Innocence Lost: America’s dirty little secret


Victims of Domestic Minor Sex Trafficking

AT AGE 14, Tina thought her true love was a man 10 years her senior who showered her with attention and listened to her complaints about her parents. But when he took her to meet “the family,” she discovered that meant herself and three other girls whom he forced out into the streets every night to sell themselves for sex. If they fell short of their $500 nightly quota, he beat or starved them.

ASIA GREW UP around a drug-addicted mother and her abusive drug dealer, a situation that sent her bouncing between family members’ homes. She became homeless at age 16. Alone and outdoors on a cold, snowy night, she accepted a man’s offer of shelter and clothing – and spent the next two years being sold for sex.

AFTER YEARS of being physically and sexually abused by her mother’s boyfriend, Brittany was sent to a group home for counseling at age 15. She ran away from the facility with another girl, only to end up broke and hungry on the streets. A man offered her a modeling job but instead held her captive, forcing her to perform sex acts on men for money.

These true stories are among those of thousands of children, both girls and boys, who are being coerced and sold for sex. While the sex trafficking of persons under age 18 may conjure up images of faraway third-world countries, this heinous crime occurs across the United States to American-born kids, in rural and urban areas, affluent neighborhoods and in our own communities – Tina, for example, in Chicago; Asia, in Boston; and Brittany, in Cedar Rapids, IA, where her captor approached her in broad daylight in a Hy-Vee grocery store.

This crime has a name and an acronym: domestic minor sex trafficking, or DMST. And whether they know it or not, health care providers encounter its victims in emergency rooms, clinics and hospitals.

“Every time I talk to a medical audience, I like to ask if anyone can give me the definition of human trafficking,” says Jeffrey Barrows, D.O.’78, M.A., vice president of education and advocacy for Abolition International, an organization working to end sex trafficking and exploitation. “Most people say, ‘Yeah, that’s in Cambodia and Vietnam, not in the city where I live.’ But the reality is that it is everywhere in the U.S. as well as other countries.”

Human trafficking is modern-day slavery, involving victims who are forced, defrauded or coerced into labor or sexual exploitation. Experts say there are more slaves for sex and labor today than at any other point in human history. With the drug trade and sales of illegal arms, human trafficking is one of the world’s top three criminal industries. Sex trafficking alone is estimated to be a $35 billion-plus industry.

In America, many trafficking victims are children.

In fact, while research on the number of victims is lacking, in 2010 Ernie Allen, director of the National Center for Missing and Exploited Children, testified to the U.S. House of Representatives that the best estimate of the current number of DMST victims in the U.S. is 100,000. A 2011 FBI report on trafficking estimated that about 293,000 U.S. children are at risk of being exploited and trafficked for sex. Most are girls; the average age at which they first become victims is 12 to 14.

Who are DMST victims and where do they come from? According to Barrows, some are teenagers who are either kidnapped or are forced into commercial sexual exploitation. The majority are teenage girls who have run away to escape abuse in their homes and end up being picked up on the streets by traffickers. Children are typically approached by traffickers within 48 hours of running away.

Barrows, who also is a health consultant on human trafficking for the Christian Medical and Dental Associations, emphasizes that health care providers must become educated on the signs and consequences of human trafficking and accept a role in fighting it.

“The occurrence of trafficking is so widespread, yet in many ways it’s also invisible,” he notes.

Echoing that grim reality is Michael Ferjak, M.A., senior criminal investigator for a statewide human trafficking squad of the Iowa Department of Justice and the Iowa Attorney General’s Office.

“No single agency is large enough to deal effectively with sex trafficking on its own. We have to work together and share resources,” he said at a recent Des Moines panel discussion on the issue. “We need training and communication among law enforcement, prosecutors, juvenile court officers, judges and front-line health care professionals.”

What roles, then, should health care professionals play in the fight against domestic minor sex trafficking?

“I couldn’t not do something about it”

After 15 years as an obstetrician/gynecologist in Ohio, Jeffrey Barrows, D.O.’78, M.A., reduced his full-time practice so he could teach physicians in Africa and Asia through the Christian Medical and Dental Associations (CMDA). In 2004, a CMDA staff member asked him to research the health consequences of human trafficking for a report the staff member was producing for the U.S. State Department.

“I said, ‘I’d be glad to help, but what is human trafficking?’” Barrows recalls. “After he sent me information, I went through a series of shocks on what it is and how prevalent it is. I use the phrase that I was gloriously changed by that. My faith drives a lot of what I do. I couldn’t be aware of the issue and not do something about it.”

Since then, Barrows has become a leader in tackling this human rights violation by educating other health care providers on recognizing its signs among patients and taking action to assist victims. A health consultant for CMDA on human trafficking, he and his colleagues in the organization have produced 11 online educational modules, accessible on the association’s website (see sidebar), that explore multiple facets of the crime’s identifiers, health consequences and care for victims.

In America, many victims of human trafficking are childrenThat many in health care lack this knowledge, as he once did, represents tragically missed opportunities.

“Three segments of society are most likely to encounter trafficked individuals: law enforcement, the clergy and health care,” he says. “Trafficking is largely a hidden problem, and its victims are very isolated and controlled by their pimps, but many victims are in plain sight to providers who know the signs.”

The first step, Barrows says, is being ready. “I tell audiences they need to do their research in advance; do not wait until a potential victim is in your office. Find out the anti-trafficking organizations in your area and make contact with them. Make sure your staff gets trained. Know the National Human Trafficking Resource Center hotline number.”

That center is a program of Polaris Project, a nonprofit, non-governmental organization that works exclusively on the issue of human trafficking. Its national toll-free hotline takes calls and text messages in all languages 24 hours a day, 365 days a year. Crisis calls and urgent tips receive immediate follow-up that may include involving law enforcement and anti-trafficking services in the caller’s area. Michael Ferjak, leader of the Human Trafficking Enforcement and Prevention Initiative of the Iowa Department of Justice and the Iowa Attorney General’s Office, encourages all individuals to use the hotline any time they suspect a person is a trafficking victim.

“If you see something, say something. If you report it, the system has to respond to the situation,” he says. “I don’t care if you’re wrong. The important thing is that we have the opportunity to investigate.”

Once a potential victim enters a health care facility, Barrows and the CMDA modules point out that possible indicators of sex trafficking include the following:

  • signs of physical/sexual abuse
  • frequent need for pregnancy tests
  • multiple sexually transmitted infections
  • signs of illicit drug use
  • positive HIV test results
  • lack of knowledge of location

Possible indicators for victims of domestic minor sex trafficking, or DMST, may include the above as well as the following:

  • possession of numerous hotel room keys and/or large amounts of cash, jewelry and new clothing
  • attempts to lie about their age
  • numerous school absences
  • dates with much older, abusive or controlling men
  • disappearances for blocks of time
  • pagers or cell phones not paid for by parents or guardians

Trafficking victims often are accompanied, including during interactions with health care providers, by overly controlling individuals who may identify themselves as boyfriends, spouses or parents.

“Sometimes there’s a ‘bottom girl’ who works very closely with the pimp and acts as a mother figure to the child,” says Amy Mundisev, R.N., a sexual assault nurse examiner at Trinity Medical Center, which serves Iowa’s and Illinois’ Quad Cities. “The bottom girl will be really interested in whether the child will be okay and how long she’ll have to be in the hospital. That can be a red flag.”

If a provider suspects a patient is a victim, it’s critical to separate her or him from the controlling individual.

“We have that opportunity in health care. We can have rules such as no family members in the pelvic exam room,” Barrows says. “You want to get as much information as you can – phone numbers, addresses, etc. – so if they walk out the door, you can turn that information over to law enforcement.”

Getting that information can be a huge challenge with these traumatized individuals. Barrows warns against judging patients who admit to engaging in risky behaviors, such as stripping, using drugs and having numerous sexual partners. “The physical examination must be done in a compassionate, respective manner,” he says.

Mundisev says asking the tough question “Are you being forced to have sex?” and not viewing DMST victims negatively can be difficult. “When these girls present, they are very rough-and-tumble, hard-core,” she says. “They’ve been on the streets. But you have to keep in mind, they’re kids.”

Victim identified; now what?

The enormous challenges in fighting domestic minor sex trafficking go beyond preventing it, stopping it and punishing its perpetrators. Another is helping its victims heal, a painstaking and difficult process among these often deeply scarred youth.

“You’ve got to understand many victims come from homes where they’ve been told they’re absolutely worthless,” Jeffrey Barrows says. “They come under total control of their pimps, and trauma-bonding often occurs.”

Sara Swensen, Ph.D., clinical services director at Youth Emergency Services and Shelter (YESS) in Des Moines, Iowa’s largest youth shelter, says DMST victims’ age alone is a risk factor. “Many are children with numerous unmet needs at an age when they are shaping their identities,” she said during a recent discussion of the issue sponsored by the Chrysalis Foundation in Des Moines. “They are very vulnerable.”

Once pimps have established a relationship with these children, whether by persuasion or force, they isolate them and take complete control of their lives through physical, psychological, emotional and financial means, Swensen explained. Victims are afraid for themselves and their loved ones, are trained to distrust law enforcement and social service providers, and see no way of escape.

“You may see victims refusing rescue efforts and the opportunity to testify against their perpetrator,” she added. “It’s trauma driving their behavior. They’re in survival mode.”
Michael Ferjak, with the Iowa Department of Justice/Iowa Attorney General’s Office, says DMST victims, once rescued, return to their traffickers “on average seven to eight times.”

The best model for addressing these victims’ needs, he adds, is a minimum of 18 months of intensive, sustained services. But in a nation with more facilities for abandoned pets than for trafficking victims, “we’re a long way from that,” he says.

When police encounter DMST victims, they often arrest them or place them in juvenile detention facilities either because the police believe they’ve committed crimes or because there is no other way to separate the victims from their traffickers. In some cases, the victims are returned to their families, which federal law generally favors. For most DMST victims, however, neither of these is a good option.

“We know residential care with a bunch of disordered kids won’t help minor trafficking victims,” says Barbara Harre, M.D., a child abuse pediatrician with the Child Protection Response Center in Davenport, IA. “And we have mothers and other family members who force their children to prostitute for them.”

Harre says a “tiered response approach” of acute care, acute intervention, intensive therapy and long-term care is what’s needed. That point was driven home to Barrows early in his fight against trafficking, when he encountered two victims in Ohio. “Both had gotten out of a trafficking situation but were in very bad shape mentally and physically. One had been abused starting at age four by her father, who was a pedophile; when she reached age 15, he started selling her to his business partners. That’s a lifetime of counseling.

“I’m happy to say both victims are doing better and are well on their way to recovery, but they’ve been in rehabilitation over a year,” he adds.

Barrows is among the individuals working to address the extreme shortage of programs and services for DMST victims. He is director of the Abolition International Shelter Association (AISA), which is developing an international network of professionals committed to the highest standards of care for survivors of trafficking, while promoting the best and most promising practices among AISA member shelters.

Barrows spent much of last year working with other experts on developing accreditation standards for such facilities. “There are under 30 organizations across the country that are set up to deal with this,” he says. “It takes three to four years to put a facility together that’s prepared for the absolute complexity of the psychological phenomena of this highly traumatized population. The accreditation process is designed to help organizations think through all the scenarios and develop policies and protocols for dealing with them.”

The enormity of DMST and its consequences is overwhelming, but examples of recovery offer hope. Of the three girls described at the beginning of this article, Tina Frundt escaped sex slavery by being arrested; she is now a national advocate engaged in street outreach, group training and presentations to entities including the United Nations and Congress.

Asia Graves works for Fair Girls, a Washington, DC-based nonprofit that strives to educate schools and students about the issue.

Brittany Phillips, also arrested out of her situation, eventually was adopted into a loving family in Story City, IA, where she’s rebuilding her life by going to school, volunteering with the Story City Ambulance Service and occasionally sharing her story through speaking engagements and the media.

Still, much heavy lifting remains to prevent DMST, rescue its thousands of victims and help them recover.

“This is difficult work, horrific and even traumatizing to those working in the field, but I see this as a calling,” Barrows says. “If you told me 10 years ago this is what I’d be doing, I’d have said, ‘No way.’ But I feel this is where God wants me to be for the time being.”

Is your patient a possible trafficking victim? Ask these questions:

The U.S. Department of Health and Human Services’ Administration for Children and Families suggests the following questions for front-line health care providers who suspect a patient is a trafficking victim. Before being questioned, the patient must be separated from the individual accompanying her or him, as that person could be the trafficker.

  • Can you leave your job or situation if you want?
  • Can you come and go as you please?
  • Are you attending school?
  • Has anybody ever threatened you to keep you from running away?
  • Has anyone threatened your family?
  • Did anyone ever touch you or hurt you?
  • Where do you sleep and eat?
  • Do you have to ask permission to eat, sleep or go to the bathroom?
  • Is there a lock on your door so you cannot get out?


The Christian Medical and Dental Associations’ 11-module “Trafficking in Persons: A Primer for the Health Care Professional” that DMU alumnus Jeffrey Barrows helped produce can be viewed and downloaded at no charge at

The modules provide overviews of domestic and international trafficking; describe physical and mental health consequences; probe the identification and medical evaluation of victims of labor trafficking and sex trafficking; explore the crime’s long-term health consequences; describe multidisciplinary care and the health professional’s role beyond the clinic setting; discuss the spiritual basis for a response to human trafficking; and explore ways to serve victims in low-resource settings.

National Human Trafficking Resource Center (NHTRC) hotline number, 888-373-7888 or text HELP or INFO to BeFree (233733)

Polaris Project, an organization that works to fight human trafficking and modern-day slavery:

U.S. Department of Health and Human Services’ Administration for Children and Families:

National Center for Missing and Exploited Children (NCMEC), the nation’s clearinghouse on the issue with programs and services for law enforcement, other professionals and families:

Abolition International, a nonprofit organization working to create, expand and improve after-care programs, standards of care, resources for shelters and education
in fighting sex slavery:

Innocence Lost National Initiative, a combined effort of the FBI, the Department of Justice Child Exploitation and Obscenity Section and the NCMEC to tackle DMST Childhelp® National Child Abuse Hotline, in which professional crisis counselors connect callers with local numbers to report suspected abuse: 800-4-A-CHILD (800-422-4453)

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