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Female Survivors of Sex Trafficking: How Do They Perceive Returning to Work?

Authors

Jazmin Bolduc, Kaylynn Esguerra, and Claudia G. Peyton, PhD, OTR/L, FAOTA Principal Investigator and Faculty Mentor, Department of Occupational Therapy, California State University, Dominguez Hills, USA.

Correspondence concerning this paper should be addressed to Claudia G. Peyton, Ph.D., OTR/L, FAOTA, Department of Occupational Therapy, California State University, Dominguez Hills, 1000 E. Victoria Street, CA, 90747, USA. Email: cpeyton@csudh.edu

Abstract

Sex trafficking is a growing human rights issue that calls for research and implementation of recovery programs that meet survivors’ unique needs. Six adult, female survivors of sex trafficking currently enrolled in a residential recovery program described their perception of returning to work using photovoice data collection. Photo narratives and individual semi-structured interviews were audio recorded and transcribed verbatim. The steps followed in descriptive phenomenological data analysis were bracketing, horizonalization, compiling clusters of meaning and deriving overarching themes in order to deduce an exhaustive description of the survivors’ perception of returning to work. The major themes discovered were: (a) transition is a challenging process; (b) past influences the present; (c) value a positive work environment; and (d) desire for meaningful outcomes. Findings included: (a) the perception of a need to be ready for work and work preparation as slow and difficult; (b) negative emotions rooted in past work experiences create the perception of not being able to succeed in a typical work environment; (c) a positive work environment would include non-judgmental attitudes toward their background, accommodations for their mental health needs, and an atmosphere of teamwork; and (d) a career is perceived as a means to provide personal fulfillment and a better quality of life. These findings support a potential role for occupational therapists (OTs) to provide client-centered, trauma-sensitive life and work skills training that addresses female sex trafficking survivors’ unique perception of the return to work recovery process.

Keywords: Occupational Therapy, sex trafficking, recovery, work, photovoice, phenomenology

Understanding How Female Survivors of Sex Trafficking Perceive Returning to Work

Introduction

Globally, every 60 seconds one woman is trafficked for sexual exploitation (Kara, 2010). Sex trafficking, is defined as “the recruitment, harboring, transportation, provision, or obtaining of a person…in which a commercial sex act is induced by force, fraud, or coercion” (Trafficking Victims Protection Act, 2000). Of the incoming signals (i.e. phone calls, text messages, online tip forums, and emails) made to the National Human Trafficking Resource Center (2013) the types of sex trafficking reported were brothels, internet-based, hotel/motel based, street-based, escort services, truck stop-based, pornography, personal servitude, strip-club-based, bar-based, and sex tourism. In the United States alone, 10,000 to 11,000 individuals are trafficked into the sex industry every year (Clawson, Dutch, Soloman, & Goldblatt Grace, 2009). A staggering 80% of those trafficked are women and girls (U.S. Department of State, 2006). These statistics are only a modest estimate of the actual number of women who are trafficked for sex because of traffickers’ efforts to keep the nature of this heinous crime concealed (Muftić & Finn, 2013).

The fight against the larger issue of human trafficking was recently expanded in the state of California. Harris (2012) reported that between 2004 and 2010, the State of California Department of Justice created nine regional anti-human trafficking task forces, through federal grants, to identify and respond to trafficking. In Southern California, the anti-human trafficking task forces located in Los Angeles, Orange, Riverside and San Diego counties pair law enforcement with local, state, and federal prosecutors, as well as other governmental and nongovernmental organizations in a multidisciplinary, comprehensive, victim-centered approach to prosecute perpetrators, train service providers, and reach victims. The majority of task force services provided are to victims of sex trafficking.

Sex trafficking literature stresses the importance of providing comprehensive aftercare services to survivors of sex trafficking in recovery (Hom & Woods, 2013; Macy & Johns, 2011; Tsutsumi, Izutsu, Poudyal, Kato, & Marui, 2008; Zimmerman, Hossain, & Watts, 2011). Macy and Johns (2011) framed the discussion of survivor’s recovery needs within a continuum of care consisting of immediate, on-going, and long term needs. The seven core service areas within the continuum of care model reflect the areas of need for survivors of sex trafficking in recovery: (a) basic necessities; (b) secure, safe shelter, and housing; (c) physical health care; (d) mental health care; (e) legal and immigration advocacy; (f) job and life skills training; and (g) substance abuse services (p. 89).

Literature Review

The literature review covered a 10-year period, from 2006 to 2016. The search was conducted by using three electronic databases, CINAHL, PsycARTICLES, and PsycINFO. A total of 114 articles were examined, of which 29 relevant articles were chosen. No studies were found that used photovoice as a qualitative research method to understand how female survivors of sex trafficking perceive returning to the occupation of work; however, one occupational therapy study, conducted by Muffly and Gerney (2015), examined the impact of sexual trauma on occupational performance and demonstrated a clear need for occupation-based intervention, specifically sensory integration (SI) therapy.  Most recently, the American Journal of Occupational Therapy (AJOT), published an issue brief on the profound role the profession can have in providing client-centered care to survivors of human trafficking as well as advocating to combat its proliferation (Gorman & Hatkevich, 2016). Our research is, in part, a response to Gorman and Hatkevich’s (2016) and Muffly and Gerney’s (2015) call to action.

 

Health Outcomes of Survivors of Sex Trafficking and Vulnerable Populations

Negative outcomes. The sex trafficking literature details common negative physical, somatic, cognitive, and mental health outcomes associated with sex trafficking. Survivors report high rates of health problems, including infections, sexually transmitted diseases, pain, broken bones, head injuries, and fatigue, which result from detrimental and violent working conditions (Hossain, Zimmerman, Abas, Light & Watts, 2010; Macy & Johns, 2011; Zimmerman et al, 2011). Symptoms that the “body remembers” such as “physical and somatic symptoms, sleep disorders, nightmares and intrusive memories of the violence and trauma experience” are also prevalent (Hom & Woods, 2013, p. 78). Antecedents to sex trafficking, such as childhood trauma and sexual assault, can have a negative impact on cognition (i.e. adaptive capacity, learning, memory, executive functioning and thought patterns) (Cole & Lynn, 2010; Gronski et al., 2013; Hom & Woods, 2013). Research on mental health outcomes centered around psychological disorders (i.e. mood, anxiety, and substance use disorders), low self-esteem, distorted self-concept, social isolation, maladaptive coping patterns, suicidal ideation, and disassociation (Hom & Woods, 2013; Macy & Johns, 2011; Muftić & Finn’s, 2013). The experience of Post-Traumatic Stress Disorder (PTSD), anxiety, and depression after trauma was substantiated throughout the literature (Tsutsumi et al., 2008; Zimmerman et al., 2011) with some studies finding up to 50% of participants to have symptoms of PTSD and up to 57% experiencing symptoms of anxiety, depression, and PTSD (Hossain, et al., 2010; Zimmerman et al., 2011).

Positive outcomes. Descriptions of positive health outcomes after the experience of sex trafficking were limited in sex trafficking literature, yet the concept of posttraumatic growth (PTG) in individuals who experience trauma is a well documented phenomenon in psychological research and hypothesized to be an example of improved psychological functioning and source of resilience (Cole & Lynn, 2010). Tedeschi & Calhoun (2009) defined the concept of PTG as the perception of positive change or personal transformation after experiencing a trauma. PTG is thought to result from the process of struggling to overcome adversity and they summarized the experience as “an increased appreciation for life in general, more meaningful interpersonal relationships, an increased sense of personal strength, changed priorities, and a richer existential and spiritual life” (p. 1). Studies of vulnerable populations after experiencing trauma confirm the experience of PTG in those who have experienced sexual trauma and interpersonal violence (Cole & Lynn, 2010; Elderton, Berry, & Chan, 2015), yet no studies were found to investigate the experience of PTG specifically in survivors of sex trafficking.

Sex Trafficking’s Negative Impact on a Survivor’s Occupation of Work

Sex trafficking literature describes the barriers encountered by survivors of sex trafficking when returning to work. Re-integration (as cited in Zimmerman et al., 2011) is “not achieved until the individual becomes an active member of the economic, cultural, civil and political life” (p. 330). The barriers faced during this process mirror the risk factors that caused them to be trafficked initially: lack of education, lack of familial and social support as well as low socioeconomic status (Kanopienė & Blažytė, 2010). The negative physical, psychosocial, and cognitive outcomes brought on by being trafficked further impedes their return to work (Kanopienė & Blažytė, 2010). Pandey, Tewari, and Bhowmick (2013) highlight the need to teach life and job skills to survivors of sex trafficking in order for them to acquire and maintain employment. Learning these vocational skills increases their chances of becoming self-sufficient and decreases their likelihood of being re-trafficked (Macy & Johns, 2011). Self-sufficiency has more benefits than meeting one’s material needs: it also increases the survivor’s self-esteem, which is essential during the recovery and re-integration process (Macy & Johns, 2011).

Using a Trauma-Sensitive Approach with Survivors of Sex Trafficking

There is a consensus for the need for trauma-informed services across disciplines (Hom & Woods, 2013; Macy & Johns, 2011; Yakushko, 2009). The trauma-informed care model is a framework for treatment where services and practitioners are client-centered and responsive to the unique needs of those who have experienced violent trauma. This includes practices that are central to OT, such as client-centeredness and a strong therapeutic relationship to restore their trust in others and engage in treatment (Johnson, Friedman, & Shafer, 2014; Macy & Johns, 2011). Researchers outlined specific criteria for providing trauma-informed services to survivors of sex trafficking:

(a) give priority to survivor’s physical and emotional safety; (b) concurrently address

co-occurring problems; (c) use an empowerment philosophy to guide service delivery; (d)

maximize survivors’ choice and control of services; (e) emphasize survivors’ resilience;

and (f) minimize the potential of the survivor experiencing additional trauma (as cited in Macy & Johns, 2011, p. 94).

Purpose of the Study

Our study aimed to inform occupational therapy (OT) literature on the recovery experience of sex trafficking survivors, particularly in the occupation of work. The American Occupational Therapy Association (2014) defines the occupation of work as including employment interests, pursuits, seeking, acquisition, and job performance. The purpose of our study was to describe how female survivors of sex trafficking perceive returning to the typical work environment.

Need for the Study

The literature emphasizes the need for client-centered, trauma-sensitive, comprehensive, and community-based recovery services for survivors of sex trafficking (Macy & Johns, 2011). Gronski et al. (2013) suggests that in order for services to be effective they should be community-based and prevention oriented: both of which are common practice areas for occupational therapists (OTs). These recommendations mirror OT’s core beliefs (American Occupational Therapy Association [AOTA], 2014) and support the distinct value of a role for OTs in working with sex trafficking survivors (Gorman, & Hatkevich, 2016). Central to the practice of OT and highlighted in AOTA’s Centennial Vision is the profession’s growth into emerging practice areas (AOTA, n.d.). According to Muffly and Gerney (2015) OT is in the unique position to create a sensory integration protocol for survivors of sexual trauma. It is based in this theoretical tradition that OT is well positioned to serve the needs of this population.

Furthermore, the literature supports the effectiveness of OT in vocational rehabilitation or “improving and developing the work-related skills needed to attain employment” (Inman et al., 2013, p. 61). OT based vocational rehabilitation was shown to be effective with female victims of domestic violence (Helfrich & Rivera, 2006) and with women suffering from mental health issues (Inman et al., 2013): both are marginalized populations that display the same symptoms as women trafficked for sex.

Method

Research Question

How do women who have been sex trafficked perceive returning to the typical work environment?

 

Photovoice Qualitative Approach

Photovoice, a qualitative research method in which the participants take photographs that best describe their lived experiences, aims to (1) convey the concerns of a community (2) facilitate discussion on areas of concern and (3) inform lawmakers to make social change (Wang and Burris, 1997). One of the benefits of using photography as a means for data collection is that it is a universally accessible tool with no literacy prerequisites. The use of a photograph helps participants convey an experience that words alone cannot do justice (Brunsden & Goatcher, 2007). During the discussion portion of data collection, photographs help the participant recall details about an experience (Crang, 1997). Something as tangible as a photograph has been seen to have a relaxing effect on the participant, particularly when discussing topics that can be discomforting (Hazel, 1995). When photographs and language are combined it becomes a “powerful tool” in understanding the lived experience of another (Smith & Osborn, 2003, p. 47). Photovoice methodology is sensitive to the needs of marginalized populations because it invites participants to take an active and collaborative role in the research process.

Phenomenology Qualitative Approach

Phenomenology examines the meaning and structure of a phenomenon in order to derive its underlying meaning or essence (Moustakas, 1994; van Manen, 1990). In a collaborative effort, both the participant and researcher examine and reflect on the participant’s perspectives and lived experiences to ultimately describe a deeper understanding of the “what” and “how” of a larger phenomenon.

Pairing Photovoice Methodology with a Phenomenological Approach

Smith and Osborn (2003) recommend analyzing both visual and verbal data collected through photovoice methodology using a phenomenological approach. Photovoice enables researchers to view perceived issues and solutions through the participant’s perspective. A phenomenological framework focuses on capturing and synthesizing “levels of meaning” derived from transcripts (Smith, 1995, p. 48). The use of a phenomenological framework adds credibility to our study. Pairing both approaches will result in a better understanding of the participant’s perspective of the phenomenon of returning to work.

Participant Selection

Participants met the following criteria for inclusion: (a) female; (b) at least 18 years old; (c) history of being trafficked for sex; (d) interested in taking photographs about employment interests, pursuits, seeking and acquisition; (e) willing to be interviewed and (f) able to demonstrate a clear understanding and use of the English language. Adult females were the focus population of the study because a staggering 80% of those trafficked are women and girls (U.S. Department of State, 2006) and the legal age to provide informed consent in a research study is 18 years old.

Snowball sampling, a technique used to acquire participants through a point of contact that has access to socially isolated populations (Atkinson & Flint, 2004), was implemented to recruit six participants (see Table 1 for participants’ demographic information and Table 2 for information about participants’ previous work experience as well as current school and work status). We sent emails to professional and personal contacts throughout Los Angeles, Riverside, San Bernardino and San Diego counties inquiring about facilities that work with survivors of sex trafficking. Once informed of these facilities (e.g. recovery homes, transitional housing, drop-in resource centers) we emailed the sites directly with a description of our study and asked permission to recruit participants from the site. Letter of supports were secured and recruitment materials included IRB approved flyers and email templates.

Ethical Considerations

The research design protected and minimized the potential risks to this population. Prior to the beginning of research, approval from the Institutional Review Board (IRB) of California State University, Dominguez Hills was obtained. Informed consent was obtained from all participants and they were assured of their right to withdraw consent and stop participation at any time without penalty or loss of incentives. Pseudonyms were used to protect participant confidentiality. Participants were advised to obtain verbal and written photographic consent before taking any photographs of others in order to protect the privacy and rights of individuals featured in the participant’s photographs. When photographic consent from the person(s) featured in the photographs was not obtained, their identifying features were pixelated to preserve anonymity. All research data was kept on a password-protected flash drive that was used exclusively for this study and viewed on a password protected computer. All research materials were kept confidential from all others except the investigators of this research, stored in a locked cabinet when not in use, and will be destroyed one year after the research has concluded.

Table 1

 

Participant Demographic Data

 

Pseudonym Age Race Highest education level Number of years trafficked Time in recovery (months)
Ads 20 Caucasian Some college 4.3 5
Beverly 23 African American GED 8 9
Ladybug 23 African American High school 9 1
Michelle 21 Filipino High school 5 10
Robin 25 Asian/Caucasian Some college 3 3
Sophia 20 African American GED 3 7

 

 

 

 

Table 2

 

Participant School and Work Data

 

Pseudonym Previous work experience Current school status Current work status
Ads Fast food, volunteering,

sign holder

Looking into

courses

Not looking; not working
Beverly Fast food, telemarketer,

in-home care

Enrolled at a

community college

Not looking; not working
Ladybug Customer service, retail,

call center representative

Looking into

vocational programs

Not looking; not working
Michelle Receptionist,

call center representative

Enrolled at a

community college

Looking; not working
Robin Retail, barista Enrolled at a

community college

Not looking; not working
Sophia None Enrolled at a

community college

Not looking; not working

Participants were recruited from two residential recovery programs based in San Diego County: Alabaster Jar Project and Generate Hope. Alabaster Jar Project provides a drop-in resource center, transitional housing as well as educational and vocational opportunities for survivors of sex trafficking. Generate Hope, a Christian faith-based organization, provides housing and services to survivors of sex trafficking with the ultimate goal of reintegration into society and empowerment (Generate Hope, 2016).

As an incentive, each participant received a $60 Target Gift Card for their participation. Calvary Chapel Murrieta, an Inland Empire based church invested in combatting human trafficking, donated the gift cards. All other research related costs (i.e. disposable cameras, postage, and film development) were covered in full by the researchers.

Data Collection

Participants contacted the researchers via email or phone call, at which point their eligibility was determined through a preliminary screening. Three meetings were conducted with participants, each lasting approximately 1 hour, held at a mutually agreeable location, and audio-recorded. The study took place over a period of two months.

An introductory meeting was held with individual participants to explain the purpose of the study, collect basic demographic information, obtain informed consent, and conduct photovoice training. Due to the sensitive nature of discussion topics and the likelihood of it causing the participant emotional discomfort, we provided them with a list of mental health resources.

Photovoice training consisted of explaining the general structure of photovoice data collection, photographic consent, and use of a disposable camera. We provided participants with a disposable camera and a list of occupation-based guiding questions for photo taking: (a) What jobs are you interested in? (b) What is your dream job? (c) How can you prepare for your dream job? (d) How do you feel about looking for work? (e) What motivates you to work? (f) How do you feel about work? (g) What helps you in finding a job? (h) What challenges do you face in finding a job? (i) What would help you in keeping a job? (j) What challenges you in keeping a job? Participants were given one week to take the photographs and instructed to return the camera to the researchers in a prepaid mailer for photo developing.

After the photographs were developed, the second meeting took place with individual participants. Participants led the interview by reviewing their developed photographs and choosing five to contextualize during the semi-structured interview. A detailed description and meaning of each photograph was elicited using the guiding, open-ended questions provided in the “PHOTO” technique (Hussey, 2006) as well as additional probing questions. For each of the five photographs the participant was asked (a) Describe your picture. (b) What is happening in your picture? (c) Why did you take a picture of this? (d) What does this picture tell us about your life? (e) How can this picture provide opportunities for us to improve your life? (Hussey, 2006). A few weeks after the second meeting, participants attended a final meeting to give feedback on their experience, confirm the study’s findings, and collect their photographs.

Data Reduction and Analysis

Wang and Burris (1997) stated that photovoice methodology describes participants as providing the foundation for analysis by participating in a three stage process of selecting, contextualizing, and codifying. This begins with the participants leading the way by choosing several photographs to focus on. Next, the participants contextualize the photographs. Contextualizing involves creating a narrative of the photo through group discussion; however, other researchers have completed this step in an individual setting (Desyllas, 2014; Fritz, & Lysack, 2014; Tomar, & Stoffel, 2014). Our study used an individual format for the contextualizing portion to protect the participants’ confidentiality and sensitive stories.

Following the individual interviews, researchers used phenomenological data analysis (Moustakas, 1994). The researchers implemented bracketing, through journaling and discussing their personal experience with the phenomenon in order to (a) minimize bias and preconceptions and (b) increase their understanding of the participants’ lived experiences. Horizonalization, or the compilation of significant statements made by the participants, was conducted. These significant statements were then transformed into clusters of meaning, which helped develop the overarching themes later used to describe the phenomenon. The reduced data created a textural description (i.e. “what” phenomenon the participants experienced) and a structural description (i.e.”how” the participants experienced the phenomenon). These descriptions helped the researchers identify the underlying structure, or essence, of the phenomenon. During the final meeting with the participants, researchers used member checking to verify the findings.

Results

Using the phenomenological analysis of the data the first step was to derive significant statements from the interview transcriptions (see Appendix A). The significant statements represent the participants’ descriptions of the phenomenon under study: returning to the typical work environment. The second step was to extract clusters of meaning from the significant statements (see Appendix B). From those clusters of meaning, common themes arose (see Table 3) and are elaborated below. After reviewing all of the data, an exhaustive description of the data was formulated (see Appendix C).

Table 3

 

Common Themes: Perception of Returning to Work

 

1.     Transition is a challenging process

a.     Work preparation is perceived as beneficial to their recovery.

b.     Participants perceive work as something they need to get ready for and find work preparation to be difficult and slow.

2.     Past influences the present

a.     Creates a fear of failing

b.     Decreases motivation to pursue, acquire, and perform effectively at work

3.     Value a positive work environment

a.     Non-judgmental of their background

b.     Accommodations for their mental health needs

c.     Atmosphere of teamwork

4.     Desire meaningful outcomes

a.     A career will provide personal fulfillment through independence, happiness, altruism, empowerment, and life balance.

b.     A career is believed to result in a better quality of life and is viewed with optimism and hope.

 

Transition is a challenging process

Recovery mindset. As recovery home residents, all of the participants interviewed were

in the midst of a major life transition and their recovery experience provided one context for their perception of work. Their vision for work in the future differed from what they had experienced in the past. They described themselves as in the process of building a new life with a new career. All participants expressed that the process of preparing for a career, work preparation, was part of growing and moving forward toward a better life in the future and part of their recovery.

Participants made a clear distinction between a job and a career. They associated a job with their past, short term thinking, and just getting by; whereas, they associated a career with their future, long term thinking, and fulfillment. Robin remarked, “in the past, I got so overwhelmed with the job that I wasn’t focusing on any of my long term goals.” Many participants reported wanting to own their own business in the future. Overall, developing this “new mindset” that is future-oriented was emphasized by most participants and important to their perception of returning to work.

 

Figure 1. “I don’t wanna just work like I want a career…I want a fulfilling career, exciting career, a career where I could expand and go to higher levels” (Beverly).

 

            Work preparation. Most participants described themselves as not working by choice. Their decision to forego work was intentional because they felt that they needed to become ready to return to the typical work environment. Participants described personal healing and education as important elements of their work preparation. Sofia captured the overall feeling of being unready to return to work and her focus on personal healing in her description of herself as a disassembled puzzle.

Figure 2. “This symbolizes me putting my life back together. Me moving forward with my life from my past and just figure out a new me. These puzzle pieces represents me as a person. Each piece is something I have to pick back up from the old life or something new I have to add to my life…There’s a lot of pieces that I have to put together” (Sophia).

All participants described education as an important part of work preparation. Beverly stated “I feel that education is extremely vital to expanding in a career and to expanding horizons and branching out and stuff like that. I feel that education is extremely valuable.” The majority of participants were enrolled in community college courses and those who were not enrolled were looking into courses and vocational programs.

Participants described the overall process of work preparation as “difficult.” When elaborating on the challenge of furthering their education or acquiring work they described work preparation as triggering anxiety and a fear of failing. Sophia described her anticipation of returning to school: “I doubt myself a whole lot and put myself down because I feel like I’m not smart enough. That’s a big part of my limitation day to day. Me just starting school I’m already afraid of the idea of being in school and learning this thing that I’m interested in, but I’m afraid at the same time…I have bad anxiety.”

For participants, work preparation was sometimes an agonizingly slow process. Most participants described a desire to “get it done faster” and attributed it to the fast pace of their previous lifestyle. They described their changing mindset from one of instant gratification to long-term thinking as part of their struggle with preparing for work.

Figure 3. “I see the future…I’m optimistic about the future but I’m thinking about how can I get to the future faster and that’s when I tend to go on the left side…The left side is fast money…The right side is just being humble like knowing that things take time” (Ladybug).

Participants described work preparation as sustained by their own perseverance and resilience. When reflecting on the process, participants shared the recurrent urge to escape the challenge. They spoke of feeling the temptation to give up working toward a career and get a “stupid job” where they could simply get by. Several participants used the term “hanging in there” to describe the feeling of persevering. Robin stated, “I just feel like if I just keep going and I don’t fail because that would mean that I’m dumb. I hate this, so I just keep hanging on and hoping that eventually it’s gonna come through, eventually I’m gonna have something to show for it.”

Past influences the present

Memories of being overwhelmed or anxious during past work experiences as well as feeling inadequate and lacking confidence created the perception of not succeeding in returning to a typical work environment.

Figure 4.“I don’t feel adequate. Intellectually I’m capable. I’m starting to become capable emotionally or mentally because I’m learning to manage my anxiety, but I still have this nervous feeling because of my history, because of my lack of work experience, because of my background, because of all these other factors” (Beverly).

Several of the participants shared that they have been diagnosed with mental health disorders, such as anxiety, PTSD and bipolar disorder. Participants reported feeling overwhelmed at work as a result of the negative impact of their mental health disorder on their ability to function in the work environment. When asked about her previous typical work experiences, Ads replied, “last time I had a job my anxiety got too high and I couldn’t deal with it…I was overwhelmed and I couldn’t focus and I’d yell at people…I don’t feel like I’m moving fast enough and then I feel like I’m moving too fast and then I just like break down….I just like leave…I just like walk out.”

Low self-confidence, brought on by a lack of work experience and education, in addition to feelings of inadequacy decreased their motivation to pursue, acquire and perform effectively at work. Sophia expressed how her past influenced her present situation in returning to work, “Just like having a resume with nothing on it. Not having any experiences. Not having any background of anything. That’s what kind of stops me in applying for jobs because I don’t know what to tell them.

Value a positive work environment

Non-judgmental attitudes toward their background, accommodations for their mental health needs and an atmosphere of teamwork were all perceived by participants as valuable components they would want to have in a typical work environment.

            Accepting. A work environment in which managers and co-workers are non-judgmental of both their sex trafficking history and their mental health diagnoses was highly valued. The participants spoke of what the typical work environment previously felt like for them. “People don’t understand it. People don’t get it. They’re like ‘Whoa! What do we do with you?’” (Ladybug).

Figure 5. “I have a record that is not pretty. There’s a lot of judgment made when you see…prostitution or loitering or soliciting or anything like that…so it’s just difficult” (Beverly).

The participants’ past typical work experiences shaped their thinking of the qualities they would look for in future colleagues. For example, when one participant was asked what they would look for in a manager she responded “someone who is there…to help you…to build you up…even if they gotta do a little criticizing… I’ll be able to take that from them as long as they are there and I see them frequently. That’s important” (Michelle). Participants expressed a hope for coworkers and employers who are safe people, helpful, encouraging, and honest.

Accommodating. The participants want to be assured that their future work environment is sensitive to their mental health needs and works with them in order to make reasonable accommodations. They expressed that their apprehension over returning to a typical work environment stemmed from past work experiences in which they were alienated by their employers. One participant shared how she wants to feel comfortable enough with her future employer to disclose her mental health needs in order to have access to accommodations that would support her work performance. “I would probably disclose that I suffer from bipolar disorder…and how we can go about [it] so that I’m still useful…and not hurting the company” (Beverly).

Fosters teamwork. Most of the participants highlighted the importance of teamwork within the work environment. One participant expressed the challenges in dealing with people and connected a positive work environment with teamwork. “I think everything about a co-worker is challenging because I’m working on my people skills that I don’t have yet…everyone is on their own and yet together as a team and that’s the kind of vibe and energy where I want to be at. Where everybody is as a team” (Sophia).

Desire meaningful outcomes

Participants expressed a desire for personally meaningful outcomes through work. They viewed their future career with optimism and hope and a conviction that work would result in a better quality of life. Participants expected outcomes of returning to work included personal fulfillment through independence, happiness, altruism, and empowerment as well as life balance through the daily structure and routine created by work.

Independence. Participants expressed a desire for independence and described work preparation and securing a career as a means to achieve it. Sophia remarked, “It’s teaching me to be independent and to think more of myself. It’s like I’m learning to be more independent. Because it’s just me and this book having the courage and the strength do this on my own.” Participants also described a career as evidence of achieving financial independence and meeting responsibilities. Michelle stated, “I’m a mom… so just having that mother-daughter relationship with my daughter [and] a nice home of my own.”

Figure 6. “I can have money in my hand and it’s my very own money” (Ads).

 

Happiness. Participants connected a career with happiness. They described interest and happiness as key considerations in choosing a career path and often described feeling happy when engaging the task in the past or anticipated that the activity would bring them happiness at work. Sophia described why she chose computer programming as her future career, “It’s just amazing how you can program a computer and have it do what you want it to do. So me when I was making that website I was like a little kid. I can do this and do that. I’m happy when I’m on the computer and I’m happy that I can program it. I don’t know… it just makes me happy.”

Altruism and empowerment. Most participants identified giving back to others as an important aspect of work and some specified working for a non-profit organization that helps survivors of sex trafficking as a potential career. Michelle described her desire to help others through work, “If you work for a non-profit organization seeing how it impacts people’s lives and how much you can help another person. I love to help others and be there and help out how I can. Whether it’s time, through my words, motivating them. There’s always ways to help others, not always financially, but be a good mentor to them.” Other participants described giving back to others as a means of empowerment. They described becoming more empowered as a person by telling their “story” and empowering others to leave the life they left behind. Sophia described her sense of empowerment, “I’ve been in a world full of myself and my selfish needs and I’m no longer that person so I want to be able to take what I know and to help others.”

Life balance. Participants expressed the belief that work would provide a daily structure and routines that would bring balance into their life. They felt structure was particularly important during the initial stages of returning to work. Most participants described their struggle to achieve balance as difficulty with staying organized, establishing a routine, and following a routine. Sophia described herself as “on the spontaneous side” and felt that work would provide consistency in her life: “I think it’ll be pretty good because before I get to that point. I’ll be able to know what a nine to five look like and know what a structured schedule look like, so if I go off on my own I’ll know the main points of things.” When speaking of their future career, participants emphasized independence in structuring their time.  Robin stated, “I could work freelance. I could pace myself. Work my own hours.” Participants who expressed a desire to own their own business spoke of the freedom to structure their own time as important to being able to balance their responsibilities and live a more “settled” life. Overall, a structured work environment was perceived to be a means of teaching and establishing daily routines in the beginning of their return to work and instilling habits that would enable them succeed and maintain life balance in more flexible work environments that they anticipated in their careers.

Quality of life. Participants described the most important outcome of work to be a “better life.” They described a career as a means to achieve a higher quality of life and found that vision to be motivating during work preparation.

Figure 7.“The big one that motivates me is seeing where I come from and where I can be headed and where I can be at. Coming from my background of being in the life to being somewhere else in a new life and my family it motivates me” (Sophia).

When discussing the past and the present, participants emphasized financial security and earning money by working a job as means to quality of life, yet in the long term participants emphasized the personal fulfillment that they anticipated a career would bring as more valuable than income. Beverly stated, “I just want a better quality of life than what I’ve had so far and I think that if I find a career that I would enjoy doing I think that would set me up for success.”

Trustworthiness

Several efforts were employed to ensure the trustworthiness of this research data. Wang and Burris’ (1997) photovoice methodology of having the participants undergo photovoice training (i.e. discussion of the purpose of the study, cameras and ethics) and participatory analysis (i.e. select, contextualize and codify photographs) was used to enhance the credibility of the study. Additionally, Hussey’s (2006) “PHOTO” acronym was used to facilitate the semi-structured interview. To enhance the transferability of our study, a detailed description of our recruitment efforts, inclusion criteria, participation procedure, and data reduction and analysis plan was included in our Methods section. To enhance the dependability of our study, field notes were taken throughout the research process and all interviews were audio recorded. To ensure the confirmability of our study, member checking was conducted at the end of data analysis (Hoffart, 1991).

Discussion

The findings reveal that even though the process of returning to work is perceived as overwhelming and complicated by their past, survivors nevertheless optimistically pursue returning to work in order to achieve independence and meaning in their life. Consistent with the literature, survivors experienced anxiety, low self-esteem and a distorted self-concept (Hom & Woods, 2013; Macy & Johns, 2011; Muftić & Finn’s, 2013). Survivors revealed how the negative emotional sequelae experienced after trafficking directly influences their motivation and perception of not being able to succeed in returning to a typical work environment. Descriptions of their pursuit, acquisition and performance at work as being difficult confirms the need for developing job-related skills in this population (Macy & Johns, 2011; Pandey, Tewari, & Bhowmick, 2013). Concurrently, the participants perceived returning to work in a career, not just a job, as a means to achieve desired outcomes, such as independence and a better quality of life. Evidence of posttraumatic growth (PTG) was not highlighted in sex trafficking literature but was substantiated by the participants’ descriptions of their expectations for personal growth and resilience. The findings highlight the role of vocational skills training in increasing the participant’s’ chances of successfully returning to work, achieving their desired outcomes, and decreasing their likelihood of being re-trafficked (Macy & Johns, 2011; Zimmerman et al., 2011).

Questions for Future Research

Future research is needed to address the unique needs of this population when returning to the typical work environment. The findings of this study highlight specific areas of research that would close gaps in sex trafficking literature and identify specific areas for OT to address when providing therapy for this population. Areas of focus for future research include

  • occupation-based training for life and work skills essential to survivors functioning effectively in the typical work environment;
  • occupation-based interventions to restore, establish, and maintain survivors’ mental health, so that they feel ready to cope with the demands of a typical work environment;
  • performance patterns, such as habits and routines, that support survivors in work preparation, acquisition, and job performance;
  • specific performance skill deficits that create a barrier to survivors functioning effectively in the typical social environment of a workplace; and
  • specific performance skill deficits that create a barrier to survivors meeting the performance demands of the typical work environment.

A discussion of these topics would substantiate the need for the development of occupation-based interventions and programs to improve outcomes for survivors as they return to work.

Limitations

Although the data collected details the participants’ perspectives on returning to a typical work environment, it is not generalizable to survivors outside of this sample of participants recruited from the two residential recovery facilities in San Diego. Some participants expressed uncertainty of how to take pictures to convey their experiences. In this case, researchers collaborated with participants to brainstorm ideas for photo taking; however, it is unclear how this additional step influenced photo taking or the content of the interviews. Two limitations also arose given that the participants were living in a confined setting: (1) possibility of sharing ideas and collaborating on photo taking with other residents; and (2) limited ability to take photos outside of the recovery home. These factors may have influenced the subject matter of the participants’ photographs. The length of time between when the photos were taken and the interview may have affected their recollection; therefore, influencing their photo narratives. Another limitation was the use of disposable cameras. One participant expressed concern over not being able to view whether or not the picture came out the way she intended to (e.g. brightness, clarity). The majority of participants’ pictures came out blurry or too dark, while some photos could not be developed. There are several factors that may have affected the quality of the photos: improper use of the cameras (i.e. not using the flash); damage to the cameras (i.e. exposure to heat) and the development process (i.e. film is outsourced to a third party and not developed on site). Some of the participants were disappointed with the quality of the photos, which may have affected their mood. In some cases, missing photographs may have influenced the depth of the content shared during their interview.

Implications

The findings of this study suggest a role for OT to support females who have been trafficked for sex in their return to work. Previous literature emphasizes the need for client-centered, trauma-sensitive, comprehensive (Macy & Johns, 2011), community-based, and prevention oriented (Gronski et al., 2013) recovery services for this population: all of which fall under the scope of OT practice. OT theory recognizes meaning as central to engagement in occupations, which positions OTs to take a unique intervention approach to survivors’ recovery needs in the area of work (AOTA, 2014). The participants’ perception of their return to work emphasizes the importance of meaningful occupations in the recovery process, which is minimally described in sex trafficking literature. Intervention that emphasizes functional routines using the Model of Human Occupation or the Person-Environment-Occupation Model may improve survivors’ occupational performance in work (Kielhofner, 2008; Law, Cooper, Strong, Stewart, Rigby, & Letts, 1996). This study highlights the potential for OTs to provide both life and work skills training to this population in order to reduce survivors’ likelihood of being re-trafficked.

 

 

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Appendix A

Significant Statements: Perception of Returning to Work

1.     Finding a career that I enjoy will set me up for success and give me a better quality of life than what I’ve had so far.
2.     I don’t wanna just work like I want a career.
3.     It just makes me happy.
4.     In the past, I got so overwhelmed with the job that I wasn’t focusing on any of my long term career goals.
5.     Now it’s the time in the healing process and there’s growth and I’m able to get back to working.
6.     I do force myself to do certain things so that when opportunities come I’ll be ready.
7.     Gotta speed up the process and get it done now!
8.     I also have a little bit of hope because I know that I can…redeem myself.
9.     I feel that education is extremely vital to expanding in a career.
10.  I need community before I’m able to go all back out in the world on my own.
11.  I have no connections and I know they’re important.
12.  I’m already afraid of the idea of…learning this thing that I’m interested in.
13.  We’re going to have to get our butts out there and persevere.
14.  I’m pretty resilient with a lot of things.
15.  I just keep hanging on and hoping that eventually it’s gonna come through.
16.  Many days I feel like giving up and I feel like I’m not worth the effort.
17.  I’m not going to succeed.
18.  It’s just difficult.
19.  The only stressful part is thinking about going to a job interview again. I get super nervous.
20.  There’s a lot of judgment made when you see you know prostitution or loitering or soliciting on a background check.
21.  I would just have to have an employer who’s willing to take a chance.
22.  Work is really fast paced and I get super anxious when things go fast.
23.  Last time I had a job my anxiety got too high and I couldn’t deal with it.
24.  I don’t know if I’m going to be able to work.
25.  I think looking for work there’s a level of a lack of confidence because of my background.
26.  Right now I’m not confident in looking for work.
27.  I’m inadequate.
28.  I hate looking for jobs. I’ll always find a stupid job.
29.  Co-workers didn’t know how to treat me.
30.  Bad attitudes from coworkers.
31.  I think everything about a coworker is challenging.
32.  My coworkers were safe people.
33.  Someone who is there to help you.
34.  Someone who builds you up, but give constructive feedback on performance.
35.  Everyone is on their own and yet together as a team.
36.  They would tell me the truth, the hard truth.
37.  I want to feel like I’m progressing with my life, growing, and moving forward.
38.  A desire for something better motivates me to work.
39.  I’m still optimistic.
40.  I’m pretty excited because now I know what I want to do.
41.  Work will make me feel independent.
42.  I can have money in my hand and it’s my very own money.
43.  I want to be able to empower other people and myself.
44.  It would be my way of giving back.

 

 

 

Appendix B

Clusters of Meaning: Perception of Returning to Work

1.     A career was defined as fulfilling, making them happy, enjoyable, interesting, and as an arena where they can expand; whereas, a job was seen as a distraction from not focusing on any long term goals.
2.     Getting back to work and being ready for opportunities was perceived as taking time as well as with a sense of urgency for they want to get it done now and speed up the process.
3.     Being ready for work included redeeming themselves through education and being able to be out in the world on their own which is achieved through personal healing, growth, community, and making connections.
4.     Even though they are afraid of the difficult process of work preparation and acquisition, they persevere, are resilient, and plan to hang on until their long term career goals come through.
5.     Feeling like they’re not worth the effort makes them feel like they’re not going to succeed and many days they feel like giving up on their long term career goals.
6.     Work acquisition is stressful because going to a job interview makes them nervous and employers make judgments when they see their prostitution background: the hope that an employer takes a chance on them by giving them a job keeps them going.
7.     Feeling overwhelmed by previous jobs because they were too fast paced and they couldn’t deal with the anxiety makes them question if they’re going to be able to go back to work.
8.     Low self-confidence in looking for work, because of their background, feeling inadequate, and hating looking for jobs decreases their motivation to look for work.
9.     Coworkers and employers are perceived as not knowing how to treat them, having bad attitudes, and they anticipate it being challenging to work with them.
10.  Coworkers and employers who are safe people, will help them, build them up, work as a team, and tell them the hard truth are hoped for in the future.
11.  A career is part of growing, moving forward, and progressing toward a better life than what they’ve had in the past and it motivates them to return to work.
12.  Knowing what they want to do makes them they optimistic, excited, and have hope for their future careers.
13.  A career would be a source of empowerment, positive human connection, happiness, success and independence.
14.  Work would be a way to give back and empower others.

 

 

 

Appendix C

Exhaustive Description: Perception of Returning to Work

Survivors’ perceive returning to work as a challenging transition that is integral to their recovery, moving forward, and personal growth. They feel that they need to become ready for work through personal healing and education, yet they find work preparation to be difficult and slow, want to speed up the process, and often experience anxiety and a fear of failure alternately with excitement. Reflecting on memories of being overwhelmed or anxious during past work experiences as well as feeling inadequate and lacking confidence create the perception of not being able to succeed in returning to a typical work environment. Non-judgmental attitudes toward their background, accommodations for their mental health needs and an atmosphere of teamwork are perceived as valuable components of their future work environment. Overall, survivor’s view their future careers with optimism and hope, and returning to work in their chosen career is perceived to be something that will provide them with personal fulfillment described as independence, happiness, altruism, empowerment, and life balance, and ultimately provide a better quality of life than what they have experienced in the past.

 

 

 

Appendix D

Letter of Permission

Claudia G. Peyton, Ph.D., OTR/L, FAOTA

Primary Investigator

Department of Occupational Therapy

WH A-320D College of Health, Human Services, and Nursing

California State University, Dominguez Hills

1000 E. Victoria Street, CA 90747

Office Phone: (310) 243-3067

 

July 22, 2016

 

RE: LETTER OF PERMISSION

 

Dear Claudia G. Peyton:

 

Alabaster Jar Project supports Jazmin Bolduc and Kaylynn Esguerra’s research project entitled Understanding How the Lived Experiences of Female Survivors of Sex Trafficking Impact Work: Employment Interests, Pursuits, Seeking, and Acquisition and agrees to have you conduct your study in our facility.

 

As a facility that offers a Drop-in Resource Center, transitional housing and vocational opportunities for survivors of human trafficking in our community, the individuals we provide services to may meet the eligibility criteria for this study.

 

We understand that the research process will entail recruitment of participants, collection of demographic data and photo narrative interviews by survivors of sex trafficking receiving services from Alabaster Jar Project. We are open to having the collection of data and interviews take place at our facility.

 

We understand that enrollment and participation is purely voluntary and all participants will be fully informed of the project details before they sign up for the study. If they sign up and decide later on that they no longer want to participate, they can withdraw at any time.

 

Alabaster Jar Project supports the potential value of the research project informing and guiding the practice of long term service providers for this population, specifically Occupational Therapists.

 

Sincerely,

Signature

Name and Position

Date

 

 

Appendix E

Email Template for Participant Recruitment

Dear Research Candidate,

Thank you for your interest in participating in our research study. My research partner and I are Occupational Therapy graduate students at California State University, Dominguez Hills (CSUDH). Occupational Therapists (OTs) work with individuals experiencing challenges with personal care, work, education, home and financial management, leisure activities, and socializing. OTs help individuals recovering from an illness or trauma return to these meaningful activities. We are conducting research on the recovery experience of survivors of sex trafficking in the area of work.

The benefit to you, the participant, will be the chance to get your voice heard. Survivors of sex trafficking face a long recovery road towards physical, mental and emotional health as well as establishing self-sufficiency (i.e. work). How you are navigating through your recovery process is of importance to us. We would like to know what supports or barriers you face in becoming self-sufficient in order to inform Occupational Therapists of the areas to focus on when working with survivors of sex trafficking.

Requirements to participate:

  • You must be (a) female; (b) at least 18 years old; (c) history of being trafficked for sex; (d) interested in taking photographs about employment interests, pursuits, seeking and acquisition; (e) willing to be interviewed and (f) able to demonstrate a clear understanding and use of the English language

 

Expectations for participants:

  • First Meeting: 1 -1 ½ hours
  • We will collect basic demographic information (i.e. age, ethnicity, highest level of education completed, number of years trafficked, short life narrative).
  • We will provide you with a disposable camera. Over the course of 2-3 weeks you will take pictures to answer the following questions: (a) What jobs are you interested in? (b) What is your dream job? (c) How can you prepare for your dream job? (d) How do you feel about looking for work? (e) What motivates you to work? (f) How do you feel about work? (g) What helps you in finding a job? (h) What challenges do you face in finding a job? (i) What would help you in keeping a job? (j) What challenges you from keeping a job?
  • Second Meeting: 1 -1 ½ hours
  • During this meeting, you will share your story behind the photographs you took.
  • Third Meeting: 1 – 1 ½ hours
  • During this meeting, we will share with you our research findings and give you the opportunity to verify its accuracy.
  • Participation is voluntary and you may withdraw at any time
  • Interview times and locations will be held at your preferred location when possible
  • You will be compensated with a $60 Target gift card for your completion of the study.

We would like to touch base with you in regards to the project either via phone or email, whichever works best for you. We look forward to hearing from you.

 

Sincerely,

Jazmin Bolduc & Kaylynn Esguerra

jbolduc1@toromail.csudh.edu

(951) 436-6053

 

 

Appendix F

Letter of Funding

Claudia G. Peyton, Ph.D., OTR/L, FAOTA

Primary Investigator

Department of Occupational Therapy

WH A-320D College of Health, Human Services, and Nursing

California State University, Dominguez Hills

1000 E. Victoria Street, CA 90747

Office Phone: (310) 243-3067

 

September 6, 2016

 

RE: LETTER OF FUNDING

 

Dear Claudia G. Peyton:

 

Calvary Chapel Murrieta will donate Target Gift Cards as incentives for Jazmin Bolduc and Kaylynn Esguerra’s research project entitled Understanding How the Lived Experiences of Female Survivors of Sex Trafficking Impact Work: Employment Interests, Pursuits, Seeking, and Acquisition.

 

As an incentive, each participant will receive a $60 Target Gift Card for their participation.

Calvary Chapel Murrieta cover one hundred percent of the cost for the incentives.

 

All other research related costs (i.e. disposable cameras, postage, and film development) will be covered in full by the researchers.

 

Calvary Chapel Murrieta is invested in combatting human trafficking. For several years, we have hosted the Justice Matters Conference which aims to raise awareness and educate people on how they can become involved in anti-human trafficking efforts.

 

Calvary Chapel Murrieta supports the potential value of the research project informing and guiding the practice of Occupational Therapists meeting the long term rehabilitation needs for this population.

 

Sincerely,

 

Name and Position

 

Date

 

 

Appendix G

Recruitment Flyer

Appendix H

Photograph Release Form

I give permission for my photograph(s), both in printed and electronic form, to be used in publications and presentations for educational purposes.

Date:

Printed name:

Signature:

Witness:

*Will turn in other 4 participants Photo Release Forms as soon as we receive them

 

 

Appendix I

Guide for Taking Photographs

Take photographs to answer these guiding questions:

  • What jobs are you interested in?
  • What is your dream job?
  • How can you prepare for your dream job?
  • How do you feel about looking for work?
  • What motivates you to work?
  • How do you feel about work?
  • What helps you in finding a job?
  • What challenges do you face in finding a job?
  • What would help you in keeping a job?
  • What challenges you from keeping a job?

Guidelines

  • We advise to NOT take photos of individuals but if you are to take pictures of a single person, you must have their verbal and signed consent (Photograph Release Form).
  • Please use all the exposures on the camera.
  • Return the camera in the pre-paid, addressed envelope as soon as possible but no later than DATE:
  • When you mail the envelope EMAIL or CALL either Jazmin or Kaylynn so we know to be expecting it

 

 

Appendix J

Demographic Data Form

Date:

Pseudonym (Fake name):

Age:

Ethnicity:

Highest level of education completed:

Number of years trafficked:

Tell me about yourself:

 

 

Appendix K

Individual Dialogue Session Guide

The individual dialogue session will be around the participant’s photographs. It will last approximately 1 – 1 ½ hours and will be audio-taped and transcribed.

  • Each participant will choose 5-10 photographs to discuss
  • The questioning acronym PHOTO will be used to contextualize the meaning of each of the participants’ chosen photos
  • The acronym PHOTO (Hussey, 2006) asks the following:
  1. Describe your Picture?
  2. What is Happening in your picture?
  3. Why did you take a picture Of this?
  4. What does this picture Tell us about your life?
  5. How can this picture provide Opportunities for us to improve life?

 

 

 

Appendix L

Individual Debriefing Session Guide

The individual closing session will center around member checking the researcher’s findings with the participant. It will last approximately 1 – 1 ½ hours and researchers will take notes.

  • Summarize initial findings.
  • Is there anything that you would like to clarify about the findings?
  • Is there anything that you would like to add to the findings?
  • Would you like to discuss anything about the research process that you just completed?
  • Do you have any questions?

 

 

Appendix M

California State University, Dominguez Hills

Consent to Act as a Research Subject

 

Understanding How the Lived Experiences of Female Sex Trafficking Survivors

Impact Work

 

You are being asked to participate in a research study. Before you give your consent to volunteer, it is important that you read the following information and ask as many questions as necessary to be sure that you understand what you will be asked to do.

 

Investigators: The investigators of this research study are Jazmin Bolduc, who has a Bachelors’ of Arts in History from California State University, San Marcos and Kaylynn Esguerra, who has a Bachelors’ of Science degree in Child Development from California State University, Dominguez Hills. The person supervising the research is Claudia Peyton, Ph.D., OTR/L, FAOTA. We are all working within the Occupational Therapy Masters Program in the School of Health and Human Services Department at California State University, Dominguez Hills.

 

Purpose of the Study: The purpose of this study is to understand how the lived experiences of female survivors of sex trafficking impact work: employment interests, pursuits, seeking and acquisition. The study will use photovoice methodology to elicit narratives from up to seven participants about employment interests, pursuits, seeking and acquisition. All participants must be female; at least 18 years old; have a history of being trafficked for sex; interested in taking photographs about employment interests, pursuits, seeking and acquisition; willing to be interviewed; and able to demonstrate a clear understanding and use of the English language.

 

Description of the Study: Once you have contacted us with an interest to participate, a preliminary screening to determine eligibility will occur either via phone call or email. The questions asked during the screening will be the inclusion criteria: (a) female; (b) at least 18 years old; (c) history of being trafficked for sex; (d) interested in taking photographs about employment interests, pursuits, seeking and acquisition; (e) willing to be interviewed and (f) able to demonstrate a clear understanding and use of the English language. If you are not eligible to participate, the information obtained during the screening will be omitted from the study and shredded to protect your privacy. If you are eligible to participate, the procedure for participation will include attending three meetings, each lasting approximately 1 – 1 ½ hours and held at a mutually agreeable location. This study will take place over a period of 1 – 2 months.

 

The first meeting will be an introductory meeting in which the purpose and procedures of the project will be explained. You will be given a disposable camera and a list of questions to help guide your photo taking: (a) What jobs are you interested in? (b) What is your dream job? (c) How can you prepare for your dream job? (d) How do you feel about looking for work? (e) What motivates you to work? (f) How do you feel about work? (g) What helps you in finding a job? (h) What challenges do you face in finding a job? (i) What would help you in keeping a job? (j) What challenges you from keeping a job? In the event that your camera is lost or broken we will replace it for you. You will be given 1 week to take the photographs. After you take your photographs, you will send the camera back to us in a prepaid mailer.

 

After we develop the photographs, the second meeting will take place. This meeting, will be an individual session in which you will choose which photographs you would like to share and we will facilitate that discussion using guiding, open-ended questions: (a) Describe your picture (b) What is happening in your picture? (c) Why did you take a picture of this? (d) What does this picture tell us about your life? (e) How can this picture provide opportunities for us to improve your life?

A few weeks after this second meeting, we will meet for a final meeting for you to give feedback on our summary of your comments to be sure we understood what you said.

 

Risk or Discomforts: The main risk involved in this study is psychological: feeling some discomfort or embarrassment when talking about personal life experiences during the individual sessions. When answering the personal questions asked on the Demographic Data Form and sharing your photo narratives you may remember some unpleasant memories. You do not have to share or discuss anything you do not wish to talk about. You are free to stop the questionnaire and/or dialogue either temporarily or permanently. The potential risk of taking photographs to describe your life experience may cause you to feel a loss of privacy. Your photographs will not be used without your consent. It is important that others’ privacy and rights are also respected. You will be advised to always obtain verbal and signed consent (i.e. photo release form) before taking any photographs of other people. You will be supplied with a list of contacts for psychological support should you need additional support following participation in the study.

 

Benefits of the study: The benefit to you, the participant, will be the chance to get your voice heard. Survivors of sex trafficking face a long recovery road towards physical, mental and emotional health as well as establishing self-sufficiency (i.e. employment). How you are navigating through your recovery process is of importance to us. We would like to know what supports or barriers you face in becoming self-sufficient in order to inform Occupational Therapists of the areas to focus on when working with survivors of sex trafficking. However, there is no guarantee that you will receive any benefits from your participation.

 

Confidentiality: All preliminary questionnaires, recorded interviews, transcribed interviews, hand-written notes, and any other relevant information will be kept on a password-protected flash drive that will be used exclusively for this study and viewed on a password protected computer. Only the investigators and the supervisor of the research will have access to any and all information pertaining to this research. All research material will be stored on the flash drive, in a locked safe, and destroyed one year after the research has concluded. All participants will have an opportunity to review the transcribed interview prior to use by the investigators. Confidentiality will be maintained to the extent allowed by law. As mandated reporters, we are required by the law to report threats and/or incidences of harm to self or others (e.g. suicidal thoughts, homicidal thoughts, and/or abuse), to the appropriate authorities.

 

Incentives to Participate: You will receive a $60 Target gift card for your participation and one set of photographs. If you discontinue participation before completing the study you will be compensated for your time (i.e. attends 1 meeting $20, attends 2 meetings $40, attends all 3 meetings $60).

 

Voluntary Participation: Participation in this study is voluntary. Your choice of whether or not to participate will not influence your future relations with California State University, Dominguez Hills. If you decide to participate, you are free to withdraw your consent and to stop your participation at any time without penalty or loss of benefits to which you are entitled.

 

Questions about the Study: If you have any questions about this study or your rights as a participant, you may call investigator Jazmin Bolduc (951) 436-6053, Kaylynn Esguerra (310) 415-7935, or the Institutional Review Board for the Protection of Human Subjects at California State University, Dominguez Hills, (310) 243-3756.

Your signature below indicates that you have read the information in this document and have had a chance to ask any questions you may have about the study.  Your signature also indicates that you agree to be in the study and have been told that you can change your mind and withdraw your consent at any time.  You have been given a copy of this consent form.  You have been told that by signing this consent form you are not giving up any of your legal rights.

 

 

Name of Participant (please print)

 

 

Signature of Participant    Date       

 

 

Your signature below indicates that you are giving permission to audio/video tape your responses.

 

 

Signature of Participant    Date       

 

_________________________________________________________________

Signature of Investigator    Date

 

Subject recruitment and data collection may not be initiated prior to formal written approval from the

California State University, Dominguez Hills Institutional Review Board

 

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