Healing the Trafficking Survivor: Residential Treatment Considerations Amanda Shultes GRC MSW Program - Trafficking and complex trauma defined - 5,500 cases documented in 2015, 75% of which were cases of sex trafficking 1 - As of 2013, 33 existing programs offered 682 beds and 27 programs were in development/implementation to offer 354 additional beds 2 - Social work values: social justice and working with oppressed groups; service – access to and provision of appropriate services - Theoretical basis: strengths-based approach, resilience theory and post-traumatic growth Definitions, Rationale & Theoretical Basis Connecting Trauma, Abuse & Trafficking - Characteristics of survivors and impact of trafficking - Developmental and intergenerational trauma, traumatic attachments and betrayal trauma theory - Adverse Childhood Experiences (ACEs): connects negative childhood experiences to poor adult health outcomes 7 - Biological impact of trauma: survival brain, chronic stress response activation, rigid emotion regulation and cognitive processing 8 - Complex PTSD symptoms: traditional PTSD features, as well as impaired emotion regulation and relational functioning - Key features: dissociation, emotional dysregulation Organizational Development Trauma-Informed Care (TIC) and Organizational Culture: - Systems level and service level application of TIC values - Survivor leadership and inclusion of local communities - Staff: hiring, training and continuing education, vicarious trauma and self-care - Sanctuary Model 5 : micro, mezzo and macro level practice Program Requirements, Barriers and Best Practices: - Funding and referral sources - Barriers: identification, lack of knowledge/services/funding, “Not In My Back Yard” or NIMBY-ism - Best practices: - Agency level: ARC framework 6 , use of survivor leaders - Direct services level: safety planning, comprehensive services, evidence based interventions Policy & Advocacy Context - Federal level: - Trafficking Victims Protection Act - Impact of prostitution legislation - Law enforcement approach vs. victim-centered approach 3 - Survivors as criminals vs. victims - Arrest and punishment vs. protection and provision of services - State level: - Safe Harbor laws: provide legal protection and provision of services, states offer one or both depending on their definition of ‘minor’ - Advocacy focus: - Misidentification - Vacatur laws: connects prostitution and other charges to trafficking, allows record to be expunged 4 Therapeutic Interventions - Grounded in a biopsychosocial and person in environment approach and utilizes Herman’s 9 phased treatment model - Safety: - Trauma Affect Regulation: Guide for Education and Therapy (TARGET) 10 - Skills Training in Affect Regulation (STAIR) - Trauma-Focused Cognitive Behavioral Therapy (TF- CBT) 11 - Trauma Recovery Empowerment Model (TREM) 12 - Remembrance and Mourning: - Eye Movement Desensitization Reprocessing (EMDR) 10 - Narrative Therapy - Cognitive Processing Therapy (CPT) 13 - Reconnection: - Sensorimotor Therapy 14 - Seeking Safety 15 - Mindfulness Meditation 16 Safe Space 17 This work provides a discussion of considerations for residential programs treating trafficking survivors, emphasizing comprehensive services and efficient organizational design to support the creation of additional agencies to serve this population. Building on a foundation in the strengths-based approach, resilience theory and post-traumatic growth theory, this work considers the policy and advocacy climate of anti-trafficking work, explores the connection between trafficking and trauma and general symptom presentation, and provides recommendations for organizational development rooted in trauma-informed care. It draws on the experience of existing organizations and discusses specific treatment interventions for direct practice with trafficking survivors based on Herman’s phased trauma treatment. This work seeks to connect each of these related topics to the provision of service to the individual thereby empowering service providers who desire to work with this vulnerable population with the knowledge and expertise on how to do so. Abstract
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Healing the Trafficking Survivor: Residential Treatment Considerations
Amanda ShultesGRC MSW Program
- Traffickingandcomplextraumadefined- 5,500casesdocumentedin2015,75%ofwhichwerecases
ofsextrafficking1- Asof2013,33existingprogramsoffered682bedsand27
programswereindevelopment/implementationtooffer354additionalbeds2
- Socialworkvalues:socialjusticeandworkingwithoppressedgroups;service–accesstoandprovisionofappropriateservices
- Theoreticalbasis:strengths-basedapproach,resiliencetheoryandpost-traumaticgrowth
Definitions, Rationale & Theoretical Basis Connecting Trauma, Abuse & Trafficking- Characteristicsofsurvivorsandimpactoftrafficking
- Developmentalandintergenerationaltrauma,traumaticattachmentsandbetrayaltraumatheory
- AdverseChildhoodExperiences(ACEs):connectsnegativechildhoodexperiencestopooradulthealthoutcomes7
- Biologicalimpactoftrauma:survivalbrain,chronicstressresponseactivation,rigidemotionregulationandcognitiveprocessing8
- ComplexPTSDsymptoms:traditionalPTSDfeatures,aswellasimpairedemotionregulationandrelationalfunctioning- Keyfeatures:dissociation,emotionaldysregulation
Organizational DevelopmentTrauma-InformedCare(TIC)andOrganizationalCulture:- SystemslevelandservicelevelapplicationofTICvalues- Survivorleadershipandinclusionoflocalcommunities- Staff:hiring,trainingandcontinuingeducation,vicarioustrauma
andself-care- SanctuaryModel5:micro,mezzoandmacrolevelpracticeProgramRequirements,BarriersandBestPractices:- Fundingandreferralsources- Barriers:identification,lackofknowledge/services/funding,“NotIn
MyBackYard”orNIMBY-ism- Bestpractices:
- Agencylevel:ARCframework6,useofsurvivorleaders- Directserviceslevel:safetyplanning,comprehensiveservices,
evidencebasedinterventions
Policy & Advocacy Context- Federallevel:
- TraffickingVictimsProtectionAct- Impactofprostitutionlegislation- Lawenforcementapproachvs.victim-centered
approach3- Survivorsascriminalsvs.victims- Arrestandpunishmentvs.protectionandprovision
ofservices- Statelevel:
- SafeHarborlaws:providelegalprotectionandprovisionofservices,statesofferoneorbothdependingontheirdefinitionof‘minor’
- Advocacyfocus:- Misidentification- Vacaturlaws:connectsprostitutionandothercharges
totrafficking,allowsrecordtobeexpunged4
Therapeutic Interventions- Groundedinabiopsychosocialandpersoninenvironment
approachandutilizesHerman’s9phasedtreatmentmodel- Safety:
- TraumaAffectRegulation:GuideforEducationandTherapy(TARGET)10
- SkillsTraininginAffectRegulation(STAIR)- Trauma-FocusedCognitiveBehavioralTherapy(TF-
CBT)11- TraumaRecoveryEmpowermentModel(TREM)12
- RemembranceandMourning:- EyeMovementDesensitizationReprocessing(EMDR)10- NarrativeTherapy- CognitiveProcessingTherapy(CPT)13
- Reconnection:- SensorimotorTherapy14- SeekingSafety15- MindfulnessMeditation16
SafeSpace17
Thisworkprovidesadiscussionofconsiderationsforresidentialprogramstreatingtraffickingsurvivors,emphasizingcomprehensiveservicesandefficientorganizationaldesigntosupportthecreationofadditionalagenciestoservethispopulation.Buildingonafoundationinthestrengths-basedapproach,resiliencetheoryandpost-traumaticgrowththeory,thisworkconsidersthe
policyandadvocacyclimateofanti-traffickingwork,explorestheconnectionbetweentraffickingandtraumaandgeneralsymptompresentation,andprovidesrecommendationsfororganizationaldevelopmentrootedintrauma-informedcare.ItdrawsontheexperienceofexistingorganizationsanddiscussesspecifictreatmentinterventionsfordirectpracticewithtraffickingsurvivorsbasedonHerman’sphasedtraumatreatment.Thisworkseekstoconnecteachoftheserelatedtopicstotheprovisionofservicetotheindividualtherebyempoweringserviceproviderswhodesireto
workwiththisvulnerablepopulationwiththeknowledgeandexpertiseonhowtodoso.
Abstract
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