U.S.

Department of Health and Human Services,

Office of the Assistant Secretary for Planning and Evaluation

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CASE MANAGEMENT AND THE VICTIM OF HUMAN

TRAFFICKING: A CRITICAL SERVICE FOR CLIENT SUCCESS

Heather J. Clawson, Ph.D. and Nicole Dutch, B.A

I. STUDY OVERVIEW restrictions of available federal funding to

this population.
This is the fourth in a series of Issue Briefs
produced under a contract with the U.S. II. LEGISLATIVE BACKGROUND
Department of Health and Human Services AND UNDERSTANDING THE NEED
(HHS), Office of the Assistant Secretary for FOR CASE MANAGEMENT
Planning and Evaluation (ASPE), to conduct
a study of HHS programs serving human The Trafficking Victims Protection Act of
trafficking victims. Funded in the fall of 2000 (TVPA) recognized the importance of
2006, the purpose of this exploratory project providing benefits and services to victims of
is to develop information on how HHS human trafficking. Initially, emphasis was
programs are currently addressing the needs placed on the needs of international victims
of victims of human trafficking, including who were largely understood to be either
domestic victims, with a priority focus on undocumented or in possession of marginal
domestic youth. This project also consists legal documentation related to their presence
of reviewing relevant literature, and in the U.S., thus making these individuals
identifying barriers and promising practices generally ineligible for most major benefit
for addressing the needs of victims of programs. Specifically, Congress wanted to
human trafficking, with a goal of informing ensure that trafficking victims were treated
current and future program design and humanely and had access to assistance. To
improving services to this extremely this end, international victims were to be
vulnerable population. treated the same as refugees for benefit
eligibility purposes. That is, international
This issue brief focuses on the importance of adult victims of human trafficking who
case management in working with receive an HHS letter of certification are
international victims of human trafficking eligible to apply for benefits and services
from the point of identication until a victim under Federal or state funded programs, to
reaches self-sufficiency. This brief looks at the same extent as refugees. Services
the characteristics of an effective case include refugee cash, medical assistance,
manager along with the benefits not only to and other social services. International
victims but also to other key stakeholders, minor victims do not need to be certified but
including law enforcement and service instead receive a letter of eligibility from
providers. This brief also examines the HHS and are then eligible to apply for a
challenges to effective case management similar range of services, including the
and the implications for victim recovery. Unaccompanied Refugee Minor program.
While much of the information presented in
Subsequent reauthorizations of the TVPA
this issue brief may also apply to the case
recognized domestic trafficking victims and
management of U.S. citizen and legal
their needs for service, in particular
permanent resident (or “domestic”)
residential facilities for domestic youth. No
trafficking victims, the focus is more
resources have been appropriated to
directly on international victims due to the
implement or provide services to domestic
victims. Instead, the legislative assumption
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seems to have been that domestic victims having a central case manger is viewed by
would have better access to various service providers and law enforcement
mainstream programs (e.g., child protective representatives as a critical service not only
services, foster care, runaway and homeless for the victim but also for other service
youth programs, Medicaid, etc.) by nature of providers and agencies involved in a
their citizenship or legal permanent trafficking case. Victims of human
residence.
“We meet the clients where they are both
While the process for becoming eligible for emotionally and physically. We act as their
and accessing benefits and services may be safety net, sometimes we are the only ones
there for them.”
laid out in the legislation or guidances of
Case Manager
agencies, it is not well-known or understood
by victims of human trafficking, whether “Informal support networks will grow over
international or domestic. So how do time but until then, these victims are isolated
victims navigate through this process? How and in most cases, only have us [case mangers]
do they learn about their rights as victims? to depend on for support.”
How do they obtain the necessary Case Manager
documentation and complete the required
forms in order to access the services that
they need? This is where the role of the case trafficking often interact with multiple
manager becomes critical throughout the systems and their representatives, such as
duration of a case, whether the victim is law enforcement, prosecutors, immigration
male or female, an adult or child, or attorneys, medical providers, mental health
international or domestic. professionals, shelter/housing providers,
child care providers, public benefits
III. THE ROLE OF THE CASE personnel, employers, and landlords. This
MANAGER can be overwhelming for victims, especially
international and minor domestic victims
The National Association of Case who are unfamiliar with U.S. systems and
Management (2008) defines case are dealing with the trauma of their
management as “a professional practice in trafficking experience.
which the service recipient is a partner, to
the greatest extent possible, in assessing In addition to serving as a single point of
needs, defining desired outcomes, obtaining contact, a central case manager can assess a
services, treatments, and supports, and in client’s need for services and support;
preventing and managing crisis.” This identify, obtain, and coordinate those
collaborative process is intended to promote services for the client; coordinate and
quality of care and cost-effective outcomes manage communications across systems;
that enhance the physical, psychological, and serve as a liaison for the client. Other
and vocational health of the participant. At functions of the case manager include:
the center of this “We’re [Case translating for the victim or obtaining
process are the case Managers] the ones translation services; accompanying clients to
manager and the that act as the hub appointments; assisting/teaching clients to
client. and refer to others access public transportation; and in some
and help them get cases, teaching clients basic life skills.
While many agencies settled; and help Sometimes this includes teaching clients
provide case them work with law how to use kitchen appliances or how to
management as part enforcement while
make a phone call.
of their menu of their case is being
investigated.”
services for
trafficking victims, Case Manager
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For many case managers the most important trafficking victim requires more of my time
service provided to their clients is general than 25 of my domestic violence cases.”
support. This can be in the form of
answering a call in the middle of the night Some agencies find it difficult to retain
from a client who has experienced a qualified case managers because the
nightmare, or spending an afternoon sitting compensation is low and the demands of the
with a client to keep them company because job are high. Many smaller agencies report
they are afraid to leave their apartment out struggling with the structure of some
of fear of being identified by the trafficker. funding streams. For example, the per-
Offering reassurance and comfort to clients capita funding available under the ORR
often occupies much of a case manager’s Anti-Trafficking Services Subcontracts is
time, but it is essential in building trust and based on reimbursement for services and can
rapport with the client. In fact, many pose challenges for agencies without diverse
providers and law enforcement funding streams or large infrastructures to
representatives note that the case mangers support staff during “downtimes” (i.e., low
are often the first and sometimes the only client referrals). Larger agencies are able to
person a victim trusts. support case managers under other funding
streams and often have case managers
IV. CHALLENGES, LIMITATIONS, working with different victim populations
AND BENEFITS TO CASE whereas some of the smaller agencies, often
MANAGEMENT specific to human trafficking, have not been
able to diversify their funding. This has
Given the multiple roles of the case manger resulted in some agencies needing to move
and the comprehensiveness of the case to part-time case managers; a challenge
management services required by most given the 24/7 responsibility of their job
trafficking victims, it is not surprising that with some victims.
case management comes with some
challenges and limitations. However, those in the field recognize that
the current per-capita funding is intended to
The Challenges and Limitations be a more efficient use of limited resources
than previous funding streams in that it
Resource Limitations. One of the most allows for the provision of services to
common challenges reported by service victims “anytime, anywhere” throughout the
providers is the limited resources available country, and ensures an efficient use of
to support case management services. Those limited resources. But it may take time for
working with victims have described case some agencies to figure out how to work
management as a 24/7 responsibility. While within the various reimbursement systems.
case managers admit this is not true of all
victims, it does appear to be the case when Although there are challenges, HHS has
one first begins working with a victim and recognized some of these limitations and
during critical points, such as following made resources available to fund case
depositions, appearances in court, management services for international
application renewals for benefits and victims. For domestic victims, however, the
services, and reunification. This intensive lack of comprehensive case management has
and sometimes unpredictable need for not yet been addressed. According to law
support and assistance by international enforcement and service providers, this
victims specifically, limits the size of the remains a critical problem in need of
case load a case manager can effectively resources to begin to solve. Domestic
carry. As one case manager stated, “My one victims have to rely on case management
services offered through what are described

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as already overburdened systems, such as managers are viewed as setbacks to
the child welfare system and domestic recovery.
violence and youth shelter programs.
Availability of Services. Regardless of the
Length of Service Eligibility. Although it type of service sought, the role of the case
is possible to get exceptions from funding manager in helping victims’ access services
agencies, case managers note that time is viewed as essential for both international
limits associated with some types of and domestic victims. Unfortunately,
services, such as the 8 months for refugee accessing certain services can be a challenge
cash and medical assistance, are often not in many communities. Specifically, service
sufficient to move a client from “crisis to providers report limited availability of
thriving.” According to service providers, emergency and permanent housing (in
pre-certification can take more than a year particular for men and children), mental
and post-certification resources requiring health services, and dental services. When
month-to-month approval are limited in services are available, there are often long
duration. There is general recognition in the waitlists or significant costs associated with
field that significant time, and thus the services.
resources, are needed to build trust with
clients, move them into recovery, and help Additionally, access to culturally-
them become self-sufficient. It also often appropriate services, including providers
takes time to convince victims to cooperate who can communicate with clients in their
with investigations and prosecutions, and/or native languages, are limited. While case
for law enforcement agencies and officials managers themselves did not report
to determine that a trafficking crime has problems communicating with clients, either
occurred. directly through multi-lingual staff or
indirectly through the use of translation
Staff Burnout and Turnover. Case services, other benefit or service agencies
managers are characterized as dedicated, that clients were referred to often lacked
committed individuals who are overworked these capabilities.
and underpaid. As a result, staff burnout
and ultimately staff turnover are significant Access to Information. Another significant
problems for many agencies. Many case challenge identified by case managers is
managers’ report experiencing secondary or limitations to information sharing among
vicarious trauma. Unfortunately, they also providers and with other agencies.
acknowledge that they have very little time Specifically, issues of confidentiality are
to take care of themselves. Not only did this often identified as barriers to keeping clients
affect the case managers, but victims often informed about their legal case and, in some
experience changes in case managers as a cases, medical diagnoses or results. As the
result. Given the time needed to establish liaison for the client, some case managers
trust with the victims and the importance of report finding themselves in difficult
the relationship between the case manager positions where the client expects them to
and the victim, these changes in case have the information they need and when
they cannot provide answers to the client, it
“This is a major issue. It is more than burnout is the case manager who is viewed as the
and compassion fatigue, it’s worse. This type of
“bad guy.” This creates issues of distrust,
work is hard and the staff get stressed. And
what is in place to support the staff? Nothing. which ultimately can cause setbacks in the
We need to find ways to help staff address client’s progress toward self-sufficiency.
secondary trauma. For example, I would like to
be able to offer my staff a day off or a small
token to show how much they are appreciated.”
Service Provider
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Benefits of Case Management for prosecutors describe trafficking cases as
Victims, Law Enforcement and victim-dependent. That is, the testimony of
Prosecutors the victim or victims is essential to the
success of the case. It is not surprising,
Despite these challenges, case management then, that case management and case
is viewed as a critical service that has managers play an important role for the
benefits not only for the victim, but for other prosecution.
stakeholders in this fight against human
trafficking. V. PROMISING APPROACHES TO
EFFECTIVE CASE MANAGEMENT
Benefits for Victims. First and foremost,
the case manager is seen as critical by Agencies that work with victims of human
service providers, law enforcement, and trafficking have identified several promising
victims themselves as helping the victim approaches to case management for these
move toward self-sufficiency. Through victims that other agencies can adopt.
educating victims of their rights, helping
them understand and navigate through our Culturally Appropriate Case
criminal justice, immigration, and human Management and Services. Culturally
service systems, identifying and making appropriate case management services and
appropriate referrals, assisting victims in support can include education regarding the
accessing services, advocating on behalf of culture and religious beliefs of potential
the victim to other providers and agencies, clients to ensure their initial contact with the
and providing moral and emotional support, case manager is a positive and appropriate
the victim can focus on his/her recovery. experience. Additionally, this preparation
and education can assist a case manager
Benefits for Law Enforcement. The case with the assessment of the victim’s needs
manager is viewed as critical in helping (e.g., knowing how to ask for information
stabilize the victim to assist in the that might be sensitive or taboo in some
investigation by providing services and cultures). A case manager can also use
support that are beyond the means and knowledge of a client’s culture and
expertise of law enforcement. This results background to help identify appropriate
in victims who are able to share, more services. As one case manager stated, “You
quickly, with the officers, information that can’t tell if a service or program is culturally
can aid in an investigation and, in some appropriate from the yellow pages. You
cases, the apprehension of the trafficker. need to meet with the providers, in some
Additionally, for many in law enforcement, cases, offer them training on the issue of
the case manager is viewed as a “timesaver” human trafficking, and ensure that they can
for the officer. That is, law enforcement offer culturally sensitive services.”
officers note that having a case manager Case managers acknowledge that they
from the outset who can work with the cannot expect a client to follow a service
victim frees up the officer to conduct the plan successfully if it is not developed with
investigation. consideration of the client’s background.

Benefits for the Prosecution. According Client-Specific, Flexible Approaches.

to some Federal agents, the case manager is Another promising approach noted by case
the one constant for victims throughout the managers is to work with clients from where
process of the investigation and prosecution. they are and move them toward self-
For the prosecution, this source of stability sufficiency. Specifically, case managers
for the victim translates into a more indicate that it is important to be flexible and
consistent and credible witness. Some start where the client is most comfortable

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instead of making assumptions about the criminal prosecution component) is
client and his/her abilities. For some case essential.
managers, a promising approach to moving
clients toward self-sufficiency includes Additionally, having a single, central point
teaching clients how to do things for of contact within each agency providing
themselves rather than doing too much for services for victims of human trafficking is
them. While there are some clients that viewed as an essential promising practice to
need more hand-holding than others (in ensuring seamless delivery and effective
particular during the pre-certification phase), communication across all agencies,
there has to be a gradual decrease in case including law enforcement.
manager involvement to reduce dependency
on the case manager and other service Self-Care for the Case Manager. Finally,
providers. Yet, all service providers note an overall theme across service providers,
that the timeline toward self-sufficiency although it is not always in place, is support
varies by client, and therefore a single for the case managers (and other service
approach to case management does not work providers). The long hours, emotional
with this population. commitment, and vicarious trauma
experienced by many case managers needs
Collaborating with Others. A consensus attention. Case managers report
across providers is the importance of experiencing stress, frustration, and
working collaboratively with other agencies difficulty providing the level of service and
to address human trafficking adequately and support needed by their clients. They need
effectively to meet the needs of victims. the time to deal with their own reactions to
Case managers note that collaboration is these cases, whether this includes an
essential to helping victims. This includes opportunity to talk to a mental health
collaboration among case managers from professional or just some time off. Any
different agencies who are providing agency providing case management to
services to victims, collaboration between victims of human trafficking needs to
case managers and law enforcement, and examine its policies and practices related to
collaboration between case managers and secondary or vicarious trauma experienced
attorneys. Through formal memoranda of by its staff.
understanding; information-sharing
protocols; and shared policies, practices, and
Ingredients for Effective Case Management
procedures, some agencies have begun to
work effectively together while recognizing ƒ Establishing a hopeful relationship with
their boundaries or limitations. the client;
ƒ Assessing client strengths and needs;
Consistent, Central Case Manager. The ƒ Developing, in partnership with the client,
importance of assigning a single case a service plan to achieve desired outcomes;
manager for each victim of human ƒ Locating, linking, and following up with
trafficking is shared across service providers needed services and support;
and law enforcement. Given the difficulty ƒ Monitoring, coordinating, and adjusting
services and supports to achieve desired
of building trusting relationships with
outcomes;
victims, the more change or turnover in case ƒ Providing crisis prevention and
managers the more difficult it is to make intervention services and support; and
progress with clients. Assigning a single ƒ Advocating for the client.
case manager to each victim from the time
of referral or identification until the closure Extracted from the NACM Web site,
of all aspects of the case (e.g., service www.yournacm.com/definition.html
component, immigration component,

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VI. SUMMARY

Case management services are vital to a

victim’s road to recovery. While faced with
challenges and limitations, service provider
agencies and case managers have found
ways to overcome these barriers through
promising approaches to effective case
management. Consistent, compassionate,
culturally competent and dedicated case
managers are offering comprehensive case
management services and support to victims
of human trafficking and are producing
positive results for their clients and funding
agencies, as well as benefiting law
enforcement.

The issue briefs in this series and the final

study report can be downloaded from the
following Web sites:

http://aspe.hhs.gov/hsp/07/HumanTrafficki
ng/
http://www.icfi.com/markets/social-
programs/

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