1. Uncovering the Truth: Identifying and Assisting Sex Trafficked Youth In a Health Care Setting Visit www.ecpatusa.org or email us at ecpat@ecpatusa.orgecpat@ecpatusa.org

2. What is Child Sex Trafficking? A severe form of trafficking in which a commercial sex act is induced by force, fraud or coercion OR in which the person induce to perform the act has not attained 18 years of age. Visit www.ecpatusa.org, or email ecpat@ecpatusa.org

3. Who are the Victims? Runaways/ “throwaways” Any socio-economic status Occurs everywhere in the United States All races and ethnicities Mainly adolescents Both genders are vulnerable – Girls are more often pimped – Trafficking is significantly underreported, regardless of gender Visit www.ecpatusa.org, or email Michelle Guelbart at michelle@ecpatusa.org Visit www.ecpatusa.org, or email ecpat@ecpatusa.org

4. How Do Pimps/Traffickers Act? Target young, vulnerable adolescents – Victims have no place to go – They want to prove their love for their pimp Pimps/traffickers withhold food and affection Play mind games on the victims – Threats Threaten to hurt their family or friends Rape and humiliate the victim by sending photos to his/her family – Prey on their fear of the police Prostitution is already a crime Pimps/traffickers promote illicit drug use May have committed other crimes with the pimp Visit www.ecpatusa.org, or email Michelle Guelbart at michelle@ecpatusa.org Visit www.ecpatusa.org, or email ecpat@ecpatusa.org

5. How to Identify Potential Victims Clothing (Little to no clothes on; inappropriate dress for weather outside) Arrival time at ER (Late at night/early morning) Physical appearance (Looking pale, sick, and sleep deprived) Tattoos on neck or lower back area with the trafficker’s name or other symbol Visit www.ecpatusa.org, or email Michelle Guelbart at michelle@ecpatusa.org Visit www.ecpatusa.org, or email ecpat@ecpatusa.org

6. How to Identify Potential Victims If victim is with another person who they refer to as “Daddy” If victim looks hesitant to answer or move without permission from the other If victim looks at the other for approval Visit www.ecpatusa.org, or email Michelle Guelbart at michelle@ecpatusa.org Visit www.ecpatusa.org, or email ecpat@ecpatusa.org

7. Warning Signs to Look For: Common Physical Problems Contusions Cuts Bruises Burns Broken bones Dehydration Bacterial infections Impacted sponges, condoms, tampons or baby wipes Visit www.ecpatusa.org, or email Michelle Guelbart at michelle@ecpatusa.org Visit www.ecpatusa.org, or email ecpat@ecpatusa.org

8. Warning Signs to Look For: Common Physical Problems STDs (including HIV) Pelvic Inflammatory Disease Infertility Miscarriages Unwanted Pregnancy Unsafe Abortion Poor reproductive health If pregnant--little to no prenatal care Visit www.ecpatusa.org, or email Michelle Guelbart at michelle@ecpatusa.org Visit www.ecpatusa.org, or email ecpat@ecpatusa.org

9. Warning Signs to Look For Common Mental Problems Depression Suicidal Attempts Anxiety Hostility Flashbacks PTSD Visit www.ecpatusa.org, or email Michelle Guelbart at michelle@ecpatusa.org Visit www.ecpatusa.org, or email ecpat@ecpatusa.org

10. Warning Signs to Look For Substance Misuse Overdose Alcohol or Drug Addiction Visit www.ecpatusa.org, or email Michelle Guelbart at michelle@ecpatusa.org Visit www.ecpatusa.org, or email ecpat@ecpatusa.org

11. From the Victims Themselves “When you are in ‘the life,’ nobody offers you anything unless they want something from you.” –Trafficked Victim It is vital that health care providers understand that when a trafficking victim is in “the life,” it will impact how they interact with you. Visit www.ecpatusa.org, or email Michelle Guelbart at michelle@ecpatusa.org Visit www.ecpatusa.org, or email ecpat@ecpatusa.org

12. Why Victims are Hesitant to Approach Police Usually victims feel they cannot rely on police for help. Fear of stigma and judgment. Lack of sympathy and empathy exhibited towards the victims. Fear of being arrested; prostitution is a crime. Visit www.ecpatusa.org, or email Michelle Guelbart at michelle@ecpatusa.org Visit www.ecpatusa.org, or email ecpat@ecpatusa.org

13. Indicators: Branding Pimps use tattoos to brand their victims. Tattoos often refer to the girls as a money maker or make reference to the trafficker. Ex: Daddy’s Money Maker, C-Lo’s Ho Visit www.ecpatusa.org, or email Michelle Guelbart at michelle@ecpatusa.org Visit www.ecpatusa.org, or email ecpat@ecpatusa.org

14. Indicators: Terminology The Life/The Game: commercial sex industry Bottom Bitch/Bottom Girl: the trafficker’s head girl Daddy: trafficker John: purchaser of sex/client Track: street location for commercial sex Turnout: someone who recruits you into the life Square: those who were never in the life Visit www.ecpatusa.org, or email Michelle Guelbart at michelle@ecpatusa.org Visit www.ecpatusa.org, or email at ecpat@ecpatusa.org

15. Benefits of Action Hospitals and staff are in a unique position to address this issue. It is the right thing to do. Hospital staff should be empowered and knowledgeable about what to do. You can be the first one to identify the signs of a trafficked victim, and then assist them in the correct way. Visit www.ecpatusa.org, or email Michelle Guelbart at michelle@ecpatusa.org Visit www.ecpatusa.org, or email ecpat@ecpatusa.org

16. How to Open Dialogue with Victim Often health care workers do not understand that they are victims and are not prostituting by choice. Be subtle. Do not use word “Prostitute.” Do not ask open-ended questions. Ask questions which can be answered with a “Yes” or “No.” Do not make victim nervous and feel pressured to say things. Generalize the situation. Visit www.ecpatusa.org, or email Michelle Guelbart at michelle@ecpatusa.org Visit www.ecpatusa.org, or email at ecpat@ecpatusa.org

17. The “Do’s”: What to Say and Do Find ways to speak to the victim alone without the person who brought her or him. For ex., suggest that a private examination is required. When youth is separated from other the other, simply ask if they feel safe. Understand that some victims may have a hostile or negative attitude; they don’t trust the system or that there is any help for them. Visit www.ecpatusa.org, or email Michelle Guelbart at michelle@ecpatusa.org Visit www.ecpatusa.org, or email ecpat@ecpatusa.org

18. Who to Call Your social work office National Human Trafficking Resource Center: 1-888-373-7888 National Center on Missing and Exploited Children Visit www.ecpatusa.org, or email at ecpat@ecpatusa.org

19. Other Resources Sex Trafficking: A Clinical Guide for Nurses Edited by Mary De Chesnay. www.springerpub.com www.springerpub.com Practice Guides from American Professional Society on the Abuse of Children www.apsac.org/practice-guidelines Visit www.ecpatusa.org, or email at ecpat@ecpatusa.org

20. Contact ECPAT-USA for these additional resources Palm cards to distribute to victims information Training video about why U.S. youth are in the life and why it is hard to get out. Visit www.ecpatusa.org, or email at ecpat@ecpatusa.org