Familial sex trafficking in the United States: A scoping review guided by the Three Ps Framework to end human trafficking
Brannock, Mary K. ; Quesenberry, Deborah L. ; Smith, Michael G. ; Blackwell, Roger L. Child abuse & neglect, 2024-12, Vol.158, p.107143, Article 107143
Abstract
Background: Familial sex trafficking is a form of sex trafficking that involves a family member exchanging sex with a child, to someone else, for something of value. Due to its covert nature, human trafficking is severely under-reported, however, in 2021 over 10,500 sex trafficking survivors were reported to the National Human Trafficking Hotline and the majority had a familial recruiter (33 %) (Polaris, 2022). To our knowledge, this is the first scoping review on familial sex trafficking. Objective: The objectives of this study are to map the available peer-reviewed evidence on familial sex trafficking and to synthesize that evidence within the Three Ps Framework and grey literature. Methods: In summarizing evidence on familial sex trafficking, a scoping review was the chosen design. Results: Eight studies were included and identified victim and perpetrator characteristics, practice needs such as services, screening, and training, as well as barriers to prosecution, such as lack of adequate community and interpersonal resources. The grey literature uncovered a similar phenomenon and supplemented peer-reviewed findings. Conclusions: This review demonstrates a need for original research that can provide context. Moreover, it highlights how the social determinants of health impact familial sex trafficking
Introduction
Globally, 28 million people are living in human trafficking situations (US Department of Health and Human Services, 2022). Annually, this form of exploitation is one of the fastest growing, generating an estimated 150 billion dollars (United Nations, 2020). Sex trafficking is defined in the US as “the recruitment, harboring, transportation, provision, obtaining, patronizing, or soliciting of a person for a commercial sex act in which a commercial sex act is induced by force, fraud, or coercion, or in which the person induced to perform such act has not attained 18 years of age” (US Department of Justice, 2015). Due to its covert nature, human trafficking is severely under-reported, however, in 2021 nearly 7500 US cases of sex trafficking accounting for over 10,500 survivors were reported to the National Human Trafficking Hotline (Polaris-Analysis-of-2021-Data-from-the-National-Human-Trafficking-Hotline.pdf). Of these survivors, the majority were female (79 %) and many had a familial recruiter (33 %) (Polaris-Analysis-of-2021-Data-from-the-Familial sex trafficking, also referred to as family-facilitated, family-controlled, or familial pimping, is a form of sex trafficking that involves a family member exchanging sex with a child for something of value, often drugs or cash (Sprang & Cole, 2018).
To our knowledge, this is the first scoping review on familial sex trafficking. Providing a synthesis and overview of currently available research can inform policy, practice, and future research. The objectives of this scoping review are to first show the types of existing peer-reviewed evidence and then to synthesize evidence surrounding the Three Ps, a global framework for ending human trafficking that was adopted by the Palermo Protocol and the United States Trafficking Victims Protection Act of 2000 (United States Department of State, n.d.). The Three Ps encompass Prosecution, Protection, and Prevention, and a fourth P, Partnership, was announced in 2009 by Secretary of State Hilary Clinton as a means to amplify progress among the other Ps by recognizing the importance of collaboration and collective action to end human trafficking. Within the framework, the first P, Prosecution, requires the criminalization of all human trafficking, that cases are investigated, properly prosecuted, convicted, and sentenced. Lastly, it calls for victim compensation. The next P, Protection, refers to the successful identification of victims, referral to comprehensive services, providing direct services or funding them, and offering other victim support. The third P, Prevention, includes efforts like targeted information campaigns, at-risk intervention programs, policy implementation, enhanced reporting, and reducing demand to stop trafficking before it happens. Lastly, while not considered one of the “Three Ps”, Partnership, crosscuts the aforementioned Ps and recommends the engagement of the community to end human trafficking (United States Department of State, n.d.).
Methods
The chosen design for this study is a scoping review. Scoping reviews differ from systematic reviews considering the aims are to synthesize existing evidence while not answering a clinical research question (Delgado, 2023). Importantly, scoping reviews can identify common evidence and uncover literature gaps that inform policy, practice, and future research. A protocol was registered for this study and PRISMA for Scoping Reviews was utilized. An additional review of the grey literature was conducted to further support this evidence.
Eligibility criteria
To meet inclusion criteria, papers needed to be empirical articles focusing on familial sex trafficking in the US, published within the last 10 years, and be peer-reviewed. Studies that were not primarily focused on familial sex trafficking were excluded. For our purposes, familial sex trafficking is conceptualized as family members or caregivers exchanging sex with a child for something of value. These criteria are important given the political nature of human trafficking, prevalent misconceptions, and the need for high-quality evidence. However, the authors acknowledge the limited peer-reviewed information on this topic and have included a separate summary of recent grey literature from national organizations working on familial sex trafficking.
Information sources and search strategy
Searches were conducted utilizing Web of Science, Pub Med, and Proquest from May 20–23, 2023. In Web of Science, the search string “famil* AND sex trafficking” was used in combination with the date (2013–2023), geographic location (US), citation topics (human trafficking), as well as a filter to allow only full articles to be considered. In Pub Med, the search string used was “famil* AND sex trafficking” in combination with both “sex trafficking” and “famil*” appearing in either the title or in the abstracts of articles. Additionally, the advanced search function was used to filter articles by date. In Proquest, articles were filtered to include only those articles with “family AND sex trafficking” appearing in abstracts. Citations within publications, specifically Edwards et al. (2022) and Reid et al. (2015) served as additional sources. Before screening, search results were exported into Excel.
Screening
The first author screened 70 articles from Web of Science, three articles from Pub Med, and 29 articles from Proquest (n = 102) which returned six articles meeting the criteria. Ten citations from Edwards et al. (2022) (eight), Reid et al. (2015) (one), and White et al. (2023) (one) were screened and resulted in two additional articles. Lastly, through visiting a human trafficking website (Shared Hope International), one additional article was discovered and met the screening criteria. Altogether eight articles met the inclusion criteria for this review (Fig. 2.1).
Data charting and synthesis
The first author reviewed each article using an inductive approach to articulate the range of evidence provided and a deductive approach when applying codes related to the Three Ps framework. A codebook was created in Excel and included the themes Prosecution, Protection, Prevention, Partnership, and Evidence Type, and their codes are shown in Table 2.1 Each article's coded utterances were further included in the Excel document. The first author used memo-writing to further develop ideas regarding each code and its meaning.
Results
From this review, a total of eight studies met scoping review eligibility criteria and were included (Table 2.2).
Types of evidence
Of the eight reviewed articles, 75 % included secondary familial sex trafficking case reviews which were primarily quantitative (n = 1133) and ranged from 2011 to 2021. Of the six case review papers, two included supplemental data from service providers (focus groups and interviews) and one included interviews and surveys from justice professionals. In the case review studies, data-sharing agreements were established with child welfare organizations, hospitals, and service providers. Familial sex trafficking survivor characteristics were pulled from these studies and are presented in Table 2.3. The percentage of familial sex trafficking cases ranged from 10 to 100 % (n = 19–405). Familial sex trafficking was shown to occur in both non-urban and urban settings, however, non-urban settings were shown to have more familial sex trafficking cases. Cases were predominantly female, within 12–13 years of age, and had child welfare involvement of some kind. The use of drugs or exchange for drugs in these cases ranged from 21 to 82 %. The remaining studies were qualitative (secondary and primary) including both survivor interviews and document reviews. Only one article included primary interviews with survivors of familial sex trafficking (n = 4). There was one mixed-methods original research article with justice professionals (survey n = 39 and interviews n = 7) that also had a case review element. All studies were conducted in the US and came from Kentucky (2), a rural state (1), a south-western metropolitan city (1), metropolitan cities in southern and central Florida (1), multiple states (1), unknown (1), and one at the national level (1).
The Three Ps Framework
The Three Ps Framework, an internationally accepted framework to end human trafficking, consists of three strategies: protection, prosecution, and prevention. Later, partnership was added (as a crosscutting element that applies to each P) to assist the overall strategy by amplifying the Three Ps. These elements were adopted by the TVPA and signed into law by President Clinton in 2000 (Sheldon-Sherman, Penn State Law Review). The following sections describe how the Three Ps, as themes, emerged within the eight reviewed articles.
Protection
Overall, the theme of protection appeared in every article and was the most common theme. One element of protection, identifying victims, was mentioned in several studies. For example, every case study provided details on survivor characteristics. These characteristics summarized in Table 2.3 can be used to aid in victim identification and subsequently protection. These studies show that Table 2.2 Included studies. Search strategy Lead author, article title Journal Year Study design FST sample size Web of Science: family AND sex trafficking Edwards, Cole, Middleton, FamilyControlled Trafficking in the United States: Victim Characteristics, System Response, and Case Outcomes Journal of Human Trafficking 2022 Secondary quantitative case review from Kentucky child welfare (DCBS) 332 Web of Science: family AND sex trafficking Sprang and Cole, Familial Sex Trafficking of Minors: Trafficking Conditions, Clinical Presentation, and System Involvement Journal of Family Violence 2018 Secondary quantitative case review from a clinical database 31 Web of Science: familial sex trafficking Reed, Friends, family, and boyfriends: An analysis of relationship pathways into commercial sexual exploitation Child Abuse and Neglect 2019 Secondary qualitative interview data from a larger study on exiting ST. This study looked for relationship pathways in ST, and FST was one of them. 4 Web of Science: “Family AND sex trafficking” Reid et al. Family-facilitated juvenile sex trafficking Journal of Crime and Violence 2015 Secondary case review and semistructured interviews with providers who worked on cases. 19 Cited in When Families Become Perpetrators: A Case Series on Familial Trafficking Raphael, Parents as pimps: Survivor Accounts of trafficking of children in the United States. Dignity: A Journal of Analysis of Exploitation and Violence Dignity: A Journal of Analysis of Exploitation and Violence 2020 Qualitative: in-depth interviews with FST survivors and analysis of newspaper articles Interviews 4 Newspaper articles 100 Web of Science: “Family AND sex trafficking” White et al. When Families Become Perpetrators: A Case Series on Familial Trafficking Journal Family Violence 2023 Secondary EMR case review from level 1 trauma center in metropolitan SW city. Open and closed-ended data 9 Citation from Edwards et al. (2022) Middleton and Edwards, A five-year analysis of child trafficking in the United States: exploring case characteristics and outcomes to inform child welfare system response Forensic Research & Criminology International Journal 2020 Secondary case review and prepost focus groups (with survey) with task force 405 cases 2 focus groups, 27 focus group participants Website Allert, Justice Professionals' Lens on Familial Trafficking Cases Criminal Justice Review 2021 Mixed-methods descriptive study with justice professionals 307 FST cases, 38 LE surveys, and 7 LE interviews Table 2.3 Survivor characteristics from case review studies. Case review studies % FSTa FST N Non-urban Female Age (M) Drug involvement Child welfare involvement Edwards et al. (2022) 4 victims are often younger than traditional sex trafficking victims, live in non-metropolitan communities, and have been involved in the child welfare system. Additionally, we know the presence of drugs is common and truancy or frequent absence from school was identified in 86 % of cases (Sprang & Cole, 2018). Interestingly, this same article found that run away behaviors, something considered a common risk factor for human trafficking, is not as common in familial sex trafficking cases. Sprang and Cole found that only two cases in their review were considered run away and felt this could be due to the young age of survivors, which could strike challenges with identification since it is often used as a proxy (Sprang & Cole, 2018). Helpful for identification is the knowledge of familial trafficking venues, which can lead to intervention. Findings from two studies indicate traffickers use diverse venues ranging from victim (32 %) and buyer homes (29 %), to hotels (42 %), and brothels (10 %). Several studies call for enhanced training on identifying familial sex trafficking victims. It is further recommended that training is trauma-informed and teaches professionals and community members how to both identify and respond to victims who share their abuse. One author writes, “When Anny told the doctor of her abuse memories, he did not believe her. He tried to obtain corroboration from her parents [the perpetrators] but of course, they denied the allegations.” Other recommendations for training include forensic interviewing skills and targeting law enforcement. For example, one study detailed an instance where a child victim ran away from home and law enforcement returned them to their abusers, resulting in a missed identification opportunity (Raphael, 2020). Informed by the social determinants of health (SDH), other ideas included targeting training in rural areas where there are more cases and fewer resources (Sprang & Cole, 2018). Screening, an important element of victim identification, was lamented in several papers that explain how adapting existing tools to identify familial sex trafficking cases is needed. Two papers shared how common sex trafficking screening tools like Quick Youth Indicators for Trafficking Youth (QYIT), Rapid Appraisal for Trafficking (RAFT), and (Simich et al., 2014) were not developed with familial perpetrators in mind, translating yet again into missed opportunities (White et al., 2023; Sprang & Cole, 2018). This could explain why anonymous callers, relatives, and non-relative community members are more likely to identify and report familial sex trafficking cases in comparison to non-familial cases (Edwards et al., 2022). In fact, referrals from justice professionals were negatively associated with identifying familial sex trafficking cases further demonstrating a gap in law enforcement and other professionals' screening and identification of familial sex trafficking (Edwards et al., 2022). Services, and more specifically, the provision of services, are another way to protect survivors. Findings from the review show that survivors have unique needs that are multi-layered. Experiences such as Substance Use Disorder, Post Traumatic Stress Disorder, witnessing violence, torture, contracting sexually transmitted diseases, and pregnancy are common (Raphael, 2020; Reid et al., 2015; Sprang & Cole, 2018; White et al., 2023). These experiences call for multi-layered interventions that can address survivors' biopsychosocial needs. Other needed services include temporary placement options for victims (Allert, 2022). For instance, during familial sex trafficking allegations, children were left in the home with their perpetrator(s) 86–89 % of the time (Edwards et al., 2022; Middleton & Edwards, 2020). With victims living in the homes of their perpetrators and often in their legal custody, these allegations can be dangerous for children and potentially reduce the odds of prosecution. To overcome this barrier, law enforcement recommended temporary placement for suspected cases (Allert, 2022).
Prosecution
Prosecution, the second most common theme, covers perpetrator characteristics and motives, prosecution rates, and justice barriers. This review confirms that most perpetrators are biological mothers (58–66 %), however, other family members such as biological fathers (11–50 %), stepfathers or boyfriends (45 %), male cousins (16 %), uncles (11–42 %) and siblings are also traffickers. Interestingly, it was shown that familial traffickers often work together with someone else. Two studies found that familial sex trafficking cases have more perpetrators than non-familial sex trafficking cases (Edwards et al., 2022; Middleton & Edwards, 2020). In addition, 45 % of perpetrators who are biological mothers worked with a non-relative to traffic their child(ren) (Sprang & Cole, 2018). Trafficking motives included drugs (21–82 %), cash (47–51 %), and goods, like rent (30 %) (Allert, 2022; Reid et al., 2015; Sprang & Cole, 2018). Many of the motives for trafficking children stem from SDH. For instance, one mother exchanged her daughter for free rent and when the daughter complained, she replied “It's better than being homeless” (Raphael, 2020). In comparison to non-familial cases, rates of human trafficking founding or substantiation (verification) were lower among familial cases (Edwards et al., 2022). It is also important to note that CPS has a focus on care and supervision. Meaning, that even if trafficking was occurring, it would be unlikely to reach substantiation through their interactions. For familial cases, prosecution ranged from 0 to 30 % (Allert, 2022; Middleton & Edwards, 2020; Sprang & Cole, 2018). Barriers to prosecution, like time to develop cases and build trusting relationships with victims, strike a challenge for justice professionals (Allert, 2022). This is especially true considering the unique relationship the child victim has with their perpetrator. These victims are not only dependent on the family member but have been groomed from a young age to not trust the police and to believe what they are doing is normal or even a choice (Allert, 2022; Raphael, 2020; Reid et al., 2015). This bond results in the unwillingness to testify (Allert, 2022). In fact, most children were still in contact with their familial trafficker after realizing they were being trafficked and that trafficking is not a normal or legal behavior (61 %) (Sprang & Cole, 2018). Further, children may fear for their safety considering the majority are not removed from their homes by Child Protective Services (CPS) when accusations have occurred and testimonies from children are not always believed (Allert, 2022; Edwards et al., 2022; Raphael, 2020). Unfortunately, there is often a lack of evidence and credible witnesses, making testimonies the bulk of these cases (Allert, 2022).
Prevention
The third P, Prevention, was mentioned in several studies through interventions targeting the SDH, enhanced data recording and research, child welfare training, and policy. All studies mentioned at least one SDH impacting familial sex trafficking such as poverty, substance use disorder, structural violence, and inequality. With rural areas experiencing the majority of cases, some authors felt SDH interventions could target rural settings while enhancing record-keeping, awareness, and training (Edwards et al., 2022; Sprang & Cole, 2018). Child welfare training more generally was highlighted as an opportunity to prevent familial trafficking. Not only do most cases have child welfare involvement, but authors feel they could identify mothers with substance use disorder and increase services and supports (Allert, 2022; Reid et al., 2015). Lastly, some authors believe policy should increase the support for child welfare organizations so they can better identify and prevent cases (Middleton & Edwards, 2020). Further developing data collection strategies and increasing research on familial sex trafficking is another way to improve prevention efforts. Authors identified challenges with existing data recording such as not having a discrete category for familial trafficking in governmental and non-governmental organizations (Allert, 2022; Raphael, 2020). Without this fundamental categorization, it becomes challenging to fully understand the characteristics of these cases, their prevention, and how to raise awareness (Allert, 2022). Standardizing the categorization of familial sex trafficking is needed to estimate prevalence and improve awareness and programming around familial sex trafficking. In the same vein, additional information and context were an identified need. Authors feel this context should come from traditional or original research like interviewing and surveying (Sprang & Cole, 2018; White et al., 2023).
Partnership
Partnership, the P that crosscuts and supports the Three Ps was the least mentioned theme throughout the papers. Authors support the value of multi-disciplinary teams that consist of social services, child welfare, schools, service providers, victim advocates, law enforcement, and child advocacy centers (Allert, 2022; Edwards et al., 2022; Middleton & Edwards, 2020; Sprang & Cole, 2018). These teams were considered to both increase the chances of prosecution and be less traumatizing (Allert, 2022). Lastly, increasing child welfare funding can enhance the capacity to build meaningful partnerships (Edwards et al., 2022; Sprang & Cole, 2018). This line of investigation is developing, but the opportunity to explore how partnerships can impact the Three Ps remains.
Discussion
The goal of this review was to examine what type of evidence exists on familial sex trafficking and to synthesize evidence within the Three Ps Paradigm of Protection, Prosecution, Prevention, and Partnership (a crosscutting element of all three Ps). In total, this review identified eight peer-reviewed articles on familial sex trafficking within the last 10 years and summarized grey literature from diverse entities including government, non-profits, and survivors. While these studies were few, important concepts for ending familial sex trafficking were discussed. For instance, regarding protection, authors identified common victim characteristics such as living in non-urban areas, frequent absences from school, being young, female, and having some form of drug and child welfare involvement. These characteristics can begin to inform needed services, trainings, and screenings, both for human trafficking and SUD. For instance, we can echo the recommendations from Sprang and Cole that non-metropolitan areas should be targeted while adding that non-urban areas with high rates of SUD should be prioritized (Sprang & Cole, 2018). Resource scarcity is a common challenge in rural areas which makes implementing recommendations difficult, however, over the next 18 years, there may be an opportunity to leverage national opioid abatement funds, especially considering the bi-directional influence trauma has on SUD and SUD on trauma. Research showed that school absences and child welfare involvement are common among familial sex trafficking cases, both can serve as indicators for which children and/or families to engage in services or screenings, and with the co-occurrence of familial sex trafficking and drug use, screening for both SUD and trafficking may help identify victims. However, we mirror concerns other authors have regarding screening since existing and validated human trafficking screening tools were created without the consideration of a familial perpetrator. For instance, tools have not been adapted and validated for familial sex trafficking screening and there is an education gap on familial sex trafficking for professionals and communities alike (Smith, 2023). We also recognize the complexities surrounding familial sex trafficking and do not feel that a traditional screening tool will develop the trust needed for a child to confide in or share their experience with someone who can intervene. In overcoming this barrier, we recommend researchers work closely with practitioners and survivors on developing a non-traditional screening tool and training on how to use this tool, with a trauma-informed approach, in different practice settings, and with different populations administering it (law enforcement, school counselors, behavioral health aids, community members, etc.). Both the screening tool and training should be rigorously evaluated and made publicly available. Data is another area these studies covered, specifically the lack of data. Data recording is an important first step in ending familial sex trafficking and there is a need for robust research on program dissemination, implementation, and evaluation. It is further recommended that as this body of research and data on familial sex trafficking grows, that scoping reviews be completed to help inform practice and future research. Considering prevention, the authors identified means to prevent familial trafficking through interventions guided by the social determinants of health, collecting and analyzing high-quality evidence, and working together in multi-disciplinary teams. From these studies, social determinants like poverty and drug use are common experiences among survivor families, meaning, communities may need to reconsider how services and resources are provided to vulnerable mothers and families, especially in non-metropolitan settings where familial trafficking is more common and where cultural nuances, stigma, or barriers influence service use and availability. We recommend reducing family vulnerabilities by identifying at-risk mothers (the most common perpetrator) and families in nonmetropolitan settings and enhancing services for basic needs, economic development, and culturally tailored behavioral health prevention, treatment, and recovery. Further, research can explore how these vulnerabilities can influence the behavior of familial sex trafficking through building and testing conceptual models and identifying ways to prevent this behavior through social determinant of health programming. When reviewing the studies for elements related to prosecution, victim safety emerged as a concern. For example, many victims were not removed from homes where allegations were made against their parent(s). While prosecution is a fundamental part of the Three Ps framework, familial sex trafficking survivors may be further harmed during the process. There is also a dearth of research showing the impacts of prosecution on familial sex traffickers. For example, we are curious if perpetrators are inclined to continue trafficking their children after prosecution or if the cycle does indeed stop. With research showing the complex relationships of child survivors and their bond with familial perpetrators, we wonder if the crime continues after prosecution and what other interventions could effectively halt this practice. Research exploring this relationship and the impacts of prosecution can inform familial sex trafficking prevention, prosecution, and frameworks to end it. Lastly, we recognize the reviewed data has primarily come from law enforcement and child welfare case reviews, which may ultimately skew perceptions of perpetrator and survivor characteristics. For example, child welfare cases are more likely to have lowincome perpetrators with fewer resources making them more likely to be identified than a high-income perpetrator who has the social standing and resources to hide their exploitation (Salter, 2023). For example, in Raphael (2020), the only study that interviewed survivors, we see higher income familial perpetrators with different motives. We also see in the grey literature that some survivors of familial sex trafficking claim motivations come from desires for power and popularity and not from financial necessity (Survivors Against Familial Exploitation, 2022). Researchers, law enforcement, and practitioners should consider that familial sex trafficking is not reserved for low-income families who are acting solely out of survival and may be motivated by other means.
Limitations
Limitations within this scoping review exist. Namely, the existing body of work on this topic is limited. With only eight peerreviewed studies, the authors leveraged grey literature to help address this limitation. As more literature emerges, additional opportunities for scoping and systematic reviews will be presented. Further, many of the reviewed studies came from case reviews which are limiting in the type and depth of data available. Studies that can qualitatively contextualize this form of trafficking are needed. Also, these case reviews originated from child welfare and law enforcement data which may further bias the characteristics of survivors and perpetrators by systematically excluding higher-income families with different trafficking motivations. Additionally, these institutions likely do not track this type of trafficking in a way that provides high-quality data for studies like these. Lastly, discussing the limitations of using a framework like the Three Ps is important, especially if prevention, protection, prosecution, and its added crosscutting theme of partnership are not clearly defined. In this scoping review, we mitigated this concern by creating a codebook that defines these concepts to help prevent misunderstanding. Future researchers should consider defining these concepts clearly within their methods and if this framework fits their needs based on the research available and the questions they are asking.
Conclusion
In conclusion, this review outlined common victim and perpetrator characteristics, highlighted a need for interventions that focus on the SDH in non-urban settings with high rates of SUD, and the development of familial sex trafficking-specific screening and training. Moreover, this review demonstrates the opportunity for enhancing data reporting and research that can impact practice regarding familial sex trafficking. Lastly, with few studies implementing traditional and original research methods, exploratory research methods such as interviewing or surveying survivors, perpetrators, and service providers are recommended. Specifically, qualitative studies can strengthen practice by speaking to regional and cultural nuances that will impact needed actions like awareness campaigns, screenings, and training.
Funding This work was supported by the East Tennessee State University Small Grants in Support program.