The study, led by UofL researchers in collaboration with the Department for Community Based Services (DCBS) and partners at the Attorney General’s Office, is funded through a grant from the Kentucky Children’s Justice Act Task Force. The latest Project PIVOT recommendations build on a previous review of 698 reported cases of child trafficking over a 5-year period, between 2013 and 2018.

“We learned that the majority of child trafficking is happening at the hands of family members – people in our community that we know, live next to or interact with,” said Jennifer Middleton, principal investigator for Project PIVOT and associate professor, UofL Kent School of Social Work. “This has implications for how we educate our communities about child trafficking, as well as how we prepare child welfare workers and first responders to identify and respond to potential child victims.”��

Researchers interviewed child welfare leaders across the United States to learn more about screening tools used to recognize potential child trafficking victims. The interviews revealed that 24 states have screening protocols, and only two screening tools – the Human Trafficking Screening Tool (HTST) and the Commercial Sexual Exploitation Identification Tool (CSE-IT) – were found to be validated and successfully utilized across multiple states.

In addition, the research team reviewed the with key leaders, advocates and investigators on the Statewide Human Trafficking Task Force, who generated recommendations for DCBS.

The study also pointed to the following policy recommendations:

• Develop regional anti-trafficking champions: The lack of training and resources in rural communities may serve as a potential risk factor or predictor of family-controlled trafficking, making it imperative to build capacity in rural communities for specialized training and coordinated investigations among multidisciplinary teams.
• Tap into existing child advocacy centers as anti-trafficking resources: Findings indicate an increased likelihood of child trafficking cases being confirmed if a forensic interview is conducted at a child advocacy center. The study’s authors recommend regional consultants be partnered with and perhaps housed within regional child advocacy centers.
• Hold family members accountable: This study revealed that significantly more cases with non-relative perpetrators (39.6%) had a case outcome of substantiation or founding when compared to cases with family member perpetrators (21.1%). Investigators, advocates and others reported concerns that family members who were traffickers may be less likely to be charged or may receive a reduced charge or finding, such as child sexual abuse.

“Identification of the commercial aspect of the sexual exploitation can allow law enforcement to broaden the scope of the investigation to potentially include buyers of commercial sex,” said Middleton, who also serves as director of the UofL Human Trafficking Research Initiative. “Until more buyers of commercial sex are arrested and charged with criminal offenses, the demand for commercial sex with children will continue unabated.”

New grant to help Kentucky address study findings

A new $1 million federal grant from the U.S. Department of Justice will help the state respond to of Project PIVOT.

Specifically, the funding will address the project’s following recommendations: the creation of the Department for Community Based Services advisory council; the launch of a human trafficking and child labor screening tool to identify high-risk children; and the hiring of a full-time child protection specialist.

“I have always made seeking justice for victims and fighting human trafficking part of my core mission,” Governor Andy Beshear said. “The resources made possible through this grant will allow my administration to address research findings that will help us to better fight this scourge of human trafficking and save lives. I would like to thank Dr. Middleton and her team for their hard work in this crucial area.”

Donna Pollard, Community Enrichment Officer, , says conducting this research, protecting vulnerable youth and advocating for survivors is critical.

“As a survivor of sexual exploitation, I know firsthand how critical the research conducted under Project PIVOT is for protecting those vulnerable to human trafficking,” Pollard said. “Knowledge is power in terms of both prevention and empowerment of survivors so they can reframe their pain into purpose and break exploitive cycles in their families.”

State working to combat human trafficking

In 2020, Kentucky was one of only four states to receive a $1 million grant related to human trafficking from the U.S. Department of Justice’s Office for Victims of Crime.

With grant funding, DCBS will engage with child-serving agencies in Kentucky to develop and implement an advisory council on human trafficking and child labor prevention and awareness.��The advisory council will work to identify a human trafficking and child labor screening tool, funded by this grant, which will be used to reveal victimization for both sex and labor trafficking of children and youth.

DCBS has a dedicated specialist whose responsibilities include consultations on assessments and trainings, but that the agency is considering the creation of a full-time child trafficking protection specialist position that could provide training and case consultation to staff throughout the state.

The department also is implementing evidence-based, trauma-informed training for child welfare staff, leadership, foster parents and providers across the state.

“We are so pleased the Project PIVOT results will help the state enhance its efforts in combating child trafficking as we work alongside survivors – our most important advisors and warriors in this fight against human trafficking” Middleton said. “I continue to pledge my support and resources of the UofL Human Trafficking Research Initiative to DCBS, the Governor’s Office, and survivors as we continue this fight against child trafficking in Kentucky.”

Kentucky Attorney General Andy Beshear joined a UofL social work researcher, survivors and other advocates at the Survivors’ Corner nonprofit office recently to entreat the public to watch for signs of criminals who exploit victims for sex and to report their activities to protect their traumatized victims, who often are minors.

Jennifer Middleton, Kent School of Social Work associate professor and director of the Human Trafficking Research Initiative, shared research findings from Project Pivot (Prevention and Intervention for Victims of Trafficking), funded through a grant from the Kentucky Children’s Justice Act Task Force.

Analyzing 2013-2018 data from the Kentucky Department for Community-Based Services, the research team has preliminary results indicating 83% of the 698 alleged child-trafficking victims reported to the department were female, with the most commonly reported age of 16. Victims ranged from 2 weeks old to 17 years.

“Alarmingly, the majority (57%) were trafficked by a family member, often a biological parent,” Middleton said.

The Project Pivot research echoes some findings from previous research showing that homelessness, youth and adversity are factors that make children vulnerable to being trafficked and “serves as a call to action to our community and our state,” she said.

“However, despite the weight of these statistics, there is hope,” Middleton said. “By ramping up community education and awareness efforts and educating the community about the warning signs of human trafficking and what to look for, community members, parents, educators and first responders can help prevent child trafficking from occurring.”

Her team in this project includes research assistants Emily Edwards, a counseling psychology graduate student in the College of ����ֱ�� and Human Development, and Rianna Ayala, a graduate student in the Kent School of Social Work.

“It’s going to be impactful,” Ayala said.

Project Pivot aims to increase awareness of child trafficking in the state and to improve the ability of various systems to respond to victims in a manner that limits additional trauma to the children. The group should wrap up its report with data and focus-group findings by July and work with a local human trafficking task force and others to prioritize policy and practice recommendations.

When addressing issues such as trafficking, it’s important to understand the root causes, which is why research is important, said Beshear, who has made the fight against human trafficking a core mission of his office.

“The work out of the Kent School helps us do our job better. Jennifer (Middleton) is a warrior. We view her and the Kent School as partners,” he said.��

Survivor Summer Dickerson, founder of Women of the Well support ministry, told people at the April 22 news conference that four years ago she spent time at the track’s Millionaires Row after being flown in to be trafficked during Derby season.

“Four years ago I was being sold on Derby and Oaks. Now I’m part of the solution,” Dickerson said. “Please be aware it is happening. It’s happening everywhere.”

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Beginning at age 19, Cotie was pimped out or walked the streets, offering sex for money for her next high. She was repeatedly physically and emotionally abused and sexually assaulted.

Cotie didn’t have help to avoid what she and others like her call “the life,” but the University of Louisville is working to give victims like Cotie assistance to leave that life behind or elude it altogether.

Sex and labor trafficking combined are, as defined by the National Human Trafficking Hotline, “a form of modern-day slavery in which traffickers use force, fraud or coercion to control victims for the purpose of engaging in commercial sex acts or labor services against their will.” Nationally, more than 8,500 cases of human trafficking were reported in 2017. Almost 6,100 involved sex trafficking, but researchers warn that as many as two-thirds of cases are never reported.

Several departments on UofL’s Belknap and Health Sciences Center campuses began working a few years ago to address human trafficking through the university’s quadruple enterprises of education, research, clinical care and community engagement. Today, the university is leading the way nationally in educating health care providers to recognize signs of trafficking.

UofL’s approach to studying the problem is truly transdisciplinary. Faculty members in social work, criminal justice, engineering, law and medicine are investigating various aspects, from the mental and physical health of victims to the routes and logistics of the actual trafficking.

Cotie didn’t have access to most of UofL’s services until she was leaving the life. But if she had, it could have made a world of difference.

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It is a practice that always increases during high-profile events such as the Derby, say providers with the . But armed with knowledge on what to look for, bystanders at the Derby may be able to help sex trafficked youngsters get help.

“The average age of sex trafficked victims ranges from 14 to 17, most are female, and we know that incidences of sex trafficking triple during the Kentucky Derby,” said Emily Neal, RN, a forensic nurse specialist with the Kosair Charities Division of Forensic Pediatric Medicine.

“It is directly a case of supply and demand,” said Jennifer Green, MD, child abuse pediatrics fellow in the . “The more people there are who are willing to purchase other people, the greater the number of people there are who are available to be purchased.”

Green and Neal provide these recommendations on what bystanders can do to recognize potential sex trafficked victims during Derby season:

• Signs to watch for include young people who may appear overly sexualized for their age, do not possess or have control of their documentation such as driver’s licenses or passports, and who are in the presence of an older, usually male adult, who is controlling them and their behavior.
• Sexually trafficked victims may have tattoos to “brand” them, such as bar codes or the names of someone other than themselves.
• They could be wearing clothes that are inappropriate for their age, are too revealing or are not climate appropriate.
• They could be staying confined to one area, seemingly to “work” that area for customers.
• They could have signs of trauma: bruises, lesions, black eyes or other marks that raise concern.
• They could have two or more cell phones in their possession, taking calls from all of them.

If Derby fans see someone they suspect may be a sex trafficked victim, Green and Neal emphasize getting professional help.

“The first step is to call the National Human Trafficking Resource Center Hotline, 1-888-373-7888,” Neal said. “The center will stay on the phone with you to help you get local resources, such as law enforcement, to intervene.”

“If you see direct signs of abuse to a child or are concerned about a child’s safety, involve law enforcement officers immediately and indicate your concerns clearly,” Green added.

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A new medical school curriculum to fill this training gap has been proposed and tested by researchers from the University of Louisville, Harvard University and the University of South Florida. Their research is published this month in .

The paper, “Medical education and human trafficking: using simulation,” explores the use of a patient simulation training module incorporated into the third year of medical school.

Human trafficking is a public health crisis in the U.S., and victims are consistently under recognized by health care providers (HCPs), the authors write. The National Human Trafficking Resource Center Hotline documented 8,042 cases of reported trafficking in 2016. U.S. studies of trafficking survivors show that anywhere from 25 to 88 percent of these victims interact with an HCP during the time they are being exploited by traffickers.

“One survey shows that 63 percent of HCPs – including physicians, nurses, social workers and physician assistants – did not have training on how to identify and intervene in human trafficking situations,” said Olivia F. Mittel, MD, associate professor of pediatrics at UofL and Norton Children’s Hospital who is a co-author of the paper. “Providers must be educated about the issue of trafficking, including how to recognize it in the clinical setting.”

To meet this need, the UofL School of Medicine created a simulation-based medical education curriculum to prepare students to recognize victims and intervene on their behalf. Known as the Medical Student Instruction in Global Human Trafficking, or M-SIGHT, the program utilizes online learning, medical documentation and standardized patient-based simulation to prepare students to see the signs of human trafficking.

“We want to ensure that all students receive the training,” said Carrie A. Bohnert, director of the standardized patient program at UofL. “Every medical student, regardless of their chosen specialty, must be able see human trafficking when it presents and intervene for the victim.”

M-SIGHT begins with a forensic medicine lecture to impart basic facts about human trafficking, among other topics, Mittel said. Later, students have a standardized patient simulation case in which an adolescent female patient presents with classic symptoms of a sexually transmitted disease as well as common characteristics of victims of human trafficking: poor eye contact, reluctance to communicate with the physician, inconsistencies in what she communicates, tattoos that could suggest branding and evidence of physical abuse.

The goal of the simulation is not to force intervention on the patient but rather to build trust. “We want the students to exercise the principles of adolescent communication that are taught as part of the medical school curriculum,” Bohnert said.

Mittel outlined these principles: “They are trauma-informed care – which is health care delivered with an understanding of what patients experiencing trauma need – and ensuring confidentiality, asking non-judgmental and open-ended questions, and gradually progressing from the less invasive questions to more direct questions.”

The simulation concludes with feedback from the standardized patient participant and documentation by the learner. The students then complete an online module developed by the authors that assesses knowledge gained and re-introduces definitions of human trafficking and trauma-informed communication techniques.

The initial project was implemented throughout a 16-month period and the authors are now evaluating the data collected from the students. They intend to share an analysis of the curriculum’s efficacy in the future. For now, they want to encourage other medical schools to implement anti-trafficking education and training.

“There is a wide array of methods for creating human trafficking simulations, and it is our hope that the description of our process will inspire others to create similar interactive educational programs,” Mittel said. “The ultimate goal, of course, is to help human trafficking victims receive both the health care they need and interventions that stop their exploitation.”

Along with Mittel and Bohnert, the other authors on the paper were Hanni Stoklosa, MD, of Harvard University and Brigham and Women’s Hospital, and Michelle Lyman, a student at the University of South Florida’s Morsani College of Medicine.

“That is alarming. That is something that we have to fix,” said Beshear, who detailed several efforts in motion to combat trafficking, which he called “the world’s fastest growing criminal enterprise.”

“Human trafficking represents the worst form of abuse, often to children, and it is increasing in Kentucky,” the attorney general said. “That’s why my office is partnering with the public and private sectors to enhance and improve policy measures and training opportunities to increase resources and awareness to help end human trafficking. Research such as UofL’s study is important and will help our efforts to combat this form of modern-day slavery.”

The Youth Experiences Survey studied 132 homeless youth aged 12-25 during two weeks in October 2016 to determine the scope of sex trafficking in Kentuckiana. More than three-quarters were from the area. The study showed approximately one of every two females and one of every three males reported being sex-trafficked with the average age of their first such experience at 16.

Youths who reported being sex-trafficked were more likely to be drug-addicted, diagnosed with more than one mental health problem and participate in self-harming, including suicide attempts. They also reported a high level of childhood trauma and abuse.

More than 70 percent of the sex-trafficked youth reported that technology was used as part of their victimization with smartphones being the most common. Social media apps such as Facebook, Snapchat, Twitter and Instagram also played a role in recruiting and selling.

The team hopes the findings will help communities better serve homeless youth through increased awareness of their specific experiences and needs, said Jennifer Middleton, assistant professor of social work and UofL Human Trafficking Research Initiative co-director.

The findings will be shared this month at the 2017 Central Kentucky Human Trafficking Summit at Georgetown College and next month at the Southern Indiana Human Trafficking Awareness Conference at Indiana University Southeast.

“This study provides us with a snapshot of the complexities homeless youth face, particularly youth who have experienced sex trafficking. The results highlight the need for early identification and screening of sex-trafficked youth as well as enhanced, trauma-informed services to help them,” Middleton said.

Middleton said the team’s goal is to expand the study to the entire states of Kentucky and Indiana. The next wave of data collection is underway with youth involved with the justice system.

“This work by the Kent School and the University of Louisville is going to make a difference, and I know it’s just getting started,” Beshear said.

The UofL Human Trafficking Research Initiative at the Kent School of Social Work conducted the initial survey with the aid of eight agencies that helped collect the information: YMCA Safe Place Services, Transition Age Youth Launching Realized Dreams (TAYLRD), Home of the Innocents, Haven House, Center for Women and Families, Clark County Youth Shelter, Floyd County Youth Services and the Kristy Love Foundation.��

Angela Renfro, a trafficking survivor who is founder and executive director of the Kristy Love Foundation, said the research confirms “what we have known for a very long time.”

“Human trafficking is a crime and its victims are often hidden, which makes awareness important and difficult to achieve,” she said.

“It’s very important and I really thank the University of Louisville for helping us.”