition of TIP. The indicators are divided into three sections:  • Actions  • Means  • Purpose If “Yes” box is checked for at least one indicator in each section, the client is potentially been trafficked.
Anti-Slavery International (2005)	Generalist	Front-line responders: Police officers Immigration officers Detention center workers Service providers	This comprehensive protocol and training kit for identification and assistance to trafficked persons offers a two-page checklist of situational/circumstantial indicators aligned with the terminology of the UN (2000) definition of TIP and presented in the form of statements. The indicators are divided into six sections:  • Recruitment  • Personal documents and belongings  • Freedom of movement  • Violence or threat of violence  • Working conditions  • Living conditions If the assessor ticks one or more statements in each section, it is reasonable to suspect that this might be a trafficking case.
Standardized assessment/screening instruments based on a scoring system
Covenant House New York (2013: 22–28)	Generalist	Service providers Medical professionals Law enforcement Researchers	Human Trafficking Interview and Assessment Measure (HTIAM-14) – a brief questionnaire that allows to determine if a person is a victim of TIP in about 20 min:  • Questions are divided into sections A (personal info), B (for non-US citizens only), C, D, and E.  • The focus is on situational/circumstantial indicators, particularly person’s working conditions.  • For every answer to the questions, a score ranging from 0 to 3 is assigned to indicate the degree/evidence of trafficking activity – e.g.,   0 = No evidence   1 = Slight evidence   2 = Moderate evidence   3 = Strong evidence  • Responses that indicate trafficking activity receive a minimum score of 2.  • Then scores are calculated for every section.  • The interviewer is given space to write notes on the interviewee’s nonverbal indicators.  • At the end of the interview, the assessor has to assign a score between 0–3 to the question, “Do you believe this person is a victim of human trafficking?” and to identify the type of TIP (check all that apply):   __Non-Victim   __Victim: Labor   __Victim: Sex (all ages; force, fraud, coercion)   __Victim: Sex (under 18; no force, fraud, coercion)   __Survival Sex (over 18; no force, fraud, coercion)   __Other The HTIAM-14 was designed for a research study and may be modified in applied settings.
International Labour Office (2009)	Labor and sex trafficking	Researchers Practitioners Labor inspectors	This scientifically tested tool offers four sets of a total of 67 operational indicators for adult and child victims of trafficking for labor and sexual exploitation, aligned with the terminology of the UN (2000) definition of TIP. Each set is a structured list of indicators relevant to the following dimensions of the TIP definition:  • Deceptive recruitment (or deception during recruitment, transfer and transportation): 10 indicators  • Coercive recruitment (or coercion during recruitment, transfer and transportation): 10 indicators  • Recruitment by abuse of vulnerability: 16 indicators  • Exploitative conditions of work: 9 indicators  • Coercion at destination: 15 indicators  • Abuse of vulnerability at destination: 7 indicators Within each set, each indicator is qualified as either strong, medium, or weak. A single indicator can be strong for children, yet medium for adults, or strong for sexual exploitation, yet weak for labor exploitation. For each potential victim, each of the six dimensions of the trafficking definition is assessed independently from the others. The result of the assessment is positive if the dimension is present for the potential victim, negative if not. In order to be assessed as positive, a dimension must include at least:  • Two strong indicators  • One strong indicator and one medium or weak indicator  • Three medium indicators  • Two medium indicators and one weak indicator After an assessment is done for each dimension, the final analysis involves combining the six elements to identify the victims of trafficking. In the case of children, the presence of deception and coercion is not necessary to characterize a case as trafficking.
Vera Institute of Justice (2014)	Sex and labor trafficking	Researchers Service providers	This scientifically validated tool focuses on situational/ circumstantial TIP indicators. The questions/indictors are divided into four domains:  • Migration  • Work  • Living and/or working conditions  • General health Research demonstrated that this screening tool accurately measures several TIP dimensions and is highly reliable in predicting victimization for both sex and labor trafficking across diverse subgroups, including those divided by age, gender, and country of origin. Statistical validation determined that a short version of the tool consisting of 16 questions (about 50% of the questions tested) also accurately predicts victimization for both sex and labor trafficking cases. The tool can be further shortened if an interviewer suspects a specific type of trafficking victimization (sex or labor) based on circumstances.
Love Justice International (n.d.)	Generalist	Service providers	A set of standardized tools aimed at identifying and intercepting trafficked persons at the Nepal-India border. Available in hard copy and as software. Includes color-coded “Victim Interview Form,” “Interception Record Form,” and “Case Exploration Form.”
			A sophisticated scoring system is used to screen potential TIP victims. These tools are currently being piloted and adjusted for the purpose of identifying trafficked persons at the international airport in Johannesburg, South Africa.