Examining Commonly Reported Sex Trafficking Indicators from Practitioners' Perspectives: A Pilot Study

Background: U.S. governmental/non-governmental organizations’ trainings disseminate commonly reported sex trafficking indicators (i.e. red flag signs/ warning signs) across multiple domains (including physical health, mental health, criminal justice involvement, personal risk, access to personal possessions). However, very little research evaluates such indicators. This pilot study explored which indicators are most commonly identified by practitioners who encounter sex trafficked individuals, including social service, healthcare, and justice system professionals. Our research questions were:

• What are the most commonly identified indicators encountered by practitioners?
• Which domain of indicators is most salient among practitioners?
• How do indicators differ across practitioners who work with different service populations (USA-born minors, USA-born adults, foreign born minors, and foreign born adults)?

Methods: We developed a web-based survey using indicators derived from peer-reviewed journal articles and gray literature from government and non-governmental organizations. Sixty-two indicators were grouped in six domains: 1) mental health, 2) physical health, 3) restricted behavior, 4) criminal justice involvement, 5) personal risk and abuse histories, and 6) access to personal possessions. Practitioners who provided direct services to sex trafficking survivors were asked to indicate how commonly sex trafficking victims report, experience, or exhibit symptoms of each indicator on a Likert scale (1-5) to determine observed frequencies. Eighty-six practitioners in one Midwestern city completed the survey. Survey participants indicated which populations(s) they served: USA-born minors (n=55), USA-born adults (n=62), foreign-born minors (n=21), and foreign-born adults (n=30). Frequency distributions for each of the indicators as well domain means were computed for the overall sample and each service population subsample. All domains had internal reliability scores of .8 or higher. We conducted sensitivity analyses to assess whether findings held under different assumptions.

Results: The most commonly identified indicators included mental health symptoms of depression (M=3.82), low self-esteem (M=3.59), anxiety (M=3.55), low levels of interpersonal trust (M=3.52), sense of fear (M=3.36), feelings of shame or guilt (M=3.34), isolation from family, friends, and communities (M=3.3), and fear/distrust of law enforcement (M=3.80).

The least commonly identified indicators included exhibiting low English proficiency (M=1.62), previous history of loitering charges (M=1.74), presenting false documents (M=1.85), presence of tattoos or branding (1.89), presenting delayed cognitive development (M=1.91), being unaware of one’s location (1.94), owing large debt (M=1.95), previous history of prostitution or drug charges (M=1.98, M=2.01), and physical evidence of torture (M=2.07).

Domain means for the sample included mental health (M=3.05), physical health (M=2.67), restricted behavior (M=2.64), personal risk and abuse history (M=2.47), criminal justice involvement (M=2.07), and access to personal possessions (M=2.14). Mental health domain was identified as especially common among USA-born adults (M=3.07). Criminal justice involvement was identified as less common among foreign-born minors (M=1.82) and foreign-born adults (M=1.96).

Implications: Practitioners reported being most likely to encounter mental health indicators of sex trafficking particularly among USA-born adults, a finding inconsistent with information often provided in trafficking trainings. Trafficking trainings that include diverse case examples may be important in strengthening identification of sex trafficked individuals. Future research should determine for which indicators practitioners are actively screening, and engage in regional comparisons.