Occupational Therapy for Human Trafficking

Anjana Aluri Boyanapalli, MOT, OTR/L

According to the Global Survey Index, 35.8 million adults and children are estimated to be in situations of forced labor as a result of human trafficking globally (Dank et al., 2014). Most human traffickers use psychological means, such as tricking, defrauding, manipulating, or threatening victims into commercial sex or exploitative labor. These experiences of trauma have grave negative impacts on many areas of a person’s occupations. For occupational therapy students, this article offers insights on working with the population of human trafficking survivors as an emerging area of practice. This article also outlines ways and means by which occupational therapy students can contribute to developing effective occupation-based programs for human trafficking survivors during Level I and II fieldwork.

Where Does Occupational Therapy Fit In?

Experiences of human trafficking are very traumatic, and individuals may present with an array of psychological challenges, including post-traumatic stress disorder, anxiety, depression, panic disorder, and Stockholm Syndrome. In fact, a single experience of coercion, rape, or abuse can have severe adverse impacts on the physical and emotional well-being of a victim of human trafficking (United Nations Office on Drugs and Crime, 2014). They may also experience dissociation and emotional under engagement, leading to difficulties in forming social relationships (Thompson et al., 2020). The trauma from trafficking can even lead to cognitive impairments, such as memory loss (Clay, 2013). Such traumatic mental health and cognitive problems can impact all areas of occupations, including ADLs, instrumental ADLs, rest, sleep, and social participation (Bryant et al., 2015).

Occupational therapy practitioners are aptly suited to treat the occupational performance problems associated with cognitive impairments and mental health challenges experienced by victims of human trafficking. In addition to addressing cognitive and mental health interventions, OT practitioners can also apply their knowledge of body systems and body functions to help individuals improve their capacity to perform daily tasks. By collaborating with the individual to ensure that the rehabilitation process remains relevant and motivating, OT practitioners can assist trafficking survivors with physical, cognitive, or psychosocial dysfunctions to restore function, develop new skills, learn to use adapted techniques, and maintain existing skills.

OT practitioners can help meet the needs of human trafficking survivors by providing trauma-informed care with a client-centered focus. Treatment goals and outcomes may include successful community integration, resurrection of lost roles and self-identity, enhanced emotional stability, improved self-esteem, and improved participation in occupations, such as rest, sleep, work, and social activities (Cole et al., 2016).

Suggested Models and Tools

Due to the array of potential psychological challenges and extreme sexual, physical, and psychological abuses often associated with human trafficking, many theoretical frames of reference, models, and assessments from mental health could be used by OT practitioners during treatment. During fieldwork, OT and OTA students can use these theoretical models to develop occupation-based, client-centered intervention plans for enhancing community reintegration of human trafficking survivors. A few approaches are suggested below:

1. Cognitive Behavioral Therapy (CBT): A form of behavioral therapy, CBT is widely used to treat patients with depression and a range of other mental health conditions. OT practitioners can use CBT techniques to help trafficking survivors with depression and anxiety by modifying dysfunctional emotions, behaviors, and thoughts (Cohen et al, 2017).
2. Beck Depression Scale: OTs (and OTAs under the supervision of OTs) can use this self-report questionnaire as an assessment to better understand the symptoms of depression and its effects on occupational performance in trafficking survivors (Steer et al., 2000).
3. Person-Environment-Occupation (PEO) Model: Using this approach, OT practitioners can analyze the transactional relationships between human trafficking survivors’ occupations and their environment to address occupational performance issues and goals (Law et al., 1996).
4. Recovery Model: The active use of the Recovery Model throughout the treatment process can help OT practitioners empower individuals by fostering their intrinsic motivation to redefine their sense of self and establish a sense of hope (Clay, 2013).
5. Wellness Recovery Action Plan (WARP) Tool: WARP provides a unique, individualized recovery tool focusing on five key components: hope, personal responsibility, advocacy, education, and mutual support (Copeland, 2002).

Possible Work and Fieldwork Settings

OT practitioners may apply to work in women’s shelters and community outreach programs at organizations that support survivors of human trafficking and help them navigate the challenges they face day to day. Additionally, OT practitioners can work in partnership with government agencies, schools, and social services providers to develop and deliver intervention programs to trafficking victims in the places where they live, work, and play. For example, intervention programs developed and delivered in community-based settings may focus on the occupations of work, education, and social participation.

During OT school, students can choose to be actively involved in government programs and nonprofit organizations focused on preventing trafficking. Further, there are many organizations in this sector that may be suitable for Level I FW students to get their feet wet. OT students can also take part in interdisciplinary collaboration with other fields, such as social work, to provide services to this population. Alternatively, students and new practitioners may take a downstream approach after trafficking has occurred to help survivors to re-integrate into community life again.

Conclusion

While still an emerging area of practice, OT students and practitioners have the potential to play a valuable role in treating survivors of human trafficking due to the profession’s client-centered, holistic approach and training to work with individuals with mental health conditions. Combining solid foundational models, evidence, creativity, and experience, practitioners can implement trauma-informed, culturally sensitive, and occupation-based programming to address the occupational performance needs of this population.

 Anjana Aluri Boyanapalli, MOT, OTR/L, is a Master’s in Occupational Therapy graduate from Stanbridge University in Irvine, California. She practices clinically with adult, geriatric, and pediatric populations. An active member of AOTA, Anjana likes to focus on evidence-based research and wishes to build her own private practice in the future. In her spare time, she likes to read and write articles advocating for occupational therapy.

References

Bryant, C., Freeman, L., Granata, M., He, A., Hough, H., Patel, S., … Tran, M. L. (2015). Societal statement on the role of occupational therapy with survivors of human sex trafficking in the United States. OCCUPATION: A Medium of Inquiry for Students, Faculty & Other Practitioners Advocating for Health Through Occupational Studies, 1(1), Article 4. https://nsuworks.nova.edu/occupation/vol1/iss1/4/

Clay, P. (2013). Shared principles: The recovery model and occupational therapy. Mental Health Special Interest Section Quarterly, 36(4), 1–3.

Cohen, J. A., Mannarino, A. P., & Kinnish, K. (2017). Trauma-focused cognitive behavioral therapy for commercially sexually exploited youth. Journal of Child & Adolescent Trauma, 10(2), 175–185. https://doi.org/10.1007/s40653-015-0073-9

Cole, J., Sprang, G., Lee, R., & Cohen, J. (2016). 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, 31, 122–146. https://doi.org/10.1177/0886260514555133

Copeland, M. (2002). Wellness recovery action plan. Occupational Therapy in Mental Health, 17(3–4), 127–150.

Dank, M., Khan, B., Downey, P., Kotonias, C., Mayer, D., Owens, C., … Yu, L. (2014). Estimating the size and structure of the underground commercial sex economy in eight major U.S. cities. https://www.urban.org/sites/default/files/publication/22376/413047-estimating-the-size-and-structure-of-the-underground-commercial-sex-economy-in-eight-major-us-cities_0.pdf  

Law, M., Cooper, B., Strong, S., Stewart, D., Rigby, P., & Letts, L. (1996). The Person-Environment-Occupation Model: A transactive approach to occupational performance. Canadian Journal of Occupational Therapy, 63, 9–23.

Steer, R. A., Rissmiller, D. J., & Beck, A. T. (2000). Use of the Beck Depression Inventory with depressed geriatric patients. Behavior Research and Therapy, 38(3), 311–318.

Thompson, T., Flick, J., & Thinnes, A. (2020). Occupational injustice and human trafficking: Occupational therapy’s role. https://myaota.aota.org/shop_aota/product/CEA0120

United Nations Office on Drugs and Crime. (2014). Global report on trafficking in persons. https://www.refworld.org/docid/5492a3d94.html