Abuse, neglect, discrimination, and violence are powerful experiences that can lead to lasting trauma. For survivors of human trafficking, this trauma can affect how they respond to healthcare, social services, and even the criminal justice system. Given its strong emphasis on safety, trust, and empowerment, a trauma-informed approach to care and service delivery is critical for addressing the complex needs of human trafficking survivors and others affected by trauma.

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What is Trauma?

A commonly referenced definition of trauma is from the Substance Abuse and Mental Health Services Administration (SAMHSA), which states, “Individual trauma results from an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or life threatening and that has lasting adverse effects on the individual’s functioning and mental, physical, social, emotional, or spiritual well-being.” 

More comprehensive understandings of trauma emerged after the Adverse Childhood Experiences (ACE) study, which showed that children who were exposed to adverse childhood experiences are at a greater risk for chronic health conditions such as chronic pulmonary disease, and harmful behaviors including smoking and substance and alcohol misuse.

Common causes of trauma include but are not limited to:

• Physical, sexual, emotional, or psychological abuse, neglect, or harassment
• Threats of harm and intimidation
• Grief, loss of a loved one, and abandonment
• War and conflict
• Natural and manmade disasters
• Pain and serious health issues
• Witnessing traumatic events
• Interpersonal, generational, or domestic violence
• Being subject to coercive control and manipulation

Experiencing trauma can change one’s brain structure, resulting in long-term health problems related to the body’s processes of fight, flight, or freeze. Trauma can result in a decreased sense of safety and ability to trust, increased fear, and psychological changes in a person’s belief in themselves and the world around them. Individuals who have experienced human trafficking may have experienced trauma at the hands of their trafficker(s), but also possibly over the course of their lives from determinants that put them at risk of trafficking. This can lead to numerous psychological and emotional struggles, including depression, substance abuse, suicidal ideations, and post-traumatic stress disorder. Reflecting on these long-term effects, Chris, a survivor of human trafficking, shared, “Trauma physically changes the way your neurotransmitters fire in your brain. I have been in trauma therapy for 3 years and things still impact me.”

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What is Trauma-Informed Care?

Trauma-informed care is a compassionate approach to care and service delivery that stresses the importance of understanding an individuals’ life experiences. It is “grounded in an understanding of and responsiveness to the impact of trauma; that emphasizes physical psychological, and emotional safety for both providers and survivors; that creates opportunities for survivors to rebuild a sense of control and empowerment.” Trauma-informed care is mindful of the impact of trauma, recognizing its signs, symptoms, and how it affects recovery. It considers how pervasive trauma is and promotes an environment of healing and recovery. 

As Chiquita Tillman, a survivor of human trafficking, describes it, “Trauma-informed care to me is when the environment is safe, supportive, and understanding [so that it can] help a person to heal and recover. Coming out of my trafficking situation, I did not have that available to me, which caused me to have a lot of emotional and mental instability, triggers, and suicidal ideations. It wasn’t until I was an adult that I received the proper help, and it changed my life.”

Human trafficking survivor Kimberly Bitz adds, “Trauma-informed care means recognizing the impact of past trauma on a person’s emotional, mental, and relational well-being. It involves creating a space where clients feel safe, understood, and empowered rather than judged or re-traumatized.”

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The Risks of Neglecting Trauma-Informed Care

Several studies indicate abysmally low rates of training on trauma-informed care. In one study, 89% of medical professionals reported having received no instruction on trauma-informed care. In a survey of family medicine residency programs, only 6% of residents reported advanced competency in human trafficking. In a study published in the International Journal of Environmental Research and Public Health, just 24.4% of physicians agreed that, in their practices, “communication skills training is provided to all office staff about how to sensitively talk to patients who disclose a history of trauma.”

Without this crucial training, it is possible that healthcare professionals and service providers could re-traumatize survivors of human trafficking. According to the Buffalo Center for Social Research, re-traumatization “refers to any procedure, interaction, situation or environment that replicates someone’s history of trauma literally or symbolically — activating the body’s survival (fight, flight or freeze) response, and activates the emotion, body responses and cognitions associated with the original experience(s).” Re-traumatization can include:

• Mislabeling traumatic stress responses as personality or other mental disorders
• Using a confrontational approach
• Challenging or discounting survivors’ reports of traumatic events
• Being unaware of how survivors’ traumatic pasts affect their lives

There are many ways the criminal justice and victim services systems can inadvertently re-traumatize survivors. For instance, convictions for crimes they may have been forced to commit can cause significant damage to the lives of trafficking survivors. Requiring survivors to repeat their stories multiple times, using interrogation-style interviews, and not allowing them to make their own choices in the criminal justice system can also negatively impact the healing process.

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Moving Forward with Trauma-Informed Care

Trauma-informed care integrates knowledge and understanding of trauma into practices and procedures to help providers avoid interactions, environments, or policies that can re-traumatize. Trauma-informed care ensures survivors are at the center of service provisions. Key principles include:

• Safety: Providing a welcoming environment that is sensitive to potential triggers
• Trust & Transparency: Maintaining appropriate boundaries, clarifying roles, and obtaining informed consent
• Collaboration: Engaging with empathy, respect, and support; hiring survivors with appropriate skills to provide peer-to-peer programming
• Empowerment: Allowing patients to share their experiences, and respecting client decisions
• Cultural, Historical, and Gender considerations: Recognizing and validating a survivor’s history, culture, language, experiences, and preferences

Other trauma-informed practices that help human trafficking survivors include adjusting policies and practices to accommodate patients who have unstable housing or transportation difficulties or lack insurance or access to healthcare during normal business hours. Law enforcement officials, prosecutors, service providers, and other allied professionals can solicit feedback from survivors on organizational policies and programming to ensure services are grounded in real-world needs. When survivors are involved in decision-making, they can help to assess the effectiveness of service delivery and ensure that programs are truly meeting the needs of those they are designed to support.

Service providers, law enforcement and criminal justice professionals, and healthcare professionals will likely observe a wide range of reactions related to trauma during the course of their work with survivors. Understanding the reason behind a survivor’s actions will contribute not only to building rapport and trust with survivors but also to creating a positive healing environment. Trafficking survivor Kimberly Bitz explains, “It took me 14 years to begin addressing the impact of being sex trafficked, and when I did, I worked with professionals who understood how trauma affects the brain, body, and relationships. Instead of pushing me to “move on” or minimize my experiences, they allowed me to process things at my own pace, validated my emotions, and helped me regain a sense of agency over my healing.”

Changing the culture of treatment toward human trafficking survivors and other individuals with past traumatic experiences depends on increasing the recognition of the impact of trauma on people’s mental, physical, and emotional health. This shift requires survivor-informed policies, training, and a commitment to compassionate care.