The Trauma They Carried, with Dr. Jordan Greenbaum

Teresa Huizar:
Hi, I’m Teresa Huizar, your host of One in Ten. In today’s episode, “The Trauma They Carried,” I talk with Dr. Jordan Greenbaum, director of Global Child Health and Well-Being Initiative at the International Center for Missing and Exploited Children and an expert on child sex and labor trafficking.

Years ago, few Americans—even in the field of child abuse—knew or understood child sex trafficking. The media portrayed it as a problem “over there” someplace, far from our shores. Now we know that child sex trafficking is both a global problem and a local one, one that affects children and youth who come across our borders, and youth in schools right down the street.

What makes children vulnerable to trafficking, and those who cross our borders especially vulnerable to it? How do we identify those at risk? How do we address the trauma and pain victims of trafficking have survived and carry with them? And perhaps most critically, now that we do know better, how do we do better on this issue? Join me as I discuss these critical issues with Dr. Greenbaum. Take a listen.

Teresa Huizar:
Welcome to One in Ten, Jordan. Thanks for joining us.

Jordan Greenbaum:
Thank you so very much for having me. I feel honored.

Teresa Huizar:
How did you come to this work, especially with human trafficking, child sex trafficking, those kinds of things? What brought you to this?

Jordan Greenbaum:
For a long time, I’ve been a child abuse physician at a children’s hospital—Children’s Healthcare of Atlanta, so was medical director of the child protection program for many years. It became very obvious to me, about 10 years ago that, there was a lot of child trafficking going on in Atlanta, as everywhere else, and that this really was a child protection issue. And it wasn’t something that we could just say, oh, that’s something else.

This was in our wheelhouse and we needed to address it and become involved. And so I began reaching out and trying to get as involved as I could with task forces and learning from others in the community. And it just sort of took off from there.

Teresa Huizar:
You know, I feel like this is an area where in the last 10 or 15 years, there’s been so much more public awareness around this issue. And, even more awareness on the part of child abuse professionals, that we have a long way to go. We’ll talk about that in a minute. But I’m just wondering, what do you think really shifted public perceptions about this?

Jordan Greenbaum:
I think the media became involved, and their media portrayal of sex trafficking concentrated on children—specifically girls in sex trafficking. And I think the public was easily brought into it. It was very, sort of, something that everybody could feel bad about and want to do something about it. So it was easy to, to accept as: This is a problem. We’ve got to do something about it. So everybody kind of became involved.

Teresa Huizar:
I mean, I remember when some of the first stories broke, they focused on sort of international child sex trafficking. So you would see specials that were on something that was going on in Thailand or kids who were coming over the border. And I think that one of the things that had to shift in public perception is that it happens here, too. This is not primarily an international problem, that we have our own domestic child sex trafficking problem. I’m wondering what else you think are misperceptions that still exist, maybe, among the public or among child abuse professionals, as it relates to child sex trafficking.

Jordan Greenbaum:
I think that there are persistent misperceptions about who is at risk, and we tend to continue to concentrate on adolescent girls. And we need to broaden our horizons and think more about all populations who may be at increased risk, including boys, LGBTQ youth, younger children, children in specifically vulnerable populations like Native American populations, for example. We also really need to be thinking about labor trafficking and broadening our view from just sex trafficking to seeing all types of trafficking. And I think that’s the next big step for Child Advocacy Centers and the health care, mental health care world, is to take that next step, as well as the step of recognizing that children, especially unaccompanied minors who are coming across the border, and other immigrant families, are at very increased risk of both labor and sex trafficking and really need to be acknowledged and to have services offered to them.

Teresa Huizar:
Well I want to unpack this a little bit, because I think that you’ve mentioned several very important things that we want to clear up, you know, that people may have misunderstandings about. One, I think it’s interesting, this issue about age range, that it really covers a much broader spectrum.

And also the issue that some folks that we might not perceive initially as at risk probably are. And I’m just wondering what you see about that in terms of socioeconomic status. I know that here in [Washington,] D.C., the D.C. area, a few years ago, a story broke about sex trafficking that was happening out of suburban schools and fairly affluent neighborhoods.

And it kind of shook up the local community to go: Ah, there are people who are at risk, who we might not have thought were at risk. Do you see that same sort of thing playing out elsewhere, where people have begun to understand that risk factors just don’t relate to poverty, no poverty, or those types of things?

Jordan Greenbaum:
Yes. I think it’s a slow realization, but it’s becoming more apparent, especially as we realize that a lot of recruitment and manipulation of children into the sex trafficking world occurs online.

Teresa Huizar:
Right, right.

Jordan Greenbaum:
And that knows no socioeconomic boundaries because kids are online a lot. And so they can be very vulnerable no matter what socioeconomic level their family is in.

And I think it becomes more apparent that this is truly a broader thing. If you look globally, of course, poverty is a huge push factor.

Teresa Huizar:
Of course.

Jordan Greenbaum:
And I’m not saying that that’s not an issue, but I think, as you’re saying, we’re realizing more and more, that it’s much more than that.

Teresa Huizar:
That it’s more complex than we thought and not strictly an economic issue, that’s driving it.

Jordan Greenbaum:
Yes.

Teresa Huizar:
So for those people who may not be as familiar with risk factors, you know, now that there has been more research on what places individuals at risk for being trafficked, particularly sex trafficked, you know, what are those risks?

Jordan Greenbaum:
Well, I think it helps to look at risk factors through a socioecological model.

So if you look at some risk factors, they really apply to the individual person who’s experiencing the trafficking. And there are certain things like a past history of abuse, sexual abuse or physical abuse or neglect raises that child’s risk. Homelessness, runaway status, are individual risk factors. And then there are risk factors that are within interpersonal relationships, close to the child, the family and the peers. So for example, a dysfunctional family where there’s intimate partner violence or caregiver drug use, or there’s peer bullying, or friends who are involved in commercial sex, or gangs. Those are all interpersonal risk factors that render a child more vulnerable.

And then there are also risk factors at the community level that really literally put everyone in the community at risk. So for example, I think a very sort of obvious one would be children who are living in a community where there are a lot of sex venues, adult sex venues, where there is an active transient male population, a military base, for example, or gold mine or construction, or something where there’s a lot of transients.

Teresa Huizar:
Oil fields, that kind of thing.

Jordan Greenbaum:
Oil fields. Yeah. So, community factor. It’s a tourist area, puts kids at risk in tourist areas. And then what is really important to look at, I think, is the societal level of our cultural beliefs and our cultural attitudes and practices that really marginalize some people. And think about the xenophobia associated with having kids or adults coming across the border.

And most people are marginalized. Anyone who’s marginalized—the minute we’re marginalized, we’re vulnerable because we don’t have the same opportunities that everybody else does. And so we’re put in places where we have very limited options and are forced to accept very risky situations. So that, and homophobia, transphobia, gender bias are all cultural issues that render large groups of people at risk.

Teresa Huizar:
I think you just pointed out something so important about marginalization being a critical risk factor in and of itself. And that that’s an umbrella that’s sort of overarching that as child abuse professionals, we can pay some attention to, as opposed to strictly looking at individual factors among other things.

I’m wondering about—and you know I’m thinking about, particularly, although not exclusively, individuals who are coming over the border. And I’m wondering about the intersection between sex trafficking and labor trafficking. Do you see lots of overlap between those two things in the same population?

Jordan Greenbaum:
I think there is tremendous overlap.

What we do see often are children coming from Central America who are threatened by gangs in their home country or en route. And the threat is you join our gang and you sell drugs, or we kill you or we hurt you or hurt your family. And so the child is essentially forced to do illegal activities like drug running, and so that’s forced labor. And then there also may be sexual exploitation as well. So there’s a lot of overlap children who may be in domestic situations—live-in nannies or housekeepers can also be sexually exploited. So there’s a lot of potential overlap. And I think that that’s certainly a big risk factor for—both labor and sex trafficking are very big risk factors for children who are trying to come across the border, especially those who are unaccompanied, because they’re extremely vulnerable.

Teresa Huizar:
One of the issues that, you know, involves both trafficking issues and xenophobia and other kinds of things is this sort of deep lack of empathy in our culture for people who are essentially economic refugees or political refugees or whatever might drive someone out of their home country and makes them particularly vulnerable to these types of exploitation.

And I’m going to ask you a very difficult question that I don’t really expect you to necessarily have an answer to, but I’m just curious about what you think about that as you reflect on it, having worked with these populations so long. What drives that lack of empathy? I mean, it just feels so appalling to me and it feels like it’s grown some, this othering of these populations, and it’s hard for me to make sense of it. So I’m hoping you’ll help me out.

Jordan Greenbaum:
And I’m just speaking for my own self. And I don’t know, it’s an extremely difficult question. I suspect that some of it is fear, fear that outsiders are coming in and we don’t know them. We don’t feel like we can trust them. Perhaps they mean us harm. They might take our jobs. There may be some fear to that. And just sort of an ongoing sort of sense that other people are not to be trusted.

It renders these kids so very vulnerable because they have so many needs. And the way I really see that Child Advocacy Centers could change that we could do so much for these kids if we sort of advocate for them. If we do what we did with child sex trafficking 10 years ago, if we do that now with children who are unaccompanied minors coming into the country who have been exposed to incredible trauma. If we take that on and say, “Yeah, that’s in our wheelhouse, we need get involved. And these kids need services, and they need culturally appropriate services. And we’re going to advocate for them.” Think of what that could do. The child advocacy movement’s huge, it could really have an impact.

Teresa Huizar:
Oh, absolutely. And you know, why do you think, I mean, I certainly think there are border CACs that certainly welcome in these kids and serve them and serve them well. But as you say, I think there’s also this perception that it’s only at the border, right? That this is not something that extends beyond that. “That’s that problem down for Texas and other people that deal with it. That’s not a problem. That’s not something that we all need to be paying attention to.”

Jordan Greenbaum:
Such a good point.

Teresa Huizar:
I’m just wondering—I can tell how passionate you are about this. So what do you see specifically as the ways in which Children’s Advocacy Centers and other child abuse professionals who may be on multidisciplinary teams can be most helpful with this vulnerable, vulnerable population.

Jordan Greenbaum:
So glad you asked, because I just hope this sparks some more ideas. These are only mine and it’s only the beginning. But I think there are things that we can do. So for example, a lot of these kids have been exposed to sexual violence, sexual assault, sexual abuse in their home country, sexual assault on the way here, gang violence, other physical abuse, tons of community violence.

So they’re terribly traumatized. But all of this has happened outside the country. So when they get here, the police are not necessarily going to get involved because these are crimes that have happened somewhere else. So in general, a lot of CACs will say, well, we get our referrals from law enforcement and child protective services. So these kids are kind of left out. So what I think we could do is say, by God, these kids need us as, as much as anybody else does, what can we do to provide services to address some of that historical trauma that may be only two months old by the time they get to their sponsor city, which could be anywhere in the United States.

Teresa Huizar:
Yes.

Jordan Greenbaum:
They need the offer of mental health services. In some cases they need a good forensic exam because they haven’t had one.

Teresa Huizar:
Yes.

Jordan Greenbaum:
They need support for all of these things that admittedly did not happen in the United States. But that doesn’t matter. It’s still traumatizing. So I think that if Child Advocacy Centers could say, “OK, we have to figure out how this is going to work. We’ve got to make this work because these kids need us.” And if we could also be aware of community resources. So for example, if you’re a CAC in New Jersey, let’s say, and you have a family, a sponsor who has a child, uh, and they come to you and they say, “Well, my child speaks Spanish.” Maybe you don’t have a Spanish counselor, but at least the Child Advocacy Centers could say, “Well, we know of all the resources around us and we can plug you in to this refugee center and that mental health center.” So you could sort of act as liaisons to help guide sponsors, to get their children services. It’s overwhelming. If you think about it, you’re sponsor of a child, you may be undocumented yourself. You may not have a good command of the English language. And so suddenly you get this child, with a list of, you know, “Oh, by the way, if you want to, you know, hook up with some resources. Here’s a list.” They’re overwhelmed with that.

Teresa Huizar:
They’re never getting it to that list. And even someone who’s not from another country is not going to ever get there based on a list, right? So.

Jordan Greenbaum:
But if they could somehow make it to the CAC and we could then say, “OK, let’s sit down. What can we do for you?” I don’t know. What do y’all think?

Teresa Huizar:
Well, one of the things that I think is that a lot of CACs, I think one reason they haven’t become more involved is because they worry about—it may be true that law enforcement and CPS aren’t initially involved. There’s no child protection issue. You know, there’s no, this happened in another country. But they’re worried about bringing in the involvement of law enforcement. Not because they don’t trust their own team partners, but because that may alert someone with about undocumented status and those kinds of things.

And I think, you know, not to go too political here, but I think particularly during the last administration, there was a lot of fear about that.

Jordan Greenbaum:
Absolutely.

Teresa Huizar:
About having unintended consequences—

Jordan Greenbaum:
Exactly

Teresa Huizar:
— and making someone’s life worse than it already was. And so I’m wondering, because you do have a lot of experience dealing with these families, what’s your advice to aCAC or other, you know, group of child abuse professionals who really do want to help and maybe have felt constrained in the past for whatever reason. And clearly don’t want to make the situation worse. What’s your advice about how to go about that work responsibly?

Jordan Greenbaum:
I think that’s such a great question, and you’re absolutely right. There has been, and there still is, concerns about the unintended consequences. But I’m wondering—two things, whether the CAC within its own establishment could say to each other and the staff get together and say, “How can we help these children without involving law enforcement? If law enforcement is not going to investigate, maybe we don’t even involve them. We just provide services. So is there a way that we can safely provide services to these families where we are not putting them at risk for deportation?”

Another suggestion might be, and I, you know, I don’t claim to have the answers, but I’m interested in it. So. What if we had a task force among the national CACs, and a bunch of us got together and said, “OK, how are we going to make this work? This is what we want, how are we going to do that? And what’s realistic?” Because CACs all over the country have very different resources.

Teresa Huizar:
Absolutely.

Jordan Greenbaum:
We can sort of say, you know what, a relatively low resource CAC, what can they do? What can a high resource CAC do? And then maybe come up with some ideas and disseminate them.

Teresa Huizar:
Are you finding that people generally do present for care? I think your setting is a little different, and that when people have a health care issue, they come to a hospital and they think of it as a safe place generally to seek help.

I think that many CACs around the country are not connected with hospital systems in that way. And so, you know, certainly outreach becomes more important as a part of that. And so what are you seeing for those that are not connected? I mean, they’re connected in the sense that they have a health care provider, but they’re not located within a hospital system. Families may not present for care in the same way. How are you seeing that they’re identified—not just trafficking victims, but those who are at risk of it—how are they being identified? Because this is an issue, whether it’s unaccompanied minors or anyone else, it came up in a survey that we did last summer, we were really asking: What’s preventing you from serving victims of child sex trafficking and folks who were the subject of child pornography. What’s keeping you out of that if you have a desire to serve that population?” And what we had, what we received most was CACs just feeling like, “I don’t know how to identify those kids,” you know? And so I know there are certainly screening tools and other kinds of things, but what’s your best advice about folks who just feel kind of stymied? They think, “This is a smaller population. I don’t see these cases very often. How do I even know where to start?”

Jordan Greenbaum:
I think it’s very difficult because the few screening tools we have are not necessarily validated for this population of unaccompanied minors. So we don’t know exactly how to identify. And you know, most CACs don’t just sort of take phone calls from the family saying, “I want to get help.” That also presents a barrier. So I think we have to really sit down and think about that. How would that work? Would you encourage perhaps referrals from the local refugee organizations who might have more of an established—

Teresa Huizar:
Other community groups.

Jordan Greenbaum:
A community group. One of the things that kids get hooked up with when they’re discharged from shelters is a federally qualified health center.

Teresa Huizar:
Oh, interesting.

Jordan Greenbaum:
Maybe we need to say to the federally qualified health center, “You need to be the referral to the CAC because the CAC is not going to take it just from the mother calling up.”

Teresa Huizar:
Sure

Jordan Greenbaum:
But a physician or nurse practitioner calling with the same concern about this kid. Would you provide services? Or similarly if the local Latin American association says, “I’m really worried about this child, this family, can you help?”

It’s sort of a different way of thinking for CACs. We’re not used to doing this, but I guess what I’m suggesting—

Teresa Huizar:
Well it doesn’t mean it can’t be done, because we’re not used to it.

Jordan Greenbaum:
Exactly. Exactly. Yeah, I guess I’m just thinking, you know, I’m just—these are my thoughts, but other people have much better thoughts. We just need to think outside the box and figure out how we can.

Teresa Huizar:
Well, I think that the way that it began with CACs receiving referrals from law enforcement and CPS was because there wasn’t a legal framework for them to provide services to kids who were abused without that, that was their in to providing that service.

And I think that makes, you know, complete sense for kids and families that are, you know, dealing with—I mean, there’s, it’s hard to describe, you know, that—and you don’t want to ever call any abuse case “typical,” but you know what I mean. The sort of familial or extra-familial cases that come through our doors every day. But then there’s the other special populations that I do feel like, if it’s not going to have the involvement of law enforcement or CPS, it doesn’t mean that those kids don’t still need help, you know?

Jordan Greenbaum:
You’re right. That’s the fundamental thing. You’re right.

Teresa Huizar:
And we’re the trauma experts. I mean, I guess that’s the other thing that I keep thinking about, is in so many communities, there’s not a wealth of people who understand trauma and how to respond to it. In many, many communities across the country, the CAC is the only entity in that community that has any kind of really trauma-informed wraparound services available. There’s no one else to do it. So that’s something for us to be thinking about as well.

What do you—just put beyond sort of a: We’ve always done it this way. So we have to think about, you know, changing minds and thinking outside the box a little bit—but what do you see as other potential barriers that we should overcome?

Or are they primarily perceptual barriers that we, the type we’ve been talking about, or other kinds of things?

Jordan Greenbaum:
I think the barriers to referrals is such a big one because that’s such an ingrained part of every Child Advocacy Center. It’s sort of the foundation of how they, how they work. It’s how they receive referrals.

So I think that was a barrier and, and I think getting sponsors and families to be able to get the initiative to, to reach out for help. And then we have to get them to reach out to the right people who can refer to the CAC. So it’s almost a three-step process, getting the family mobilized, getting the referral person aware and mobilized, and then getting the CAC ready to provide services. It’s three steps. So we have to look at barriers on each of those.

And I think in many cases, there’s a stigma around mental health issues, PTSD, certainly a stigma around sexual violence. And so it may be very hard for some of these families to say, “OK, we’re going to go out and try to look for some help. That maybe this child’s behavior issues are related to what’s happened to them. So let’s do something about it.” That’s a big leap for a lot of families. And so that might be hard.

Teresa Huizar:
You know, you raise a good point. I mean, there are lots of kids who wind up in counseling because of behavioral issues. And then we discover that it’s abuse driving the behavior issues. And I would expect there to be something there too.

So, I mean, the connection and the importance of schools as a part of the conversation for school-aged children—

Jordan Greenbaum:
That’s a great idea

Teresa Huizar:
And I wonder about faith communities too. I mean, in many cases, immigrants get connected with their faith community fairly early. When they come into a community, they see it as a resource to them. And I think we have found and have talked on this program before to people who have talked about the importance of that connection and CACs doing better outreach to faith communities as a way of helping reassure marginalized communities that CACs are safe places. It just, it feels like we have a systemic problem that needs a systemic response essentially, and some shift in the system in order to accommodate this.

One of the things that I’ve been thinking about in terms of not only serving populations that come over the border, but serving any of these populations well. You know, kids who’ve been trafficked or who are at risk of trafficking. You know, we’ve been meeting for the last however many months, and developing a national standard for accreditation around serving this population. And I have to tell you, I was delighted, but sorry that we didn’t see it sooner, the Core Competencies document that was developed for serving individuals who’ve been trafficked in health care and behavioral health care settings. And I know that you were very involved in that project. Can you, just for our listeners explain a little bit about this project? Because I read it. I thought it was wonderful. And now we’re thinking about how we incorporate that in our work.

Jordan Greenbaum:
Oh, I’m so glad that you found it helpful. So, so about four years ago or so, the National Human Trafficking Training and Technical Assistance Center, HEAL Trafficking, and the International Center for Missing & Exploited Children, [National Association of Pediatric Nurse Practitioners] NAPNAP—a bunch of organizations got together and we started to come up with ideas for improving the general medical and mental health response to human trafficking of adults and children, labor and sex trafficking. And, we felt that we needed to come up with some sort of core competencies that people can say, “If I want to make my program really good, or I want to improve my own care, this is what I need to achieve.”

It sort of outlines the basics that need to be addressed. You have, a high quality response to suspected trafficking. So we created these, this list of core competencies. There are competencies for individual practitioners, medical and mental health professionals. Things like learning about human trafficking and learning about the trauma-informed approach and other things, being culturally sensitive. So those are all direct individual things that I can control.

And then there’s another level of core competencies that are directed at organizations. Hospitals, mental health clinics, for example. And those are things like creating protocols for suspected trafficking, doing community mapping so that you know what resources are available. So when you identify somebody who’s at risk, you can do something about it. You can offer resources. So things directed at the organization, and specifically at CEOs and administrators saying, “This is what you guys need to be doing.”

And then there’s another layer of the core competencies that are addressed for academic researchers and clinical researchers saying, “You know what we have to do to really understand and improve our response to human trafficking is have a really solid scientific evidence-based about what we’re dealing with.” So we need, really need research on these particular areas, resilience—for example—factor, resilience factors, risk factors, health consequences. We need to know, we need to have research on the impact of all of our intervention strategies that we’ve implemented. We need to evaluate our prevention strategies, sort of all these areas of research that we suggest academicians think about if they’re interested in human trafficking research.

And then the last section. So there are four tiers of core competencies. The last one is directed at institutions that train the next generation of medical and mental health professionals: nursing schools, psychology programs, post-doc psychology, medical post-doc programs, medical schools, that kind of thing. Saying these are the things that you need to build into your curriculum to train the next generation so that they’re trauma-informed, culturally sensitive, attuned to human trafficking, etc., etc.

So basically it’s a set of guidelines. And it follows eight different sort of topics of, competency. And it’s suggested that you read through these and you say, “OK, I’m going to, I’m interested in the organizational level.” So maybe you read all the organizational competencies. You’re not going to change every one of them. There must be a hundred, so we’re not going to do that, but you can say, “OK, I’m going to choose two. I’m going to choose that we write a protocol and we do our community mapping. That’s a big askm but I’m going to do that. For the next year, that’s what our organization is going to do.”

And then maybe next year you do something else. So it’s a gradual thing. It’s a constantly improving strategy that we hope will sort of generally bring up the quality of health and mental health care response to human trafficking.

Teresa Huizar:
I feel like for a while it was a little bit like the wild, wild west in terms of human trafficking response. Like everyone was being so creative and trying different things. And of course, a body of research developed, you know, over time and is still developing over that. And what I loved when I read through that document was—first of all, it was the distillation essentially of what the evidence is saying today, about what we ought to be doing. But just, as you say, it was so practical in terms of pointing people to very specific actions that they could take either organizationally, individually, and all of these other ways. And that weren’t really overwhelming. I mean, yes, it’s some work, but so is everything else that we do. Um, and I just—kudos to all of you involved in that project. Because, you know, from revising the Standards, which is a smaller project than what you took on, I will just tell you it’s a monumental task.

Jordan Greenbaum:
It is a monumental task. [Laughter.]

Teresa Huizar:
It’s hard to get agreement among all the different parties, all the different readers, everyone else. And to take that in. I think it’s just wonderful in terms of setting some guidance.

Jordan Greenbaum:
Well, thank you. I learned a lot from the team people. So I just learned a lot from them. So it was great.

Teresa Huizar:
It was great. Let me ask you this: So the document sort of embodies all that you could find agreement around as these types of documents do. What surprised you most? Either in the process of developing it or some consensus that you were able to gain where you’re like, “Wow, I am not sure we were going to get to there, but that’s great.” Or something that you were like,” I wish we could have gotten to there, but I’m kind of surprised we didn’t. And we couldn’t because it’s still a developing issue in the field.”

Jordan Greenbaum:
I was sort of surprised that—because I had felt like you that this is massive amount of information, ideas, efforts, it’s just sort of like a cloud of stuff. And it was sort of amazing to me that we could eventually distill it and say, “This is what we know.” Which was pretty impressive.

Teresa Huizar:
Absolutely.

Jordan Greenbaum:
I mean, in the last 10 years, people have done a lot. And so, you know, kudos to everybody for all their work that, that we could, once we distilled it down and we had a significant number of ideas, that people could build a consensus around. And I guess I’m most excited about the idea that there’s sort of uniform consensus around the whole idea of a trauma-informed, culturally sensitive approach. To me, that’s the whole foundation. And so that, that is so prominent within those core competencies—there’s a universal competency written all the way through it. I was happiest about that.

Teresa Huizar:

One of the things that I was struck by in the document itself is the way in which it was so clear with medical and mental health professionals, that what you’re not trying to primarily do is get people to disclose—

Jordan Greenbaum:
Right.

Teresa Huizar:
—that they’ve been trafficked. And I think some people would find that surprising because they’re so used to asking people questions, to get a narrative, to do something with that, especially mental health professionals. And so I’m wondering whether there was any debate in the group about that, or did you find that consensus emerged early on that with this special population that’s just really not the starting point?

Jordan Greenbaum:
That’s such a great point. I’m glad you brought it up. I think there was consensus among us early on, but I think that it’s a big issue that is surprising to a lot of people and is going to be a major focus  of training that within the medical field and mental health, you’re right, we’re sort of used to asking pointed questions and figuring out the answer. So the idea of maybe asking you about risk and not pushing it is a culture change in the way we do things.

So I think that’s a huge, that’s going to be a big task to change that view, but it’s a very important one. I think we realized that pretty early on amongst the working group.

Teresa Huizar:
You know, I think that one of the things that we’ve seen emerge in among CACs on this issue is I think that’s one of the key surprises to them, you know, because if you think about much of the model of the CAC is the forensic interview as a gateway to other things.

So the fact that some of these kids or youth, it may take a long time for them to be ready for that—if ever—and in some cases, in many cases, it’s not going to be the starting point, for sure. I think just really, it’s not that people were resistant to it once they understand, it’s more than it’s just like, “Oh, I’m going to have to really think about a new starting point and an entirely different way of starting.”

Jordan Greenbaum:
Yes, that’s so true. It is very different than the 8-year-old with sexual abuse where you’re trying to sort of figure out exactly what happened. It’s a different approach in one interview. It’s a very different approach interviewing an adolescent, multiple interviews and sort of looking at the vulnerability factors. You’re right, that’s very different. And I think it’s different among medical personnel as well, because we say, “Well, there’s a screening tool.” And people will say, “Well, yeah, but you get all these false positives, all these kids who are at risk, but they don’t seem to be trafficked.” And my response is: But those kids need the services just as much because they’re at risk.

So the fact that you’re screening and identifying this large group of kids tells us that we need to offer these kids resources, whether or not they’re actually being trafficked. They have a lot of the same vulnerabilities, a lot of the same needs, but it’s sort of different than what we typically do in medicine.

Teresa Huizar: [00:33:23] Well, one of the things that I really appreciated about the document—and it even had an infographic for it, which I think people should go look at—but it was really making clear how a public health model is different. And I think that that’s a useful sort of frame shift when you’re working with this population, because this idea that, yes, lots of people would be screened in because they’re at risk, but that’s also your opportunity for prevention. You know?

Jordan Greenbaum:
Exactly. Exactly.

Teresa Huizar:
But if that’s not really wha—if you’ve been trained to think strictly in the terms of intervention, again, it’s just a mind shift to go, OK. That’s not really what we’re doing here. We’re going to intervene where that pops up, but we’re also trying to prevent all these at-risk kids from winding up there in the first place.

Jordan Greenbaum:
That’s exactly it. That’s a really good way of saying it. Yeah. Absolutely.

Teresa Huizar:
Well, thank you guys for including that, because it made my job very easy. When I was reading the document, I was like, “Oh, so clear. Maybe we should put this up on our website,” with permission of course or something because it’s just like, it’s so good as a way of framing working with these kids and families.

I’m just wondering about where you think this field is going next. I mean, you had an opportunity to sit with your colleagues and talk amongst yourselves for years actually about where the field has come, but what is next in terms of could be service provision? It could be identifying, you know, kids and families who need these services. It could be the way that services are organized themselves. It could be public policy. Just sort of, what do you see as the future of serving kids and families who are at risk of human trafficking?

Jordan Greenbaum:
Well, I hope there’s push forward in all of those areas. I think that contrary to, I dunno, seven, five, seven, 10 years ago, there is much more of a view of a public health approach. So that’s good. And I think that’s going to sort of push the scientific research and evidence-based strategies that in this assumption that we have to have evaluation, we have to measure impact. We have to, you know, build an evidence base. I think that’s going to push research.

And I think there’s more, gradually more attention being paid to the need to evaluate our intervention strategies and prevention strategies that, you know, donors are saying, well, you need to show whether this works or not. Which is good because that’s the public health approach. We need to be able to measure it and tweak it and then implement it and measure it again. So I think that there is more of a rigor in the efforts now. They’re getting to be a little bit more refined and directed than they were say 10 years ago.

I also think that the next step is going to be recognizing the other vulnerable populations and labor trafficking. I think that’s where things are going. We’re just beginning to acknowledge labor trafficking among children and that needs to move forward.

Teresa Huizar:
You know, to that point, I’m wondering, you know, you have all these listeners who are listening to the podcast. They’re all child abuse professionals or virtually all, and most of them are probably working in or around a Children’s Advocacy Center. When you think about this connection between sex trafficking and labor trafficking, when you think about unaccompanied minors and immigrant populations and how vulnerable they are, what would you like to see those professionals start doing right now?

Jordan Greenbaum:
I would like us to start thinking, when we see any child and especially children in marginalized populations, that we start to think about vulnerabilities. Not with the idea that we’re going to assume that they are being victimized, but just be open to the idea that they’ve been traumatized and need some sort of resources. They may not take them. They may not want them, but we can at least recognize that that is a possibility and we need to be ready to offer resources. If we know a child is an unaccompanied minor, we can be pretty sure they’ve had a lot of trauma in their lives. And so it’s important for us to use a trauma-informed lens for interacting with them and offer services and help them build resilience.

Teresa Huizar:
And if you had the ear of Congress or the White House for a few minutes, although they seem a little distracted at the moment, but let’s just say you were able to break through that and you had their ear for a moment. And you said, you know, here are one or two policy changes that if it was made at this level, it would make such a difference to kids and families. What would you like to see?

Jordan Greenbaum:
I’d like to see more unaccompanied minors get case management when they’re discharged to their sponsors so that they really have somebody who can take them by the hand and take the sponsor by the hand and make sure that they get plugged into services.

They’re in school, they get mental health services. Maybe they call the Child Advocacy Center. They get a federally qualified health center. They get these things in place because their security is going to protect them from all sorts of trauma that could lie ahead, if they don’t have that. That’s a major thing that I think that’d be really helpful if we increase the services that we provide to families and unaccompanied minors who come across the border.

Teresa Huizar:
What’s a question that you wish I’d asked you and that I should have asked you that, or anything else that you want to talk to or talk about or add to this conversation?

Jordan Greenbaum:
I hope that this sort of opens the door to more discussions about how we might be able to, as a bunch of CACs around the country, how we can come together and figure out ways to offer services to marginalized populations like unaccompanied minors and immigrants, and others, in sort of unconventional ways. Not necessarily having a law enforcement case open, but how can we come together and figure it out as a group?

Teresa Huizar:
I just so appreciate your passion for the subject and the fact that you care so much about the us and are so dedicated to it and have been for a long time. I appreciate this conversation, which has certainly gotten me thinking, so thank you, Jordan.

Jordan Greenbaum:
Thanks for having me. I really appreciate it.

Teresa Huizar:
Thank you for listening to One in Ten. If you enjoyed this episode, please share it with a friend of two. And to learn more about NCA and the work of Children’s Advocacy Centers, please visit our website at www.nationalchildrensalliance.org.