Missouri Nurse Winter 2022/2023

Initiation Phase The initiation phase begins when the trafficker starts pretending to be in love with the trafficked victim (Carville, 2015). Bringing gifts, being a friend, beginning a romantic relationship, or providing drugs and alcohol may all be means of seduction (Carville, 2015; Moore et. al., 2017; Peterson, 2019). However, as one trafficker emphasized, there is no love in the sex trade. It is merely a manipulation tactic (Carville, 2015). This stage, often called the boyfriend phase, is so realistic that even family and friends do not suspect the manipulation (Peterson, 2019). By slowly isolating the victim from friends and family, the trafficker begins to play a major role in the victim’s life. Through controlling messages victims receive, traffickers are in better positions to psychologically manipulate victims. (Helton, 2016; Peterson, 2019). Furthermore, traffickers will often recruit same-age peers to normalize these manipulative acts for victims. Indoctrination phase Abuse begins in what is called the indoctrination, or sales phase (Peterson, 2019; Helton, 2016). The victim is manipulated into believing that prostitution is an acceptable way to make a living. Even through victims have multiple sex partners, the trafficker reassures them that they will always be loved (Carville, 2015). The abuse is subtle at first and may begin with requests for illicit images (sexting). These in turn, can be used to blackmail the victim (Peterson, 2019). In other cases, victims are told that services provided, such as money spent on drugs, must be repaid. Once a trafficker gets a victim addicted to methamphetamine or heroin, the trafficker makes them engage in sexual acts to pay for the next fix (Helton, 2016).

Characteristics of Human Trafficked Victims Underserved and vulnerable populations are at a higher risk to become HT victims (Barnert et al., 2017; Kehl, 2020). Victims in these populations include women and children, people with disabilities, elderly, gay, transgender, and bisexual persons. Victims are generally women and children who come from low income, poverty-stricken areas with little access to education and employment opportunities. Due to a higher incidence of running away from home, adolescents are more vulnerable to becoming victimized. Higher incidences of HT are also found in Indigenous people, who live in poverty and rely on the welfare system. The average age of entry into HT is pre-to-mid teens (Chaffee & English, 2015; Leary, 2016). Teen brains are highly sensitive to pleasures and rewards which makes young victims susceptible to grooming tactics (Peterson, 2019). Becoming independent of parents, the importance of peer relationships, sexual experimentation, in combination with impulsivity, risk taking behaviors, and a sense of invulnerability, make it easy for teens to be preyed upon (Moore et. al., 2017). The undeveloped prefrontal cortex in the teenager, which aids in making major decisions and foreseeing consequences, makes the teen more vulnerable to HT coercion techniques of flattery, attention, affection, or gifts (Greenbaum & Bodrick, 2017; Peterson, 2019). This is especially true when the minor lacks a loving homelife (Peterson, 2019). Challenges in Identifying Trafficked Victims Victims are difficult to identify and often hesitant to disclose their imprisonment due to the hidden criminal structure of HT (Helton, 2016). Often it is the health care

provider who first encounters the victim. Statistics vary, but it is estimated that between 28% to 87% of trafficked victims in the United States visit a health care provider while in captivity for a broad range of physical and psychological conditions (Chaffee & English, 2015; Grace et al., 2014; Scanlon & Krausa, 2016). However, even though victims have encounters with health care providers during their captivity, few are identified at that time. This may be partially due to professionals’ lack of awareness, education, and intervention protocols (Helton, 2016). Several factors contribute to the under-identification of victims. Although studies show that health care providers place importance on knowing about HT, providers are unaware of the magnitude of HT, and lack the education needed to identify and intervene on the victim’s behalf. (Grace et. al, 2014; Greenbaum & Bodrick, 2017; Helton, 2016; Moore et. al., 2017). Despite the fact there are HT screening tools, these instruments lack the validation needed to provide evidence-base practice guidelines (Chaffee & English, 2015; Doherty et al., 2016). In addition, protocols on how to intervene once a suspected human trafficked victim is identified are lacking (CdeBaca & Sigmon, 2014). Identifying young trafficked victims is often complicated because children lack the verbal skills and maturity to disclose their situation (Greenbaum & Bodrick, 2017). Furthermore, the child’s abuse symptoms may be so nonspecific that they may be misinterpreted by the heath care provider. During clinic visits, traffickers maintain such strict control the victim may not have the opportunity to identify themselves as being trafficked (CdeBaca & Sigmon, 2014). Victims may withhold or falsify information due to a distrust of authority figures and may be unaware of their rights or of the existence of

10 | The Missouri Nurse :: Winter 2022/2023

www.missourinurses.org