NEEDS ASSESSMENT FROM THE PERSPECTIVE OF
PROFESSIONALS/SERVICE PROVIDERS WHO WORK WITH SURVIVORS OF
SEXUAL EXPLOITATION
A Project
Presented to the faculty of the Division of Social Work
California State University, Sacramento
Submitted in partial satisfaction of
the requirements for the degree of
MASTER OF SOCIAL WORK
by
Jamie S. Baskett
Margarita Herrera-Gutierrez
SPRING
2012
©2012
Jamie S. Baskett
Margarita Herrera-Gutierrez
ALL RIGHTS RESERVED
ii
NEEDS ASSESSMENT FROM THE PERSPECTIVE OF
PROFESSIONALS/SERVICE PROVIDERS WHO WORK WITH SURVIVORS OF
SEXUAL EXPLOITATION
A Project
by
Jamie S. Baskett
Margarita Herrera-Gutierrez
Approved by:
_____________________________________, Committee Chair
Jude M. Antonyappan, Ph.D., MSW
_________________________________
Date
iii
Students:
Jamie S. Baskett
Margarita Herrera-Gutierrez
I certify that these students have met the requirements for format contained in the
University format manual, and that this Project is suitable for shelving in the library and
credit is to be awarded for the Project.
__________________________, Graduate Coordinator
Dale Russell, Ed.D., LCSW
Division of Social Work
iv
___________________
Date
Abstract
of
NEEDS ASSESSMENT FROM THE PERSPECTIVE OF
PROFESSIONALS/SERVICE PROVIDERS WHO WORK WITH SURVIVORS OF
SEXUAL EXPLOITATION
by
Jamie S. Baskett
Margarita Herrera-Gutierrez
This study examined the needs of survivors of sexual exploitation, who are in the sex
work industry, through the perspectives of the service providers who work with this
population. In depth interviews were conducted with 17 service providers, some of whom
chose to self-disclose their status as survivors of sexual exploitation themselves.
Perspectives of service providers were sought regarding the economic needs and barriers,
the health needs and barriers, the psychological needs and barriers, the social needs and
barriers, as well as any other additional needs that the providers felt were important to
meeting the needs of sex workers. The major findings indicate a strong need for sex
workers to have choices for economic self-sufficiency as a pre-requirement for health
needs fulfillment, and opportunities for vocational training as a way to achieve
sustainable income. Additionally, the service providers interviewed for this study
indicated a need for survivor run support groups and quality health coverage. The
recommendations made by the researchers emphasize the importance of allocation of
v
funds for health and basic needs restoration of sex workers, harm reduction approach to
service delivery, training of professionals who deliver services to this population on the
need for integrated non-judgmental service delivery systems.
____________________________________, Committee Chair
Jude M. Antonyappan, Ph.D., MSW
______________________________
Date
vi
DEDICATION
First, I would like to thank God for being my strength with each step I take and
filling my life with so many blessings. To my father, without any words you have always
managed to make me know that you completely believed and supported me which has
given me courage each and every day. To my mother for constantly letting me know that
I am loved and cherished by you. To my brother Brandon, one of the smartest people I
have ever met, for being my best friend and providing me with moments each day to
laugh and enjoy life which has kept me sane throughout this process. I wouldn't trade
what we have for anything. To Mandy, my sister from another mister, for loving every
opportunity to give me a reality check and make fun of me (always with love of course
lol) whenever needed. I am so glad you have come into our family. My brother Ryan, the
professor, your eagerness for knowledge is an inspiration that I have used to motivate me
throughout life. I am so proud of you, for all you have accomplished and for all I know,
without a doubt, that you will accomplish!
To my grandma Georgia Su, the voice in the back of my head that is always
pushing me for more. My grandma Betty Jean, for giving me her shoulder to lean on and
her ear to vent to at 3:00 in the morning, I miss you. To Merrilynn, my healer, mentor,
guide and dear dear friend. My thesis partner Kitzia, thank you for riding this crazy
journey with me. God definitely threw us together for a reason and I am so grateful for it.
Lastly, to George, Oddie and Mooey, our dogs and our children. You come into
this world only knowing how to love us and each other. You live your lives only knowing
vii
how to love us without judgment and without hate. All humans can learn how to live life
through your examples, except when we catch you standing on the kitchen counter of
course. I have needed each and every one of you through this journey. You all have my
love and gratitude forever.
I am truly blessed
-Jamie Baskett
Quisiera dedicar esta tesis a mi familia, a Celia y a mi bebe Beasty. I would also like to
thank my TP (thesis partner) for accepting my proposal of tag-teaming this right of
passage we call a thesis; most importantly I am honoured to say we are still BFFs. Lol.
Dad, el orgullo que siempre eh visto en tus ojos hacia a mi, me a dado la fuerza y
motivación cada vez que me quería dar por vencida.
Mom, tus expectativas crearon motivación y eliminaron la posibilidad de fallar. Espero
que cumpliendo esta meta te de una gran satisfacción como mi madre, y que te de la
certeza que has creado algo bueno, ósea yo.
Yare, the bravery you showed in venturing out on your own led me to believe I was born
with the same strength for venturing out and pursuing my goals in life.
Michi, thank you for providing me with the comic relief of which I have needed in this
oh-so serious field of social work. You can always make me laugh, a lot.
Natalie, for being the sweetness in this world that I fight to protect.
To my dearest Celia. Thanking you every day for the rest of my life would not be enough
to show my gratitude towards you. The serenity, love and beauty that always shine
viii
through you kept me calm, blissful and inspired throughout one of the most challenging
times in my life.
To my dog Beasty, for your non-judgmental, unconditional, sweetest love of all. I
promise you a lot more TLC.
Muchas gracias por el apoyo que me an brindado, no habria el porque logralo sin ustedes.
Los quiero mucho,
Lic. Herrera Gutiérrez.
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ACKNOWLEDGEMENTS
We would like to express our gratitude to Dr. Jude Antonyappan for being a great project
advisor. Our wonderful tutor provided by the CSUS social work division, David
Reynolds. The CSU Sacramento faculty and staff for all your contributions and help
through this process, as well as all of the professionals who took time out of their
extremely busy schedules to participate in our study.
x
TABLE OF CONTENTS
Page
Dedication ........................................................................................................................ viii
Acknowledgements ..............................................................................................................x
List of Tables ................................................................................................................... xiv
List of Figures ....................................................................................................................xv
Chapter
1. THE PROBLEM ..............................................................................................................1
Introduction ..............................................................................................................1
Statement of Collaboration ......................................................................................2
Background of the Problem .....................................................................................2
Statement of the Research Problem .........................................................................6
Theoretical Framework ............................................................................................7
Social Construct Theory ..............................................................................7
Ecological Systems Theory..........................................................................9
Feminist Theory .....................................................................................................10
Circle of violence/ Stockholm syndrome ...................................................11
Definitions of Terms ..............................................................................................12
Operational Definitions ..........................................................................................13
Assumptions...........................................................................................................14
Justification ............................................................................................................15
Limitations .............................................................................................................15
2. LITERATURE REVIEW ..............................................................................................17
Introduction ............................................................................................................17
Lack of parental resources .....................................................................................18
Personification of freedom as absence of discipline ..............................................21
Lack of self-efficiency and lack of opportunities for self-actualization ................23
Social conceptions of women: historical perspectives...........................................26
xi
Conceptions of the female body in the media ........................................................29
Women in the marketplace as sex workers ............................................................31
Why “prostitutes” are not seen as victims .............................................................33
Prostitution and sexualized violence ......................................................................34
Reasons for Lack of Resources ..............................................................................37
3. METHODOLOGY ........................................................................................................41
Introduction ............................................................................................................41
Study Design ..........................................................................................................41
Population and Sampling .......................................................................................42
Data Collection Approaches ..................................................................................43
Human Subjects Protection ....................................................................................44
Data Collection ......................................................................................................45
Analysis..................................................................................................................45
Limitations .............................................................................................................46
4. FINDINGS .....................................................................................................................47
Introduction ............................................................................................................47
Demographics ........................................................................................................49
Economic ...............................................................................................................51
Economic needs of surivors of sexual exploitation ...................................51
Barriers to meeting economic needs ..........................................................54
Health .....................................................................................................................55
Health needs of surivors of sexual exploitation .........................................55
Barriers to meeting health needs ................................................................58
Psychological .........................................................................................................60
Psychological needs of surivors of sexual exploitation .............................60
Barriers to meeting psychological needs ...................................................63
Social......................................................................................................................64
Social needs of surivors of sexual exploitation..........................................64
Barriers to meeting social needs ................................................................66
xii
Additional ..............................................................................................................68
The additional perceived needs of survivors of sexual exploitation .........68
Barriers to meeting these additional needs ................................................69
Resources for assisting needs.....................................................................70
5. SUMMARY ...................................................................................................................72
Introduction ............................................................................................................72
Economic Needs and Barriers to Meeting Economic Needs .................................72
Health Needs and Barriers to Meeting Health Needs ............................................74
Psychological Needs and Barriers to Meeting Psychological Needs .....................75
Social Needs and the Barriers to Meeting Social Needs........................................77
Additional Needs and the Barriers to Meeting those Additionally Listed Needs ..78
Appendix A. Informed Consent Form ...............................................................................80
Appendix B. Data Collection For Providers Of Survivors Of Sexual Exploitation ..........83
Appendix C. Approval By The Committee .......................................................................88
References ..........................................................................................................................90
xiii
LIST OF TABLES
Tables
Page
Table 1 Statistical Analysis of the Number of Responses
from Interview Participants ................................................................................. 50
Table 2 Statistical Analysis of the Experience of Abuse/Exploitation
Greatest Barriers to Among the Respondents ...................................................... 50
Table 3 Statistical Analysis of the Greatest Economic needs of
Survivors of Sexual Exploitation ......................................................................... 53
Table 4 Statistical Analysis of the Greatest Barriers to Meeting
Economic Needs of Survivors ............................................................................. 55
Table 5 Statistical Analysis of the Greatest Health Needs of
Survivors of Sexual Exploitation ......................................................................... 57
Table 6 Statistical Analysis of the Greatest Barriers to
Meeting Health Needs of Survivors ..................................................................... 59
Table 7 Statistical Analysis of the Greatest Psychological
Needs of Survivors of Sexual Exploitation ......................................................... 62
Table 8 Statistical Analysis of the Greatest Barriers to Meeting
Psychological Needs of Survivors ....................................................................... 64
Table 9 Statistical Analysis of the Greatest Social Needs of
Survivors of Sexual Exploitation ......................................................................... 65
Table 10 Statistical Analysis of the Greatest Barriers to Meeting
Social Needs of Survivors ................................................................................. 67
xiv
LIST OF FIGURES
Figures
Page
Figure 1 Experience of abuse/exploitation among survivors ............................................ 51
Figure 2 Greatest Economic Needs................................................................................... 53
Figure 3 Greatest Health Needs ........................................................................................ 57
Figure 4 Barriers to meeting Health Needs....................................................................... 59
Figure 5 Greatest Psychological Needs ............................................................................ 62
Figure 6 Greatest Social Needs ......................................................................................... 66
Figure 7 Additional Needs ................................................................................................ 69
xv
1
Chapter 1
THE PROBLEM
Introduction
The profession of social work holds human rights and justice as crucial values at
the core of the social work practice; especially to highly vulnerable populations such as
children and women. Many social workers are aware of human trafficking as a problem,
but are unaware that youth are more likely to become sexually exploited victims than
adults and that most women who become sex workers entered the profession as minors
(Kotrla, 2010). Although it is extremely difficult to determine the number of survivors of
sexual exploitation, it was estimated in 2001 that there were over forty million prostitutes
worldwide (Audet & Carrier, 2004), and the National Task Force on Prostitution
suggested that approximately 1% of American women, or over one million people in the
United States, have worked as prostitutes which has led to an arrest record for over
100,000 individuals (The Prostitutes’ Education Network, 2007). These high statistics
for sex workers are cause for concern among the social work professionals, especially
since this number is likely to be significantly higher due to the effort created to keep this
population hidden. Some of the public health challenges that occur with sex workers are
trauma, spread of disease, substance abuse, and gender violence (Lutya, 2009). The
purpose of this study is to explore and assess the services needed by survivors of sexual
exploitation. It is hoped by the researchers that this knowledge will contribute to the field
of social work and assist in breaking the cycle of violence.
2
Statement of Collaboration
This project is a joint collaboration by Jamie S. Baskett and Margarita I. Herrera
Gutiérrez. The researchers contributed jointly and equally to the following parts of the
project: defining the research problem, reviewing the literature relevant and pertinent to
this topic, choosing the study design, selecting the sample, collecting the data analyzing
the data. The organizing principles used in gathering the materials and assembling them
into the final product, analyzing and summarizing the study findings as well as making
recommendations for the future were also undertaken jointly.
Background of the Problem
Human trafficking is increasingly becoming a national and international concern.
Although we are unable to formulate an exact number of trafficking victims due to the
concealed nature of this population, it is estimated that anywhere from 700,000 to four
million women and children are trafficked around the world each year (USAID, 2001).
As this form of modern day slavery becomes more and more prominent in our society
and around the world it is crucial for all aspects of public service agencies, such as law
enforcement, social services, and public health, etc. to be examining the needs of this
growing population in order to assist the recovery of these individuals as much as
possible.
Sex work is the exchange of sexual services for financial compensation. Due to
the nature of the work, individuals involved in sex work are at a higher risk for
developing physical and/or psychological health issues, economic dependence, increased
3
chances for alcohol and/or substance abuse, and are at constant risk of physical,
emotional, psychological, financial and spiritual abuse. Some of the mental health issues
that victims of sexual exploitation face include post-traumatic stress disorder,
disassociation, insomnia, depression, flashbacks, anxiety, suicidal thoughts and memory
loss (London School of Hygiene and Tropical Medicine, 2006; Polaris Project, 2007).
These are often compounded by alcohol and/or substance abuse which are common
among sexually exploited victims. Often traffickers will forcibly make the individuals
they are victimizing take drugs or other addictive substances both as a way of controlling
them and because some substance will allow them to work for longer hours with less
food and less sleep. It is also often used by victims and survivors as a way to help them
cope and block out the constant abuse they are faced with (London School of Hygiene
and Tropical Medicine, 2003).
Some of the most prevalent physical health issues reported by victims of sexual
exploitation include dizzy spells, fatigue, memory loss, and stomach/abdominal pain, as
well as frequent headaches which are often the result of physical abuse carried out in the
neck or head areas (London School of Hygiene and Tropical Medicine, 2006). Other
physical health issues frequently reported include pelvic pain, gastrointestinal problems,
and dermatological complaints which are often physical attributes of post-traumatic stress
disorder; as well as a decrease in appetite and/or severe weight loss which is often
attributed to both the lack of food provided to exploited victims and the emotional stress
that someone who is sexually exploited endures (London School of Hygiene and Tropical
4
Medicine, 2006). There is also a significant increase in the risk for sexual health related
trauma such as contracting sexually transmitted infections (STI’s) or sexually transmitted
diseases (STD’s) and unwanted pregnancies.
Sex work is not only a public health and social concern, but also an economic
one. Cities throughout the United States expended an average range of anywhere from
$7.5 to $16 million per year implementing sex workers laws and in services for the
victims of sex exploitation. In an interview with Siddharth Kara, a member of the Carr
Center for Human Rights Policy at Harvard Kennedy School, author of the awardwinning book, “Sex Trafficking: Inside the Business of Modern Slavery,” and an advisor
to the United States Government and United Nations on antislavery policies, research and
law, he compared modern day slavery to the slavery that legally existed only a couple
hundred years ago. From an economic perspective, modern day slavery is significantly
more financially lucrative for the exploiters. For example, the costs to kidnap, transport,
sell and/or traffic these individuals is significantly less costly as well as substantially
easier than it was two centuries ago. It is also important to note that a modern day slave
can annually produce a 900% return on the “investment” for an exploiter whereas a slave
from two-hundred years ago could produce an annual return of 15%-20% at the most; and
this plays a significant factor into why the number of human traffickers and sexual
exploitation cases have only been growing throughout the years (Kara, 2012)
Efforts to combat sexual exploitation and human trafficking remains severely
underfunded. The United States spends over 350 times more money combating drug
5
trafficking then human trafficking; and yet the US still spends significantly more battling
this issue than any other country or government (Kara, 2012). Since 2001, when services
for trafficking victims were first made available in the United States, it is estimated that
less than 1,000 of the 100,000 to 150,000 slaves in the U.S. (Bales, N.D.) have been
assisted through the efforts of federal, state, and local law enforcement (U.S. Department
of Justice, 2006). The resources that are available to this population are neither adequate,
nor relevant. Additionally there has not been an effective outreach strategy to reach this
population in order to administer these services effectively.
At a local level, Sacramento has been recognized as having a high number of
children being sexually exploited. Despite this fact, and due to Sacramento County
budget cuts, there have been fewer arrests and fewer convictions of sexual exploitation
perpetrators (Minugh & Reese, 2010). Accurate statistics of survivors who have either
previously experienced or are currently experiencing this type of victimization are hard to
obtain due to the low reporting rate. Unfortunately, the low reporting rate contributes to
creating the low priority in rescuing these victims. Because this type of crime holds such
a low priority, due to the inability to recognize these victims when they are seen,
difficulty prosecuting the perpetrator, inability to find the perpetrator, etc., the services
aimed at alleviating this situation are scarce. What services are available are almost as
hidden as the population is due to the need to both protect the location of safe areas for
victims as well as the negative image this population oftentimes receives from society.
6
At this point in time a significant portion of the information that has been
obtained in regards to the needs of this population has been anecdotal (Kara, 2012). In
order to address the multifaceted layers of challenges victims and survivors of sexual
exploitation face we must seriously assess what services have worked, what services have
not and what services have not been provided at all or in an effective manner. It is
important to note that in examining these needs there cannot solely be a focus on one
aspect of this population, such as only looking at the physical health needs for example.
Because only addressing one challenge that the victim has faced is like placing a
metaphorical Band-Aid over a very large wound that needs stiches; it is only one small
piece of the problem and addressing only that small piece will not be effective long-term.
By focusing on discovering these needs in a concentrated area, such as
Sacramento and the Bay Area, there is a significantly higher chance of obtaining
information that will be most effective in implementing services in these locations. There
is potential to be effective at helping the survivors of sexual exploitation who live in
these areas, as well as possibly modeling interventions that can be adapted to many other
areas both nationally and internationally.
Statement of the Research Problem
There is an increasing gap between the services needed and the services available
for the protection of women and children who are sexually exploited and trafficked. This
study hopes to assess the gap between existing needs and existing services among current
victims and survivors of sexual exploitation from the perspective of the providers. These
7
perspectives were sought from professionals who work at agencies where services are
provided to survivors of sexual exploitation. Understanding why women stay in sex work
and knowing the lack of services that make women and children vulnerable to human
trafficking and other forms of sexual exploitation is imperative. Until these factors are
known, intervention programs designed to disrupt the cycle and ultimately preclude sex
workers cannot be properly articulated in the most effective manner.
Theoretical Framework
This section will introduce the theoretical frameworks used for this project and
why they guide this study. The main theoretical framework we chose was Social
Construct theory with Ecological Systems theory and Feminist theory as support theories.
We also included sub-theories, which are not theoretical frameworks but they shine light
on reasoning behind many of the behaviors that perpetrators and victims display.
Social Construct Theory
Sexual exploitation, like all other constructs of human life, is structured by sex
role conceptualizations and expectations held by the society with regard to economic
mobility. Peter Berger and Thomas Luckmann proposed that “Society is a human
product. Society is an objective reality. Man is a social product.” (1967, p. 61) Meaning
that people are the products of the society they create. No one is inherently born to be
sexually exploited. This is something that humans have created through interactions with
one another and it is driven by their sexual needs and a desire to control. Society has
created a perception of this group of people, as well as individual perceptions of
8
themselves, and both are socially constructed. Many argue that gender is purely a social
construct that is not defined as male or female but more of a flexible, free-flowing
continuum (Butler, 1990). Yet we reside in a society where gender has been defined and
used interchangeably with sex (male or female).
We live in a society where gender roles are not only accepted and used to define
how people should act, look, and be perceived, but also used to manipulate and control
women. Social construction theory argues that there are historical constellations of social
and political powers that define gender and it’s accompanying sexual and familial
relationships (Unger, 1989). Historically we have expected woman to look, act, and be
perceived as over-sexualized beings in addition to being submissive and less equal to
men. This relates to the social construct of sexual exploitation because it is generally
accepted that women are used for sex and not seen as sexually exploited victims because
they are women, and it is ok for over-sexualized women to work as prostitutes if they
choose to make their money that way. In a way, society sees this type of activity
happening and labels these women as criminals and not as victims because they are
viewed as over-sexualized women who chose this type of work.
Language is a good indicator of how we view the problem of sexual exploitation
as a country. Commonly used words such as “sex workers” and “teen sex workers” have
a negative stigma that tends to focus on the crime itself and not the victims. Most of the
time sexually exploited victims, both adults and teens, were forced into this type of work,
but we do not use the terminology “forced sex workers” nearly as much as we say sex
9
workers. When speaking about teens that have been sexually exploited, the phrase “teen
sex workers” is more common than “sexually exploited teens.” For example the phrase
“teen sex workers” implies teens had a choice and chose to be prostitutes when, in reality,
teens tend to be pushed toward sex work as a last resort for survival, many times not
being able to seek any other possibilities. A document, written for the UK’s Save the
Children, suggested that all children, which is everyone under the age of 18, are
considered to be sexually exploited. Therefore the terms of “child prostitute” and “child
sex worker” should be avoided at all times since they imply that the child has some
control over the situation (Ireland, 1993). The language and labels we use are socially
constructed in a way that give a certain meaning and either gives to or takes power from a
powerless group.
Ecological Systems Theory
Urie Bronfenbrenne’ (1979) asserts that in order to find ways to help a client, we
first must get to know him/her as a person in their environment. We must take into
consideration what makes up their micro, mezzo, and macro systems, the system’s
relationship to one another and their indirect influence on the developing person through
their effects on those who deal with him/her first hand. We must take in consideration the
person in the environment through time. For example, we must take in account the
relationship the victim has with her abuser, how closely she works with community
services to escape the sex work, and how the government laws could prosecute her for
being a sex worker and providing illegal services to men who solicit sex. The ecological
10
systems theory would analyze the nature of the relationships between the systems and see
how relationship directly affects the people, like the pimps or community service
providers, who are working directly with the victim, and how the systems affect the
victim itself.
Feminist Theory
Feminist theories typically achieve three things, they raise dilemmas and
awareness of issues women typically face, they provide interventions for women’s issues
and they provide a perspective for evaluating experiences of groups and individuals
(Coady & Lehmann (Eds.), 2008). Sexual exploitation is an issue that, more often than
not, affects women more than men. Although it is an issue of concern for all genders,
women seem to be at the forefront of the consequences of the sex trade. Feminist theories
would argue that sex workers are in existence because of the perspectives, needs and
demands of men. If men would see and treat women as they treat other men and not as
second class citizens, they would not be engaging in demeaning and hurtful acts such as
sexual exploitation. But because some men feel that their sexual needs need to be met and
because there are women that are, in their eyes, willing to meet those needs for a price,
than they take advantage of that situation. Feminist would be able to see the issues
surrounding sexual exploitation, state that it is a concern for women, and propose
solutions that would decrease the number of victims, benefit the victims and punish the
exploiters such as higher sentencing for those involved in soliciting sex and exploiting
sex workers.
11
Circle of violence/ Stockholm syndrome
In order to understand part of the reason why sexually exploited women do not
leave their situation even when possible, we must understand the circle of violence and
how some women are more vulnerable to becoming victims of sexual exploitation. Men
who are in the business of sexually exploiting women, in other words “pimps”, are master
manipulators with experience in preying on women. The Domestic Abuse Intervention
Project: Power and Control Wheel illustrates the different types of behaviors abusers use
to gain power and control while manipulating their victims into a situation they are
fearful to leave. Pimps are experts at finding vulnerable girls such as those who are raised
in a violent home, poverty, and those who are homeless and are seeking financial
assistance to survive. The relationship might start off as a romantic relationship where the
pimps gain the girls’ trust and love. In order to get what they want, the pimps tend to use
intimidation, isolation, blaming, coercion, threats, and economic and emotional abuse on
the victims that might have started as their girlfriends. The women might not know how
to react or what to do, but they trust the “boyfriends” and might engage in sex work to
please them. Soon, the victim is in a situation that is very dangerous to escape and so they
stay.
In many cases of Domestic Violence, victims develop Stockholm Syndrome,
sexually exploited victims run the same sick. After victims are manipulated into the trade,
and even after they see and live the abuse, they have a hard time leaving this situation and
prosecuting their abuser. Due to the past history and bond the victim has created with her
12
abuser, she is in the perfect situation to develop Stockholm Syndrome; where the victim
appears to have sympathy for the abuser, identifies with the abuser and thinks the abuser
has shown some degree of kindness.
Stockholm Syndrome victims typically go through the following four stages of
victimization, which may prevent them from leaving the situation and reporting the
abuse: disbelief and denial, they might make excuses to why the boyfriend is treating
them that way. The second phase is when reality sets in and psychological mechanists
emerge to produce Stockholm Syndrome, traumatic psychological infantilism and
pathological transference. Once released from captivity, traumatic depression and
posttraumatic stress disorders are experienced. Lastly, the trauma is resolved and
integrated into the person’s future behavior and lifestyle (Yllö & Bograd (Eds.), 1988).
This last phase can only be achieved with the proper services offered and maintained for
a long term. This is why it is necessary to analyze what services are in the area of
Sacramento, not only to help victims, but also in helping them, we help law enforcement
by bringing forward victims that are able to detach themselves from the abusers and aide
with the prosecution.
Definitions of Terms
There are several terms that are familiar or unfamiliar. These are defined below:
Sex workers a branch of the sex industry where a person (the prostitute) exchanges sexual
favors/activities for payment of some kind (i.e. money, drugs, food, shelter, etc.).
Human Trafficking refers to women and children who are being moved from different
13
locations and sold as slaves against their will either for sexual or forced labor purposes.
Sexual Exploitation is the sexual abuse of an individual in exchange for food, shelter, etc.
The sexual abuse can be in the form of pornography, rape and/or sex workers and is often times
arranged by a third party.
Needs Assessment is a type of survey and/or study conducted to determine the needs of a
certain population/program/etc.
Professional is an individual who works in a certain vocation for monetary gains. They
are usually highly trained and/or educated within their field.
Economic Needs are the monetary/financial needs of an individual in order to survive.
Health Needs refer to what is required for individuals in order to combat illness, recover
from injury and function at their optimal level physically.
Psychological Needs are what is required by each individual to feel mentally sound and
well.
Social Needs refer to the human desire to intact with others in a positive and healthy
manner, it also refers to feeling support from other individuals and/or groups.
Operational Definitions
Sex workers is a branch of the sex industry where a person (the prostitute) exchanges
sexual favors/activities for payment of some kind (i.e. money, drugs, food, shelter, etc.).
Human Trafficking refers to women and children who are being moved from different
locations and sold as slaves against their will either for sexual or forced labor purposes.
Sexual Exploitation is the sexual abuse of an individual in exchange for food, shelter, etc.
14
The sexual abuse can be in the form of pornography, rape and/or sex workers and is often times
arranged by a third party.
Needs Assessment is the type of study being proposed in this research proposal to
determine the needs of survivors and/or current victims of sexual exploitation.
Professional is the term used to refer to the individuals who work with survivors and/or
current victims of sexual exploitation in a helping manner.
Economic Needs are the monetary/financial needs of a survivors and/or current victims of
sexual exploitation that they require in order to successfully escape and recover from this form of
exploitation.
Health Needs refer to the medical services/treatments/etc. that are required for survivors
and/or current victims of sexual exploitation whose health has been damaged and put at risk due
to this exploitation.
Psychological Needs for the purpose of this study, refers to counseling, support groups,
etc. that are needed to help recover emotionally from this type of exploitation in order for them
to be able to have healthy and meaningful relationships in the future.
Social Needs for the purpose of this study, refers to the support system that individuals
who have suffered sexual exploitation have access to in order to help them through their
recovery.
Assumptions
The assumptions of this study are centered around the notion that sexual work carries a
negative connotation, and, as a consequence of this, resources for services to rehabilitate victims
15
of sexual exploitation and prevent sexual exploitation, are scare and therefore it is assumed that
there is a gap in the existing services. Women and men pursue sex work to escape their current
situation, whether that is poverty, sexual abuse, homelessness, etc. The reasons why victims
expose themselves to this type of work are negative and are acts of desperation. Due to the
nature of this research, the researchers are not interviewing any survivors of sexual exploitation;
therefore, the reasons why individuals become sex workers may remain unknown.
Justification
Research findings may help further identify, from the perspectives of professionals who
work with sex workers, the gaps in services for survivors of sexual exploitation and will
hopefully enhance the rehabilitation and prevention of individuals engaging in sex work. The
information collected will better inform social workers as to the needs of survivors and current
victims of sexual exploitation, as well as possible ways to reach the population and distribute
these services successfully. It also will give social workers and individual(s)/agencies who are
working with this population information to develop programs based on the recommendations of
the study.
Limitations
In order to ensure that ethical and legal considerations were taken, the researchers
had to restrict their research subjects to professionals working with survivors and/or
current victims of sexual exploitation. Although the researchers would have liked to
conduct the needs assessment by interviewing actual survivors and/or current victims of
sexual exploitation the researchers recognized that this would be a high-risk study. In
16
working with professionals who work with this population, this needs assessment
becomes a low-risk study where confidentiality is even further protected since the
researcher has no contact and/or access to any of these professionals’ clients.
Our representation is also limited due to sample size. This is a cross sectional
survey with a sample of convenience and therefore the study findings cannot be
generalized to any of the population other than the programs and services represented by
the professionals surveyed for this study.
17
Chapter 2
LITERATURE REVIEW
Introduction
This chapter presents the themes that emerged from the literature review. The
themes are organized into the following subsections: lack of parental resources, the
personification of freedom as an absence of discipline, lack of self-efficiency and lack of
opportunities for self-actualization, social conceptions of women, historical perspectives,
conceptions of the female body in the media, women in the marketplace as sex workers,
why “prostitutes” are not seen as victims, prostitution and sexualized violence, and
resources and reasons for lack of resources. For the purpose of this review the researchers
reviewed articles, books, and databases containing articles on human trafficking and
sexual exploitation.
The term prostitution is used to define what many consider the oldest profession
in the world, yet despite the extended history around this topic, there continues to be very
little done to address this social ill or related forms of sexual exploitation. Sexual
exploitation refers to not only prostitution but human trafficking, sexual abuse, rape and
any act which is likely to result in emotional, physical or psychological harm if a sexual
act is refused. Victims of sexual exploitation face risk of violence, venereal diseases,
legal prosecution, depression, addiction and death, among many other potential risks.
The researchers reviewed literature on topics related to sexual exploitation, the
sex industry and the stigmatization of sex workers. They briefly investigated the cause of
18
sexual exploitation and how through media, literature and changing trends in American
society women are seen more frequently as sexualized objects to the degree that the
sexual exploitation is, at times, not even noticed. This study also explores the needs of
sexually exploited victims by examining the current literature surrounding the issue of
sexual exploitation in order to identify the most impacting challenges in preventing and
fighting this social issue, available services and the current support system for victims.
The shame that our society places on sexually exploited individuals is a crucial
factor in why there continues to be so little effort made to assist these victims and remove
them from this situation. “Two hundred years ago, British and American Christians were
galvanized into action to stop the slave trade, but the difference in public response to the
problem today is stark” (Carson, 2011, p. 220-221).
Lack of parental resources
Although there continues to be a debate amongst researchers as to whether
childhood abuse determines future behaviors, there is a vast amount of literature that
shows a correlation between childhood trauma and future delinquent behaviors. In
regards to sexual victimization there is often a strong connection reported by survivors of
sexual victimization between childhood sexual abuse and non-violent offenses such as
robbery, substance abuse, sex work and other statute offenses. For these individuals, they
have already had their boundaries violated when they were sexually abused as a child.
This is especially true if they were victimized by their parent(s) or another close and/or
trusted family member because it creates a paradigm where the victim learns that they
19
must use their bodies to pay for affection with some form of sexual contact
(Dunlap, Golub, & Johnson, 2003). As a result, according to social learning theory, these
individuals grow up already viewing themselves through a sexually deviant lens and base
their future identity on that belief system (Van Brunschot & Brannigan, 2002).
In a study conducted to investigate the variables in adolescent prostitution such as
family structure and personality traits, the researchers used a control group of 65 high
school students and gathered as subjects 158 adolescent prostitutes currently living in a
halfway house. From the data collected using the Junior Eysenck Personality
Questionnaire and the Parental Bonding Instrument the researchers discovered that,
through structural equation modeling, negative child rearing behaviors are a significant
potential factor for adolescent prostitutes, most specifically the lack of maternal
protection and parental care (Lung, Lin, Lu & Shu, 2004). In situations such as the ones
evidenced by this study, the parents often do not have the resources to be effective
parents. The reasons for this could include any number of causes from poor modeling by
parents who have difficulty delaying gratification themselves to a lack of skills and/or
access to knowledge of constructive and positive parenting techniques and even to the
lack of resources of the society in treating these children as an investment. For instance, a
lack of childcare as a universal resource is a significant problem in our society. It instills
certain behavior patterns in vulnerable children early on-which can make them
susceptible to victimization.
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When looking at the lack of parental resources available to adolescents in
prostitution, it is important to also examine the lack of resources available for parents
whose child(ren) have already become involved in some form of sexually exploitive
activity. According to the Federal Bureau of Investigation (FBI) the average age for
young girls being recruited by “pimps” and traffickers is thirteen years old, with some as
young as nine (Smalley, Contreras, Childress, Bailey, and Sinderbrand, 2003). These
young girls are being recruited at malls, shopping centers, food courts and other areas that
many parents would assume are safe place for their teenagers to be in the middle of the
day with friends.
Even as the number of teen sexual victimization cases increase and the mean age
of the girls becoming victims decreases, there are still very few resources aimed at the
parents of sexually exploited individuals. Much of the causation for this lack of resources
is due to the stigma of the population. Professionals from The Paul and Lisa Program, a
nonprofit organization that seeks to break the cycle of sexual exploitation and works
closely with the FBI, states that the shame parents feel can often times be overwhelming
for them (Smalley et. al, 2003). These parents are not only unsure of where to turn, but
when they do reach out for help they are often met with professionals who criminalize
their child(ren), rather than offering support; which only increases the barrier for parental
resources.
21
Personification of freedom as absence of discipline
Prostitution and other forms of sexual exploitation have often been “justified” as a
freedom of choice instead of educating and “disciplining” the community on how it
affects society and sexually exploited victims. In mainstream society it appears that
prostitution transmits an image of freedom while being free from any type of regulation,
order or authority. However, this could not be further from the truth as victims of sexual
exploitation, which includes prostitution, are victimized physically, emotionally,
financially, sexually and spiritually. Their physical health is under constant threat and
they are criminalized, which leads to high arrest rates. Many are in and out of jail without
being given the resources to escape that world. The research to date shows that the
majority of individuals who are being sexually exploited are victims of survival sex.
Many of these studies have found that over 25% of homeless and runaway youth have
engaged in survival sex (Tyler, Whitbeck, Hoyt & Cauce, 2004). This means that they
trade sex for food, clothes and a place to stay, because they are being forced into
prostitution and are afraid of being harmed or being their only source of income.
One of the most prevalent populations that are at risk for being victims of sexual
exploitation are the homeless population and runaway youth population. When looking at
these populations it is important to understand that there is an extremely wide range of
causation behind these individuals becoming homeless and/or running away. These can
include any combination of abusive home environment, alcohol and/or substance abuse,
22
mental health diagnosis, unemployment and barriers to resources, being evicted by their
parents/guardians or legal trouble just to name a few.
Once living on the streets runaway youth and homeless individuals are exposed to
high-risk behaviors that they may not have engaged in prior to living on the streets
(Whitbeck & Hoyt, 1999). This is often the results of trying to form a “street family” or
some form of cohesion amongst other individuals living on the streets; often for safety
purposes. However, this often becomes a violent cycle since the attempt to form a
protective group while living on the streets leads to high-risk behaviors, which exposes
these individuals to offenders thereby increasing the risk of victimization by the people
they were trying to form a cohesive group with for safety.
In 2004 a study was conducted by Kimberly A. Tyler, Les B. Whitbeck, Dan R.
Hoyt, professors of sociology at the University of Nebraska Lincoln, and Ana Mari
Cauce, a professor of psychology at the University of Washington, in which risk factors
of sexual victimization were examined among the homeless and runaway youth
populations. During their work they sampled 372 homeless and runaway youth, 35% of
which had been victims of sexual exploitation (Tyler, et al, 2004). From this study the
researchers observed that substance and alcohol abuse increased the risk for victimization
significantly; with one study citing that over 75% of homeless youth reported that they
engaged in sexual activities while under the influence of alcohol or other substances
(Hoyt, D. R., Ryan, K. D., & Cauce, A. M., 1999; Tyler, et al, 2004).
23
There it is often a strong desire and/or necessity for many homeless individuals
and runaway youth to form “street families” as a protective measure. However, studies
have shown that in cases of sexual victimization for females, the perpetrator is often an
acquaintance of the victim (Tyler, et al, 2004). When discussing the occurrence of this
with females, survival sex is often associated with individuals that they considered
friends or acquaintances who have either coerced or forced that individual into some
form of sexual exploitation. Tyler et al (2004) also discovered a significant positive
correlation between homeless and/or runaway youth who were well groomed and
acquaintance sexual victimization; as well as a positive correlation between poor
grooming and stranger sexual victimization.
In regards to males who have engaged in survival sex, the opposite was found.
For males who turn to sexual acts as a means for survival, they often go outside of their
circle of acquaintances, friends and/or individuals they interact with; showing that there
was a six times higher probability for men who engaged in survival sex to be sexually
victimized by strangers (Tyler, et al, 2004).
Lack of self-efficiency and lack of opportunities for self-actualization
One theme that has been consistent throughout the research is that the social issue
of sexual exploitation is often a hidden one (Scott & Harper, 2006; Tremblay, 2010).
With the shame placed on these individuals by society, and the lack of viable as well as
visible resources there are very few individuals who come forward seeking assistance
even if they had the freedom to do so, which many do not. Due to the hidden nature of
24
this population, and since it is often still seen as an “unworthy” population to serve, the
services for this population also appear hidden as well; making it appear as if there are a
lack of opportunities, resources and services, even in areas where that may not be the
case. This has created a significant barrier in assisting survivors of sexual exploitation to
achieve self-efficiency in both spiritual and emotional ways such as self-esteem and selfidentity; as well as financial efficiency such as maintaining safe housing, ability to
continue with a job and/or educational training, and generally be able to achieve
independent living.
Many survivors of sexual exploitation entered that arena as a means to survive;
either through force or when they saw no other options. For example, according to a
study done by Kemper (1990) a third of homeless teens turn to prostitution to survive
living on the streets. Mainstream society does not always take into consideration that
these individuals turn to this option as a last resort. It is not widely known that over 79%
of these individuals are living on the street and cannot access shelters because there are
too few beds, or because the shelter requires parental permission when the child is trying
to live in a shelter to get away from an abusive situation at home, or because these youth
are former foster youth that are trying to escape a system in which they will just be
placed back into if they attempt to access a shelter (Kemper, 1990).
For individuals who do try to obtain employment outside of the sex industry, they
are often met with resistance and negativity. Miyuki Tomura conducted interviews with
women who self-identify as prostitutes in 2004. One of his findings during an interview
25
was that there is a common belief that if a woman who has worked in the sex industry,
more specifically as a prostitute, were to disclose that information to a potential employer
it would automatically eliminate her chances of obtaining whatever position she may
have been applying for (Tomura, 2009). Therefore these individuals either lie about their
career history or state that they have not been working, both of which significantly lowers
their chances at obtaining meaningful and substantial employment outside of the sex
industry.
When there is a lack of opportunities to become self-efficient it results in a lack of
opportunity for self-actualization. This top tier of Maslow’s hierarchy of needs is still
used as a motivating force for individuals from all backgrounds and various stages of life.
It is the need for self-fulfillment, to have the gratification that as an individual you have
achieved the best you are capable of becoming (Sadri & Bowen 2011). This need is
extremely relevant for many survivors of sexual exploitation who have not felt that they
have been afforded the opportunity to achieve self-fulfillment due to the sexual
exploitation they have endured and the many ways that encompasses that individual’s
life. Individuals who are sexually exploited frequently have their psychological needs
overlooked (Tomura, 2009), but what research that is available has shown how
significant of an impact the negative stigmatization has on the self-esteem and
opportunities for self-actualization on sexually exploited individuals. Research has shown
that individuals who work in the sex industry, and are sexually exploited, experience high
levels of burn out, emotional stress in their personal relationships and a strong sense of
26
shame, all as a result of the negative stigmatization placed on them by society (Bradley,
2007; Freed, 2003; Vanwesenbeeck, 2005); which therefore inhibits their ability to
achieve self-actualization and feel gratification as an individual.
Social conceptions of women: historical perspectives
Throughout history the social conceptions, or perceptions, of both men and
women have defined their roles in the home, the workplace and throughout society.
Those who are in power develop and maintain these social conceptions, and in the United
States, as well as many other countries around the world, these theories that have become
imagined in our culture have been created by a patriarchal society. As Judith Bennett,
Ph.D., a professor specializing in feminist history and women’s history throughout the
medieval era, states in her book, History Matters: Patriarchy and the Challenge of
Feminism, patriarchy is not only a core problem as the developer of the social
conceptions of women but one of the greatest challenges in history itself (Bennett, 2007).
At the Berkshire Conference, a conference on the history of women, over 700
professional papers were presented with less than one-quarter of them focusing on a time
period prior to the 1800s. In an article by Dr. Bennett (2008) she documented how in her
experiences, such as the one at this particular conference, many “feminists” have chosen
not to research too deeply into the history of the social conceptions of women; but have
instead taken a stance of “non-remembrance” to many developments that occurred prior
to the 1970s. The underlying goal of this “non-remembrance” could in fact be a desire to
simply pretend that the years of oppression prior to the women’s movements of the 1970s
27
did not exist, or that we can ignore certain aspects of the past because, as a society, we
have moved so far away from those socially constructed gender roles that they are best
left in the past. Although, as a society, we have made significant strides in changing the
socially constructed gender roles of the past it cannot be accurately stated that these
social constructs no longer exist, and it is crucial to examine the historical perspectives of
the country in regards to gender roles. By examining these historical periods it will show
how even though the roles of women have changed and altered throughout the years,
there has been significantly less change in the balance of power between men and women
as a result of patriarchal power in both US history and current society (Bennett, 2007).
It is important to learn from previous time periods in order to best comprehend
how patriarchal societies have influenced the conception of women, therefore defining
their roles and abilities up to the present day. Dr. Ruth Robbins wrote of the oppressions
that women have dealt with under a patriarchal society. In this example, and for the
purpose of this study, the oppression the researchers feel is the most relevant is the
psychological oppression that Dr. Robbins presented which state that patriarchal societies
“attack women by virtue of their bodies (childbearing and rearing defined as ‘women's
work’, “or the fact that women are physically less powerful than men, and can be
subjected to violence and rape)” (Gardiner, 2007, p. 394). Under a patriarchal society the
role of women has been viewed primarily as one of childbearing and rearing, therefore
only defining the purpose of women by their bodies. This conception of women has
28
influenced, and in many ways justified, the different practices that sexually exploit
women by instilling a belief that if a woman’s only use is in the abilities of her body,
which by nature is weaker than a man’s body, than it is justifiable for women to be used
only for their bodies especially by men who are by nature physically stronger and
therefore more dominant.
Historically, these conceptions have been pushed onto society long before the
formation of the United States; however, the US had joined the ranks of many other
patriarchal societies by continuing to portray these social conceptions of both men and
women by identifying their roles in and outside of the home. Historically these social
conceptions where enforced through laws such as laws denying women the right to own
their own property or even rightfully inherit it, the right to vote in an election, and the
right to obtain work outside of the home unless it was in a position caring for children or
cooking. These laws both legally and socially forced women to be dependent on men and
therefore continue to be perceived as essentially the property of men; property whose sole
purpose is in the use and abilities of their bodies.
Although there are no longer such blatantly misogynistic laws in the United
States, such as the ones that have been seen historically in this country, the social
construct of women being perceived as equivalent only to the “value” of their bodies is
still enforced in this country. Now these social constructs of women are enforced through
the media.
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Conceptions of the female body in the media
Media has always played an important role in how men, women, children, and
individuals in general define themselves and how they interact and relate to each other. It
is society’s way of dictating the preferred gender roles to the masses without the need to
blatantly state how men and women should behave, but instead to imply these roles
through the modeling of individuals and their interactions between the genders on
television, movies, newspapers, magazines and now the internet. As societies use of
media has grown it has become almost impossible to not be constantly in the presence of
some form of image that is directing the preferred gender roles of men and women.
The mainstream popular culture in society today aims to over sexualize both boys
and girls at a young age, to view males as individuals who are entitled to access the
female body whenever and however they choose to, while girls supposed to be available
to men whenever desired, because that is how the value of a woman is defined
(Tremblay, 2010). This dilemma has presented itself through mainstream societies
pushing this sexually exploited image continuously in the media, while, at the same time,
viewing other types of sexual exploitation as the fault of the individual without
examining outside factors or even its own role in the over-sexualization of young women.
Sharlene Azam (2009), in her book Oral Sex is the New Goodnight Kiss,
interviewed young women who were part of the largest teen sex ring in Edmonton,
Canada’s history, which included over 50 women between the ages of 12-16. The young
girls who were members of this teen sex ring were not what many would consider the
30
“typical” teenage prostitute, nor were they doing this in order to survive; all of the
members of this group came from upper middle class and extremely wealthy and affluent
families (Azam, 2009). During these interviews what Azam discovered was the reason
these girls engaged in these sexual acts was for money to buy new clothes, jewelry,
electronics and other high price material possessions. They did not see any harm in what
they were doing, and many of these sexually exploited young women were upset with
law enforcement for essentially coming in and ruining what they perceived to be a good
thing (Azam, 2009). For these young women, this experience gave them power. They
were no longer having sex for free as one interviewee stated. They perceived themselves
as having control and were using what they had of value, their bodies, and getting
something in return (Azam, 2009). The views expressed by these young women are
consistent with a research report conducted in 2001 on the commercial sexual
exploitation of children in the U.S., Canada and Mexico, which stated that 22 percent of
sexually exploited youth were trying to earn money—not for survival, but for luxury
items (Tremblay, 2010).
A study conducted by Davies, Spencer and Steele (2005) on the effects that
stereotypical images of gender roles in television commercials played on the aspirations
and self-worth of women showed that by exposing the participants of their study to
commercials that had women portraying “traditional” gender roles, even for brief
amounts of time, significantly impacted their aspirations and desires for leadership
positions. Therefore, it could be concluded that being bombarded with these images
31
significantly impacts the self-worth that women feel and derails feelings of equality
between men and women, making women feel once again that their sole value is in their
domestic abilities and their bodies.
Lisa Tremblay, a writer for the Horizon who has also studied sexual exploitation,
shares many of the same opinions with Azam on the causes behind the normalization of
teen prostitution. Today teens are engaging in oral sex acts behind the movie theater
versus thirty years ago when they were playing spin the bottle, and it must be asked how
our society reached this point (Tremblay, 2010). Both Tremblay and Azam bring up the
almost unlimited access to pornography in our society. Today teens have access to
pornographic material in a way that they never had before. It is essentially everywhere,
and the images it portrays are normalized. As adults, pornography can be viewed and
criticized; however, for a teen who is first learning about sex the discrepancies between
pornography and real life cannot as easily be distinguished, therefore altering any future
perceptions about sexual encounters as well (Azam, 2009; Tremblay, 2010).
Women in the marketplace as sex workers
Sex workers are part of a wide spectrum of services that include Pornographic
models, prostitutes, escorts and erotic dancers. Women who work as sex workers have
different reasons for doing so. Some start as exotic dancers as a means to earn money
while going to school, move on to an escort service, and, ultimately, begin prostituting on
the street. Others were trafficked and forced to work in brothels, as an addiction to drugs
is created by their pimps or madams. Many women feel they are left with no choice but to
32
sell their bodies for money. A survivor of prostitution states “I chose to work as a
prostitute because I believed I had no other options. I entered prostitution due to extreme
emotional and financial stress and lack of a supportive family system” (Farley, 2005).
Some sex workers simply state that they have been abused since they were children “so
why not get paid for it?” (Farley, 2005). Whatever the reason to join the sex industry, it
has been documented that most of the sex workers interviewed would like to escape their
work situation (Farley, 2003).
While it has been hotly debated whether or not different types of sex work pose a
danger to women, there have been studies that show the dangers and negative outcomes
that sex workers face while on the job. Each job setting has its own risks and negative
long term effects, for example indoor prostitution increases the safety of the consumer by
hiding his identity while doing nothing for the safety of the workers. Melissa Farley
(2005) explains that working inside a building decreases the social visibility to the public
of what is really happening inside; thereby increasing the danger for the sex workers. The
workers could be, and often are, beaten, drugged and raped in indoor brothels away from
the eyes of the community.
Some tips for sex workers addressing these issues can be found in the St. James
Infirmary Occupational Health and Safety Handbook (2010). This handbook provides
many safety tips for sex workers, including indoor workers, and advices those readers
what to wear and what not to wear due to the dangers the reader’s job poses. It states
33
“Shoes should come off easily or be appropriate for running…clothing should be ‘straitjacket proof.’ A half-zipped or button jacket can be pulled over shoulders to trap arms”
(2010, p. 90-91). The handbook provides other safety tips such as “always know where
your exits are and try to not let your client block them at any time” (2010, p. 89). The
publication of a handbook with safety tips such as these is clear evidence that sex
workers face danger while on the job. In addition, a separate study done by Ross,
Anderson, Heber, and Norton (1990) showed that women who prostituted in strip clubs
had higher rates of dissociative and other psychiatric symptoms than those in street
prostitution. This is to clarify that although there are arguments for and against
prostitution, there is research and support material that conclude there are dangers that
sex workers face.
Why “prostitutes” are not seen as victims
Many of the services provided by sex workers, with the exception of prostitution,
are provided legally. Many of these services, including prostitution, are seen as
consensual given the female worker’s choice to work in these situations. Because of this,
prostitution is seen as a victimless crime. According to West's Encyclopedia of American
Law, a victimless crime is defined as a crime where there is no apparent victim or
apparent injury (Phelps & Lehman, 2004). On the surface, conveniently at times,
prostitution does not have a victim, but studies show that there are several lasting
negative effects from prostitution. Farley et al (2003) conducted a study of 854 male and
female sex workers from nine different countries that inquired about the participants’
34
lifetime history of physical and sexual abuse (including rapes during their time in
prostitution), whether or not the participant wishes to leave the lifestyle, what it would
take to leave, and other related questions. The participants also completed a self-report
inventory for assessing the 17 DSM_IV symptoms for Post Traumatic Stress Disorder
(PTSD). The results showed that 63% of the participants were sexually abused as
children, 89% of the participants wanted to escape prostitution, and, 63% of participants
reported being raped as prostitutes. Over half (68%) of the participants met the criteria
for PTSD.
These statistics for physical and emotional violence against sex workers are
overwhelming. This study was well planned and had a large diverse sample group.
Everyone’s experience was uniquely theirs, yet there were many commonalities around
violence. With staggering violence rates such as the ones provided by Farley et al (2003),
we can clearly see the probability of victimization while prostituting. For 89% of the
people interviewed, this is not the lifestyle they would remain in if they were given the
chance to escape. When stating the risk involved in this trade and the reasons why many
cannot escape this work, it is unlikely that we may think this is a victimless crime.
Prostitution and sexualized violence
The media, as stated previously, has portrayed women as sex objects for better
advertisement outcomes. The well-known phrase “sex sells” has been rapidly proven to
be true. What about the selling of sex itself? How violent is pornography? Is it degrading
towards women? These themes have been hotly debated and have motivated several
35
studies supporting different sides of the controversy. But analyzing the content itself can
provide meaningful information on whether or not sexualized violence is accessible
without difficulty or is clearly portrayed through pornography.
Stacy Gorman, Elizabeth Monk-Turner and Jennifer N. Fish (2010) researched the
prevalence of degrading acts in free and easily accessibly online pornography. The
researchers in this study viewed a total of 45 sex videos provided by the first five
websites of free pornography that came up doing a Google search. The results indicated
that 55% of all the videos portrayed the male in the video in control, which illustrate the
power relations among women and men. 79% of the videos portrayed fellatio while only
37% of the videos included scenes where the female actress was the recipient of oral sex.
47% of the videos displayed submission by the female participant, whereas none of the
videos displayed male submission. Almost half of the videos (49%) showed women eager
and willing to pleasure and comply with what was asked of them. Although violent
content was not a major theme displayed in the 45 videos surveyed, Cowan et al. (1988),
in a similar study of pornographic video tapes, found that rape was shown in 51% of the
sample videos and physical aggression in 23% of the films which is a dramatic increase
from the Gorman, Monk-Turner and Fish (2010) study. The researcher affirmed that
violent sex videos can be easier to find if you solicit that genre specifically and/or pay for
access to those videos. Nonetheless, the study proves that it is easy and free to access
videos where sexual violence is displayed.
36
The accessibility of material where there is sexualized violence is not the only
concern researchers have noted, the content and the effects of the content are also
problematic. Grand Theft Auto is a carjacking video game that contains several extra
features. One of these features is being able to solicit prostitutes. The game has picking
up a prostitute as an actual mission for which the gamer can earn “health” points in the
event he successfully solicits a prostitute and has sex with her. After he is done having
sex with the prostitute he can kill her and rob her of her money. He can also deliver the
prostitute to the Police Station to complete the mission. This is an exchange of sexualized
violence for mere merit points.
What are the effects of such games on people? In June 2003 in Fayette, Alabama,
Devin Moore shot and killed three police officers after he was brought in for suspicion of
stealing a car. Detectives state that Moore had been cooperating with officers, and it was
not until he was brought in to the Police Station that he snapped. Moore shot 3 officers
just as he had been simulating while playing Grand Theft Auto day and night for months.
Moore escaped in a cop car and was quoted after his capture “Life is like a video game.
Everybody's got to die sometime” (Leung, 2009). Now, what if Moore had come across a
sex worker during his escape? Would he have imitated the sexualized violence taught in
Grand Theft Auto? No one knows, but what is known is that when influencing factors are
united such as mental health and repetitive learned behaviors, this combination could
result in a dangerous outcome as seen in Moore’s case.
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Reasons for Lack of Resources
For the purpose of this section, it is important to make a distinction between sex workers
who were forced into this work and would like to escape and other sex workers. This is not to
say that the two types of sex workers (willing and forced) are not alike at some point in their
lives. We make this distinction because resources for victims of this trade, resources for girls and
women who would like to escape this type of work, are based on different needs than those needs
of women who would like to remain in this type of work. In addition, women who choose to
remain in this trade with the opportunity of earning money in a different type of job are not as
common as those who would escape if they had they opportunity. As stated previously, most
women have a strong reason why they resort to this type of work, some of them become sex
workers as a last resort because they do not see any other way to earn a living and survive. Some
of them rely on the money they make in order to afford their drug of choice. But many sex
workers have been forced into this labor with false promises and are also forced to use drugs,
which starts the drug dependency cycle and reinforces their imprisonment in this work.
Based on the research of a resource center who specifically focuses on helping victims of
sexual exploitation, resources needed and offered in these centers are court advocacy and
alternatives for incarceration, comprehensive case management, individual counseling,
educational, recreational and therapeutic groups, employment and leadership training,
transitional and crisis housing and referral services to agencies that have specific goals such as
Alcoholics Anonymous and Narcotic Anonymous (Girls Educational & Mentoring Services,
2011).
38
Currently in California sex work is illegal therefore it is criminalized. Girls, boys
and adults who are caught in sex work are violating California Penal Code 647(B)
(Legislative Counsel State of California) which criminalizes any person who solicits or
agrees to engage in an act of prostitution. Furthermore, if and when sex workers are in
danger or have been physically or sexually abused, many of them are deterred from
seeking help and justice from Law Enforcement because they themselves are seen as
criminals and have been mistreated by Law Enforcement because of their line of work
(Sex Workers Outreach Project, 2011). Keep in mind that most sexually exploited victims
are in desperate need for rehabilitating services; which they will not get if they are treated
as criminals. In addition, as the California law stands, in order to prosecute sex
trafficking of a minor, the prosecutor must prove force, which is very hard to prove in
many cases (California’s Against Sexual Exploitation, 2012). This could set many
traffickers free and leave victims at a high risk of retaliation. This is why legal advocacy
with experts on this matter are instrumental in treating these victims as survivors of
sexual exploitation, not as criminals.
Comprehensive case management is an essential component to the recovery of
these victims. They need a person who can work with them, providing services and
keeping track of their success, someone who can keep them on track with services
provided. Along with case management comes individual therapy. The mental health
providers working with victims of sexual exploitation should be trained in several areas
such as rape and crisis and emotional and physical abuse. Experts who have experience
39
and the tools to work with this population are crucial to the recovery of these survivors.
Due to fact that sexual exploitation has only recently been growing at an alarming rate in
Sacramento, and is now in the eye of the public and Law Enforcement, there had not been
a need for experts in this matter until now; therefore, experts in this field are scarce.
In order for victims to feel like they are not alone and they are not the only ones
who have gone through this experience, groups which provide education and an
opportunity to participate in recreational activities is part of reassuring the members they
stand among a group of people who not only care about them, but truly understand what
they have gone through. Therapeutic groups have been proven to be very helpful to some
participants when taken voluntarily. This type of setting should be offered as well as safe
environment for survivors to explore their deep feelings about their experiences.
For many, sex work is the only trade survivors know. This might be the only type
of work they feel they are “good at” or able to do. It is very important to provide the tools
for the victims to be competent in the areas they wish to work in. Providing job training
and leadership skills can produce more job related opportunities for victims, therefore
reducing the chances of them going back into the sex trade to make a living.
Many of these services are costly and very intensive, a center should consider
building a strong collaboration with other centers that can provide specific services and
who both understanding and non-judgmental to the population served. Having the ability
to refer out to other services is not only a tool survivors can benefit from but also a way
to show that there is a large group of agencies working towards the same goal of keeping
40
sexually exploited survivors safe and providing the services needed for them to feel
empowered and competent as individuals.
It is evident from the review that there is dearth of knowledge regarding resources
and gaps in services for sex workers to escape their exploitive environment. This study is
designed to add to the existing body of knowledge and assist in closing the extent of gaps
in services for the sex workers in the North of California.
41
Chapter 3
METHODOLOGY
Introduction
This chapter presents the methods used to conduct a study of the perceptions of
professional/service providers who work with survivors of sexual exploitation with
special focus on the gaps in services. The sections included in this chapter are: study
design, population and sampling, data collection/ instrument, human subjects’ protection,
analysis and limitations, which depict the restrictions of this research.
Study Design
The research design chosen for this study is an exploratory research design, with
qualitative and quantitative focus, that examines the perspectives of professionals on the
references that victims of sexual exploitation need and can benefit from. According to Bonnie L.
Yegidis and Robert W. Weinbach, an exploratory study is, “appropriate when problems have
been identified but our understanding of them is quiet limited. It is conducted to lay the
groundwork for other knowledge building that will follow.” (2002, p. 106). The researchers felt
this study design was appropriate since this study explored a phenomenon that is relatively
unexplored due to its sensitive nature.
Also, due to limited access to this population, both in the limited number of professionals
in this field and limited access to those professionals, the researchers determined that attempts to
gain a high number of responses would be impractical. This aspect could also alter the validity of
the results of this study if the population interviewed were primarily composed of individuals
42
who did not have frequent access and/or a limited amount of work with this population in a
professional aspect. Therefore the researchers would like to focus more on obtaining limited
quantity but higher quality data to preserve the legitimacy of the research.
Population and Sampling
The population for this study will be individuals who work with agencies and/or privately
with former and/or current survivors of sexual exploitation in California. Those who responded
to the advertisement for the study, were recruited through trainings on human trafficking,
Sexually Exploited Teens and Children (SECT) community meetings, and other forms of
outreach conducted by the researchers to find organizations, agencies and professionals who
work with this population, represent a convenient sample. The researchers have determined that
this shall be the research population in order to protect the potential high risk statues if former or
current survivors of sexual exploitation were used for this study. A non-probability convenience
sampling “entails selecting cases for study primarily because they happen to be readily
accessible to the researcher…If the researcher is exploring a new area of inquiry and it is hard to
locate people with certain characteristics” (Yegidis & Weinbach, 2002, p. 190).
Because the extent of this population is unknown, and the researcher has limited means,
the sampling used is a combination of purposive sampling and convenience sampling. Purposive
sampling has been used because the respondents must all work with this population in a
professional and helping aspect. Convenience sampling has been used because in discovering
certain agencies that come in contact with former and/or current sexual exploitation survivors
this has often led the researcher to other agencies.
43
Data Collection Approaches
Prior to beginning this study the researchers advertised this study in various places in the
community where professionals had the opportunity to learn briefly about the study and
volunteer to participate, such as the “Human Trafficking of Minors” conference that took place
in Sacramento in October of 2011.
Once contact with these professionals had been made, and the researchers Human Subject
Protection application was approved by the Protection of Human Subjects through the Division
of Social Work at California State University Sacramento, the researchers then obtained
permission from the directors of the specific agencies that the researchers had been in contact
with. The researchers met with the directors of various agencies that work professionally with
survivors of sexual exploitation and discussed in detail the purpose, methods and approaches of
the researcher’s project. The researchers also delivered information about participating in this
study to the employees of these agencies, informing them of the purpose of this study, requesting
their voluntary participation, and assuring them that the information will remain confidential.
The directors of these agencies provided written permission in the form of letters of
support, which were provided to the researcher’s project advisor. These agency directors also
provided opportunities for their staff to learn about the researchers study as well as provided
them with the researchers contact information in order for them to volunteer to participate if they
wished.
44
Human Subjects Protection
In the fall 2011 semester an application was completed for the protection of
human subjects by the researchers. The application was then submitted to the researchers’
project advisor for review and approval. The researchers’ project advisor collaborated
with both researchers to make corrections to, and assist in the completion of, the
application.
Once this application was reviewed and approved by the researchers’ project
advisor, it was submitted to the department of the committee for the protection of human
subjects on October 5, 2011 for final approval. On October 21, 2011 both researchers
received a letter from the department of the committee for the protection of human
subjects approving the application as no risk for the protection of human subjects with an
approval number of 11-12-020.
The participants in this study were all obtained on a voluntary basis and are
professionals who regularly work with sexual exploitation victims. The participants were
given a consent form which informed them of their confidentiality rights and the right to
terminate their participation at any time during the study without penalty. The researchers
also provided resources to the volunteer participants to seek professional help if needed
in the case that they become emotionally distressed. All participants were asked to sign
the consent form provided which acknowledged that they had received the form and were
aware of their rights as a voluntary participant. No interviews were conducted by the
researchers if the consent form was not provided and signed by the participant.
45
Data Collection
The data collection process was both qualitative and quantitative. Although the
information given could have helped with qualitative analysis, due to the limited sample size the
researchers did not have enough data to conduct a qualitative analysis. For the purpose of this
needs assessment, the researchers developed a Data Collection Instrument consisting of fifteen
open ended questions divided into four different subject areas: economic, health, psychological,
social needs and other needs and one closed ended question which pertains to the amount of time
that the specific professional has worked with this population. Volunteers participating in this
study were asked the set of questions regarding the service providers’ perceptions about the
existing needs of survivors of sexual exploitation and allowed to answer in narrative form. The
Validity and Reliability of this questionnaire have not yet been established.
The procedure in which the data was collected for this study was through interviews with
professionals from law enforcement and social services agencies in the Sacramento county area.
The researchers conducted face-to-face interviews with the subjects that were available locally;
as well as interviews over the phone when face to face interviews were not possible or when
phone interviews were preferred by the participants.
Analysis
The data was analyzed for qualitative themes and examined by the researchers
who identified common and repeated words and phrases identified throughout the
interviews. The common themes, patterns and phrases seen by the researchers were
broken down into categories of needs, barriers and resources for economic, social, health,
46
psychological and any other pertinent needs that the interviewees saw as a reoccurring
need within their own practice. The proposed research questions were studied through
multidimensional research designs, with qualitative and quantitative investigations. The
reason the researchers chose this design was due to the fact that the research question is a
needs assessment. Therefore, the purpose of the study is to describe the needs of this
population in order to better understand how to serve them; as well as how to make the
appropriate interventions the most effective.
In order to analyze this research the researchers will thoroughly read each individualized
response and identify commonalities, trends, patterns and resources mentioned (i.e. did all
surveyed state that former and/or current survivors of sexual exploitation need a social support
system but do not have access to one?). After that aspect has been accomplished the researchers
will rank and synthesize the results in the order that they were most frequently mentioned,
observed and/or reported by the participants in the study.
Limitations
The limitations found in this study are the limited available population which
resulted in a small sample size. The geographical location was also limited to the
Sacramento county area and the researchers had a relatively short time frame to interview
the participants and complete this study. Findings of the study cannot be generalized to
other populations besides the sample and similar samples.
47
Chapter 4
FINDINGS
Introduction
This chapter presents the researchers’ findings on the needs of survivors of sexual
exploitation from the perspective of the service providers. As stated in the previous
section, the research findings are a result of interviews conducted by the researchers with
individuals who work with agencies and/or privately with survivors of sexual exploitation
in Northern California. The researchers advertised this study through trainings/workshops
on forms of sexual exploitation, through community meetings that are aimed at working
with and assisting sexually exploited survivors, as well as through outreach by the
researchers to known agencies that work with this population throughout Northern
California. The interviews were conducted by the researchers in person, over the
telephone or through Skype depending on the interviewee’s preference.
Once the interviews were completed the researchers analyzed the data received
for reoccurring themes presented by the interviewees. A qualitative data method was
used and responses were elicited through open-ended questions, giving the individuals
interviewed the opportunity to provide additional input and elaborate on the questions
asked. The respondents were also allowed to after more than one response for each
question; therefore, the results and themes mentioned in this chapter reflect that. In terms
of qualitative data, the researchers have inputted one statistical research table in chapter
four. A significant difference between the statistical research data and the narrative
48
explanation of the observed themes is that the statistical table in which the researchers
used SPSS to document and analyze the data only reflects the first response given by
each of the interviewees and not their multiple answers.
The research survey contained one demographic information question which was
closed-ended and asked how long the individual interviewed had worked with the
survivors of sexual exploitation. The analysis, which will be provided later in this
chapter, will be presented in the mean, median, mode and range. The first section
presents the mean, median, mode and range of the demographic information elicited from
the single quantitative closed-ended question. The second section will analyze the
qualitative data taken from open-ended questions and discuss major themes and specific
findings on the economic needs of sexually exploited survivors. The third section will
analyze the qualitative data taken from open-ended questions and discuss major themes
and specific findings on the health needs of sexually exploited survivors. The fourth
section will analyze the qualitative data taken from open-ended questions and discuss
major themes and specific findings on the psychological needs of sexually exploited
survivors. The fifth section will analyze the qualitative data taken from open-ended
questions and discuss major themes and specific findings on the social needs of sexually
exploited survivors. The sixth section will analyze the qualitative data taken from openended questions and discuss major themes and specific findings on any additional needs
of sexually exploited survivors as suggested by the providers who were interviewed.
49
Lastly, the seventh and final section of this chapter will look at the resources suggested
by the respondents as potential assets for survivors of sexual exploitation.
Demographics
In regards to the single, closed-ended demographic question regarding the amount
of time each provider had spent working with sexually exploited victims, the mean or
average amount of time was 7.62 years. The mode, which pertains to the most commonly
mentioned amount of time was 3, 4 and 20 years. The median, which pertains to the
middle value, was 4 years working with sexually exploited survivors; with a wide range
from 6 months to 26 years.
The researchers determined that it is important to mention for the validity of the
research that many of the individuals interviewed for this study did disclose that they
have been sexually exploited at some point in their lifetime, and that this was the primary
reason they chose to work with helping other survivors of sexual exploitation. The
researchers purposely did not ask any questions regarding the desire to work with
survivors of sexual exploitation or any history around their work and/or experiences with
this population aside from the single question mentioned above. This was done in order
to ensure that any individual who wanted to participate did not feel that they needed to
disclose this information to the researchers and/or that they would be excluded because of
their past personal experiences. Overall 29%, or 5 out of the 17 surveyed, individuals
interviewed disclosed that they were survivors of sexual exploitation in the form of sex
work or human trafficking.
50
Table 1
Statistical Analysis of the Number of Responses from Interview Participants
Greatest
Barriers to
Economic
meeting economic Health Needs
Needs
Valid
Greatest
Barriers to
Greatest
meeting Health
Psychological
Needs
Needs
needs
17
17
17
17
17
0
0
0
0
0
N
Missing
Barriers to
Greatest Social
Barriers to
Additional
Experience of
meeting
Needs
meeting Social
Needs
abuse/ exploitation
Psychological
Needs
among the
Needs
Valid
respondents
17
17
17
17
17
0
0
0
0
0
N
Missing
Table 2
Statistical Analysis of the Experience of Abuse/Exploitation Among the Respondents
Frequency
Percent
Valid Percent
Cumulative
Percent
Valid
yes
5
29.4
29.4
29.4
no
12
70.6
70.6
100.0
Total
17
100.0
100.0
51
Figure 1 Experience of abuse/exploitation among survivors
Economic
Economic needs of survivors of sexual exploitation
The first question asked the providers what they believed were the greatest
economic needs of survivors of sexual exploitation based on their perceptions and
experiences working with this population. 88% or 15 out of 17 of the respondents cited
sustainable income as the number one economic need of this population. 80% or 12 out
of 15 of those who responded with this answer, or 70% of those interviewed overall,
followed up with vocational training as the means to achieve sustainable income. One
respondent stated that in her experience “Nine out of ten sexually trafficked victims
52
escape this life with zero job skills and zero work experience. All they know is what they
were forced to do as a sexually trafficked victim.” Another respondent stated that,
“Vocational training needs to be tailored to fit the needs of this unique population. Not
only do they need vocational skills so they can get a job but skills in reframing how they
view work, because once you have been exploited like this you often get into a belief
system that you have to hustle to survive.” As stated in chapter two, many individuals
who do enter into sex work do so because they felt they had no other options. They were
in significant financial frailty without any other resources for assistance and/or
job/educational skills needed to seek meaningful employment that would provide enough
compensation for survival.
The third most listed need from respondents was around money management
skills, with 35% or 6 out of 17 listing this as a crucial economic need for this population.
“When someone goes from getting a couple hundred dollars a night to getting that much
in a single paycheck every two weeks and then losing some of that to taxes than they
aren’t going to have any idea how to budget that drastic change in finances. The same can
be said for people who have been exploited for years but never received any financial
compensation from it. How do they manage their finances when they have never had
money?”
53
Table 3
Statistical Analysis of the Greatest Economic needs of Survivors of Sexual Exploitation
Frequency
Percent
Valid Percent
Cumulative
Percent
Valid
Sustainable income
11
64.7
64.7
64.7
Vocational training
2
11.8
11.8
76.5
Other
4
23.5
23.5
100.0
Total
17
100.0
100.0
Figure 2 Greatest Economic Needs
54
Barriers to meeting economic needs
The second question asked pertained to what the providers considered the greatest
barriers in meeting the economic needs of this population. The most frequent answer was
lack of vocational and/or educational skills and/or training, which was mentioned by 41%
or 7 out of 17 respondents. This is consistent with the responses received from the first
question as a perceived significant economic need of this population. This response also
correlates with the perceived barrier that was mentioned by 35% of the respondents,
which was lack of resources/lack of knowledge on how to find resources that will assist
survivors of sexual exploitation with either continuing their education or pursuing
vocational training.
When listing the barriers to meeting the economic needs of this population the
interviewees had an equal number of responses, which was 24% or 4 out of 17, for both
the difficulty in maintaining employment due to the emotional trauma these individuals
have faced and the stigmatization and/or fear of stigmatization in seeking employment.
As mentioned in the literature review this fear of stigmatization when seeking
employment has also been seen as a significant barrier by other studies. For example, the
study conducted by Miyuki Tomura with women who self-identify as prostitutes in 2004
found there was a common belief that if a woman who has worked in the sex industry,
more specifically as a prostitute, were to disclose that information to a potential employer
it would automatically eliminate her chances of obtaining whatever position she may
have been applying for (Tomura, 2004).
55
Table 4
Statistical Analysis of the Greatest Barriers to Meeting Economic Needs of Survivors
Frequency
Percent
Valid Percent
Cumulative
Percent
Lack of
3
17.6
17.6
17.6
3
17.6
17.6
35.3
6
35.3
35.3
70.6
Other
5
29.4
29.4
100.0
Total
17
100.0
100.0
Vocational/Educational Skills
Lack of resource/unknown
resources
Valid
Emotional trauma that
prevents the ability to
maintain a job
Health
Health needs of survivors of sexual exploitation
Questions four and five of the interview pertained to the interviewee’s perceived
health needs of sexually exploited survivors and the barriers in obtaining or meeting
those needs. For these two questions there were a significant number of responses. The
most frequently given response, which was given by 65% or 11 out of 17 of the
respondents, pertained to treatment for venereal diseases, also known as sexually
transmitted diseases or sexually transmitted infections, such as chlamydia, gonorrhea,
HIV, AIDS, hepatitis, etc. This response was closely followed by 47% or 8 out of 17 of
the respondents with overall gynecological health care as a significant need. Given the
nature of sexual exploitation, survivors have often had some form of sexual contact with
56
numerous partners which is often unprotected, leaving them at a significantly higher risk
of contradicting a venereal disease which can be life threatening if not treated.
53% of the respondents cited treatment for the physical abuse and/or internal
trauma that these individuals have faced. One respondent stated that many of the
survivors that she works with, “often are disfigured, have huge scars or some type of
branding mark that was forced on them by their pimp or john.” Another respondent
stated, “The amount of neck, back and hip damage that my clients have been exposed to
from the constant physical beatings is horrific to think about. And there is no way of
knowing what type of internal trauma they have suffered from all of the physical abuse
until they are seen by a doctor for a full exam.”
65% of respondents stated during their interview that care for ongoing and/or preexisting medical conditions were also crucial. During the time period that these survivors
are being sexually exploited they develop a range of health problems due to the stress of
the situation and lack of ongoing proper care. Some that were mentioned by the
respondents were gastrological issues, sleep challenges, malnutrition/dehydration, poor
dental hygiene, migraines and diabetes just to name a few.
57
Table 5
Statistical Analysis of the Greatest Health Needs of Survivors of Sexual Exploitation
Frequency
Percent
Valid Percent
Cumulative
Percent
Treatment for STD's and
9
52.9
52.9
52.9
3
17.6
17.6
70.6
2
11.8
11.8
82.4
Other
3
17.6
17.6
100.0
Total
17
100.0
100.0
Quality Gynecological Care
Treatment for physical and
mental trauma
Valid
Ongoing and/or chronic
health conditions
Figure 3 Greatest Health Needs
58
Barriers to meeting health needs
The number one reported barrier to meeting these health needs by the respondents
was lack of medical insurance. During the interviews 76% of the respondents listed this
as the first and most significant barrier. 47% of the respondents also stated that the
excessive wait time as well as the excessive paperwork that is required of individuals to
access Medi-Cal or another type of free health care service is a significant barrier. As one
respondent stated, “It is overwhelming for survivors, so they just give up and leave
without receiving any treatment.” Another stated, “I know how difficult and confusing it
is for me to walk clients through this process and I can’t even count how many times I
have done it. I couldn’t imagine someone completing this process on their own, and that
is without all of the other issues one of my clients is facing. I don’t blame them for giving
up on the process and just leaving.”
29% or 5 out of the 17 respondents cited stigmatization and/or the fear of
judgment from medical professionals, as a barrier to meeting their health needs. As stated
throughout the literature review the fear of stigmatization and/or judgment is a huge
barrier for survivors attempting to access services of any kind. Many already have placed
a strong judgment on themselves from the emotional abuse that they have suffered at the
hands of their exploiters; there is a strong fear of being further traumatized and/or blamed
for their medical conditions when seeking treatment from medical professionals.
59
Table 6
Statistical Analysis of the Greatest Barriers to Meeting Health Needs of Survivors
Frequency
No medical Insurance
Percent
Valid Percent
Cumulative
Percent
8
47.1
47.1
47.1
5
29.4
29.4
76.5
1
5.9
5.9
82.4
Other
3
17.6
17.6
100.0
Total
17
100.0
100.0
Difficulty in navigating the
health care system/Access
to free resources
Valid
Stigmatization and fear of
judgment from medical
professionals
Figure 4 Barriers to meeting Health Needs
60
Psychological
Psychological needs of survivors of sexual exploitation
Questions seven and eight asked the respondents what they believed were the
greatest psychological needs of this population as well as the greatest barriers to meeting
those needs based on their experience working with survivors of sexual exploitation. 82%
or 14 out of 17 of the respondents listed trauma/Post Traumatic Stress Disorder
counseling with someone who has a specialization not just in the field of trauma but
specifically with this population. This would ensure that survivors who are able to obtain
trauma therapy also get additional needs addressed that are unique to the type of
exploitation they have suffered. For example, not only would a therapist address the
trauma of being exploited but also address the attachment that the survivor often feels
towards their exploiter(s). In fact, Stockholm Syndrome and/or deep attachment to the
perpetrators was mentioned by 47% respondents as a psychological need that must be
addressed. As stated previously by the researchers, in both chapter one and chapter two,
many survivors of sexual exploitation develop this attachment due to the manipulation of
their exploiters. This manipulation can lead the victim to have sympathy for the abuser,
identify with the abuser and thinks the abuser has shown them some degree of kindness.
53% of the respondents also identified treatment for anxiety and/or depression, either
through medication, therapy and/or a combination of the two, as an additional
psychological need.
61
In addition to these perceived psychological needs mentioned by the providers
interviewed, there was also a psychological need for coaching and skill building in
developing the survivor’s ability to trust their own judgment and feelings again that was
listed as a need by 47% respondents. This same percentage also stated that in doing so it
would allow the survivors to feel valued as a human being again, or for some of them, for
the first time. As one respondent stated, “My clients often have never felt that they were
worthy of being treated well, which is why they are susceptible to manipulation so easily.
They need to receive counseling that doesn’t just focus on the trauma they went through
but makes them feel like a valid and worthy individual.”
62
Table 7
Statistical Analysis of the Greatest Psychological Needs of Survivors of Sexual
Exploitation
Frequency
PTSD/Trauma Specific
Percent
Valid Percent
Cumulative
Percent
11
64.7
64.7
64.7
2
11.8
11.8
76.5
3
17.6
17.6
94.1
Other
1
5.9
5.9
100.0
Total
17
100.0
100.0
Therapy
Stockholm
Syndrome/Attachment to
Valid
Exploiter(s)
Skill Building/Coaching to
trusting self
Figure 5 Greatest Psychological Needs
63
Barriers to meeting psychological needs
Similar to the previous section, on the perceived barriers to meeting health needs,
the barriers to meeting psychological needs that had the highest response with 65% of the
respondents listing it was not having health care, funds to pay for psychological services
and/or knowledge of where to receive these services for little or no cost. This also
included limited resources, such as survivors being able to receive free counseling but
from someone who does not specialize in trauma focused therapy. Or in situations where
they can receive counseling, there is often a cap such as twelve weeks and then they are
no longer able to receive free services.
35% of respondents felt that in their experiences survivors do not place a high
emphasis on their mental health needs in comparison to their economic or physical health
needs. This could correlate with another barrier that 47% of the respondents mentioned
which was fear of discussing and processing what had happened to them. A respondent
stated that, “I don’t blame them for not wanting to talk about it. It must have been
terrifying going through the first time without having to talk about it again.” Another
respondent stated, “Many of my clients experience panic attacks just thinking about the
trauma they went through, they don’t want to remember it.”
64
Table 8
Statistical Analysis of the Greatest Barriers to Meeting Psychological Needs of Survivors
Frequency
Percent
Valid Percent
Cumulative
Percent
No medical Insurance
4
23.5
23.5
23.5
5
29.4
29.4
52.9
5
29.4
29.4
82.4
Other
3
17.6
17.6
100.0
Total
17
100.0
100.0
Lack of knowledge of mental
health resources
Valid
Lack/fear of self prioritizing
on mental health needs
Social
Social needs of survivors of sexual exploitation
Question ten asked respondents what they perceived were the most significant
social needs for survivors of sexual exploitation. 71% or 12 out of 17 stated that survivors
strongly needed survivor support groups, especially ones that are led by other survivors.
In addition 47% stated that survivors should receive peer counseling from other survivors
in order to help them develop social skills. This also correlated strongly with another
perceived need that 53% of the respondents reported, which was a buddy system, away
that survivors can go out with another survivor for emotional support and work on
building trusting, healthy relationships with others. As one respondent stated, “They
[survivors of sexual exploitation] have been socialized into this life. So we are essentially
asking them to give up their lives, culture, ‘family,’ language and asking them to come
into this mainstream culture that did not protect them in the first place. On top of that, we
65
are expecting them to already know how to act.” 35% of respondents also stated that
support and acceptance from individuals who are not survivors is also a crucial need.
“Survivors can empathize with other survivors, however, it is important to get support
from people who have not been in that situation and can treat them without judgment or
blame.”
Table 9
Statistical Analysis of the Greatest Social Needs of Survivors of Sexual Exploitation
Frequency
Percent
Valid Percent
Cumulative
Percent
Need for Peer Counseling
3
17.6
17.6
17.6
7
41.2
41.2
58.8
5
29.4
29.4
88.2
Other
2
11.8
11.8
100.0
Total
17
100.0
100.0
Survivor Support Groups
(Led by Survivors)
Valid
Buddy system to
practice/develop social skills
66
Figure 6 Greatest Social Needs
Barriers to meeting social needs
As has been listed in all of the previous sections on barriers to needs, the greatest
perceived barrier to achieving the social needs of survivors is a lack of resources. 53% or
9 out of 17 respondents stated that there is a lack of safe places for survivors to meet with
each other, especially on a regular basis, to form a support group. 53% or 9 out of 17
respondents also stated that they are unaware of any programs that offer peer counseling
to survivors, except in situations where the provider also happens to be a survivor of
sexual exploitation.
Another trend the researchers have observed is the fear of stigmatization as a
perceived barrier to achieving the needs of this population. 59% or 10 out of 17
respondents stated that there is a high level of fear around being stigmatized when trying
67
to develop social relationships; there is also the fear of becoming victimized again in any
social relationship that they are able to form. This cycle contributes to survivors having a
difficult time developing safe and healthy relationships since they have been socialized to
be exploited. For many sexually exploited individuals these are the only types of
relationships that they are familiar with, and considering the high number of survivors
who suffer from some form of attachment and/or Stockholm Syndrome as stated in the
literature review, it is understandable why many survivors maintain a strong tie and/or
have difficulty separating themselves from those previous relationships. This is a barrier
that 29% of respondents stated as a significant barrier to achieving the social needs of this
population.
Table 10
Statistical Analysis of the Greatest Barriers to Meeting Social Needs of Survivors
Frequency
Percent
Valid Percent
Cumulative
Percent
Lack of resources (such as
3
17.6
17.6
17.6
Fear of Stigmatization
4
23.5
23.5
41.2
Strong ties to "street life"
4
23.5
23.5
64.7
Other
6
35.3
35.3
100.0
Total
17
100.0
100.0
safe places) for survivors
Valid
68
Additional
The additional perceived needs of survivors of sexual exploitation
Questions thirteen and fourteen of the interview questionnaire asked providers if
there were any additional needs that they felt were essential to this population that had
not been mentioned by the researchers. In this section there was a wide range of answers
with very little overlap in the suggested additional needs of the respondents. The highest
overlap that was seen by the researches was 18%, or 3 out of 17, of the respondents stated
a need for free legal services for survivors to either get their criminal records expunged or
to help them with asylum if they are trafficking victims. The only other overlap that was
seen was 18% of the respondents suggested the need for to having a safe house and/or
long-term residential treatment for survivors.
Other responses included stronger legislation against perpetrators of sexual
victimization, such as the CASE Act which would change the prison term for individuals
trafficking a minor from three to eight years in prison to fifteen years to life in prison.
Also listed was case management services, changing the legislation around having to
prove force, fraud or coercion in cases of human trafficking, alcohol and substance abuse
treatment, community awareness/ sensitivity training for community members, strong
spiritual community support and direct street outreach to make initial contact with
individuals who are currently being sexually exploited.
69
Barriers to meeting these additional needs
Due to the wide variety of perceived needs given to the researchers in asking this
question, the researchers are unable to identify and list themes that were seen as barriers.
The only repeated answer that was listed as a perceived barrier in response to the
multitude of additional services identified by providers was a lack of resources/lack of
funding, which has been listed as a consistent barrier throughout the entirety of this study.
Figure 7 Additional Needs
70
Resources for assisting needs
In response to questions number three, six, nine, twelve and fifteen which asked
the providers if they were aware of any resources that were available in assisting
survivors of sexual exploitation to overcome the economic, health, psychological, social
and additional needs, many of the respondents answered with specific agencies and/or
programs that they were aware of that provided those services. In order for the
researchers to not appear biased and/or to favor any specific programs and/or
organizations this section is broken down into the type of agency or organization that was
mentioned by the providers as a potential resource for each question.
For question three which asked providers about resources that may help survivors
in overcoming economic barriers 65% or 11 out of 17 listed private non-profit
organizations, 41% or 7 out of the 17 respondents listed government agencies, and 24%
listed faith based organizations. For question six which asked providers about resources
that may help survivors in overcoming the health barriers 47% 8 out of 17 listed private
non-profit organizations, 29% listed government agencies, and 12% or 2 out of 17 listed
faith based organizations. For question nine which asked providers about resources that
may help survivors in overcoming psychological barriers 65% listed private non-profit
organizations, 29% listed government agencies, and 29% listed faith based
organizations. For question twelve which asked providers about resources that may help
survivors in overcoming the social barriers 59% listed private non-profit organizations,
0% listed government agencies, and 65% listed faith based organizations. For question
71
fifteen which asked providers about resources that may help survivors in overcoming the
additional barriers the providers felt were pertinent 35% listed private non-profit
organizations, 29% listed government agencies, and 18% listed faith based organizations.
72
Chapter 5
SUMMARY
Introduction
This chapter presents the findings that were established by the analysis of the
interviews conducted with the service providers who work with survivors of sexual
exploitation. In this chapter, the researchers make recommendations for policy, practice,
research and theory in social work practice. This chapter is outlined in the following
categories: Economic, Health, Psychological, Social and Additional needs. Within each
of these headings, the researchers have summarized the most significant perceived
need(s) and barrier(s) as were suggested by the respondents. The researchers have
addressed these perceived need(s) and barrier(s) with practical suggestions at the micro,
mezzo and macro levels, depending on relevance to the perceived need. The term micro
refers to an individual level, the term mezzo refers to a group and/or community level,
and the term macro refers to a larger level, such as government and policy.
Recommendations are designed to enhance the understanding of the practitioners in the
social work field who work with the survivors of sexual exploitation in the Northern
California area to improve the service delivery to this population.
Economic Needs and Barriers to Meeting Economic Needs
From the perspectives of professionals and service providers who work with this
population, the most significant economic needs of this population are sustainable income
and vocational training as indicated by over 80% of the respondents. The most
73
significant perceived barrier to achieving the economic goals of survivors of sexual
exploitation was lack of the educational and/or vocational skills necessary to maintain
successful and meaningful employment.
As a result of these findings, the researchers suggest that vocational training be
developed to meet the specific needs of this population. At both the mezzo and macro
level, depending on the size of the community involvement, this would include involving
community members as well as local businesses to collaborate with each other and
develop a guide and/or outline of the skills that they perceive to be crucial to being a
successful employee. At a mezzo level, the vocational training needs to integrate building
job skills with interpersonal and communication skills. Since survivors of sexual
exploitation are often socialized to communicate and interact with others in a way that
does not conform to the norms set by mainstream society; this is a crucial skill set
essential to obtaining and maintaining employment. This type of vocational and
communication skills training can be conducted in a group setting in order for individuals
to practice and develop those skills through role playing. At a micro level, the researchers
also feel, based on the findings of this study, that individual counseling should be an
integral part of vocational training. This can either be conducted through the vocational
training program or referred out as a requirement in order to address the emotional
trauma and develop strength and resiliency-based coping skills that can interfere with
maintaining long term employment.
74
Health Needs and Barriers to Meeting Health Needs
From the perspectives of professionals and service providers who work with sex
workers, the most significant health needs of this population are opportunities to quality
gynecological care and sexual health treatment. Due to the nature of the exploitation there
are a high number of sexually transmitted diseases amongst this population. Bacterial
sexually transmitted diseases, such as chlamydia, gonorrhea and syphilis, are easily
treated with antibiotics; however, they do become life threatening if not treated. There
are also others such as Human Immunodeficiency Virus (HIV) or Hepatitis B which are
fatal and require regular and ongoing treatment to prolong life expectancy. Survivors of
sexual exploitation are in need of quality and timely treatment to address these issues
before they potentially become life threatening or do permanent damage to the body.
It is important to also note that the health needs of this population are not limited
to sexually transmitted diseases and infections. Another highly perceived health need of
this population is ongoing care for chronic and/or pre-existing health conditions. Some
that were listed include diabetes, hypertension, insomnia, gastrological issues and poor
dental hygiene, to name a few. As was shown by this study, individuals who face sexual
exploitation are at high risk of facing numerous other health conditions brought on by
stress, malnutrition and/or lack of proper medical treatments since they are not receiving
adequate or competent preventative care. This can be due to their subjection to isolation,
fear of self-exposure, or any of the other many barriers listed below that survivors
encounter. From the information gathered during this study on the perceived barriers to
75
achieving the health needs of this population, the most frequently listed perceived barrier
was absence of health insurance. Additionally, difficulty in navigating the medical
system, such as excessive wait times to see a provider, long and complicated forms, and
lack of valid identification were listed as significant barriers.
Although there are several health clinics that provide services at either no cost or
a sliding scale (which refers to the determination of fees based upon income level) the
number of clinics, as well as their availability, is not enough to meet the demand. In
calculating the demand for these free or low cost services, the researchers feel it is
important to also recognize that due to the high cost of health care, many low-income
individuals use these clinics/facilities as a way of obtaining health care services.
Therefore, the amount of wait time increase, the cost of services increase and the limited
availability of providers are factors that affect the quality of services and accessibility if
health services to this population. The researchers therefore suggest that there be an
increase in funding to these organizations to either expand on the services being
provided, and/or open new free clinics to meet the needs of this population.
Psychological Needs and Barriers to Meeting Psychological Needs
The primary psychological need of this population, as indicated by the service
providers include counseling from someone who specializes in this field or are
themselves survivors of sexual exploitation. According to the interviewees, disorders
such as Post Traumatic Stress, Anxiety and Stockholm Syndrome are disorders that
survivors must address with the help of experts. Barriers keeping survivors from getting
76
this type of help are lack of health care and lack of funds which allow programs to
provide these services, resources, and the professionals who specialize in this type of
trauma.
The researchers recommend that these barriers be addressed by incentivizing
commitment to providing competent and trauma based/specialized counseling for this
population. Incentives can be directed at students in the field of psychology or social
work. Currently, many Universities in California have incentive programs such Title IVE (Child Welfare) and Mental Health stipends through the CaslSWEC programs that
encourage students to specialize in an area which needs professionals with more
experience to address difficult problems and combat the high turn-around and burn out
rates in these professions. Since working with survivors of sexual exploitation is an
intense line of work, there is a need for professionals with a passion and dedication to
serve this population. Incentives at the University level can promote a higher number of
specialists taking up this career path with programs that will provide focus and
specialization on the importance of evidence-based practices that are grounded on
theories such as resiliency, crisis intervention and trauma. These are practices social work
students and professionals should master in order to best serve sexually exploited victims.
The implications for the social work profession based on the recommendations of
the researchers to create specialized programs and incentives to gain competent
professionals to work with this population could include an initial increase in government
spending to fund these programs. However, another implication can be a decrease in
77
governments long-term spending on services to survivors of sexual exploitation since
there would be more professionals who specialize in working with these individuals. For
example, social work professionals with experience and training in providing mental
health services for sexually exploited victims would be in high demand. In addition,
training for mental health social workers on the basics of dealing with this population
could be adopted by and incorporated into programs that are already in existence or
different agencies to better assist the growing rate of sexually exploited survivors.
Social Needs and the Barriers to Meeting Social Needs
The study findings indicate that the social needs of this population include:
support groups led by survivors of sexual exploitation, peer counseling, and utilization of
a buddy system for safety. The barriers to these needs are: lack of resources, and the fear
of being stigmatized and victimized again.
To address these barriers, the researchers recommend interventions to increase
awareness at the macro, mezzo and micro level systems, regarding the importance of
addressing social needs as a precursor to the self-actualization of these individuals.
Providing awareness at the macro level can encourage stakeholders and people in power
to create changes in legislature and establish grants that support local programs to offer
services for survivors of sexual exploitation. At the mezzo level, awareness of sexual
exploitation, its patterns and its consequences, is crucial to decrease stigmatization of and
discrimination against this population. Knowledge can empower communities to come
together and minimize the obstacles faced by this population. Lastly, the researchers
78
recommend working with survivors at the micro level in educational support groups that
allow survivors opportunities to learn how to build relationships in a safe setting,
ultimately, lowering the risk of being victimized.
Addressing the social needs of this population would imply that social work
professionals need to become better advocates for the needs of this population and be
able to explain, not only the mental health and financial needs, but also the social and
safety needs of survivors. Fundamentally, social workers need to acknowledge the victim
as a person and should advocate at the micro, mezzo, and macro levels of social work for
services that will allow this person to build safe relationships.
Additional Needs and the Barriers to Meeting those Additionally Listed Needs
Additional needs of this population as presented by the professionals surveyed for
this study include: obtaining legal services to address criminal records and immigration
challenges and the use of safe houses which allow survivors to stay for long periods of
time until they can support themselves. The barriers in achieving these needs are the lack
of affordable legal services and immigration services and funding for the development of
a safe house.
To address these barriers, the researchers recommend a focus on outreach and
awareness interventions among Law Enforcement and Immigration service providers.
Educating these two departments regarding their current effect on this population and
how their ability to create change as they encounter victims of sexual exploitation can
promote a need for evaluation of services and encourage much needed change within
79
these systems. Currently, there is one safe house located in Northern California. This is
the only safe house that is dedicated to working with victims of sexual exploitation. The
researchers recommend that studies such as this one be taken as a foundation for grant
writing in support of building a safe house in the Sacramento area.
The findings imply that social workers must strengthen relationships with
community partners, especially those who offer legal and immigration services, and
should help to connect sexually exploited victims to these services providers. When
encountering law enforcement officers, immigration service providers or any service
providers that are not aware of the challenges sexually exploited victims face on a daily
basis, social workers can reach out and share their knowledge with other professionals.
By being a source of information and skills in working with survivors of sexual
exploitation, social work providers can assist other professionals in building and
developing their own skills in working with this unique population. An implication for
social work practice overall is the need to train professional social workers in trauma
treatment, management and prevention due to the trauma that is inherent in sex work for
various reasons. Such trainings must require effective empowerment techniques and
positive conceptions of self and resources of the self.
80
APPENDIX A
Informed Consent Form
81
Informed Consent to Participate in a Study on the Perception
of Professionals/ Service Providers who Work with Survivors
of Sexual Exploitation
The researchers are asking for your voluntary participation in their thesis study. Please
read the following information about the project. If you would like to participate, please
sign in the appropriate box below. Thank you.
Social Work Researcher(s):
Jamie Baskett, MSW II and Margarita I. Herrera Gutierrez, MSW II
Title of Project:
Needs Assessment from the Perspective of Professionals/ Service Providers Who
work with Survivors of Sexual Exploitation.
Purpose of the study:
The purpose of this study is to assess the needs of survivors of sexual exploitation
exclusively from the perspective of professionals/ service providers to this population.
If you participate, you will be asked to:
Answer a questionnaire developed by the researchers during an interview. This
questionnaire will consist of fifteen open-ended and one closed ended interview questions
regarding the participants perceived needs of the population and their access to those
resources.
Time required for participation:
Approximately fifteen (15) to twenty (20) minutes.
Potential Risks of Study:
Taking all aspects of this research into consideration, the researchers consider this
study to be minimal risk because the nature of the questions asked to the service
providers are such that they could encounter on a daily basis in their line of work. In the
event that the questions cause any discomfort, please contact Sacramento County Mental
Health Services at (916) 875-7070 for counseling resources.
Benefits:
The information collected will better inform social workers as to the needs of
survivors and current victims of sexual exploitation as well as possible ways to reach the
population and distribute these services successfully. Furthermore as a result of initial
programs being implemented due to the findings of this study, this has the potential to
lead to further studies on the subject. It also will give social workers and
82
individuals/agencies who are working with this population opportunity to see, through the
initial programs, what resources are the most successful in assisting this population move
on successfully as survivors with the tools and skills they need to be successful in their
lives.
How confidentiality will be maintained:
Information identifying you will not be documented. All information provided
during the interview and/or on the questionnaire will not be shared with anyone other
than the researchers. Only neutral information pertaining to the general needs of the
population will be documented.
If you have any questions about this study, feel free to contact:
Jamie Baskett at email: jbaskett986@hotmail.com
Margarita I. “Kitzia” Herrera Gutierrez at email: KitziaHerreraG@gmail.com
Research Advisor, Dr. Jude Antoyappan at email/phone:Judea@csus.edu, (916) 278-7171
Voluntary Participation:
Participation in this study is completely voluntary. If you decide not to participate there
will not be any negative consequences. Please be aware that if you decide to participate,
you may stop participating at any time and you may decide not to answer any specific
question.
By signing this form I am attesting that I have read and understand the information above
and I freely give my consent/assent to participate.
Printed Name of Research Participant: ________________________________________
Signature: _______________________________________________________________
Date: ___________________________________________________________________
83
APPENDIX B
Data Collection For Providers Of Survivors Of Sexual Exploitation
84
Interview Schedule for the Study on the Needs of
Survivors of Sexual Exploitation from the Perspective
of the Professionals/Service Providers
Economic Needs
1. What do you consider the greatest economic needs of this population? _________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
2. What are the greatest barriers in getting these needs met? ___________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
3. What resources are you aware of that can assist this population in getting those
needs met? ________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
Health Needs
4. What do you consider the greatest health needs of this population? ____________
__________________________________________________________________
__________________________________________________________________
85
__________________________________________________________________
__________________________________________________________________
5. What are the greatest barriers in getting these needs met? ___________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
6. What resources are you aware of that can assist this population in getting those
needs met? ________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
Psychological Needs
7. What do you consider the greatest psychological needs of this population? ______
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
8. What are the greatest barriers in getting these needs met? ___________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
9. What resources are you aware of that can assist this population in getting those
needs met? ________________________________________________________
86
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
Social Needs
10. What do you consider the greatest social needs of this population? ____________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
11. What are the greatest barriers in getting these needs met? ___________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
12. What resources are you aware of that can assist this population in getting those
needs met? ________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
Other Needs Not Yet Mentioned
13. Are there any additional needs that you feel are crucial to this population? ______
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
87
14. What are the greatest barriers in getting these needs met? ___________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
15. What resources are you aware of that can assist this population in getting those
needs met? ________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
How long have you worked with this population? _______________________________
88
APPENDIX C
Approval By The Committee
CALIFORNIA STATE UNIVERSITY, SACRAMENTO
89
DIVISION OF SOCIAL WORK
TO:
Jamie Baskett & Margarita Herrera-Gutierrez
Date: October 21, 2011
FROM: Committee for the Protection of Human Subjects
RE: YOUR RECENT HUMAN SUBJECTS APPLICATION
We are writing on behalf of the Committee for the Protection of Human Subjects from
the Division of Social Work. Your proposed study, “Needs Assessment from the
Perspective of Professionals/Service Provider Who Work With Survivors of Sexual
Exploitation.”
__X_ approved as _ _
_EXEMPT _ X_ NO RISK _ __ MINIMAL RISK.
Your human subjects approval number is: 11-12-020. Please use this number in
all official correspondence and written materials relative to your study. Your
approval expires one year from this date. Approval carries with it that you will
inform the Committee promptly should an adverse reaction occur, and that you
will make no modification in the protocol without prior approval of the
Committee.
The committee wishes you the best in your research.
Professors: Jude Antonyappan, Teiahsha Bankhead, Maria Dinis, Serge Lee, Kisun Nam,
Francis Yuen.
Cc: Dr. Jude Antonyappan
90
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