The Multimodal Social Ecological (MSE) Approach: A Trauma-Informed Framework for Supporting Trafficking Survivors’ Psychosocial Health
Human trafficking can have devastating effects on survivors’ emotional, psychosocial, and physical health. Initial research has suggested that trafficking survivors may meet diagnostic criteria for multiple psychiatric diagnoses, including depression, anxiety, post-traumatic stress disorder, and other comorbid conditions. However, many of their reactions may be better understood within a complex trauma framework. Despite the potential benefits of mental health care for trafficking survivors, many people are not able to access effective services, due to structural/systemic barriers and the lack of adequately responsive services. Trauma-informed systems that utilize an empowerment approach may increase access to services. In addition, due to the multiple layers of stress and trauma exposure commonly experienced by trafficking survivors, intervention should be guided by a complex trauma framework. Instead of focusing solely on symptom reduction, complex trauma treatment emphasizes the development of competencies, including building regulatory capacity; developing healthy relational patterns; and developing a positive sense of self and future orientation. Treatment plans addressing mental health should be collaboratively developed with each person and may be based on their current struggles, stage in the recovery process, cultural identification, preferences, and goals. A Multimodal Social Ecological (MSE) framework is proposed to guide intervention strategies that can support trafficking survivors’ recovery and empowerment. The MSE framework incorporates complex trauma theory and uses multiple modalities to intervene at individual, social-environmental, and systemic levels.
KeywordsHuman trafficking Trauma Mental health Psychological Complex trauma Intervention Treatment Trauma-informed Survivors Multimodal Social ecological Framework
The author would like to express sincere appreciation to Jeff Nicklas for his administrative assistance in the production of this chapter.
- 4.Clawson HJ, Dutch N, Solomon A, et al. Human trafficking into and within the United States: a review of the literature. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation. http://aspe.hhs.gov/hsp/07/humantrafficking/litrev/. Accessed 25 May 2016.
- 5.Tsutsumi A, Izutsu T, Pouyal AK, Kato S, Marui E, et al. Mental health of female survivors of human trafficking in Nepal. Soc Sci Med. 2008;6(8):1841–7.Google Scholar
- 6.Abas M, Ostrovschi NV, Prince M., Gorceag VI, Trigub C, Oram S, et al. Risk factors for mental disorders in women survivors of human trafficking: a historical cohort study. BMC Psychiatry. 2013;13(204). doi: 10.1186/1471-244X-13-204.
- 7.Zimmerman C, Hossain M, Yun K, Roche B, Morison L, Watts C, et al. Stolen smiles: the physical and psychological health consequences of women and adolescents trafficked to Europe. London: London School of Hygiene & Tropical Medicine; 2006.Google Scholar
- 9.Raymond J, Hughes D. Sex trafficking of women in the United States: international and domestic trends. U.S. Department of Justice. 2001. https://www.ncjrs.gov/pdffiles1/nij/grants/187774.pdf. Accessed 25 May 2016.
- 11.Lederer L, Wetzel CA. The health consequences of sex trafficking and their implications for identifying victims in health care facilities. Ann Health Law. 2014;23(1):61–91.Google Scholar
- 12.Clawson H, Salomon A, Goldblatt-Grace L. Treating the hidden wounds: trauma treatment and mental health recovery for victims of human trafficking. In: Study of HHS programs serving human trafficking victims. Health and Human Services. Available via HHS. https://aspe.hhs.gov/basic-report/treating-hidden-wounds-trauma-treatment-and-mental-health-recovery-victims-human-trafficking. Accessed 5 May 2016.
- 16.OSCE Office of the Special Representative and Co-ordinator for Combating Trafficking in Human Beings in partnership with the Ludwig Boltzmann Institute of Human Rights and the Helen Bamber Foundation. Trafficking in human beings amounting to torture and other forms of ill-treatment. Occasional Paper Series No. 5, Vienna. 2013. https://www.osce.org/cthb/103085?download=true. Accessed 5 May 2016.
- 17.Williamson E, Dutch NM, Clawson HJ. Evidence-based mental health treatment for victims of human trafficking. U.S. Department of Health and Human Services. 2010. http://aspe.hhs.gov/hsp/07/humantrafficking/mentalhealth/index.pdf. Accessed 25 May 2016.
- 18.Task Force on Trafficking of Women and Girls. Report of the task force on trafficking of women and girls. Washington, DC: American Psychological Association; 2014.Google Scholar
- 20.Langham M. Human trafficking of the mentally and physically disabled. 2013. http://aconspiracyofhope.blogspot.com/2013/04/human-trafficking-of-mentally-and.html. Accessed 25 May 2016.
- 21.Rafferty Y. The impact of trafficking on children: psychological and social policy perspectives. Child Dev Perspect. 2008;2:13–8.Google Scholar
- 22.Alexander MP, Kellogg ND, Thompson P. Community and mental health support of juvenile victims of prostitution. In: Cooper SW, Estes RJ, Giardino AP, Kellogg ND, Vieth VI, editors. Medical, legal, and social science aspects of child sexual exploitation, vol. 1. St. Louis: Medical Publishing Inc.; 2005. p. 397–421.Google Scholar
- 23.Basson D, Rosenblatt E, Haley H. Research to action: sexually exploited minors (SEM) needs and strengths. Oakland, CA: West Coast Children’s Clinic; 2012.Google Scholar
- 24.Herman JL. Complex PTSD: a syndrome in survivors of prolonged and repeated trauma. J Trauma Stress. 1992;5(3):377–91.Google Scholar
- 26.Courtois C. Complex trauma, complex reactions: assessment and treatment. Psychother Theory Res Pract Train. 2004;41(4):412–25.Google Scholar
- 28.Cook A, Spinazzola J, Ford J, Lanktree C, et al. Complex trauma in children and adolescents. Psychiatr Ann. 2005;35(5):390–8.Google Scholar
- 30.Herman JL. Trauma and recovery. New York: Basic Books; 1997.Google Scholar
- 31.Cloitre M, Courtois CA, Ford JD, Green BL, et al. The ISTSS expert consensus treatment guidelines for complex PTSD in adults. International Society for Traumatic Stress Studies. 2012 Available via http://www.istss.org/ISTSS_Main/media/Documents/ISTSS-Expert-Concensus-Guidelines-for-Complex-PTSD-Updated-060315.pdf Accessed 8 May 2016.
- 34.Hardy V, Compton K, McPhatter V. Domestic minor sex trafficking: practice implications for mental health professionals. Affilia. 2013;28(1):8–18. doi: 10.1177/088610991247517.
- 35.Kissane M, Szymanski L, Upthegrove R, Katona C. Complex posttraumatic stress disorder in traumatized asylum seekers: a pilot study. Eur J Psychiatry. 2014;28(3):137–44.Google Scholar
- 39.Hopper EK, Hidalgo J. Invisible chains: psychological coercion of human trafficking victims. Intercult Hum Rights Law Rev. 2006;1:185–209.Google Scholar
- 42.Hodgdon H, Kinniburgh K, Gabowitz D, Blaustein M, Spinazzola J. Development and implementation of trauma-informed programming in youth residential treatment centers using the ARC framework. J Fam Violence. 2013;28(7):679–92.Google Scholar
- 43.Aron LY, Zweig JM, Newmark LS. Comprehensive services for survivors of human trafficking: findings from clients in three communities. Washington, DC: Urban Institute; 2006.Google Scholar
- 45.Domoney J, Howard L, Abas M, et al. Mental health service responses to human trafficking: a qualitative study of professionals’ experiences of providing care. BMC Psychiatry. 2015;15. doi: 10.1186/s12888-015-0679-3.
- 47.Yakushko O. Human trafficking: a review for mental health professionals. J Adv Counsel. 2009;31(3):158–67.Google Scholar
- 48.Substance Abuse and Mental Health Services Administration. Trauma-informed approach and trauma-specific interventions. 2015. http://www.samhsa.gov/nctic/trauma-interventions. Accessed 5 May 2016.
- 49.Elliot D, Bjelajac P, Fallot R, Markoff L, Reed B. Trauma-informed or trauma-denied: principles and implementation of trauma-informed services for women. J Community Psychol. 2005;33:461–77.Google Scholar
- 50.Blaustein M, Kinniburgh K. Treating traumatic stress in children and adolescents: how to foster resilience through attachment, self- regulation, and competency. New York: Guildford Press; 2010.Google Scholar
- 51.Bloom SL, Farragher B. Restoring sanctuary: a new operating system for trauma-informed systems of care. New York: Oxford University Press; 2013.Google Scholar
- 52.Saakvitne KW, Gamble S, Pearlman LA, Lev B. Risking connection: a training curriculum for working with survivors of childhood abuse. Baltimore, MD: Sidran Press; 2000.Google Scholar
- 55.Gray G. Resilience in Cambodia: hearing the voices of trafficking survivors and their helpers. Dissertation, George Fox University; 2012a.Google Scholar
- 56.Gray GG. Exploring resilience: strengths of trafficking survivors in Cambodia. Int J Adolesc Med Health. 2012b;24(4):363–71. doi: 10.1515/ijamh.2012.053.
- 57.Janoff-Bulman R. Shattered assumptions: towards a new psychology of trauma. New York: Free Press; 1992.Google Scholar
- 58.Ogden P, Fisher J. Sensorimotor psychotherapy: interventions in trauma and attachment. New York: W. W. Norton & Company; 2015.Google Scholar
- 59.Lloyd R. From victim to survivor, from survivor to leader: the importance of leadership programming and opportunities for commercially sexually exploited and trafficked youth. 2011. Retrieved from http://www.gems-girls.org/from-victim-to-survivor-from-survivor-to-leader. Accessed 1 Aug 2016.
- 63.Miller WR, Rollnick S. Motivational interviewing: helping people change. 3rd ed. New York: The Guilford Press; 2013.Google Scholar
- 64.Foa EB, Keane T, Friedman MJ, Cohen JA, editors. Effective treatments for PTSD: practice guidelines from the International Society of Traumatic Stress Studies. 2nd ed. New York: The Guilford Press; 2010.Google Scholar
- 65.Polaris Project, Sanar. Promising practices: an overview of trauma-informed therapeutic support for survivors of human trafficking. POLARIS Project. 2015. Available via https://polarisproject.org/sites/default/files/Sanar-Promising-Practices.pdf. Accessed 30 Apr 2016.
- 66.Katona C, Robjant K, Shapott R, Witkin R. Addressing mental health needs in survivors of modern slavery: a critical review and research agenda. 2015. Available via The Freedom Fund. http://freedomfund.org/wp-content/uploads/2015-Addressing-the-Mental-Health-Needs-in-Survivors-of-Modern-Slavery.pdf. Accessed 4 May 2016.
- 69.U.S. Advisory Council. 2015. https://www.whitehouse.gov/the-press-office/2015/12/16/president-obama-announces-more-key-administration-posts. Accessed 4 May 2016.
- 70.Girls Education and Mentoring Services. 1998. www.gems-girls.org. Accessed 4 May 2016.
- 71.National Survivor Network. 2011. nationalsurvivornetwork.org. Accessed 4 May 2016.Google Scholar
- 74.Courtois CA, Ford JD. Treating complex trauma: a sequenced relationship-based approach. New York: Guilford Press; 2013.Google Scholar
- 75.Hopper EK, Grossman F, Spinazzola J, Zucker M (under agreement) Across the abyss: components based psychotherapy for adult survivors of emotional abuse and neglect. New York: Guilford Press.Google Scholar
- 76.Briere J, Scott C. Principles of trauma therapy: a guide to symptoms, evaluation, and treatment. Thousand Oaks, CA: Sage; 2006.Google Scholar
- 78.Ford JD. An affective cognitive neuroscience-based approach to PTSD psychotherapy: the TARGET model. J Cogn Psychother. 2015;29(1):69–91.Google Scholar
- 79.Briere J, Lanktree CB. Integrative treatment of complex trauma for Adolescents (ITCT-A): a guide for the treatment of multiply-traumatized youth. 2008. National Child Traumatic Stress Network. Available via, http://www.johnbriere.com. Accessed 1 Aug 2016.
- 81.Saxe GN, Ellis BH, Brown AD. Trauma systems therapy for traumatized children and teens. 2nd ed. Guilford Press: New York; 2015.Google Scholar
- 82.Linehan MM, Dimeff L. Dialectical behavior therapy in a nutshell. Calif Psychol. 2001;34:10–3.Google Scholar
- 83.Shapiro F. Eye movement desensitization and reprocessing: basic principles, protocols and procedures. 2nd ed. New York: Guilford Press; 2001.Google Scholar
- 85.Brunovskis A, Surtees R. Coming home: challenges in family reintegration for trafficked women. Qual Soc Work. 2012;12:454.Google Scholar
- 87.Arnstein E. A trauma-informed psychoeducation program for professionals treating adolescent female victims of human sex trafficking. Dissertation, Chicago School of Professional Psychology; 2014.Google Scholar
- 88.My Life My Choice. 2016. http://www.fightingexploitation.org/. Accessed 4 May 2016.
- 89.DeRosa R, Pelcovitz D. Igniting SPARCS of change: structured psychotherapy for adolescents responding to chronic stress. In: Ford J, Pat-Horenczyk R, Brom D, editors. Treating traumatized children: risk, resilience and recovery. New York: Routledge; 2008.Google Scholar
- 90.Emerson D, Hopper EK. Overcoming trauma through yoga: reclaiming your body. Berkeley: North Atlantic Books; 2011.Google Scholar
- 91.Villareal AG. Cultural competence in the trauma treatment of Thai survivors of modern-day slavery: the relevance of Buddhist mindfulness practices and healing rituals to transform shame and guilt of forced prostitution. In: Kalayjian A, Eugene D, editors. Mass trauma and emotional healing around the world: rituals and practices for resilience and meaning-making, vol. 2: human-made disasters. Santa Barbara, CA: Praeger; 2010. p. 269–85.Google Scholar
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