Screening, Identification, and Assessment
Screening and assessment are critically important to ensure vulnerable youth and youth who are trafficked are identified and appropriate and effective services are provided. Although the terms “screening” and “assessment” are often used together and even interchangeably, they are distinct activities.
|Screening for child sex trafficking (CST) involves a systematic process of targeted inquiry to identify youth with possible experiences of CST. It is broadly applied to all youth in a service population or a subset of youth with certain risk factors (e.g., all youth seen at an adolescent medical clinic, youth entering a department of juvenile justice facility, etc.). This screening section describes different methods of screening, standardized screening tools, common screening challenges, tips for identification, and universal education as a screening strategy.||Assessment involves more in-depth information gathering to obtain a fuller understanding of the youth, their experiences of trafficking, risk factors, pathway of entry, and needs and strengths, in order to drive service planning and intervention. This section also addresses the need for comprehensive and holistic evaluation of a youth’s strengths and needs across multiple domains and areas of inquiry. These include, but are not limited to mental health, physical health, education, housing/placement and other basic needs. Cross-system collaboration for best-practice service and treatment planning is also addressed.|
Some youth may continue to deny being sex trafficked even when there is clear evidence of exploitation. It is not uncommon for youth to firmly and persistently deny being sexually exploited and then later disclose, after a safe relationship has been established with their therapist, social worker, or another trusted person.
Screening of youth ensures that those involved in child sex trafficking, or those who may be at high risk of being trafficked, are identified and signals the need for further assessment by designated systems, agencies, and professionals.
Youth who are trafficked and exploited may be reluctant to reveal their experiences to professionals for a variety of reasons. Professionals, likewise, may be reluctant to ask youth about their trafficking experiences.
Potential Reasons Youth May Not Disclose:
Potential Reasons Providers May Not Conduct Screening:
Failure to ask about child sex trafficking and common vulnerabilities may inadvertently send a message to the youth that professionals are not interested in their experiences or in taking action for their safety.
To assist in the screening process, it is important to use a trauma-informed, culturally responsive, gender affirming approach when interacting with youth and their caregivers. Professionals should, whenever possible, avoid repeated questioning by multiple professionals. Find out what information is known by other sources or individuals who know the youth.
When talking with youth:
- Screen for trafficking in a safe, private, and welcoming environment
- Attempt to create comfort before asking screening questions
- Prioritize creating physical and psychological safety
- Minimize questions regarding specific details of traumatic events
- Maintain an open, respectful, nonjudgmental demeanor with active listening
- Maintain transparency throughout the conversation (e.g., explain the purpose of questions and inform youth of any limits to confidentiality early in the conversation)
- Offer choices when possible and respect the youth's right to refuse to answer questions
- Recognize that dysregulation and maladaptive coping may be related to prior trauma, fear, and anxiety
- Use a trained interpreter, if needed
Further, it is important to use terms that are readily understandable to youth and relevant to their daily lives. The success of any screening tool in identifying youth at high-risk may be significantly influenced by the specific wording of the questions, the environment in which the screening process occurs, and the relationship between the youth and the provider.
In sum, screening, universal education, and the offer of community resources can only be successful when provided in the context of an open, nonjudgmental, supportive atmosphere. Use of a trauma-informed approach, with transparency, rapport building, respect, and normalization of sensitive questions is recommended.
Trafficking Screening Tools
There are a growing number of screening tools for identifying youth at risk for sex trafficking. These vary in length and the settings for which they are appropriate. Some tools tend to focus on adults, with some of the questions potentially less applicable to youth and children (e.g., not allowed to hold onto travel documents). The goal of most of these screening tools is not to obtain a disclosure of child sex trafficking (commercial sexual exploitation) but to assess the level of risk, in order to offer youth services that address specific vulnerabilities. Click here for a few examples of trafficking screening tools that are available.
If you are not able to access or use a trafficking screener, you are encouraged to add a trafficking item to standard trauma history screening and to incorporate questions for intake interviews with clients, such as the following:
Here are a few examples of questions to add:
- Has anyone ever asked or pressured you to engage in any type of sexual act with another person?
- Have you ever had to exchange sex for money, food, shelter, to survive, or to get something you needed?
- When you are “on the run" how do you get by?
- Do you know anyone who has been pressured by someone to do any type of sexual act with other people for money, drugs, food shelter, or protection?
In most—if not all—states, mental health professionals are required by law to report a reasonable suspicion of commercial sexual exploitation of children and child sex trafficking to authorities. However, the provider does NOT need to be certain that abuse or exploitation has occurred before making a report. Please take the time to educate yourself on your own state’s mandated reporting laws.
Assessment involves gathering in-depth information from the youth and family to obtain a holistic understanding of the youth in order to drive service planning and intervention. A holistic assessment may include: assessing youth and family safety, trafficking circumstances, immigration concerns, basic needs, strengths and resources, and mental health. Specific elements and strategies may differ somewhat depending on the focus area and role of the professional conducting the assessment.
Regardless of your role, it is essential to assess for safety and basic needs. By working together, multiple professionals may be better positioned (based on their role) to gather information in a particular domain. Collaboration and referral to case managers is needed to assist with identified barriers to service. Failure to address these important domains will interfere with a youth’s access to additional resources and engagement in intervention.
Youth and Family Safety
Youth who have experienced sex trafficking often present with an array of safety concerns. Safety threats to consider during assessment may be related to a range of vulnerabilities, including:
- Threats or fear of harm to the youth or loved ones by exploiters or others (e.g., purchasers, gang affiliation)
- Rejection due to gender identity and/or sexual orientation
- Unmet basic needs (e.g., lack of safe and stable housing)
- Mental health symptoms (e.g., suicidal ideation and self-injury, substance use-related safety threats)
- Physical/medical considerations (e.g., untreated injuries or serious medical conditions)
- Ongoing abuse or neglect in the home
- Community violence
- Revictimization - especially related to leaving placement (e.g., running away)
Targeted and robust safety planning addressing each concern is then collaboratively developed with the youth, caregivers, and other professionals positioned to assist (mental health team, case managers, mentors, school personnel, public safety). As with all recommendations and referrals, safety planning must prioritize the youth’s best interests, and include their active voice in planning and decision-making.
Trafficking Experiences and Context
It is especially important to establish an understanding of a youth’s trafficking circumstances in order to determine, and respond to, current and future risk of trafficking revictimization, what is contributing to the risk of leaving placement (e.g., running away), associated safety concerns (e.g., substance use, other risky behavior, violence exposure), how to enhance and foster engagement, and to inform treatment needs:
- Prior exploitation in commercial sex
- Pathway of entry
- Relationship with an exploiter
- Precipitants of prior runaway events
A holistic assessment of basic needs and identification of unmet needs at the outset of intervention is often necessary, especially as related to barriers to accessing services. Unless, and until, basic needs are secured and the youth and family feels physically and emotionally safe, meaningful progress is unlikely to be made. Linkage to intensive case management services and engagement of multi-disciplinary partners are recommended to address the needs of youth who were trafficked and their family, keeping in mind that needs and priorities change over time.
Youth who have experienced trafficking may present with an array of unmet basic needs that interfere with access to services and specifically contribute to risk of revictimization. These basic needs include:
- Lack of safe and stable housing
- Food insecurity
- Access to immediate and ongoing medical care
- Caregiver support (e.g., separation from family)
- Lack of, or unreliable, transportation
- Poor access to technology (e.g., phone, internet)
- Lack of access to available resources
- Lack of interpreter services
- Immigration concerns/refugee status
- Lack of documentation to facilitate access to healthcare and other services
- Sexual health knowledge and access to reproductive healthcare
In addition to basic needs, it is important to gain an understanding of other factors that have contributed to a youth’s trafficking vulnerability, especially the youth’s needs that were met through their exploiter or engagement in commercial sex (e.g., money, drugs, acceptance, love, belonging, safety, etc.) A youth is unlikely to freely and fully disclose their experiences and the impacts of those experiences early on. Rather, this information will likely be disclosed over time as trust is established. Therefore, it is important to attend to basic needs, trafficking vulnerabilities, and other risk factors and experiences as they emerge.
Youth who have been trafficked often have complex mental health needs, complicated treatment histories, and may have multiple psychiatric diagnoses. In order to effectively determine treatment needs and priorities, it is essential that youth receive a high-quality trauma-informed mental health assessment.
Youth have more than likely experienced multiple traumas. It is important to avoid assuming the commercial sexual exploitation is the most upsetting and/or most strongly associated with trauma symptoms.
The goals of assessment are to do the following:
- Give an in-depth understanding of the nature, timing, and impact of traumatic events
- Assess functioning in social, emotional, and behavioral domains
- Inform case conceptualization
- Drive treatment planning
- Monitor progress over time
Core elements of assessment include:
- Clinical interview
- Information gathering from other adults knowledgeable about the youth
- Behavioral observations with the youth (and caregiver when available)
- Broadband measure of emotional and behavioral functioning
- Measure of trauma history and symptoms
- Substance use measures
- Disorder-specific measures including complex trauma tools
- Suicidal ideation
- Self-injury screening/assessment are also beneficial given the greater presence of these concerns among youth who have experienced trafficking
Youth who have experienced trafficking often have been given multiple diagnoses and prescribed multiple medications. It is especially important for youth to receive a medication assessment to evaluate the need for and/or effectiveness of these medications.
It may be additionally helpful to assess cognitive/developmental functioning, due to the associated exploitation risk and relevance for treatment planning. Also, given a range of complex caregiver factors that often present with youth who have been trafficked, assessment of family relationships/parenting stress may further inform case conceptualization and treatment planning.
Youth's Strengths and Resources
In addition to identifying needs, assessment is good for identifying the strengths of each youth. Strengths can include: autonomy, resilience, survival skills, intelligence/insight, interests not related to trafficking, among others. Resources youth may take advantage of include peer support and/or advocacy related to sexual health, positive relationships, community and cultural resources, among others.