The first encounter Elizabeth Newlin, MD, had wasn’t what she expected. The family appeared affluent. Well put together. The little girl, who had visible signs of abuse, was throwing the world’s greatest tantrum in the middle of the emergency room—none of the doctors or nurses
knew what to do.
“It wasn’t until the next day that we knew she was being trafficked by her mother,” she remembers. “As a trainee in South Carolina, it was traumatic.” She adds that trafficking in South Carolina is not nearly as big of a problem as it is in Texas. In particular, Houston’s close proximity to a major highway, large number of sexually oriented businesses, and nearby border has made it an epicenter for sex trafficking, sexual exploitation for commercial gain.
“It happens in all socioeconomic backgrounds across Houston and the suburbs. It can literally happen to anyone’s daughter. It can be in your own home, and you’re unaware,” says Newlin. “Some trafficking happens in families; it can be generational.”
Risk factors include being involved in Child Protective Services, living in the foster system, or running away from home. Approximately 90% of victims have a previous history of sexual abuse. Sometimes they are running away from abuse at home only to be picked up on the street.
Former Child Protective Services caseworker, forensic interviewer for sexually abused children, and staff psychologist at a children’s advocacy center Danielle D. Madera, PhD, adds, “The other group of kids are missing something—few people are paying attention or looking for connections.”
Newlin and Madera are leading efforts at UTHealth to care for sex trafficking survivors, capitalizing on strong relationships with the Harris County Juvenile Probation Department, the Harris Center for Mental Health and Intellectual and Developmental Disabilities, and TRIAD Prevention Program.
In early 2019, UTHealth received funding to open a 21-bed inpatient unit in collaboration with Harris County Juvenile Probation Department to provide a secure environment for survivors during treatment. Once a young person is identified as having been trafficked, the Juvenile Probation Department helps arrange for them to receive trauma-focused mental health treatment.
“A lot of times, they are detoxing or are not yet ready to engage in treatment,” says Madera. “Often, their perpetrator will try to gain access or communicate with them. That was the real push for a unit where they can receive services in a secure environment.”
Survivors are screened during visits to the emergency room or as part of justice system involvement, but asking the right questions is a necessity. “These kids have often been taught and rehearsed what to say to authority figures,” explains Newlin. “Or they are street savvy because they are survivors and, by necessity, have had to survive some really difficult situations.”
If untreated, these children—and the next generation—face significant psychiatric and physical health consequences. As victims get older, they become recruiters for other children.
Hospitalization, while a critical part of the solution, is not the answer in all cases. A young person being trafficked or at risk of being trafficked may not speak up in order to receive services. For that reason, Newlin and Madera are trying to proactively conduct outreach and engagement, an area that could benefit from philanthropic support.
“Youth want to engage in services, but Houston is so vast. Many obstacles get in the way of treatment,” adds Newlin. “Transportation is a barrier for a lot of families.”
Despite what they have endured, their resilience shines through. “Some of the kids who have been through treatment are now in the media as
advocates trying to help others,” says Madera. “They were able to grab onto a life preserver and want to give back to the kids who aren’t yet there.”
“They are truly survivors and fighters,” adds Newlin. “Give them another path, earn their trust, and you’ll be amazed at what they can do.”
YOUTH TO IMPROVE
For Diane M. Santa Maria, DrPH, RN, it was a natural trajectory of her career.
“When I went to nursing school, I wanted to work in social justice, for adolescents and young adults—the highest risk and the most disenfranchised,” she says.
This calling led her to homeless youth. “For the most part, these are young people who have been let down by the adults in their lives,” explains Santa Maria. “Often, they are kicked out of their house or run away. Some feel like it’s safer to be on the streets than where they were living.”
Labor and sexual exploitation are high among these youth. Without a government-issued ID card, it is difficult to gain employment, and as a result, sometimes they work without being paid. Some youth are sexually exploited. Others reach a point where they think trading sex is safer than the risk for victimization while sleeping on the streets.
“These young people don’t have the connections or someone to advocate for them,” adds Santa Maria.
Santa Maria’s research and community outreach efforts focus on the intersections between sexual exploitation, labor exploitation, homelessness, and sex trade— traversing these is a need for HIV prevention.
Youth experiencing homelessness are at especially high risk for HIV transmission, with prevalence estimates as high as 13%. In January 2019, Santa Maria received funds to study whether nurse case management, enhanced with motivational interviewing strategies and behavioral feedback, may increase adherence to behavioral and biomedical HIV prevention methods.
“The critical moment is when you have a young person and can change the trajectory of their life by intervening in targeted, evidence-based ways to reduce their time being homeless and prevent risks,” she explains. “When people are cared for, their life circumstances change.”