It’s not always easy to identify a victim of sex trafficking. Because of this, people who might want to escape from it can slip by the very professionals who could help them find the mental and physical health care they so desperately need.
A few years ago, a team of forensic nurses from Allina Health developed a set of guidelines to help staff better identify patients who could be possible victims of sex trafficking. Amy Schmitz, Allina Health forensic nursing program manager, explained that her team’s goal was to help as many people as possible get the care they needed so they could escape their victimization.
“When the Super Bowl was going to be here in 2018,” Schmitz said, “the whole metro area did a lot of training around human trafficking, including — What are the medical red flags? What questions do you ask of patients when you have a suspicion they are being trafficked? How do you respond?”
Schmitz said that her team created a training protocol that they shared with Allina staff.
“We developed a sex-trafficking booklet that we have placed all over in our hospitals that has an algorithm about how our staff should respond and has three questions that they should ask a person if they suspect that they are a victim or disclose that they are a victim.”
There is no real profile of a victim of sexual trafficking, Schmitz explained. And many are afraid to tell the truth about what is happening out of fear of reprisal from their traffickers or legal consequences. Health care providers need to look for signs that indicate a patient may be wrapped up in the trafficking life. Victims of sex trafficking, she said, “Usually present with red flags like mental health or chemical dependency issues as well as repeated visits for STIs or sexual assaults. You may also see signs of physical abuse or malnutrition, dental issues, suicide attempts or previous pregnancies at a young age.”
If providers have a high suspicion that a patient has been sexually trafficked, Schmitz said that her training protocols encourage them to start asking questions that could help make a better identification and ensure patient safety.
Some of these questions include, she said, “‘Are you able to come and go on a daily basis in your life as you wish? Do you have control over your money and how you spend it? Do you have food and a bed where you sleep every night? Do you get to choose when you come and go?’” These questions, she explained, “lead to conversations where we learn more and gain rapport with patients. From there, we are able to connect them with organizations that can help them get out of the life.” If a patient comes clean about being a victim of sexual trafficking, providers can offer reassurances of legal immunity and a safe bed until the patient can be connected to a support program.
Schmitz said that she and her colleagues at Allina saw an increase in incidents of sexual trafficking “around the Super Bowl and for a year or two after.” While the number of cases of sexual trafficking have declined since then, she said, “we know that they are out there. We just want them to know that we are a safe place for them to come. We want to help them. We want to provide them medical care.”
Another nonprofit with a long history of helping victims of sex trafficking is Breaking Free, a 27-year-old St. Paul-based organization that supports clients through advocacy, housing, education and immediate action. Breaking Free also works with men who have participated in sexual trafficking through a court-mandated education program called Men Breaking Free.
“Men Breaking Free is designed for the purchasers of sex,” explained executive director Lori Quist. Individuals who have been arrested for solicitation or another crime related to trafficking come to Quist through a court-ordered 8-hour program offered monthly at a cost of $850.
Quist said Breaking Free’s founder, Vednita Carter, formed the organization as a way to “assist women in the life, women who have been exploited, to find safe, sustainable housing.”
Because many people who have been victims of sex trafficking do not have a safe place to live, providing clients with housing is a central to the nonprofit’s work, said Flora Whitfield, Breaking Free associate program director.
“The biggest and most detrimental need for survivors escaping the life is safe housing, whether that be a shelter or eventually getting your own place. If you don’t have a safe place to live, it’s really hard to maintain any of your other basic needs. That’s what we hone in on right away,” Whitfield said.
When a trafficking victim (Quist and Whitfield say they their preferred term for their clients is “victim,” or “victim/survivor”) gets connected to Breaking Free, they are enrolled in Sisters of Survival, a 14-week intensive education and advocacy program that examines sex trafficking as a “slave-based system.” It also explores the impact that trafficking has on its victims’ lives and issues related to addiction and recovery.
Whitfield is a graduate of the Sisters of Survival program. Her own experience in and eventual escape from the sex trafficking world inspires respect and appreciation in her clients. Sisters of Survival is the heart of Breaking Free’s educational programs, Whitfield said: “We discuss mental health, chemical health, healthy relationships, comparing a real job to prostitution and the benefits of real-world work.”
It is not a requirement to be out of the sex trafficking life to participate in Sisters of Survival, she explained: “We work with clients to get to the point where they can step away. They are connected through advocacy from the very beginning.”
Because a growing number of Sisters of Survival’s participants identify as trans, Whitfield explained that Breaking Free is now considering changing the program’s name to something that doesn’t focus on one particular gender. The nonprofit’s client base leans heavily toward people of color, Quist said, but they offer services to everyone: “Eighty percent of our clients are African American. Ninety percent are women. We work with some juveniles. We work with men. We work with Indigenous people, Black people, Caucasian people, transgender people, the LGBTQ community. We see between 200-300 clients a year.”
The Sisters of Survival program preps clients for participation in Breaking Free’s housing program. The nonprofit operates two 17-unit buildings on the East Side of St. Paul as well as a “scattered-site” program, where survivors go into the community and find their own housing. The nonprofit is in the process of moving to four new buildings by the end of July 2023.
All of the program’s housing is subsidized, with the U.S. Department of Housing and Urban Development paying clients’ rent, Quist said.
‘Here to empower them’
People who are victim/survivors of sex trafficking often have been stripped of everything that makes them feel human, Quist said.
“Survivors don’t have money, don’t have an identity. Their name has been changed. They don’t even have a driver’s license.” And, because being a victim of trafficking has historically been treated as a crime, she added, “They have criminal records that prevent them from getting into an apartment.” (As part of their advocacy work, Breaking Free lobbied for the passage of “safe harbor” laws in Minnesota. These laws, now in effect, ensure that young people who are sexually exploited are treated as victims and survivors, not criminals.)
These seemingly insurmountable barriers can make getting out of the trafficking life feel next to impossible. With no way to get a safe place to live, stepping away from the life can feel like a terrifying step into the abyss.
“A lot of them end up homeless,” Quist said. “They don’t know where to go. They don’t have documents to verify their identity. They don’t have dollars in their pocket to get a meal. They can’t even rent a hotel. They’ve been stripped of everything you and I take for granted.” When a victim connects with Breaking Free, they begin the process of regaining their identity and rebuilding a life.
Whitfield first came to Breaking Free when she was 18 years old.
“At the time, safe harbor laws were not in effect,” she said. “I was criminally charged for my prostitution.” She connected with the organization but struggled to accept that she could make the transition to the outside world: “I was offered Breaking Free services but I had already been trafficked for four years. I was so criminalized. My experience with the court system was, ‘You are a bad girl. You did something wrong.’”
Whitfield completed Breaking Free’s 14-week course, but, she said, “I wasn’t ready for it.” She returned to the life for a time, but eventually made her way out, with Breaking Free’s help. “The one thing it did for me was it planted a seed and made it harder for me to be involved in prostitution because I knew there was an organization that said, ‘You don’t have to do that anymore.’” she said. “I got out.”
For victims/survivors of sexual trafficking who are not ready to commit to the Sisters of Survival program, Breaking Free has created an outreach program with a drop-in center, where people can stop in for a shower, a hot meal, clean clothes and emotional support.
Support is key for victims/survivors of sexual trafficking, many of whom struggle with mental health and addiction issues, Quist said. “Probably 90 percent of our clients that come here have a substance abuse problem or a mental health problem. Some of these clients are dual diagnosed. We become a conduit to a referral system for getting them the help they need.”
Because they are a survivor-driven organization, Breaking Free staff know how to meet people where they are at, Quist said. Many potential clients are skittish and afraid like Whitfield was, so they don’t push their programs and services. In order for the changes to stick, a survivor has to want it for themselves.
“We are really here to empower them to want the help on their own,” Quist said. “That’s a concept that’s different for us than it is at some of the organizations out there. We want them at the end of the day to be able to stand on their own two feet.”