Exiting sex trafficking is an emerging topic of study in the literature. The how and why of leaving are less examined than the process of entry (Oselin 2010). The how of the exit is about strategy—literally, what steps are taken to escape and/or leave. The why of the exit is intertwined in internal and external circumstances. Both components play a role in the exit process and are the focus of this section.
Barriers to Exiting
There are multiple barriers to exiting/escaping sex trafficking. Factors that inhibit or prevent victims from seeking help are conceptualized in four categories: (1) individual, (2) relational, (3) structural, and (4) societal (Baker et al. 2010). The first two factors, individual and relational, can be thought of at the human-to-human level as they reflect the relationship with the self and the relationship with others. Individual factors are those associated with personal drive, abilities, and sense of self efficacy, which are hampered by trauma, shame, internalized stigma, substance abuse and mental illness, health issues, and lack of knowledge about resources for help (Baker et al. 2010; Oselin 2010; Wilson and Dalton 2008). Relational factors are those associated with her close relationships and informal social network (Baker et al. 2010). Strained or limited family relationships and associations with those still involved in sex trafficking may negatively impact these factors. Thus, little relational support exists for someone looking to exit; in fact, threats of violence and death for attempting to leave are likely present (Wilson and Dalton 2008).
The second two categories are on the person-to-community level and relate to one’s relationship with greater society and the local community. Structural factors are those associated with societal circumstances. These include a lack of employment available to those with few marketable job skills and a criminal record, a lack of resources for basic needs (e.g., hosing, homelessness, poverty, economic self-sufficiency), an unfinished education, and a scarcity of adequate services within the community to meet these complex needs (Baker et al. 2010; Benoit and Millar 2001; Oselin 2010). Societal factors are those that capture social perceptions (i.e., discrimination and stigma) of prostituted women and likely affect, in profound ways, the other factors (Baker et al. 2010). Attitudes about male and female roles, the context of sexuality, and the concept of sexualization are contributing factors to the demand for sex trafficking and are part of this category (Nixon et al. 2002; Oselin 2010).
These barriers do not exist in isolation and cannot be addressed outside of the context of a complicated and difficult situation. The mental and emotional inner turmoil that comes with the decision to escape, quit, leave, and inevitably change one’s circumstances is part of a long journey of qualitative lifestyle changes that are accompanied by obstacles at every turn (Arnold et al. 2000). Sadly, when one exits, it is not as if everything simply falls into place to ensure that she is safe, her needs are met, and that people are willing and able to help her restore and recover her life. In many communities, there is little awareness of sex trafficking, fragmented and inadequate responses for services, and few supportive resources. However, the identification of barriers alone is not enough to fully understand and assist with the process of exiting. The process itself is complicated and is discussed in the next subsection.
The Process of Exiting
Baker et al. (2010) propose an integrated six-stage model to describe the “complex and convoluted process” of exiting prostitution (p. 579). Their model is depicted in Fig. 1 (p. 591). The details within the stages displayed in Fig. 1 are discussed, followed by implications for various community systems that may intervene with those who are exiting.
Immersion is the first stage and is the beginning of the journey and describes the indoctrination of the individual into the lifestyle by the trafficker/pimp and other associates. Immersion is part of the entry pathway as its main goal is to detain and retain the individual. This immersion leaves little room to consider leaving or even develop the awareness of leaving. Thus, during this stage, an exit would occur typically through interception—meaning a victim is discovered and forcibly removed. However, permanent exit may be difficult for someone who is in this first stage due to intense fear of being recaptured or fear of being without any resources.
Visceral awareness and conscious awareness occurs in the second stage. Visceral awareness is described as a “gut” feeling about leaving prostitution due to the awareness that things have changed. Conscious awareness is an amplification of these visceral feelings of wanting to leave. Part of consciousness is a verbalization of these feelings. Again, this stage is a difficult one to imagine a successful exit, as awareness is not enough to ensure safety or available help. Talking about wanting to leave is a dangerous proposition and could result in severe punishment.
Deliberate planning is the third stage and involves an assessment of formal and informal support resources. This planning may be initiated by the individual or imposed by others (e.g., social services, criminal justice, family). Preparing to exit is, again, a very dangerous move and one that should be approached with significant attention paid to safety for the individual. Initial exit is the fourth stage. Baker et al. (2010) explains the complex and delicate nature of this stage as cyclical due to the reality of reentering soon after an initial exit. Baker et al. (2010) emphasize the importance of the work done in the deliberate planning stage, as it lays the foundation for a successful exit process. During this stage, formal services and informal supports are essential to ensure that the individual’s needs are met and that she does not feel the draw to return to her former situation to survive. Professionals working with the woman at this time should be aware that service provision is predicated on service receptivity, and in these early stages, her sense of safety, confidence, and motivation is regularly tested (Baker et al. 2010).
Reentry is the fifth stage in this model and captures the reality of the exit process. Reentry into sex trafficking may result in a complete reimmersion into the industry/lifestyle despite conscious awareness of a need to change. The individual may be faced with the barriers discussed in the previous section, which prevent her from being successful in her exit from sex trafficking. It is quite possible that reentry functions much like a relapse process in addiction and may be part of the journey toward final exit. Final exit is the sixth stage and the most complicated to define, as it often occurs after a series of cycling in and out of prostitution. Final exit relies on one fining legal employment, safe residence, persons supportive of this “new lifestyle,” and many other factors (Baker et al. 2010). Because these factors are volatile, reentry is always a possibility, even after significant time away.
This integrated model explains the complexity of exiting and highlights reality that leaving is more than a simple decision to go. Rather, numerous variables (both internal and external) can impact the ability of the person to successfully exit and not reenter. Resources available within the community, combined with the societal factors that contribute to support, awareness, and compassion for the victim/survivor, are essential to a successful and sustained exit. Various professionals play an important role in developing a response that is adequate to meet the needs of this population. Specific guidance for the criminal justice system and the health and social services systems is provided in the following subsections.
Exiting: the Role of Law Enforcement and Criminal Justice
Effectively combating human trafficking begins with proper identification of human trafficking cases. Thus, it is imperative that frontline responders, especially law enforcement agencies, are equipped with the know-how to correctly identify and respond. Various tools have been developed and disseminated to assist law enforcement officers to identify victims of human trafficking (i.e., Trafficking in Persons Reports from the US Department of State). However, the transfer of this information into direct community practice is slow (United Nations Office on Drugs and Crime 2012). Law enforcement officers can take first steps to (a) identify human trafficking victims and perpetrators, (b) stabilize and control the human trafficking situation, (c) prepare victims and pass information on to investigators, and (d) refer victims to specialized service providers (Farrell et al. 2012; United Nations Office on Drugs and Crime 2012). Prioritization and awareness raising through education and training for officers, state attorney generals, and district attorneys are a needed first step to impact this situation, followed by an improved understanding of the victim experience (versus the criminal experience); these efforts will facilitate a change in perception and response (Farrell et al. 2012).
Once they have identified victims, police, prosecutors, and victim service providers should commit to long-term support for them. Since most human trafficking prosecutions take between 1 and 2 years to complete, a corresponding long-term victim support plan will increase the number of successful prosecutions (Farrell et al. 2012). Collaboration between law enforcement, the courts, and community providers is an essential component of outreach, engagement, and retention in services. Victims may be more apt to engage in discussion about exiting and receiving services while in the custody of the courts (Arnold et al. 2000). However, once the individual is released from custody, she may be harder to engage. Her developmental stage within sex trafficking (Williamson and Folaron 2003), combined with her work typology (Williamson and Baker 2009), may signal her exit stage (Baker et al. 2010) and be a predictor of whether or not she will accept or decline the available resources. Thus, the role of health care workers and social workers cannot be overstated, nor can the relationship between these systems and the criminal justice system.
Exiting: the Role of Health Care Professionals and Social Workers
Social workers and health care providers are likely to encounter, and therefore identify early, trafficked persons in settings including emergency rooms, health clinics, child welfare, treatment centers, and shelters (Alvarez and Alessi 2012; Dovydaitis 2010; Newby and McGuinness 2012; Sabella 2011). Social workers that identify a trafficked person should recognize that the individual might not be able (nor willing) to seek help at the time of identification for fear of retaliation from the trafficker (Alvarez and Alessi 2012; Newby and McGuinness 2012; Sabella 2011). Attempting to identify victims is challenging, as most psychosocial assessments will not pick up on trafficking as a symptom per se; rather, the distinct physical and emotional symptoms will indicate a potential trafficked person.
Victims are often young (10 to 17 years of age) and are therefore experiencing forms of abuse and neglect. Therefore, child welfare agencies must be part of a community service approach (Fong and Cardoso 2010; Mitchell et al. 2010). The response of child welfare workers must also include proper identification of victims; suggestions for those working in child welfare include (a) an examination of organizational practices and polices related to child welfare assessments to appropriately capture the trauma experienced by child victims and accurately identify the treatment needed, (b) an inventory of potential partners for appropriate services for children, and (c) a thorough exploration into the family of the child to ensure that the child is not placed back into a trafficking situation (Fong and Cardoso 2010; Mitchell et al. 2010). Coordination efforts between child welfare and juvenile justice is needed, as detaining victims in a detention center is not seen as ideal (Kotrla 2010; Mitchell et al. 2010; McClanahan et al. 1999)
As social workers develop interventions for this population, they are faced with the creation of a comprehensive and multisystemic approach, due to the many needs described in earlier sections of this article. Complex needs such as these may not have suitable interventions available in many communities, making a referral to appropriate care quite challenging. Yet, finding appropriate care is essential to a successful exit process for trafficked persons. The importance of enhancing services to ensure the needs of this population are met represents a call to action for policy and practice in social services. The next section describes services for victims/survivors of trafficking that address their complex needs.