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Domestic Minor Sex Trafficking: Training For Professionals is Critical But May Not be Sufficient 

By Tamara Hurst, Ph.D.

Cancer InCytes Magazine - Volume 4, Issue 1, Summer 2015

Published June 30, 2015



Managing Editor: Christine Balarezo, Ph.D.

Cover Art: Ping Cao




Domestic minor sex trafficking (DMST) is defined as the sexual abuse of a youth or teen for economic gain.  Professionals in various fields of physical health, mental health, law enforcement, and others have sought to increase their knowledge of DMST through trainings on identification of risk factors and provision of resources.  Unfortunately, DMST survivors may not be amenable to offers of assistance or questions that probe for risk factors.  This may be due to behavioral symptoms such as distrust and suspiciousness which have been linked to DMST through victim/survivor experiences of complex trauma.  This article provides an overview of how multiple childhood traumas may influence interactions between professionals and victims/survivors of DMST.




Domestic minor sex trafficking (DMST) is defined as the sexual abuse of a youth or teen for economic gain, or specifically “the recruitment, harboring, transportation, provision, or obtaining of a person for the purpose of a commercial sex act ” [1].  Attempts have been made to address this issue through federal and state legislation.  For example, the U.S. Senate (114th Congress) recently passed the Justice for Victims of Trafficking Act which amends previous federal legislation by providing for increased training of professionals and enhanced resources for victims  [2].  Most states have enacted or improved existing legislation addressing DMST [3]. Outside of a policy arena, literature suggests that best practices for professionals in the fields of mental health, physical health, law enforcement, child welfare, and education includes training on identification of victims and provision of resources [4-6].  Prior to such training professionals may not have realized that DMST even existed in their communities.  Training might help professionals recognize risk factors thus prompting them to offer resources.  However, studies also indicated that victims may not be willing to accept assistance from trained professionals [7]. 


A 2013 study involving N=40 adult survivors of DMST utilized mixed methodologies including individual interviews and completion of Childhood Trauma Questionnaire (CTQ) surveys to determine the extent of participants’ trauma histories [7].  The CTQ measures childhood experiences of trauma through set cut scores for each classification (e.g., none/ minimal, low/moderate, moderate/severe, and severe/extreme) of type of trauma (e.g., emotional abuse/neglect, physical abuse/neglect, and sexual abuse) [8].  Within this study, 97.5% of the survivors endorsed experiencing two or more forms of childhood trauma.  Experiencing two or more forms of repeated childhood abuse/neglect by caregivers is also known as complex trauma, which is sometimes accompanied by heightened feelings of distrust or suspiciousness [9-12]. As a consequence of this distrust, several survivors indicated difficulties in communicating with and/or trusting professionals in the fields of physical health and mental health, among other professionals.    

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Some survivors study found their experiences with therapists or physicians unhelpful and/or distressing.  Emma, who experienced multiple forms of childhood trauma, shared her thoughts on mental health professionals, and how building trust with her might take more concerted efforts by various professionals from diverse settings.


Emma:  So I think that you can't just see somebody once a week and determine that -- or [trust them] enough after so many years of being hurt.  It just takes time and I think that’s gonna take an effort of everybody.



Izabella described how, over time, professionals would ask her directly about her own personal well-being.  She had been sexually exploited for several years by her biological father.  Her reported CTQ outcomes reflected scores in the severe to extreme range for emotional abuse and neglect, physical abuse, and sexual abuse.  Izabella’s distrust of people in general, and underlying fears of consequences for telling, were such that she could not bring herself to describe her exploitation to physicians or other professionals. 


Interviewer:  Did … doctors ever ask you about possible sexual abuse?

Izabella:  Only one doctor and I said – you know, like no.  I was shocked that they even asked me and angry at that time.

Interviewer:  Do you remember why?

Izabella:  I was afraid.  I was afraid that hell was going to break loose.  Different times [my dad] would tell me different things.  He would tell me he'd kill our pets and I believed him about the pets 'cause he beat my one cat in front of me after I tried kicking him.  And that the family would break up and it'd be my fault.  But they believed me.

Interviewer:  They believed you when you said “no”?

Izabella:  Right when I said “no”, yeah…….  And I'm thinking, "What did I do?"  And, "Who did this?  Who told?"  It was very scary.  



Another survivor, Kayla, was also mistrustful of therapists.  Prior to experiencing DMST, Kayla was sexually molested by her biological father.  This occurred between the ages of 4- and 8-years-old.  During these years, she experienced problems in school, and she described symptoms of depersonalization (e.g., feelings of detachment or being disconnected from one’s body).  These feelings have been noted as an outcome of experiencing complex trauma [12].  She further described how her lack of trust and her fear of negative consequences kept her from disclosing the molestation and exploitation.


Kayla:  I remember as a child my mom would take me to therapists, psychologists and physicians to see what was going on 'cause they knew something was going on, cause there was times where I would lose my vision, I would pass out or I'd be in school and the teacher would be tapping me and I'd disassociate and I'd be far gone.  Like I'd be there physically, but my mind was elsewhere and I could hear the teachers calling for me, the kids calling for me, but I was just so far out that it took me awhile to come back to my body.  I would literally come out of my body.  So, my mom, no one knew what was going on.  They would take me -- I kind of knew what the doctors wanted.

Interviewer:  Did they ever ask you?

Kayla:  Yeah, and I didn't want to say anything.  I held it inside because in my mind it was like -- they would even put me to play with dolls to see how I would interact with the dolls and stuff and I knew what they were trying to do.  Like y'all ain't getting it out of me.  My fear was okay, if I say something, I know what my mom's reaction's gonna be, I know what my stepfather's reaction's gonna be, I know what my grandfather's reaction's gonna be and my uncle's.  This man's not gonna make it to jail.  So I'm thinking okay, if I say something what's gonna happen.  What's gonna be the repercussion of me saying something?  I'm gonna be taken away from my family, and that was my fear.  That I would get taken away from my mom or that something ugly -- my dad would get killed -- my biological father would get killed, or something and that was my fear.  So I never said anything till I guess, I felt safe.


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Other survivors such as Gabrielle said she “didn’t trust the system,” so she would not have responded to a physician if s/he had asked if she needed help.  Survivors Elizabeth and Aaliyah remembered seeing physicians during their childhoods, and both stated they would not have responded truthfully to questions if they had been asked.  


Therapists and physicians are part of the front lines of intervention, and/or prevention for youth victimized by or at-risk of DMST.  Unfortunately, these professionals are sometimes perceived by DMST survivors as hindrances or threats rather than as helping professionals.  Potentially negative and/or challenging interactions between such youth and helping professionals have been noted in previous studies [13, 14].  To break this barrier, Ford, Courtois [15] recommended that clinicians begin engagement with at-risk youth by developing a collaborative relationships with them.  However, they also noted that this would be difficult and time-consuming, since many youth in these circumstances have “long standing feelings of mistrust,” and have never learned how to safely engage with a caregiver [15].  It has also been noted that these same deep seated feelings of mistrust in youth who experienced multiple forms of trauma are a potential pathway to recruitment by those who might sexually or otherwise exploit them [14].   Because of these difficulties it is imperative that frontline professionals increase their awareness of DMST best practices, and also take into consideration how symptoms of complex trauma may influence a victim’s response to inquiries or offers of assistance.



About The Author

Tamara Hurst’s research platform concerns prevention and intervention of the commercial sexual exploitation of children, and other issues related to child maltreatment and neglect.  She earned her doctorate from the The University of Georgia School of Social Work, and her master’s and bachelor’s degrees in social work from Georgia State University.  She is an alumni of a Doris Duke Foundation Fellowship for the Promotion of Child Well-Being. Dr. Hurst is a licensed clinical social worker with 10 years of experience as a forensic social worker, and 8 years of experience as a forensic interviewer.  She was recently appointed to the Mississippi Governor’s Task Force on Human Trafficking and chairs their subcommittee on statewide administrative practices.  She frequently conducts presentations and trainings on topics related to child abuse and neglect, and childhood sexual exploitation.   


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1. U.S. Department of State. Victims of Trafficking and Violence Protection Act of 2000.  [cited 2015; Available from:


2. S. 178, 114th Cong. (2015).


3. Shared Hope International.  [cited 2013 May 5]; Available from:


4. Hardy, V.L., K.D. Compton, and V.S. McPhatter, Domestic minor sex trafficking:  Practice implications for mental health professionals. Affilia, 2013. 28(1): p. 8-18.


5. Macy, R.J. and L.M. Graham, Identifying domestic and international sex-trafficking victims during human service provision. Trauma, Violence, & Abuse, 2012. 3(2): p. 59-76.


6. Cooper, S.W., et al., Quick reference:  Child sexual exploitation for healthcare, social services, and law enforcement professionals. 2007, St. Louis, MO: G.W. Medical Publishing, Inc.


7. Hurst, T.E., Emotional Maltreatment and the Commercial Sexual Exploitation of Children, in School of Social Work. 2013, The University of Georgia: Athens, Georgia.


8. Bernstein, D.P. and L. Fink, Childhood Trauma Questionnaire:  A retrospective self-report. 1998, Bloomington, MN: Pearson, Inc.


9.  Cook, A., et al., Complex trauma in children and adolescents. Psychiatric Annals, 2005. 35(5): p. 390-398.


10. Greeson, J.K.P., et al., Complex trauma and mental health in children and adolescents placed in foster care:  Findings from the National Child Traumatic Stress Network. Child Welfare, 2011. 90(6): p. 91-108.


11. Kisiel, C., et al., Assessment of complex trauma exposure, responses, and service needs among children and adolescents in child welfare. Journal of Child & Adolescent Trauma, 2009. 2: p. 143-160.


12. Cook, A., et al., Complex trauma in children and adolescents. Psychiatric Annals, 2005. 35(5): p. 392-397.


13. Williams, L.M. and M.E. Frederick, Pathways into and out of commercial sexual victimization of children:  Understanding and responding to sexually exploited teens. 2009, University of Massachusetts Lowell: Lowell, MA.


14. Cole, J., et al., The trauma of commercial sexual exploitation of youth:  A comparison of CSE victims to sexual abuse victims in a clinical sample. Journal of Interpersonal Violence, 2014: p. 1-25.


15. Ford, J.D., et al., Treatment of complex posttraumatic self-dysregulation. Journal of Traumatic Stress, 2005. 18(5): p. 437-447.
























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