introduction to homeless youth research paper

• Research article
• Open access
• Published: 14 November 2019

The impact of interventions for youth experiencing homelessness on housing, mental health, substance use, and family cohesion: a systematic review

• Jean Zhuo Wang 1 ,
• Sebastian Mott 2 ,
• Olivia Magwood 3 ,
• Christine Mathew 4 ,
• Andrew Mclellan 5 , 6 ,
• Victoire Kpade 2 ,
• Priya Gaba 6 ,
• Nicole Kozloff 7 ,
• Kevin Pottie 8 &
• Anne Andermann 9  

BMC Public Health volume  19 , Article number:  1528 ( 2019 ) Cite this article

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Youth often experience unique pathways into homelessness, such as family conflict, child abuse and neglect. Most research has focused on adult homeless populations, yet youth have specific needs that require adapted interventions. This review aims to synthesize evidence on interventions for youth and assess their impacts on health, social, and equity outcomes.

We systematically searched Medline, Embase, PsycINFO, and other databases from inception until February 9, 2018 for systematic reviews and randomized controlled trials on youth interventions conducted in high income countries. We screened title and abstract and full text for inclusion, and data extraction were completed in duplicate, following the PRISMA-E (equity) review approach.

Our search identified 11,936 records. Four systematic reviews and 18 articles on randomized controlled trials met the inclusion criteria. Many studies reported on interventions including individual and family therapies, skill-building, case management, and structural interventions. Cognitive behavioural therapy led to improvements in depression and substance use, and studies of three family-based therapies reported decreases in substance use. Housing first, a structural intervention, led to improvements in housing stability. Many interventions showed inconsistent results compared to services as usual or other interventions, but often led to improvements over time in both the intervention and comparison group. The equity analysis showed that equity variables were inconsistently measured, but there was data to suggest differential outcomes based upon gender and ethnicity.

Conclusions

This review identified a variety of interventions for youth experiencing homelessness. Promising interventions include cognitive behavioural therapy for addressing depression, family-based therapy for substance use outcomes, and housing programs for housing stability. Youth pathways are often unique and thus prevention and treatment may benefit from a tailored and flexible approach.

Peer Review reports

Youth homelessness is a major public health challenge worldwide, even in high income countries [ 1 ]. Youth experiencing homelessness are defined as, “youth between the ages of 13 to 24 who live independently of their parents or guardians, but do not have the means to acquire stable, safe or consistent residence, or the immediate prospect of it [ 2 ].” Youth pathways into homelessness are anomalous and seldom experienced as a single isolated event. Compared to the adult homeless population, youth experiencing homelessness are more likely to report leaving home due to parental conflicts, including: being “kicked out” of the home, abuse (physical, verbal, sexual and other), parental neglect due to mental health problems, or parental substance use [ 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 ]. The broader context of family dysfunction can lead to youth circumstances that further reinforce situations of homelessness, including desire for separation from unsupportive environments, financial independence, mental health challenges, substance use, and/or run-ins with the justice system [ 1 ].

Not only are youth’s pathways into homelessness different from the adult homeless population, but their experiences on the street are distinct as well. Once homeless, youth are exposed to many dangers and are at a high risk of further trauma [ 12 ]. Youth experiencing homelessness may face a number of daily stressors and have limited coping strategies and resources to deal with these stressors [ 13 ]. Youth homelessness is often invisible and includes vulnerable housing situations such as couchsurfing or staying with relatives [ 14 ]. Furthermore, youth experiencing homelessness are vulnerable to social and health inequities, which describe the fairness in the distribution of health opportunities and outcomes across populations [ 15 ]. Health inequities are differences in health status that are unfair and/or avoidable [ 16 ]. Often, the compounding effect of various stratifying characteristics can result in increased disparities between individuals.

Current research has largely focused on adult populations, with a gap in evidence on interventions for youth experiencing homelessness on a broad range of outcomes. Among the current interventions for individuals experiencing homelessness, non-abstinence contingent permanent supportive housing and case management have shown promising results in terms of improving housing stability and mental health outcomes [ 17 ]. However, youth are a distinct population and they require specifically tailored, context appropriate, equity-focused interventions and research attention [ 18 ]. From systematically searching the literature for youth interventions, this paper will introduce four main categories of interventions applied to youth experiencing homelessness: 1) individual and family therapies (ie. cognitive behavioural therapy, motivational interviewing, etc.) 2) skill building programs, 3) case management, and 4) structural interventions (such as housing support, drop-in centres, and shelters). These interventions are designed to address the complex, multifaceted pathways and contributors to youth homelessness, whether it be addressing substance use issues through motivational interviewing, mental health care through cognitive behavioural therapy, improving unstable family environments through family therapies, increasing access to resources through case management, and enhancing structural support such as income and housing support [ 19 , 20 , 21 , 22 , 23 ]. Given the complexity and interconnectedness of these outcomes, one would hope that these interventions would have an impact on not only the primary outcome, but also extend to other facets of a youth’s life. For instance, family therapies have shown promising results on both family functioning as well as substance use, by addressing the toxic family environment and thereby decreasing its contribution to unhealthy substance use patterns [ 24 ].

Current research on interventions for the population of youth experiencing homelessness lacks a comprehensive synthesis on a broad range of social and health outcomes. The objective of this review is to synthesize the existing scientific literature on interventions for homeless or vulnerably housed youth in high income countries, and assess the impacts of the interventions on housing, mental health, substance use, and family cohesion, with an equity perspective.

We established an expert working group consisting of homeless health researchers, academics, clinicians and youth with lived experience of homelessness to conduct this review. We report our results according to PRISMA-E [see Additional file  3 ] and published an open access protocol on the Campbell and Cochrane Equity Methods website [ 25 , 26 ].

Data sources and search strategy

Without language restrictions, we systematically searched the following databases from inception until February 9, 2018: Medline, Embase, CINAHL, PsycINFO, Epistemonikos, HTA database, NHSEED, DARE, and Cochrane Central. Combinations of relevant keywords and MeSH terms were searched, including “homeless” and “homeless youth” [see Additional file  1 for search strategy]. We hand-searched included studies for primary studies and consulted experts for additional papers. We conducted a grey literature search on homeless health and public health websites.

Inclusion and exclusion criteria

We downloaded citation information into Rayyan online software [ 27 ]. All title and abstracts were screened according to our inclusion criteria (see Table  1 ) in duplicate by two independent reviewers, and any discrepancies were resolved. Throughout a process of several consultations, our working group, consisting of persons with lived experience and experts in the field, helped develop these inclusion criteria by identifying priority areas in which to focus this review. This study focused on youth between the ages of 13 to 24, however, the age categorizations of youth tend to differ between various definitions, with the medicolegal definition utilizing ages 16 to 21. It is important to note that the broader age range utilized in this paper may lead to risks of over-inclusion, but it was chosen as it is reflective of the currently literature on youth homelessness and includes both high school and university students who are generally still dependents living with family or relying on them for financial or moral support.

Data extraction and analysis

Data extraction proceeded in duplicate using a standardized data extraction form and a third reviewer resolved discrepancies [ 25 ]. We extracted data regarding the effectiveness of interventions on a broad range of social and health outcomes. We conducted a scoping exercise to identify key outcome categories in the literature and prioritized reported outcomes with our expert working group members, which included individuals of lived experience. The outcomes rated as being of highest priority (mental health, substance use, housing, and family outcomes) are reported in the body of this paper, and the remaining outcomes (violence, sexual health, personal and social, and health and social service utilization) are reported in the appendix [see Additional file  2 ]. To reduce overlap between single studies and systematic reviews, we reported the results of systematic reviews and supplemented with data from randomized control trials (RCTs) that were not included in the systematic reviews. Due to heterogeneity of interventions and outcomes studied, we qualitatively synthesized the results. We created a forest plot to summarize RCTs for mental health outcomes, as sufficient data were available and it was a highly ranked outcome.

Health equity analysis

We used the PROGRESS+ framework to apply a health equity lens and enable us to identify characteristics that socially stratify youth experiencing homelessness, and various drivers of homelessness [ 15 ]. In particular, we extracted the following from studies to inform our analysis: 1) study rationale for focusing on youth-centred interventions; 2) the measures used to assess differences in outcomes for women and men; 3) the study’s gender-related findings and conclusions; and 4) the study’s incorporation of equity considerations (e.g. race/ethnicity and socioeconomic status).

Critical appraisal

We assessed the methodological quality of systematic reviews with AMSTAR II and RCTs using the Cochrane Risk of Bias Tool [ 28 , 29 , 30 , 31 , 32 ]. When assessing the overall risk of bias of RCTs, we defined the risk of bias as “not serious” when there were low risk ratings in all categories or one or two unclear risk, “serious” with one or two high risk categories, and “very serious” with more than two high risk categories.

The search strategy yielded 11,934 potentially relevant citations. After we removed duplicates, we screened 7499 citations and assessed 103 full text articles. Twenty-two citations met the full inclusion criteria (See Fig.  1 ). Four of the included citations were systematic reviews [ 33 , 34 , 35 , 36 ] and the remaining 18 citations reported on 15 RCTs (see Table  2 for RCTs and Table  3 for SRs) [ 19 , 21 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 ].

PRISMA Flow Diagram

Methodological quality of the included studies was low or very low, with serious risk of bias across most included studies (see Fig.  2 for RCTs and Table  4 for SRs). The most common domain with a high level of risk was knowledge of the allocated interventions, as blinding was often not possible or difficult with the nature of the interventions.

Methodological Quality of Included RCTs using Cochrane Risk of Bias Tool

The main categories of interventions applied to youth homelessness included: 1) individual and family therapy (e.g. cognitive behavioural therapy (CBT), motivational interviewing (MI), family therapy), 2) skills building (e.g. life skills, mindfulness), 3) case management and 4) structural interventions (e.g. housing support, drop-in centres, shelters). See Table  5 for the definitions of interventions. The results of RCTs have been summarized using a visual map (see Fig.  3 ).

Visual Summary of Results of RCTs by Outcome

Individual and family therapy

Cognitive behavioural therapy.

CBT led to improvements in substance use and depression, and one systematic review also reported improvements in internalizing behaviours and self-efficacy [ 33 , 34 , 35 , 36 ]. When a CBT-based therapy (community reinforcement approach) was delivered with case management in one study, there were improvements in percentage of days being housed, psychological distress, and substance use [ 33 ]. Two systematic reviews conducted meta-analyses on CBT and CBT-based interventions and found no statistically significant difference in mental health outcomes compared to services as usual, but noted that lack of a statistically significant difference may be due to heterogeneity between studies [ 34 , 35 , 36 ].

Family therapy

Family-based therapy was delivered in an office setting, known as functional family therapy, or in the home setting, called ecologically-based family therapy. Systematic reviews reported that all three family therapy RCTs showed a reduction in substance use [ 34 , 35 , 36 ]. However, Noh (2018) conducted a subgroup meta-analysis on two family intervention studies and found no significant effect on substance use [ 34 ]. Another meta-analysis found a statistically significant improvement in family cohesion, but called it a clinically marginal effect [ 36 ]. In a three arm RCT comparing home-based family therapy with MI and a CBT-based therapy, all three groups improved over time in internalizing and externalizing behaviours, family cohesion, and substance use [ 47 , 48 , 49 ]. Furthermore, when an RCT compared functional family therapy, home-based family therapy, and services as usual, all treatments showed improvements in days living at home at three, nine and 15 months, but no group was superior to another [ 52 ].

Motivational interviewing

Brief or group MI interventions were primarily designed to address substance use and/or risky sexual behaviours. A brief intervention showed declines in non-marijuana drug use at 1-month follow up, but the reduction was no longer significant after 3 months [ 33 , 34 , 35 ]. In another RCT, both the service as usual and intervention groups showed significant improvements over time, but there were no significant and durable results in favour of the experimental group [ 21 ]. A 16-week group MI intervention found significant declines in alcohol use and increased motivation to change drug use, but no significant decreases in marijuana use [ 37 ]. A two-session individual brief MI intervention compared to an education program reported significant improvements in readiness to change alcohol use [ 38 ].

Skill building

The interventions focused on vocational and life skills, mindfulness, and strengths-based skill building. One systematic review included one study evaluating a life skills intervention and found improvements in family contact and near significant improvements in depressive symptoms [ 33 ]. Another systematic review reported similar results but noted an increase in substance use over 6 months which could not be explained [ 35 ]. A training program based on a peer influence model showed non-statistically significant decreases in drug use in the treatment group. One study evaluated a strengths-based program deployed in a shelter to identify and make use of strengths in each youth [ 39 ]. This program showed no significant differences between groups but found improvements over time in depression, substance use, and satisfaction with family relations [ 39 ]. Two RCTs evaluated a vocational and life skills program and a mindfulness skills program, though did not report promising treatment effects [ 40 , 41 , 42 ].

We attempted to conduct meta-analyses whenever possible, but due to the heterogeneity between studies, it was inappropriate to pool the results into a combined effect size. As such, we developed a forest plot for short-term mental health outcomes of a mindfulness intervention, CBT intervention, strengths-based intervention, and CBT-based intervention [ 39 , 42 , 50 , 51 , 52 , 53 ]. The figure depicts a general trend favouring the interventions but none reaching statistical significance compared to control (see Fig.  4 ).

Intervention vs. Usual services for Short Term (0-6 months) Mental Health Outcomes)

Case management

Two systematic reviews reported on several case management programs, including intensive case management and multidisciplinary case management, and reported minimal additional benefit of the programs relative to their comparison interventions [ 33 , 34 , 35 ]. They noted that one program showed favourable results for substance use, but the study quality was very low due to low retention rates [ 33 ]. In a three-arm RCT, case management, a CBT-based intervention, and MI all showed significant improvements over time in housing stability, depression, and substance use, but no significant differences between groups [ 45 ]. Case management led to improvements over time in internalizing behaviours while the other groups did not [ 45 ]. Overall, there is evidence to suggest that case management may have impacts on substance use, depression, and housing stability, but different control conditions in each of the studies made it difficult to assess overall effectiveness of the intervention.

Structural support

Housing programs.

A subgroup analysis of young adults in an RCT of the housing first model for adults with mental illness found that, compared to treatment as usual, housing first significantly increased the proportion of days stably housed over the 24-month trial, but had no impact on self-rated mental health [ 43 ]. One systematic review included an independent living program and reported marginal results on psychological measures, however reported some positive outcomes on housing status [ 33 ]. The same systematic review also included a study evaluating a supportive housing program, which reported lower rates of substance abuse and improvements in self-reported health, but the study quality was noted to be low. Xiang evaluated the same supportive housing program and also concluded that the lower rates of substance use may be attributed to baseline differences between control and intervention groups instead of treatment effect [ 35 ].

Drop-in and shelter services

A systematic review included three shelter services studies, two evaluating residential services and one evaluating emergency shelter and crisis services [ 35 ]. The review showed some improvements in substance use but this was not consistent over the various studies and there were no enduring effects over time. An RCT compared referrals from case management made to drop-in versus shelter services programs [ 44 ]. There were no differential treatment effects, as both groups showed decreases in depression and substance use over time [ 44 ]. However, individuals assigned to the drop-in service had greater service contacts and access to care over 6 months [ 44 ].

Gender and equity analysis

Equity variables were not consistently measured, reported, or analyzed across studies. Several studies measured equity and PROGRESS+ factors with baseline sample characteristics, but very few included them as covariates. The most examined factors were gender and ethnicity/race, with some studies mentioning place of residence and occupation. A number of RCTs included equity variables in their analysis [ 21 , 37 , 39 , 40 , 41 , 43 , 44 , 45 , 46 , 47 , 48 , 49 ], as did three systematic reviews [ 34 , 35 , 36 ].

A number of studies indicated that females responded differently to services than males. Slesnick’s studies have showed that females initially reported higher rates of depression than males, with a greater reduction throughout the study [ 44 , 45 , 46 ]. Female adolescents showed a greater improvement in family cohesion subsequent to treatment regardless of the treatment condition [ 47 ] and appeared to derive greater benefit from shelter services than males [ 35 ].

Some variance in relation to ethnicity and employment emerged as well. While youth from ethnic minorities had greater reductions in substance use, they also relapsed more quickly than white youth [ 49 ] and had more HIV risk behaviours [ 44 ]. African Americans showed a greater reduction in percent days homeless than other ethnic groups [ 45 ]. Non-Hispanic white youth more quickly reduced their number of days drinking to intoxication [ 44 ]. Those employed or in school at baseline were more likely to remain employed at follow-up [ 39 ].

This review identified a wide variety of interventions for youth experiencing housing instability. Regarding individual and family therapies, CBT interventions showed improvements in depression and substance use outcomes [ 33 , 34 , 35 , 36 ]. Family interventions led to improvements in alcohol and drug use measures and may have had an impact on family cohesion [ 34 , 35 , 36 ]. Motivational interviewing, skill-building programs and case management showed inconsistent effects on mental health and substance use when compared with services as usual and other interventions [ 21 , 33 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 45 , 46 , 47 , 48 , 49 ]. Among the structural support interventions, housing first led to improved housing stability outcomes, while drop-in and shelter services led to inconsistent effects [ 43 , 44 ]. The equity analysis revealed differential treatment effects based upon gender and ethnicity, with females often deriving more treatment benefit than males [ 44 , 45 , 47 , 48 , 49 ]. Equity analyses were limited, with very little mention of important considerations such as sexual orientation status, as LGBTQ+ youth are disproportionately represented in the homeless population [ 58 , 59 ].

While in many circumstances, differences were not statistically significant between treatment groups, this does not preclude the lack of effectiveness of these interventions. It is important to note that a treatment as usual group was not the absence of an intervention, but rather involved referral to other community services and follow-up with researchers. This may lessen the differences between the intervention and control arms, and decrease the detectable effect of the intervention. Providing non-specific support for youth may be enough to improve outcomes and reduce the toxic effects of adverse childhood experiences. However, that regression to the mean may also potentially explain the changes observed over time [ 60 ]. As participants may enter the research studies during a point of crisis, they may naturally improve over time regardless of the study group, and this effect may lessen the observed differences between intervention and control groups.

Tailoring interventions to the needs of youth

The dynamics of youth homelessness are complex; pathways to housing are precarious, sociocultural backgrounds are becoming increasingly diverse and available resources are inconsistent. Research has shown that unstable family relationships underlie youth homelessness, and many youth have left homes where they experienced interpersonal violence and abuse [ 3 , 4 , 5 , 61 ]. Among these difficult family issues, other personal factors arise as a result of their environmental contexts, which can interplay and lead to increased distress. These challenges include substance use, depression, and disability, and can compoundly contribute to strain [ 10 ]. The interventions identified in this review may help to address the specific needs of youth and may be tailored to their situation.

One important consideration to note is that while we have defined youth as those ages 13 to 24 for the purposes of this study, this grouping brings together minors as well as young adults of legal age. While this age categorization is reflective of the literature on the youth population, we recognize that there are differences between the experiences of younger versus older youth. Furthermore, there are medicolegal implications of the mature minor and capacity to consent. Clinicians and program implementers who work directly with this population need to consider the ethical considerations of consent for treatment participation with mature minors as well as the legal obligations provided by their governing college [ 62 ].

Strengths and limitations of the review

We conducted a high quality search, complying to PRISMA-E guidelines [ 26 ]. This review included only high quality study designs: RCTs and systematic reviews. This may, however, have limited the types of interventions that were included. Limitations include a broad range of outcomes and, thus, too few studies available for meta-analyses. There was heterogeneity in the interventions, and the available evidence was insufficient to use network meta-analysis to answer the question of the relative advantages of the different types of interventions. In our systematic review, the studies did not use placebo designs and, instead, used several different interventions/comparisons. However, there was considerable heterogeneity in the outcome measures and this prevented a pooling of the effects. The services-as-usual comparisons were often not adequately described in the primary studies, limiting the comparisons that could be made across different studies. Furthermore, our definition of youth experiencing homelessness focused on unaccompanied youth and did not include accompanied youth that enter homeless situations along with their families, as this youth population has quite distinct circumstances and needs.

Implications for future research, policy, and practice

The results suggest that tailored interventions for youth may have impacts on depression, substance use and housing. Given the diverse pathways to youth homelessness, health care policy-makers, practitioners and other stakeholders should consider the specific needs of youth during prevention and delivery of care. Furthermore, we recommend additional high quality research to be conducted in the area of family-based therapies, CBT, and housing interventions, which have shown some positive results thus far. We further recommend additional considerations for equity factors. Few studies examined equity factors, and those that did were limited largely to gender and ethnicity. There remains a large gap in data regarding the intersectionality between a variety of PROGRESS+ factors contributing to youth experiences.

There is also a large gap in research on the impact of structural interventions such as housing and case management on youth experiencing homelessness. The predominance of psychological and family interventions in this paper suggests that more work could be done to study an area in which it may be more difficult to design studies. Nonetheless, future research on these interventions are important to addressing the root causes of poverty and homelessness. Furthermore, there are emerging models of housing which have not yet been evaluated rigorously in the literature. For instance, host homes provide safe and temporary housing for up to 6 months for youth while supporting them with a case manager to identify long term solutions [ 63 ]. Rapid re-housing programs provide short-term subsidies to allow persons experiencing homelessness to acquire stable housing as quickly as possible [ 64 , 65 ]. The landscape on housing models continues to evolve and future research will need to evaluate these in the context of youth experiencing homelessness.

This review identifies a variety of interventions targeted towards the unique needs of youth experiencing homelessness. CBT interventions may lead to improvements in depression and substance use, and family-based therapy may impact substance use and family outcomes. Housing programs may lead to improvements in housing support and stability. Other interventions such as skill building, case management, show inconsistent results on health and social outcomes.

Availability of data and materials

Not applicable.

Abbreviations

A MeaSurement Tool to Assess systematic Reviews

Cognitive Behavioural Therapy

Motivational Interviewing

Preferred Reporting Items for Equity-Focused Systematic Reviews and Meta-analyses

Place of Residence- Race/ethnicity/culture/language- Occupation- Gender/sex- Religion- Education- Socioeconomic status- Social capital + refers to: 1) personal characteristics associated with discrimination (e.g. age, disability). 2) features of relationships (e.g. smoking parents, excluded from school). 3) time-dependent relationships (e.g. leaving the hospital, respite care, other instances where a person may be temporarily at a disadvantage)

Randomized Control Trial

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Acknowledgements

Nicole Pinto for expert data extraction and critical appraisal.

Published on Cochrane Equity Methods Website - https://methods.cochrane.org/equity/projects/homeless-health-guidelines

This study was funded by the Inner City Health Associates. ICHA was not involved in conducting the study including study design, data collection, analysis, interpretation, and writing the manuscript.

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Wang, J.Z., Mott, S., Magwood, O. et al. The impact of interventions for youth experiencing homelessness on housing, mental health, substance use, and family cohesion: a systematic review. BMC Public Health 19 , 1528 (2019). https://doi.org/10.1186/s12889-019-7856-0

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Unpacking the discourse on youth pathways into and out of homelessness: implications for research scholarship and policy interventions.

1. Introduction

2. contextualizing youth homelessness: what do we know, 2.1. individual factors, 2.2. structural causes and systems failures, 2.3. the new orthodoxy, 2.4. the pathways discourse and youth homelessness.

Homelessness is not just a matter of lack of shelter or lack of abode, a lack of a roof over one’s head. It involves deprivation across a number of different dimensions—physiological (lack of bodily comfort or warmth), emotional (lack of love or joy), territorial (lack of privacy), ontological (lack of rootedness in the world, anomie) and spiritual (lack of hope, lack of purpose). (p. 384)

3. The Characteristics of the Pathways Approach

3.1. the social construction of homelessness, 3.2. the whatness vs. howness.

for the large majority of the youth, homelessness was not the product of a single event, nor did it lead immediately to the streets. Rather, homelessness for most of the youth resulted in a number of different living arrangements that reflected the use, and perhaps even the “burning out”, of their available social networks. On average, a youth experienced 6 of the 9 living arrangements listed, reflecting a pattern of unstable and diminishing options. [ 83 ] (p. 74)

3.3. The Temporal Dimension

3.4. pathways into and out of homelessness, 3.5. heterogeneity of homelessness experiences, 4. implications for research and practice, 5. conclusions, institutional review board statement, informed consent statement, data availability statement, acknowledgments, conflicts of interest.

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Bonakdar, A. Unpacking the Discourse on Youth Pathways into and out of Homelessness: Implications for Research Scholarship and Policy Interventions. Youth 2024 , 4 , 787-802. https://doi.org/10.3390/youth4020052

Bonakdar A. Unpacking the Discourse on Youth Pathways into and out of Homelessness: Implications for Research Scholarship and Policy Interventions. Youth . 2024; 4(2):787-802. https://doi.org/10.3390/youth4020052

Bonakdar, Ahmad. 2024. "Unpacking the Discourse on Youth Pathways into and out of Homelessness: Implications for Research Scholarship and Policy Interventions" Youth 4, no. 2: 787-802. https://doi.org/10.3390/youth4020052

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Meaningfully Engaging Homeless Youth in Research

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• Annie Smith 3 ,
• Maya Peled 3 &
• Stephanie Martin 3  

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Meaningfully engaging young people in decisions that affect them benefits not only those youth but also the adults and agencies that support them, as well as the wider community. Youth participatory action research (YPAR) is an approach to facilitate youth engagement in research which has been increasingly implemented to enable young people to collaborate and influence decisions in areas where their voices are commonly excluded. This chapter offers examples of youth engagement projects and YPAR initiatives with vulnerable youth. It then focuses on an effective approach to engaging homeless youth in research, includes a discussion of the challenges and benefits of doing so, and offers some lessons learned for future projects wishing to engage homeless young people in the participatory action research process.

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Engaging Youth in Research

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Smith, A., Peled, M., Martin, S. (2020). Meaningfully Engaging Homeless Youth in Research. In: Warf, C., Charles, G. (eds) Clinical Care for Homeless, Runaway and Refugee Youth. Springer, Cham. https://doi.org/10.1007/978-3-030-40675-2_18

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Mental Illness and Youth-Onset Homelessness: A Retrospective Study among Adults Experiencing Homelessness

Chisom n. iwundu.

1 Department of Rehabilitation and Health Services, College of Health and Public Service, University of North Texas, Denton, TX 76203, USA; [email protected]

Tzu-An Chen

2 Department of Psychological, Health, and Learning Sciences, College of Education, University of Houston, Houston, TX 77204, USA; ude.hu.lartnec@3nehct (T.-A.C.); ude.hu@leztierrl (L.R.R.)

3 HEALTH Research Institute, University of Houston, 4849 Calhoun Rd., Houston, TX 77204, USA

Kirsteen Edereka-Great

Michael s. businelle.

4 Oklahoma Tobacco Research Center, The University of Oklahoma Health Sciences Center, 655 Research, Parkway, Suite 400, Oklahoma City, OK 73104, USA; ude.cshuo@ellenisuB-leahciM (M.S.B.); ude.cshuo@rozdneK-alraD (D.E.K.)

Darla E. Kendzor

Lorraine r. reitzel.

Financial challenges, social and material instability, familial problems, living conditions, structural issues, and mental health problems have been shown to contribute to youth homelessness. Based on the paucity of literature on mental illness as a reason for youth homelessness, the current study retrospectively evaluated the association between the timing of homelessness onset (youth versus adult) and mental illness as a reason for homelessness among homeless adults living in homeless shelters and/or receiving services from homeless-serving agencies. Homeless participants ( N = 919; 67.3% men) were recruited within two independent studies from Dallas and Oklahoma. Covariate-adjusted logistic regressions were used to measure associations between homelessness onset and mental illness as a reason for current homelessness, history of specific mental illnesses, the historical presence of severe mental illness, and severe mental illness comorbidity. Overall, 29.5% of the sample reported youth-onset homelessness and 24.4% reported mental illness as the reason for current homelessness. Results indicated that mental illness as a reason for current homelessness (AOR = 1.62, 95% CI = 1.12–2.34), history of specific mental illnesses (Bipolar disorder–AOR = 1.75, 95% CI = 1.24–2.45, and Schizophrenia/schizoaffective disorder–AOR = 1.83, 95% CI = 1.22–2.74), history of severe mental illness (AOR = 1.48, 95% CI = 1.04–2.10), and severe mental illness comorbidities (AOR = 1.30, 95% CI: 1.11–1.52) were each associated with increased odds of youth-onset homelessness. A better understanding of these relationships could inform needs for early interventions and/or better prepare agencies that serve at-risk youth to address precursors to youth homelessness.

1. Introduction

Youths who experience homelessness bear a disproportionate burden of physical and mental health problems compared with their housed counterparts [ 1 , 2 , 3 ]. Homeless children and youth are described as individuals less than 25 years of age living in poverty and without a stable, reliable and adequate nighttime residence, and who may not have an alternative safe living environment [ 4 , 5 ]. Included in this group are accompanied and unaccompanied children (defined here as <18 years of age) and youth (defined here as 18–24 years of age) with and without a legal parent or guardian, respectively [ 6 ]. Unaccompanied youths experiencing homelessness are more likely to be unsheltered relative to other homeless groups [ 6 ]. Additionally, most unaccompanied individuals experiencing homelessness (89%) are between the ages of 18 and 24 (i.e., “youth”), and are particularly vulnerable to the detrimental and negative effects associated with homelessness [ 6 , 7 ]. In the United States (2019), about 31,000 individuals experienced homelessness as unaccompanied youth on a given single night [ 6 ].

Various issues including financial challenges, social and material instability, familial problems, living conditions, structural issues, etc., have been shown to contribute to youth homelessness [ 8 ]. A study exploring youths’ transition to homelessness showed that physical abuse and intense familial conflict were the most predominant factors that contributed to youth homelessness, and many homeless youths come from single-parent households [ 9 ]. In another study among homeless adults, a variety of circumstances were identified precursors to homelessness, such as unemployment leading to limited economic resources, addiction problems, and loss of support and relationships with family and friends [ 10 ]. Other predisposing factors to youth homelessness include maltreatment and violence, incarceration and transitional living, family dissolution and conflict, and exclusion from school because of frequent housing changes as a child [ 11 ].

Mental illness has also been reported as a reason for youth homelessness [ 1 , 12 ]. Among youth in general, the peak occurrence of most mental illnesses begins before the age of 25 [ 13 , 14 ]. In fact, about 75% of adults with a mental illness have experienced their first onset by 25 years of age [ 15 , 16 ]. According to the American Psychiatric Association, the average age of onset for depression is the mid-20 s [ 17 ]. Further, the median onset age for bipolar disorders is 24 [ 18 ], 22 for schizophrenia [ 13 , 19 ], and 20 for anxiety disorders [ 18 , 20 ]. Although post-traumatic stress disorder (PTSD) is not prevalent among youth, violence and trauma that precede youth onset homelessness, is highly reported among youth [ 7 , 21 ]. In addition, studies have shown that youths with mental illness are more likely to engage in a greater number of risk behaviors that may increase vulnerability to violent victimization, potentially leading to increased traumatic experiences that may consequently increase the likelihood of homelessness [ 22 , 23 , 24 ]. The occurrence of these mental illnesses could lead to increased morbidity and poor health outcomes. For example, exhibiting symptoms of bipolar disorder and depressive disorders at an earlier age is correlated with suicidal ideation and attempts, and psychiatric comorbidities [ 18 , 25 ]. Hence, not only do many serious mental illnesses occur during youth (ages 18–25), these mental illnesses tend to endure into middle age. Mental illness among youth could be the result of adverse childhood events such as neglect and abuse producing negative outcomes in adulthood, such as addiction and chronic diseases, and ultimately homelessness [ 26 , 27 , 28 , 29 , 30 ]. Therefore, there is a need for increased awareness and provision of mental health treatment programs to abate the issue of mental illness and to potentially prevent associated outcomes that may predispose individuals to youth-onset homelessness [ 31 , 32 ].

Moreover, the specific mental illness experienced by youth could be important in predicting youth-onset homelessness [ 1 ]. Some studies have found that homeless youths have greater prevalence of severe mental illness(es) such as major depression, bipolar disorder, and schizoaffective disorder, compared to homeless adults who predominantly report increased patterns of substance use as precursors of homelessness [ 3 , 29 , 33 ]. Anxiety disorders and post-traumatic stress disorder (PTSD) have also been reported to be common among homeless youths [ 34 , 35 , 36 ]. On the other hand, at least one study reported similar psychiatric comorbidities for homeless adults, except that homeless adults had a higher rate of psychosis than homeless youths [ 36 ]. Thus, the literature is somewhat mixed with regard to any patterns of mental illness that may predispose or correlate with youth-versus adult-onset homelessness.

Based on the paucity of literature on mental illness as a reason for youth homelessness, the purpose of this study was to evaluate the potential role of mental illness in homelessness onset in youth versus adulthood among homeless adults. Specifically, mental illness as a reason for the current homelessness episode and a history of specific mental illnesses, presence of severe mental illness, and severe mental illness comorbidity were examined regarding their correlations with homelessness onset in covariate-adjusted analyses. We hypothesized that several of these mental illness variables would be retrospectively associated with youth-onset homelessness among this group of middle-aged homeless adults. A better understanding of these relationships could inform needs for early interventions and/or better prepare agencies that serve at-risk youth to address precursors to youth homelessness.

2. Materials and Methods

2.1. participants and procedures.

Adults experiencing homelessness were recruited within two independent studies on health and health risk factors. Participants for Study 1 were recruited in the summer of 2013 in Dallas, TX [ 37 ], and participants for Study 2 were recruited between July and August of 2016 from 6 homeless-serving agencies in Oklahoma City, OK [ 38 ]. Participants from both studies were recruited using flyers placed around the shelter areas and targeted settings. Inclusion criteria were: aged 18 or over, English-speaking, at least a 7th grade English literacy level as indicated by a score of >4 on the Rapid Estimate of Adult Literacy in Medicine-Short Form [ 39 ], and receiving services and/or shelter at the targeted agencies. Overall, 470 participants were screened in Study 1 and 648 were screened in Study 2, from which 76 (Study 1) and 38 (Study 2) individuals were ineligible for participation (for more information, see [ 37 , 40 ] and [ 38 , 41 ]). Overall, 394 (Study 1) and 610 (Study 2) participants enrolled. For the current study, we narrowed the samples to those who met the definition of being homeless [ 42 ]. All 394 enrollees in Study 1 resided at the shelter, whereas 525 in Study 2 met the HUD definition for current homelessness (i.e., self-identified as homeless and endorsed staying at a friend or family member’s house, homeless shelter, outside or on the street, hotel/motel, drug/alcohol treatment center, or other temporary location) [ 6 ]. Thus, the analyzable sample comprised 919 homeless adults.

All subjects gave their informed consent for inclusion before they participated in the study. The study was conducted in accordance with the Declaration of Helsinki, and the protocol was approved by the Institutional Review Boards of associated Institutions.

2.2. Measures

2.2.1. predictors.

Mental illness as reason for current homelessness was assessed by asking participants “What are your reasons for current homelessness” with mental illness provided as an option coded as 0 = no and 1 = yes. Although reasons for current homelessness might differ from reasons for first homelessness, the chronicity of serious mental illnesses and their typical onset in youth/young adulthood is potentially concomitant with its perseverance as a precursor of the most recent homelessness episode. To ascertain details on the history of specific diagnoses, participants were asked to indicate whether they had a lifetime history of diagnosis of major depression, bipolar disorder, and/or schizophrenia/schizoaffective disorder, respectively (0 = no and 1 = yes). Participants from Study 2 were additionally asked to indicate if they had a lifetime history of post-traumatic stress disorder and/or other anxiety disorders (0 = no and 1 = yes). Additionally, 2 investigator-generated variables were constructed. The first was the presence of severe mental illness by history, which included major depression, bipolar disorder, and schizophrenia/schizoaffective disorder [ 43 , 44 , 45 ] whereby endorsement of any of the three yielded a 1 = historical presence of severe mental illness versus endorsement of none, which yielded 0 = no historical presence of severe mental illness. The second investigator-generated variable was indicative of severe mental illness comorbidity by history, and consisted of the number of severe mental illness diagnoses as assessed above summed with a potential range of 0–3.

2.2.2. Outcome

Homelessness onset was assessed by asking “How old were you when you first became homeless?” with responses dichotomized as youth-onset homelessness (≤24 years) and adult-onset homelessness (>24 years). These age categorizations are consistent with previous studies examining youth versus adult-onset homelessness [ 29 , 46 ].

2.2.3. Covariates

Participants were asked about their education (<GED/high school vs. ≥GED/high school), race (white, black, vs. other), sex (male vs. female), insurance status (insured vs. uninsured), employment status (employed vs. unemployed), marital status (married vs. unmarried), and annual income (≤$5000 vs. >$5000). They were also asked to report their lifetime (“What is the total amount of time you have been homeless in your lifetime?”) and current (“How long ago did the current period of homelessness begin?”) period of homelessness, and the number of discrete homelessness episodes. Data origin (Study 1 versus Study 2) was also included as a covariate.

2.3. Analytic Plan

The descriptive statistics of sample characteristics and study variables were assessed, and the comparisons between homelessness onset (youth versus adult) were examined using Mann–Whitney test or chi-square test for continuous and categorical variables, respectively. Covariate-adjusted logistic regressions were used to measure associations of homelessness onset with mental illness as a reason for current homelessness, as well as with a history of specific mental illnesses, the historical presence of severe mental illness, and severe mental illness comorbidity by history. All analyses used two-tailed tests of significance with a statistical significance level designated at p < 0.05. All analyses were conducted using SAS version 9.4 [ 47 ].

3.1. Participants’ Characteristics

The sample ( N = 919) comprised 67.25% males ( N = 618). Overall, 54.95% of all participants ( N = 505) self-identified as being of a racial/ethnic minority group (i.e., 38.74% Black or African American, and 16.21% other), and 24.37% ( N = 224) reported mental illness as reason for current homelessness. See Table 1 for participants’ characteristics overall and by homelessness onset. Relative to those who reported adult-onset homelessness, participants who reported youth-onset homelessness were significantly more likely to have more homeless episodes (3, IQR: 2–5 vs. 2, IQR: 1–3), report mental illness as reason for current homelessness (31.37% vs. 21.45%), report the presence of severe mental illness by history (70.11% vs. 61.27%), and report severe mental illness comorbidity by history (1, IQR: 0–2 vs. 1, IQR: 0–2). Those reporting youth-onset homelessness were more likely to have a history of diagnosis with major depression (66.42% vs. 58.64%), bipolar disorder (42.07% vs. 28.24%), and schizophrenia/schizoaffective disorder (29.15% vs. 15.74%) relative to participants who indicated adult-onset homelessness. For Study 2, which also queried PTSD and other anxiety disorders, there were no significant differences in the prevalence by history of either, relative to homelessness onset.

Participants’ characteristics by homelessness onset ( N = 919).

Note. * Analyses conducted using sample from Study 2 ( N = 525); PTSD = Post-Traumatic Stress Disorder; M [IQR] = Median [Interquartile range].

3.2. Main Analyses

Table 2 reports the results of covariate-adjusted logistic regressions for associations between homelessness onset and mental illness as reason for current homelessness, a history of specific mental illnesses, the historical presence of severe mental illness, and severe mental illness comorbidity by history.

Logistic regression of homelessness onset and association with mental illness ( N = 919).

Note. Covariates include education, race, sex, insurance status, employment status, marital status, income, lifetime homeless months, current months of homeless, number of homeless episodes, and study site; OR: odds ratio; CI: confidence interval; * Analyses conducted using sample from Study 2 ( N = 525); PTSD = Post-Traumatic Stress Disorder.

3.2.1. Relation between Mental Illness as Reason for Current Homelessness and Homelessness Onset

The odds of changing from reporting no mental illness as reason for current homelessness to reporting mental illness as reason for current homelessness was 1.617 (95% CI: 1.118–2.339) for youth-onset homelessness versus adult-onset homelessness. That is, the expected likelihood of having the first homeless episode during youth versus adulthood was significantly greater for those who reported mental illness as reason for their current homelessness. Additionally, being other race (vs white; p = 0.0202) and having fewer months of homelessness in the current homelessness episode ( p = 0.0178), more homelessness episodes over the lifetime ( p < 0.0001), and being from the Dallas study site ( p = 0.0303) were associated with greater odds of youth- versus adult-onset homelessness in this analysis.

3.2.2. Relation between History of Specific Mental Illnesses and Homelessness Onset

Participants who were diagnosed with bipolar disorder and schizophrenia/schizoaffective disorder had 1.746 (95% CI: 1.242–2.453) and 1.831 (95% CI: 1.223–2.739) times greater odds of experiencing youth- versus adult-onset homelessness than those with no bipolar disorder or schizophrenia/schizoaffective disorder diagnosis, respectively. Moreover, being other race (vs white; p = 0.0224) and having fewer months of homelessness in the current homelessness episode ( p = 0.0182), and more homelessness episodes over the lifetime ( p < 0.0001) were associated with greater odds of youth- versus adult-onset homelessness in analysis with bipolar disorder. Fewer months of homelessness in the current homelessness episode ( p = 0.0108), more homelessness episodes over the lifetime ( p < 0.0001), and being from the Dallas study site ( p = 0.0278) were associated with greater odds of youth- versus adult-onset homelessness in analysis with schizophrenia/schizoaffective disorder. However, the association between having major depression and homelessness onset was not significant ( p = 0.1040). Having fewer months of homelessness in the current homelessness episode ( p = 0.0172) and more homelessness episodes over the lifetime ( p < 0.0001), and being from the Dallas study site ( p = 0.0264), however, were associated with greater odds of youth- versus adult-onset homelessness in this analysis. Lastly, the association between having anxiety disorder, PTSD and homelessness onset on a subsample (Study 2) was not significant in covariate-adjusted analyses ( p = 0.4841 and p = 0.6789, respectively). However, having more homelessness episodes over the lifetime ( p < 0.0001) was associated with greater odds of youth- versus adult-onset homelessness in analyses with other anxiety disorders and PTSD.

3.2.3. Relation between Historical Presence of Severe Mental Illness and Homelessness Onset

Adjusted odds of youth-onset homelessness to adult-onset homelessness was significantly greater among those who had a historical presence of severe mental health diagnoses compared with those who did not, with an odds ratio of 1.478 (95% CI: 1.041–2.098). Additionally, being other race (vs white; p = 0.0213) and having fewer months of homelessness in the current homelessness episode ( p = 0.0153), more homelessness episodes over the lifetime ( p < 0.0001), and being from the Dallas study site ( p = 0.0275) were associated with greater odds of youth- versus adult-onset homelessness.

3.2.4. Relation between Severe Mental Illness Comorbidity by History and Homelessness Onset

The adjusted logistic regression showed that each additional increase in a severe mental illness diagnosis was associated with 30% increased odds of youth- versus adult-onset homelessness (AOR: 1.301, 95% CI: 1.113–1.521). Additionally, being other race (vs white; p = 0.0207), and having fewer months of homelessness in the current homelessness episode ( p = 0.0122), more homelessness episodes over the lifetime ( p < 0.0001), and being from the Dallas study site ( p = 0.0486) were associated with greater odds of youth- versus adult-onset homelessness in this analysis.

4. Discussion

This study explored the association between mental illness and homelessness onset in youth versus adulthood. As hypothesized, our findings support that mental illness—in particular, severe mental illness and its comorbidities as driven by bipolar disorder and schizophrenia/schizoaffective disorder- was associated with youth-onset homelessness. The results are consistent with previous studies [ 48 , 49 , 50 , 51 ] and expands upon prior literature by assessing relations with history of severe mental illness and its comorbidities, and examined these associations retrospectively among a large sample of homeless adults. Given that both bipolar and schizophrenia/schizoaffective disorder have been shown to typically emerge during youth (~22–24 years of age) [ 13 , 18 , 19 , 52 ], results linking a history of these disorders with the reason for current adult homelessness and youth-onset homelessness suggest that youths with mental illness may face compounding stressors and barriers in the access and delivery of mental health care which could result in youth-onset homelessness that perpetuates homelessness as an adult [ 5 , 33 ].

Significant associations between youth-onset homelessness and major depression were not supported in adjusted analyses, suggesting that the significant associations found between the historical presence of severe mental illness and youth-onset homelessness may be driven by bipolar and schizophrenia/schizoaffective disorder. Future work should further investigate what differentiates major depression from these other severe mental health disorders with regard to the potential link with youth-onset homelessness. In this adult sample, major depression was among the most prevalent of the mental health disorders investigated, reported by 61% of the sample. Thus, its presence may be so common among individuals experiencing homelessness as adults that it fails to distinguish the timing of homelessness onset [ 1 ]. Major depression may also be distinguished from bipolar and schizophrenia/schizoaffective disorder via a lack of prominent psychotic symptoms [ 53 , 54 ]. Medications used to treat psychotic disorders, relative to those used to treat major depression, may have unique side effects that prohibit ideal adherence [ 55 , 56 ], thereby contributing to the continued display of symptoms and the social and practical consequences of such, which may include youth-onset homelessness. Future studies should further examine these possibilities prospectively, including the potential contribution of medication non-adherence (by class) to homelessness onset.

Despite the fact that major depression was not an independent predictor of youth-onset homelessness, it is notable that mental illness comorbidity, which could include major depression, was associated with a greater likelihood of experiencing homelessness as a youth. Thus, the presence of major depression in conjunction with other disorders in young adulthood might confer additional risk for homelessness in youth relative to the presence of a singular severe mental illness. Research has shown a greater likelihood of developing a second mental illness after a first mental disorder diagnosis [ 57 , 58 ]. Thus, not only would mental illness diagnosis increase the likelihood of youth-onset homelessness, but once homeless, the likelihood of severe mental illness comorbidity may also increase. These results highlight the need for interventions focused on preventing comorbid mental health problems among at-risk youth, which could further prevent youth-onset homelessness, and the combined effect of dealing with both homelessness and mental illness comorbidities. Finally, prolonged homelessness compounded by myriad mental health problems could affect youths’ ability to engage in normative experiences in school, social and community circles, and in entering into the workforce, which could consequently contribute to chronic homelessness [ 59 , 60 ].

Similar to findings with depression, neither anxiety nor PTSD by history was associated with youth-onset homelessness among the proportion of the sample for which this information was available. Although these disorders may also occur in young adulthood, they appeared to contribute less to early homelessness than some of their more “severe” diagnostic counterparts. More research is needed to understand the reasons behind these results and their potential coalescence with those associated with null results for major depression as a distinguisher of youth- versus adult-onset homelessness. It is important to note that the lack of findings related to these diagnoses and youth-onset homelessness does not negate that traumatic experiences and resulting symptomatology (not rising to a diagnostic level) may be prevalent–and treatable–among youth at risk for homelessness. Future studies might expand to better capture non-diagnostic symptomatology and/or history of traumatic events and outcomes to better understand this possibility. Future work on this topic should also examine the relative effect, and the timing of the effects, of various disorders on social and workplace functioning.

Overall, these results highlight the need for the provision of mental health services for youth at risk for mental illness and homelessness. Particularly important in providing these services is the ability to recognize and identify those youth at risk of mental illness via various avenues such as schools, churches, workplaces, youths in juvenile detention centers, foster care, and residential treatment centers. Identification of at-risk youth for mental illness involves a recognition of warning signs that can be precursors to mental illness (e.g., youth experience of abuse and domestic violence, suicidal thoughts, motor vehicle accidents, sexually transmitted infection diagnoses, crime, and physical fights) and initial manifestations of severe mental illness (e.g., reductions in and/or non-developmentally appropriate psychological, social, and occupational functioning) by those providing services to youth [ 61 ]. An example intervention at the school level for identification of at-risk youth may involve the provision of services focused on social and emotional health, and screening tools for the identification of psychological and behavioral problems. It is important to identify youth at-risk for mental illness as they are a vulnerable group at higher risk of negative health outcomes [ 62 ]. It is also important to focus attention on at-risk youth groups, such as youth involved in foster care, to prevent homelessness and its negative effects on youth [ 4 ]. Identifying youths and providing them with appropriate care may have an impact on future homelessness, and could also lead to improved quality of care provided to homeless youth. The use of predictive algorithms and models could be particularly helpful in identifying these at-risk youth and could assist with the development of plans to change the trajectory of occurrence [ 62 ]. Further understanding mental illnesses faced by youth is instrumental to the development of successful targeted interventions. Future work should examine whether intervening to prevent and/or appropriately treat severe mental illness in young adulthood helps to reduce the likelihood of youth-onset homelessness as well as the chronicity of homelessness through adulthood. It is important to note that lack of insurance, however, could pose as a barrier to the accessibility of mental health and other support services, whereby access is limited for youth who are uninsured [ 63 ].

There are some strengths and limitations of our study. A major strength of the study is the large sample size derived by a merge of two homeless samples recruited from multiple sites across two states. Though limited samples (only Study 2) were used in specific analyses, a majority of the reported meaningful results were reported with the full sample size. There are also several limitations. The first is the cross-sectional nature of the study, which limits causal inferences. Thus, longitudinal studies will be valuable to further elucidate the measured associations. Another limitation concerns the use of self-reported measures, which could result in reporting bias. As such, future studies could incorporate the use of more objective data such as a medical record or a diagnostic interview. Our data were collected in the West South-Central region of the United States and might not be generalizable to other homeless samples in other locations. Despite these limitations, our samples (from Dallas and Oklahoma City) were representative of the homeless individuals in those cities [ 64 , 65 ]. Mental illness rates might also not be accurately reflective of the actual rate in our sample, as vulnerable groups are frequently underdiagnosed [ 66 ]. In addition, self-reporting a history of mental illness might also require participants to know and understand their diagnoses; however, effective doctor-patient communication might be lacking in some cases [ 67 , 68 ]. Additionally, a limitation of this work is that mental illness was assessed as the reason for current homelessness, which may be different than the reason for the first episode of homelessness. However, we adjusted for number of episodes of homelessness to account for this limitation. Additionally, we did not assess all possible historical mental illnesses, which may mean that other mental illnesses are important in differentiating youth- versus adult-onset homelessness. However, the assessed mental illnesses in this study have been shown in literature to be the most prevalent among individuals who are homeless [ 29 , 44 ]. We also do not have information on the timing of mental health diagnoses; thus, we do not truly know if mental illness or mental illness comorbidities preceded first homelessness. However, some of the diagnoses assessed are known to first emerge prior to age 25 (e.g., schizophrenia) [ 52 ].

5. Conclusions

The current study adds to a limited literature on mental health disorders as a distinguishing factor in homelessness onset. Results suggest that a history of specific mental illnesses–namely bipolar disorder and schizophrenia/schizoaffective disorder–as well as the historical presence of severe mental illness and severe mental illness comorbidities may be associated with reason for adult homelessness as well as youth vs. adult-onset homelessness. Results from this study highlight the need for innovative programs to address mental health issues among youth who are either at risk for mental illness, exhibiting early signs of mental illness, or at high risk for homelessness. Overall, a better understanding of these relationships could inform needs for early interventions and/or better prepare agencies that serve at-risk youth to address precursors to youth homelessness.

Author Contributions

Conceptualization, C.N.I. and L.R.R.; Data curation, C.N.I., T.-A.C., M.S.B. and L.R.R.; Formal analysis, T.-A.C.; Funding acquisition, D.E.K., M.S.B. and L.R.R.; Investigation, D.E.K., M.S.B. and L.R.R.; Methodology, C.N.I., T.-A.C. and L.R.R.; Project administration, D.E.K. and M.S.B.; Resources, D.E.K., M.S.B. and L.R.R.; Software, C.N.I. and T.-A.C.; Supervision, C.N.I., M.S.B. and L.R.R.; Validation, C.N.I., T.-A.C. and L.R.R.; Visualization, C.N.I., T.-A.C. and L.R.R.; Writing—original draft, C.N.I., T.-A.C., K.E.-G. and L.R.R.; Writing—review & editing, C.N.I., T.-A.C., K.E.-G., D.E.K., M.S.B. and L.R.R. All authors have read and agreed to the published version of the manuscript.

Study 1: This work was supported by institutional funding provided by the University of Texas School of Public Health (to MSB) and the University of Texas MD Anderson Cancer Center (to LRR). Additional support for this work came from American Cancer Society grant MRSGT-12- 114-01-CPPB (to MSB) and MRSGT-10-104-01-CPHPS (to DEK). Study 2: This work was supported by the Oklahoma Tobacco Research Center at the University of Oklahoma Health Sciences Center (to MSB), with additional support from the University of Houston (to LRR). This study was also supported by funding from the American Cancer Society grant MRSGT-12-114-01-CPPB (to MSB). Current manuscript: Work to complete the current manuscript was supported by the National Cancer Institute (P20CA221697 to LRR and its sister grant P20CA226196). The first author (CNI) was a postdoctoral fellow supported on P20CA221696/P20CA221697. Authorship of this study was further supported by funding from the Stephenson Cancer Center Support grant (P30CA225520), as relevant to MSB and DEK. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the sponsoring organizations.

Conflicts of Interest

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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Toward Understanding Homelessness: The 2007 National Symposium on Homelessness Research. Homeless Youth in the United States: Recent Research Findings and Intervention Approaches

By: Paul A. Toro, PhD, Wayne State University, Detroit, MI Amy Dworsky, PhD, University of Chicago, Chicago, IL Patrick J. Fowler, MA, Wayne State University, Detroit, MI

Disclaimer:  This paper was developed for the National Symposium on Homelessness Research held on March 1-2, 2007. The Symposium was conducted by Abt Associates Inc. and Policy Research Associates Inc. under contract for the Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services; and the Office of Policy, Development, and Research, U.S. Department of Housing and Urban Development. The paper presents the views and opinions of the respective author(s) and does not necessarily represent the views, positions, and policies of the federal government.

In this paper, the authors cite research indicating that youth may be the single age group most at risk of becoming homeless, yet comparatively little research has been done in the past decade on this vulnerable population. Some important progress has been made, including longitudinal studies on youth “aging out” of foster care. After reviewing the characteristics of homeless youth, the authors review recent research findings on the homeless youth population and interventions developed to address their housing and service needs. These include interventions directed at youth themselves (education, employment, social skills training) as well as family-focused strategies. The authors conclude with future directions for both research and practice.

Introduction

Homelessness among adolescents and young adults is a major social concern in the United States. Robertson and Toro (1999) concluded that youth maybe the single age group most at risk of becoming homeless. Nevertheless, most of the research that has been conducted over the last two decades has focused on homeless adults, including those with mental disorders and substance abuse problems. Studies that have examined homelessness among adolescents and young adults as well as other age groups, have often cast the problem as one of individual vulnerabilities rather than as a social phenomenon involving transactions between individuals and their environments (Haber & Toro,2004; Shinn, 1992; Toro et al., 1991). This research has also been of limited value with respect to the development of public policies or empirically based interventions that either assist youth who are currently homeless or prevent homelessness among adolescents and young adults who are at risk (Shinn & Baumohl, 1999; Toro, Lombardo, & Yapchai, 2002).

These problems notwithstanding, some progress has been made since Robertson and Toro reviewed the literature on homeless youth over eight years ago for the 1998 National Symposium on Homelessness Research. Longitudinal studies, including research on youth “aging out” of foster care, have been an important source of information. Our knowledge about what works when it comes to prevention and programs that target homeless youth has also increased, although significant gaps remain. After briefly discussing some definitional issues and describing the homeless youth population and its constituent subgroups along a number of dimensions, we summarize what has been learned in recent years.

Definitional Issues.  We begin with a fundamental question. What does it mean to say that a youth is homeless? Alternatively, who does the population of homeless youth include? The Runaway and HomelessYouth Act (RHYA) defines homeless youth as individuals who are “not more than 21 years of age … for whom it is not possible to live in a safe environment with a relative and who have no other safe alternative living arrangement.” Implicit in this definition is the notion that homeless youth are not accompanied by a parent or guardian (Haber & Toro, 2004). The McKinney-Vento Homeless Assistance Act, the primary piece of federal legislation pertaining to the education of homeless children, provides a somewhat different definition. According to Subtitle B of Title VII of that legislation, youth are homeless if they “lack a fixed, regular, and adequate nighttime residence.” In contrast to the RHYA, McKinney-Ventoapplies not only to unaccompanied youth but also to those who are homeless or doubled up with their families. Because homeless families with children are the focus of another paper in this Symposium, we will adopt a more restrictive definition that excludes youth who are homeless with a parent or other guardian and youth who are wards of the state.

Homeless youth can be distinguished from two other homeless populations: single adults, who are predominantly male and do not have children in their custody; and homeless families, typically comprising a mother and her children. 1  Homeless youth include  runaways , who have left home without parental permission,  throwaways , who have been forced to leave home by their parents, and  street youth , who have spent at least some time living on the streets as well as  systems youth —i.e., young people who become homeless after aging out of foster care or exiting the juvenile justice system (Farrow, et al., 1992). Although these categories reflect important distinctions among youth with respect to the reasons they are homeless and their experiences while homeless, they are neither static nor mutually exclusive(Hammer, Finkelhor, & Sedlak, 2002), and it can be difficult to determine which label best applies. Youth may perceive themselves as being thrown out by their parents, while parents may perceive their son or daughter as running away. In other cases, youth may be removed from their home by child welfare authorities and then run away from their out-of-home care placement or leave home by mutual agreement with their parents. Street youth often spend significant amounts of time in adult caregivers’ homes, shelters, and temporary quarters with friends or other family (Greenblatt & Robertson, 1993). The one thing homeless youth have in common is that they are on their own without the supervision of an adult caretaker (Haber & Toro, 2004). In order to allow review of the full array of relevant literature, the present paper uses a broad definition, including all youth ages 12 to 25 who fit either the RHYA or McKinney-Vento definition (so long as they are “homeless on their own”).

1. In the U.S. and other developed nations, relatively few homeless families (12 to 20 percent) include children age 12 or older (Buckner, Bassuk, Weinreb, & Brooks, 1999; Burt et al., 2001), and children under age 12 are rarely found homeless on their own (Robertson & Toro, 1999). In fact, many shelters for homeless families exclude children age 12 or older who shelter staff fear might prey upon the younger ones. As a result, homeless families with older children are often compelled to leave their older children with friends or relatives before entering a shelter.

Prevalence and Geographical Distribution of Youth Homelessness

Just how many youth are homeless in a given year is difficult to know. Estimates vary widely depending on how “homeless” is defined and the agerange that is used. Different sampling and estimation techniques can also yield different results. For example, Ringwalt and colleagues analyzed data collected from a representative U.S. household sample of nearly 6,500 youth,ages 12 to 17, as part of the Youth Risk Behavior Survey (YRBS) and found that approximately 7.6 percent had been homeless for at least one night during the past 12 months (Ringwalt et al., 1998). This would translate into approximately 1.6 million homeless youth each year. Similarly, the Second National Incidence Study of Missing, Abducted, Runaway and Thrownaway Children (NISMART II), which combined data from three different surveys (the National Household Survey of Adult Caretakers, the National Household Survey of Youth, and the Juvenile Facilities Study) estimated that approximately 1.7 million youth experienced a runaway or throwaway episode in 1999 (Hammer, Finkelhor,& Sedlack, 2002). Other studies have looked at the likelihood of ever becoming homeless during adolescence. According to one estimate, 15 percent of youth will become homeless at least once before age 18 (Ringwalt, Greene, & Iachan, 1994).

Homeless youth can be found in urban, suburban, and rural areas throughout the U.S., but tend to be most visible in major cities (Robertson & Toro, 1999). Moreover, although they may be an understudied population, homeless youth in rural areas have proven difficult to recruit (e.g., Heinze, Toro, & Urberg, 2004; Thrane & Yoder, 2000). Nevertheless, few differences have been found when urban, suburban, and rural homeless youth have been compared (Cauce et al., 2000; Thrane & Yoder, 2000). Studies investigating street youth have generally been based in large metropolitan areas on the east and west coasts (e.g., Los Angeles, San Francisco, Seattle, and New York City), in part because researchers have not found large numbers of homeless street youth under age 18 in most midwestern and southern cities (Robertson & Toro, 1999).

Greenblatt and Robertson (1993) found both episodic and chronic patterns of homelessness among the youth they studied. However, the number of homeless episodes youth have experienced and the length of time they have been homeless seem to depend on whether shelter youth or street youth have been studied. Many youth in shelter samples are homeless for the first time and have not been homeless for very long (McCaskill, Toro, & Wolfe, 1998), whereas street youth tend to experience longer and more frequent episodes of homelessness (Whitbeck, Hoyt, & Yoder, 1999; Witken et al., 2005).

Homeless Youth: A Brief Summary of the Existing Research Literature

In this section, we briefly review how homeless youth have been studied in the past and what is known about homeless youth from this research (for amore comprehensive review, see Robertson & Toro, 1999).

Haber and Toro (2004) describe four basic approaches used by researchers to sample homeless youth. The first approach is to survey large groups of youth in the general population and identify those with a history of homelessness (e.g., Ringwalt et al., 1998; Windle, 1989). These methods may misrepresent the total homeless youth population because they do not include youth who are currently homeless, who may well have longer histories of homelessness and other negative characteristics. The second draws youth from service settings such as inner-city clinics (Kipke, Montgomery, & MacKenzie, 1993; Yateset al., 1988). Of course, youth seeking services may be different from those who do not seek help. The third approach samples youth from shelters (e.g.,McCaskill, Toro, & Wolfe, 1998). Some of the youth these facilities serve have been brought to the shelter by their families or third parties such as the police. Many have never spent a night on the streets. Such youth are often younger and less likely to have extensive histories of homelessness than street youth (Robertson & Toro, 1999). The fourth approach involves sampling from street locations where homeless youth are known to congregate and/or from drop-in centers designed to serve street youth (e.g., Cauce et al., 1994; Kipke, O’Connor, Palmer, & MacKenzie, 1995; Roy et al.,1998). This method often yields a sample biased toward youth who are engaged in a variety of deviant behaviors, especially if the sample includes many youth who are 18 or older. Some recent studies have combined the four methods in an effort to obtain more representative samples (e.g., Heinze, Toro, & Urberg, 2004; Paradise et al., 2001; Toro & Goldstein, 2000; Unger et al., 1998; Whitbeck, Hoyt, & Yoder, 1999; Witken et al., 2005).

Age, Gender, Race/Ethnicity, Sexual Orientation, and Pregnancy

The vast majority of homeless youth are age 13 or older, although a few studies have identified small numbers of youth who are homeless on their own as young as 9 years old (Clark & Robertson, 1996; Robertson, 1991). Although at least one national survey of youth found that males were significantly more likely than females to report recent homelessness (Ringwalt et al. 1998),the distribution of males and females among homeless youth seems to vary depending on the source and age of the sample. Shelter samples tend to include either equal numbers of males and females or more females (e.g., Heinze, Toro, & Urberg, 2004). Samples of street youth or older homeless youth are disproportionately male (e.g., Cauce et al., 2000). There is also some evidence that during the transition from adolescence to young adulthood the risk of becoming homeless declines for females but rises for males (Boesky, Toro, & Bukowski, 1997).

There have been contradictory findings with respect to race/ethnicity. Neither Ringwalt et al. (1998) nor Hammer et al. (2002) found racial or ethnic differences in rates of homelessness among the youth they studied, and at least some research suggests that homeless youth tend to reflect the racial and ethnic make-up of the surrounding area. However, other studies indicate that racial and ethnic minority youth are over-represented (Cauce et al., 1994; McCaskill, Toro, & Wolfe, 1998; Owen et al., 1998).

Gay, lesbian, bisexual, and transgender (GLBT) youth comprise 6 percent of the homeless youth population according to the National Network of Runaway and Youth Services. However, other prevalence estimates range from 11 to 35 percent (Kruks, 1991; Tenner et al., 1998; Whitbeck et al., 2004). Compared to heterosexual homeless youth, GLBT homeless youth leave home more frequently and are exposed to greater victimization while on the streets (Cochran et al., 2002). In addition, these youth may experience more physical and sexual abuse from caretakers (Whitbeck et al., 2004). GLBT youth may be at particular risk for homelessness due to conflict with their family regarding their sexual orientation (Milburn, Ayala, Rice, Batterham, & Rotheram-Borus, 2006; Remafedi, 1987).

A significant percentage of homeless youth are pregnant or parenting. Greene and Ringwalt (1998) found that 48 percent of street youth and 33 percent of shelter youth had ever been pregnant or impregnated someone, compared to 10 percent of a nationally representative sample of housed youth. Research also suggests that approximately 10 percent of both street and shelter female youth are currently pregnant (Greene & Ringwalt, 1998; Solorio et al., 2006). The high rates of pregnancy in this population may reflect the fact that many homeless youth engage in risky behaviors, including sex at an early age, survival sex, and inconsistent use of birth control.

Background Characteristics

Regardless of their pathways into homelessness, homeless youth share many background characteristics and experience many of the same psychosocial problems (MacLean, Embry, & Cauce, 1999). For example, they tend to come from low-income communities (McCaskill, Toro, & Wolfe, 1998) and their families are disproportionately poor or working class (Whitbeck et al., 1997). It is also not uncommon for homeless youth to report a history of family disruption. Many grew up in single-parent households or “blended” (i.e., stepparent) families (Boesky, Toro, & Wright, 1995; Greenblatt & Robertson, 1993), and a significant number of these youth have not had any contact with their non-custodial parent (Greenblatt & Robertson, 1993). The families of homeless youth also seem to have experienced far more residential moves than those of their housed peers (Cauce et al., 2000; Toro & Goldstein, 2000). In other words, their homelessness seems to be part of a longer pattern of residential instability.

Difficulties with School

Homeless youth often have a history of academic and school behavior problems. Between 25 and 35 percent of homeless youth report that they had to repeat a grade (Clark & Robertson, 1996; Robertson, 1989; Upshur, 1986; Younget al., 1983), and many have been suspended or expelled (Toro & Goldstein, 2000). Drop-out rates are also high (Thompson, Kost, & Pollio, 2003). Research suggests that at least some of these academic and school behavior problems may be attributable to attention deficit disorder (Cauce et al., 2000) or learning disabilities (Barwick & Siegel, 1996), which may be why homeless youth often report being placed in special education or remedial classes (Clark & Robertson, 1996; Robertson, 1989). Regardless of their cause, these academic and school behavior problems can be a source of family conflict and hence contribute to homelessness.

Family Conflict and Child Maltreatment

Youth consistently identify conflict with their parents as the primary reason for their homelessness (Whitbeck et al., 2002; Robertson & Toro, 1999), and they tend to report more family conflict than their peers who are housed (Toro & Goldstein, 2000; Wolfe, Toro, & McCaskill, 1999). These conflictst end to reflect longstanding patterns rather than problems that arise just before youth leave home (Smollar, 1999). Conflicts related to step-parent relationships, sexual activity, pregnancy, sexual orientation, school problems, and alcohol or drug use seem to be the most common (Owen et al., 1998; Robertson & Toro, 1999; Whitbeck & Hoyt, 1999).

In addition to family conflict, many homeless youth have experienced child abuse and/or neglect (Boesky, Toro, & Wright, 1995; Molnar et al., 1998; Powers, Eckenrode, & Jacklitsh, 1990; Robertson, 1989; Rotherman-Boruset al., 1996; Rothman & David, 1985; Ryan et al., 2000; Tyler et al.,2001; Unger et al., 1998; Yates et al., 1988). In fact, homeless youth often cite physical or sexual abuse as their reason for leaving home (Robertson, 1989). Although the percentage of homeless youth who report a history of maltreatment varies widely across studies, research using comparison groups has found that homeless youth are more likely to have been abused and/or neglected than their peers who are housed (Wolfe, Toro, & McCaskill,1999). This may also explain why homeless youth are more likely to have been verbally and physically aggressive toward their parents compared to their housed peers (Toro & Goldstein, 2000). That is, their aggression may be in response to parental aggression directed at them (Haber & Toro, 2003).

Mental Health and Behavioral Disorders

Homeless youth seem to be at elevated risk for a variety of mental health problems, including mood disorders, suicide attempts, and post traumatic stress disorder (Cauce et al., 2000; Clark & Robertson, 1996; Feitel et al., 1992; Fronczak & Toro, 2003; Greenblatt & Robertson, 1993; McCaskill, Toro, & Wolfe, 1998; Powers, Eckenrode, & Jaklitsch, 1990; Rew, Thomas, Horner, Resnick, & Beuhring, 2001; Rotheram-Borus, 1993; Robertson, 1989; Stewart et al., 2004; Toro & Goldstein, 2000, Yates et al., 1988). The risk of mental health problems may be particularly high among street youth, who tend to have experienced more stressful events and to exhibit more psychological symptoms than homeless youth who have not spent time on the streets (Robertson & Toro, 1999; Whitbeck & Hoyt, 1999).

Behavioral problems, such as conduct or oppositional defiant disorder, maybe even more prevalent than mental health problems (Cauce et al., 2000; McCaskill, Toro, & Wolfe, 1998; Toro & Goldstein, 2000). Homeless youth also exhibit high rates of substance use disorders, including alcohol abuse or dependence and drug abuse or dependence (e.g., Baer, Ginzler, & Peterson, 2003; MacLean, Paradise, & Cauce, 1999; Robertson, 1989; Rotheram-Borus, 1993; Thompson, Sayfer, & Polio, 2001; Thompson, Kost, & Pollio, 2003; Van Leeuwen, 2002; Van Leeuwen et al., 2005; Yates et al., 1988).

Although the prevalence of some diagnoses (e.g., depression) has been consistent across studies, lower rates are found for other disorders (e.g., conduct disorder) when more rigorous assessments are used and when homeless youth are recruited from shelters rather than the streets (Robertson & Toro, 1999). Nevertheless, regardless of the sample or the assessment method used, mental health and behavioral disorders seem to be more prevalent among homeless youth than among matched housed peers or the general adolescent population (McCaskill, Toro, & Wolfe, 1998; Toro & Goldstein, 2000). Unfortunately, the reason for the high prevalence rates observed among homeless youth is far from clear (Robertson, 1992; Robertson & Toro, 1999; Toro, 1998). Mental health and behavioral disorders contribute to family conflict and thus to homelessness. However, causality could also be in the opposite direction (Cauce et al., 1994; MacLean, Embry, & Cauce, 1999). Alternatively, some other factor or combination of factors could be a cause of both.

Risky Behaviors and Victimization

A number of studies have found not only that many homeless youth are sexually active, but also that they engage in sexual behaviors that put them at high risk for both sexually transmitted diseases and pregnancy (Cauce et al., 1994; Kipke et al., 1995; Lombardo & Toro, 2004; Rotheram-Borus, 1991; Rotheram-Borus et al., 1992a, 1992b; Staller & Kirk, 1997; Toro & Goldstein, 2000; Whitbeck & Hoyt, 1999).

Homeless youth also report engaging in delinquent or illegal activities, including stealing, forcibly entering a residence, prostitution, and dealing drugs (Whitbeck, Hoyt, & Ackley, 1997). Youth who engage in these “deviant” behaviors often report that they do so to obtain money, food or shelter (Van Leeuwen, 2002; Van Leeuwen et al., 2005). In other words, these behaviors may be part of a survival strategy (Robertson & Toro, 1999).

Being on their own without adult supervision means not only that homeless youth are likely to behave in ways that are unsafe, but also that they comprise an especially vulnerable group. This is reflected in the high rates of physical and sexual victimization they report (Greenblatt & Robertson, 1993; Tyler et al., 2004). Research has found not only that homeless youth are far morelikely to be victimized than their peers who are housed (Stewart et al., 2004; Yates et al., 1988) but that many homeless youth are victimized repeatedly (Whitbeck, Hoyt, & Ackley, 1997).

Service Utilization

Despite extensive demonstration of the needs of homeless adolescents, few studies have explicitly attempted to document the full range of service utilization among this needy group. In a recent study done in Detroit (described in more detail below), a majority of both homeless and matched housed youth failed to receive adequate services given their risks for disturbances in medical and psychosocial functioning (Toro & Goldstein, 2000). Only 2 percent of the homeless youth reported utilizing soup kitchen or outreach services, while 18 percent reported using inpatient or outpatient psychological services (Toro & Goldstein, 2000). Following youths for over two years showed that less than 1 percent reported using services after the initial interview.

New Areas of Research Since 1998

Several new areas of research on homeless youth have emerged since Robertson and Toro completed their review for the 1998 National Symposium on Homelessness Research. These areas include longitudinal studies of homeless youth, research on youth leaving the foster care and juvenile justice systems, and intervention and prevention research. Also there has been some development and evaluation of theoretical models explaining youth homelessness.

Longitudinal Studies

Tracking homeless youth over time can suggest both causes of and possibles olutions to the problems they experience. Unfortunately, only a few such studies have been done to date (e.g., Cauce et al., 1994), and few of their findings have yet been published in peer reviewed journals. In part, this paucity of data reflects the fact that data in these longitudinal studies are still being collected. However, it also indicates a general lack of research on homeless youth (as compared to other homeless groups) and a particular lack of longitudinal research on this population.

In any event, we can draw some conclusions based on preliminary results from a study by Toro and his colleagues. A probability sample of 249 homeless youth from throughout the Detroit metropolitan area, plus a matched sample of 149 housed youth, were initially interviewed at ages 13 to 17 and have been followed since at six time-points over a seven-year period. The youth are now aged 20 to 24, and data collection is nearly complete. Most of the adolescents returned fairly quickly to their family of origin. Nearly all (93 percent) of the initially homeless adolescents in the sample were no longer homeless at the 4.5-year follow-up, with one-third living with their parents (33 percent), another third living on their own (34 percent), and still others living with friends or relatives (21 percent). At follow-up, the initially homeless adolescents also reported significantly less conflict with their family and fewer stressful events (Toro & Janisse, 2004). Such trends have also been observed in longitudinal studies of homeless adults (e.g., Toro et al., 1999). People who are sampled because they are currently homeless are often at a particularly low point in their lives. Over time, many exit homelessness and thus appear to function at least somewhat better at follow-up, even though they often are not fully part of “mainstream society” and are likely to be at risk for future homelessness and/or other poor life outcomes.

Ahmed and Toro (2004) used data from the same longitudinal study to examine the relationship between several dimensions of religiosity and substance abuse outcomes over an 18-month follow-up period. Both cross-sectional and longitudinal analyses found that religiosity “buffered” the potentially harmful impact of stress on the outcomes. At the 4.5- year follow-up, greater spirituality protected African American, but not European American, young adults exposed to high levels of community violence or alcohol and drug abuse (Fowler, Ahmed et al., 2006).

Roy and her colleagues in Montreal have been studying various samples of street youth (age 14 to 25) and have followed one sample to observe various health outcomes, including HIV infection (Roy et al., 2003). They have, for example, found high mortality, with an annual death rate of 1 percent (Roy et al., 2004). The most common cause of death, by far, was suicide. This research group is now conducting another longitudinal study with more general purposes. Longitudinal findings will begin to be available in late 2007.

Milburn and her colleagues have followed homeless youth, aged 12 to 20, in Los Angeles ( N =498) and in Melbourne, Australia ( N =398), over a 12-month period (see Milburn, Rotheram-Borus et al., 2006; Witken et al., 2005). The longitudinal findings are just beginning to be reported in the professional literature (e.g., Milburn, Ayala, et al., 2006; Rosenthal et al., 2007).

Homelessness Among Former Foster Youth

Many homeless youth report a history of out-of-home care placement. The percentage who report being placed in foster care or an institutional setting varies across studies, but estimates range between 21 and 53 percent (Cauce et al., 1998; Robertson, 1989, 1991; Toro & Goldstein, 2000). A similar pattern has been observed among homeless adults (Firdion, 2004; Toro, Wolfe et al., 1999).

Of particular concern in this regard is the experience of youth who "age out" of foster care when they turn 18 or, in some states, 21. Although these youth are expected to live independently and support themselves once they leave the child welfare system, they often lack the financial, social, and personal resources needed to do so (Lindblom, 1996). As a result, this population is at high risk of becoming homeless after they age out. In fact, studies conducted in both Hollywood and San Francisco found that more than one-quarter of the street youth who had been discharged from state care spent their first night in a shelter or on the streets (Clark & Robertson, 1996; Robertson, 1989). Findings from several recent studies of youth aging out of foster care also illustrate this link.

The Foster Youth Transitions to Adulthood Study.  Courtney et al. (2001) collected baseline survey data from 141 Wisconsin foster youth in 1995. The youth were 17 or 18 years old and had been in care for a minimum of 18 months. Eighty percent, or 113, of these foster youth were re-interviewed 12 to 18 months after they left care. These young adults were similar to the baseline sample with respect to gender, race/ethnicity, and placement region (Milwaukee vs. the balance of the state). Among the outcomes the researchers examined was homelessness. Twelve percent of the follow-up sample reported being homeless for at least one night within 12 months of aging out (Courtney et al., 2001).

Youth Aging Out of Foster Care in Metropolitan Detroit.  Fowler, Toro et al. (2006) surveyed 264 youth from the total population of the 867 youth who had aged out over a two-year period from the foster care system in the three largest counties in the metropolitan Detroit area. The 264 youth were interviewed, on average, 3.6 years after exiting from foster care. At follow-up, the sample had an average age of 20.6 years; 52 percent were female; and 78 percent were African American. The follow-up sample of 264 was representative of the population of 867 in terms of demographic characteristics (e.g., gender, age, race/ethnicity) and foster care experiences (e.g., number of placements, age at entry, reason for placement). The purpose of the survey was to assess the functioning of these youth across various life domains since leaving foster care. The domains included housing, education, employment, emotional and behavioral well-being, substance abuse, risky sexual behavior, and victimization.

A total of 17 percent of the youth experienced literal homelessness during the follow-up period, including 3 percent who were literally homeless at the time they were interviewed. By comparison, the national five-year prevalence rate for literal homelessness among all adults in the United States was just 2 percent in 2001 (Tompsett et al., 2006). Those who experienced literal homelessness did so for an average of 61 days; the likelihood of experiencing literal homelessness did not vary by gender or race/ethnicity.

Just because youth were not literally homeless did not mean that they always had a stable place to live. On the contrary, one-third of the youth had spent time doubled up with other families or “couch surfing” among friends and relatives because they could not afford more permanent housing. This includes 12 percent who were precariously housed at the time of their interview. The mean number of times that these youth were precariously housed was 2.8 and the median duration of each episode was 13 months.

Most commonly, youth attributed their precarious housing or homelessness to economic factors such as a lack of employment, lack of affordable housing, termination of public assistance, or eviction. One-quarter of the youth who became homeless attributed their homelessness to problems with their families. In fact, this was the most common reason for becoming homeless immediately following exit from the foster care system.

Significant differences were found among the literally homeless, the precariously housed, and the continuously housed. Literally homeless youth reported significantly more personal victimization and deviant behavior than youth who were either continuously or precariously housed. However, both literally homeless and precariously housed youth experienced higher rates of psychological distress and alcohol or other drug abuse than continuously housed youth. In addition, literally homeless youth were more likely to report engaging in risky sexual behavior as compared to housed youth. Additional analyses suggested that both literal homelessness and precarious housing increased the risk of personal victimization, which in turn, increased the likelihood of other negative outcomes, such as psychological distress, deviant behavior, and marijuana use, even after controlling for age, gender, and race.

There was also some evidence that becoming homeless immediately post-discharge may have particularly negative effects. Youth who experienced homelessness right after they left care reported greater psychological distress, victimization, and deviant behavior than those who did not become homeless until later. The former were also less likely to have a high school diploma or GED and less likely to have received additional schooling since leaving care. What is not clear is whether the youth who became homeless immediately were already more vulnerable at the time they exited, or whether they became more vulnerable as a result of becoming homeless so quickly.

In many cases, the youth who experienced housing problems after exiting foster care did not receive services to address their needs. Less than one-third received services at homeless shelters and only 3 percent received help from outreach services. Although nearly two thirds reported going a whole day without food, just 15 percent received assistance from soup kitchens.  Likewise, 70 percent of these youth had clinically significant mental health, substance abuse, or behavioral problems, but only 21 percent received psychological services.  In contrast, 88 percent of these precariously housed and homeless youth received medical care since aging out of the system. Many of the youth were able to take advantage of Medicaid eligibility allowed under state foster care policy in order to get medical care.

The Midwest Evaluation of the Adult Functioning of Former Foster Youth.  The relationship between homelessness and out-of-home care placement is also being examined by an ongoing three-state longitudinal study that is following a sample of 732 foster youth from Iowa (63 youth), Wisconsin (195), and Illinois (474) as they age out of the child welfare system and transition into adulthood (Courtney et al., 2005). All of these youth had been victims of child maltreatment and entered foster care before age 16. The youth were initially interviewed at age 17 or 18, while they were still state wards, and then again at age 19. Just over half (321) of the 603 foster youth who completed a follow-up interview were no longer in care, and their mean time since leaving care was 14.5 months.

Although few of these youth were currently living on the streets, 14 percent (45) had been homeless for at least one night since they aged out. Homelessness was defined as sleeping “in a place where people weren't meant to sleep,” sleeping “in a homeless shelter,” or not having “a regular residence in which to sleep.” Two-thirds of the ever-homeless group had become homeless within six months of exiting and more than half (54 percent) had experienced more than one homeless episode.

A multivariate analysis using logistic regression showed that the best predictor of becoming homeless after aging out was whether a youth had repeatedly runaway from an out-of-home care placement. Running away more than once was associated with an almost ninefold increase in the odds of becoming homeless. There was also a positive relationship between the odds of becoming homeless and the number of delinquent behaviors in which the youth had engaged. By contrast, feeling very close to at least one family member reduced the odds of becoming homeless by nearly 80 percent. 

Homelessness Among Youthful Offenders

Every year, approximately 200,000 juveniles and young adults ages 10 to 24 years are released from secure detention or correctional facilities and reenter their communities. Most of these individuals are not high school graduates and most have never held a job. Many have physical, mental health, or substance abuse problems. A recent study of 1,800 arrested and detained youth found that nearly two-thirds of males and nearly three-quarters of females met diagnostic criteria for one or more psychiatric disorders (Teplin, Abram, McClelland, Dulcan, & Mericle, 2002). Yet, few youth will have received high quality services while in custody. Moreover, as if their transition back into society were not difficult enough, they are often returning to neighborhoods with high rates of poverty, unemployment, and crime (Mears & Travis, 2004).

Although relatively little is known about the process of reentry among this population, Altschuler and Brash (2004) have identified a number of challenges they are likely to confront, including problems with family and living arrangements. Some youth return to supportive homes; others do not. Still others are precluded from doing so by policies that prohibit individuals who have been convicted of certain drug offenses and other crimes from living in public or Section 8 housing (Popkin & Cunningham, 2001). Without a positive support network or stable living arrangement to which they can return, these juvenile and young adult offenders are at high risk of becoming homeless after their release. Once homeless, they may find themselves engaging in prostitution, selling or using drugs, or participating in other activities that could lead to their re-arrest.

There are no good estimates of the number of juveniles or young adults who become homeless upon release from detention or incarceration. Covenant House, a shelter for homeless youth in New York City, reports that approximately 30 percent of the youth they serve have been detained or incarcerated (New York City Association, 2005). These data also indicate that 68 percent had been living with family or guardians before incarceration. Eighty percent of the youthful offenders they served had neither completed high school nor obtained a GED, and 41 percent had a history of substance use. Interestingly, 49 percent also had a history of out-of-home care placement. In some instances, their child welfare case had been closed when they were detained or incarcerated and they had nowhere else to go upon release. This is true even if they had not yet turned 18 years of age because child welfare agencies are reluctant to take these youth back into their custody, especially if they have frequently “gone AWOL” or exhibited violent behavior (Riley, 2003; Travis, 2002).

Although most studies of youthful offenders have not included homelessness as an outcome measure, at least some research suggests that they are more likely to be homeless or precariously housed than other youth. Specifically, Feldman and Patterson (2003) compared 209 court-involved youth who participated in Workforce Investment Act (WIA) programs in Seattle–King County, Washington to 419 non-involved youth who participated in the same programs between July 1, 2000 and June 30, 2002. At program entry, the court-involved youth were less likely to be living with their parents and more likely to have no permanent address. Research on homeless adults has also consistently found high rates of prior incarceration, including incarceration while the adults were juveniles (Toro, 1998).

Intervention Research

Much progress has been made in providing services to homeless youth and families since 1987 when the Stuart B. McKinney Homeless Assistance Act (Public Law 100-77) was signed into law. There now exist a vast array of shelters and other emergency services to address the diverse needs of homeless individuals and families, including homeless youth (Toro & Warren, 1999). Increased funding from the federal government as well as other sources has also led to the development of new interventions. Although many of these interventions are designed to help homeless youth become and remain housed, some include other components such as mental health services, alcohol and other drug treatment, or HIV/AIDS risk reduction.

Unfortunately, few of these new interventions have been formally evaluated, and when evaluations have been done, rigorous experimental or quasi-experimental designs have generally not been used. In fact, we are aware of only one rigorous evaluation of a program for homeless youth (Cauce et al., 1998). Below, we describe some of the interventions that have been evaluated, discuss the results of those evaluations, and suggest directions for future research on promising interventions, even if those interventions have yet to be tested among homeless youth.

Case management.  Recognizing the multiple and diverse needs of homeless youth, Robertson and Toro (1999) advocated for a comprehensive and intensive case management approach that would address the unique needs of each homeless youth. Such an approach could be implemented in existing shelters and drop-in centers, and the relationship that developed between homeless youth and their case managers could become an important resource for the homeless youth and their families.

Intensive case management has been used successfully with homeless families and adults (Homan et al., 1993; James, Smith, & Mann, 1991; Toro et al., 1997). At least some research suggests that it might also be effective with homeless youth (Paradise et al., 2001). For example, Cauce et al. (1994) evaluated an intensive case management program for homeless youth in King County (Seattle), Washington. Youth were randomly assigned to either intensive or regular case management. Both groups experienced improved psychological well-being and a reduction in problem behaviors after the first three months of the intervention. However, youth who received intensive case management exhibited less aggression, fewer externalizing behaviors, and more satisfaction with their quality of life than youth who received “treatment as usual.”

Another promising service model is Urban Peak Denver, which provides overnight shelter as well as a variety of other services to homeless youth between the ages of 15 and 21 years. A case manager conducts a needs assessment and develops a case plan that includes educational and employment goals. Youthcan receive shelter for as long as they are moving forward on their case plans, and those who have been discharged are followed for six months. According to Urban Peak’s Client Database, which tracks the housing outcomes of youth who receive services, the percentage who experienced a positive housing outcome (e.g., moving into their own apartment, obtaining permanent supportive housing, or returning to their family of origin) ranged from a low of 48 percent in 2000 to a high of 65 percent in 2003 (Burt, Pearson, & Montgomery, 2005).

Family-focused interventions.  Although many programs work primarily, if not exclusively, with the youth who are homeless, others have targeted the family. This makes sense given that youth often cite family conflict as the cause of their homelessness (Whitbeck et al., 2002; Robertson & Toro, 1999) and they often end up returning to their families of origin anyway (Toro & Janisse, 2004). Moreover, at least one study found that youth who return home to live with their parents experience more positive outcomes than other youth (Thompson, Pollio, & Bitner, 2000). Of course, this could simply reflect the fact that the youth who are able to reunify are the youth with the fewest problems.

In any event, there is relatively little evidence as to the effectiveness of family-focused interventions. One example that is sometimes cited is a 1998 study by Coco and Courtney. They described a family systems approach for preventing recidivism among runaway females. Unfortunately, their evaluation of the intervention was weak, being based on a single-case design with a simple pre and post assessment of family satisfaction to assess the impact of the intervention.

It should be recognized that there are cases in which a family-focused intervention would not be in a homeless youth’s best interest. The most obvious example is a youth who has been severely neglected or abused. Other examples would include youth who have irreconcilable differences with their families, youth who have lost contact with their families, and youth whose families are homeless or precariously housed. In these cases, efforts must be made to find alternatives such as placement in foster care or independent living. Unfortunately, placement options may be limited, and may not represent an improvement in living situation (e.g., Benedict et al., 1994; Rosenthal, et al., 1991).

Social skills training.  In addition to their various service needs, many homeless youth lack what might be considered basic life skills, including meal preparation, household cleaning, time management, and budgeting (Aviles & Helfrich, 2004). Such skills are essential if they are to successfully transition out of homelessness and into successful adult functioning. Teare, Authier, and Peterson (1994) evaluated an intervention that used role-playing and a token economy to teach social skills to homeless youth receiving emergency shelter services. The assumption was that youth with social skills would experience fewer conflicts both during and after their shelter stay. The researchers reported that youth satisfaction with the program was generally high, that only 13 percent of the youth engaged in or expressed an intention to engage in self-destructive behavior, and that 69 percent did not exhibit any behaviors that were considered “out of control” (e.g., verbal or physical aggression). However, the researchers did not examine whether these outcomes reflected a change in behavior and their design did not include a comparison group that would have allowed them to assess the relationship between outcomes and participation.

School-based interventions.  School contexts provide an opportunity to assess and address the needs of homeless youth. Although there is some evidence that school-based interventions can benefit school age children who are homeless with their families, we are not aware of any school-based interventions that target unaccompanied homeless youth. However, we believe that such interventions could easily be adapted for homeless youth, most of whom do attend school (even if not consistently). For example, the Empowerment Zone provided a mental health treatment package for low-income and homeless elementary school age children during summer school (Nabors, Proescher, & DeSilva, 2001). Trained teachers and mental health providers administered classroom and small group interventions and individual counseling, and parents were offered parenting classes. Results showed that parents reported a significant decrease in child behavioral problems following the intervention. Another study found favorable results for a classroom behavioral management system in which trained teacher assistants used bracelets to reinforce positive behavior among homeless elementary school age children (Nabors, Hines, & Monnier, 2002). Although these initial findings are promising, the programs need to be expanded and more thoroughly evaluated.

Other intervention research.  A number of other studies have also examined the outcomes of homeless youth who received shelter services. Several of these studies have analyzed data from the Runaway and Homeless Youth Management Information System (RHYMIS). RHYMIS includes information about all of the runaway and homeless youth served by the Family and Youth Services Bureau’s (FYSB) Basic Center and Transitional Living and Street Outreach programs. RHYMIS includes demographic characteristics, services provided, and status at program exit (Family and Youth Services Bureau, 2006).

For example, Thompson et al. (2002) examined the outcomes of 261 runaway and homeless youth in four Midwestern states who received emergency shelter and crisis services, and compared their outcomes to the outcomes of 47 at-risk youth who received services from longer-term day treatment programs. Demographic information about the runaway and homeless youth was obtained from RHYMIS. Baseline data were collected from both groups at program intake. Follow-up data were collected six weeks post-discharge from the runaway or homeless youth and six weeks after intake from the comparison youth. Both the shelter youth and the day treatment youth experienced positive changes across six domains (runaway behavior, family relationships, school behavior, employment, sexual behavior, and self-esteem) and there were no significant group differences in the amount of change they experienced. Whether these improved outcomes persisted beyond the six-week observation period was not addressed.

Prevention Research

In addition to research on how to best address the needs of youth who are already homeless, other studies have focused on preventive interventions. This interest in the prevention of homelessness among youth is a relativelyr ecent development (e.g., Lindblom, 1996; Shinn & Baumohl, 1999; Toro, Lombardo, & Yapchai, 2002), and many interventions designed to prevent youth from ever becoming homeless (primary prevention) could just as easily be used to prevent youth who are currently homeless from becoming homeless again (secondary prevention; see Dalton, Elias, & Wandersman, 2007). Below, we discuss a number of issues regarding the prevention of homelessness. We focus on two groups of youth for whom the risk of becoming homeless appears to be particularly high: youth aging out of foster care and juvenile offenders.

Family-focused preventive programs.  Given that the youth frequently cite family conflict as the main reason for their homelessness, it should not be surprising that some homelessness prevention programs have focused on family dynamics and their impact on youth development. These programs include support groups for parents, parenting skills classes, and teaching conflict resolution skills. The assumption is that these programs will lead to improved family relationships, and thus prevent youth from becoming homeless.

One example of this approach is Project SAFE, a program operated by Cocoon House in Snohomish County, Washington (National Alliance to End Homelessness, 2002). Project SAFE provides three services to parents and other caretakers who are concerned about a youth’s behavior: phone consultation, groups or workshops, and a resource library. Parents or caretakers can call and speak with a master's level therapist who works with parents to develop a plan of action and decide what community resources will be needed to implement the plan. Plans can include steps to help parents deal with personal problems that may be contributing to the conflict with their youth. Parents receive a follow-up call, usually one week later, to check on their situation and provide any additional referrals. Parents can also participate in support groups that focus on cognitive behavioral skills or educational workshops that seek to raise awareness of parental risk factors that contribute to problem behaviors. In both cases, the goal is to promote healthier family functioning and to prevent teen homelessness. In FY 2005–2006, Project SAFE served 194 parents/caretakers. Outcome data showed a significant increase in parents’ perceived ability to cope with their youth as well as a significant decrease in parental perception of the youth needing to leave the home (Gagliano, 2006).

Another family-focused intervention that has the potential to reduce youth homelessness is multisystemic therapy (MST). Families are provided with intensive, home-based services. Master’s-level therapists empower parents to control their adolescent’s behavior by enhancing supervisory and monitoring skills. They also coordinate service provision among parents, individual counselors, teachers, peers, and others with a stake in the youth’s future.

Numerous randomized controlled trials have shown that MST can reduce antisocial behavior, even years following the treatment among chronic juvenile delinquents (Henggeler et al., 1997; Henggeler, Pickrel, & Brondino, 1999). MST clients have significantly fewer out-of-home placements and decreased recidivism (Henggeler et al., 1997; Henggeler, Pickrel, & Brondino, 1999). MST has also been successfully adapted for a wide range of other target groups of youth, including those with mental disorders and chronic health problems (Henggeler, 2006).

Homeless youth and delinquent youth have many similarities, including an absence of adult supervision, a lack of consistent discipline, and association with deviant peers (Whitbeck & Hoyt, 1999). Thus, future research should examine ways to tailor such programs to directly address the needs of youth at risk for homelessness as well as evaluate the efficacy of such programs.

School-based preventive programs.  School-based programs have the potential to prevent homelessness in adolescents at risk to run away by providing prosocial niches outside the home where they may be less vulnerable to influences of deviant peers (Johanson, Duffy, & Anthony, 1996). In addition, youth may have more opportunity to develop positive social bonds that discourage deviant behavior often associated with family conflict (Hirschi, 1969). However, programs that target youth at risk for homelessness have yet to be developed or evaluated. In-school and after-school prevention programs have shown to be effective in reducing the risk of youth delinquency and substance abuse (Crank, Crank, & Christensen, 2003; Pierce & Shields, 1998), and thus, may be extended to reductions of homelessness.

Preventing homelessness among youth aging out of foster care.  Preventing homelessness among youth aging out of care has long been a goal of federal policy. In fact, it was partly in response to several studies indicating that young adults who had aged out of care were at high risk of becoming homeless that Congress created the Title IV-E Independent Living Program in 1986 (Citizens’ Committee for Children of New York City, 1984; New York State Council on Children and Families, 1984; Shaffer & Caton, 1984). For more than a decade, this was the primary source of funding available to states to prepare their foster youth for the transition to young adulthood. States could use their Title IV-E funds to provide housing services such as helping youth find a place to live; however, the law prohibited those funds from being used for transitional housing or independent living subsidies (Allen, Bonner, & Greenan, 1988; Barth, 1990).

The Title IV-E program was replaced when Congress passed the Foster Care Independence Act of 1999 (FCIA). Title I of this legislation established the John H. Chafee Foster Care Independence Program and doubled the federal allotment for state independent living programs that prepare foster youth for the transition to adulthood. These funds can be used to provide youth with a wide range of services, including services to promote education and employment, life skills training, health education, case management, and mentoring (Ansell, 2001). Two provisions, in particular, are relevant to the prevention of homeless among youth aging out of foster care. One allows states to use up to 30 percent of their federal Chafee funds to pay for the room and board of former foster youth who are at least 18 years old but not yet 21. The other requires states to use at least some portion of their funds to provide follow-up services to foster youth after they age out. In the past, such services could be provided at state option, but seldom were.

States are currently using their Chafee funds as well as funding from other sources to assist foster youth with housing. For example, the Massachusetts Department of Social Services uses some of its Chafee money to fund its Discharge Support Program, which helps foster youth with their first month’s rent, security deposits, and other assistance, but the youth must be employed and able to pay their own rent. Connecticut's Community Housing Assistance Program (CHAPS) provides foster youth, age 18 and older who are working and enrolled in school, with a subsidy for rent and other living expenses. In fact, CHAPS is part of a continuum of housing options for Connecticut foster youth that also includes group homes for 14- to 16-year-olds and transitional living apartments for 16- and 17-year-olds. Illinois’s Youth Housing Assistance Program targets youth who have aged out or will soon age out and are at risk of becoming homeless. The program provides housing advocacy services to help youth between the ages of 17.5 and 21 to secure and maintain stable housing as well as cash assistance to help with deposits, emergency rental assistance, temporary rental subsidies, and furniture and appliances.

Partnering is another strategy that states have implemented to address the housing needs of foster youth. Some states are taking advantage of federal legislation that made youth aging out of foster care eligible for housing assistance under the Department of Housing and Urban Development’s Family Unification Program (FUP). In these states, child welfare agencies collaborate with housing authorities and/or community-based organizations to provide foster youth with time-limited housing vouchers over 18 months as well as other services. States with FUP programs for foster youth include New York, Colorado, Ohio, and California. In addition, some localities, including New York City, give foster youth priority access to Section 8 vouchers.

Most recently, Toro, et al. (2006) have proposed a comprehensive program that would both prevent homelessness and other negative outcomes among youth aging out of foster care and improve their emotional, behavioral, and socioeconomic well-being. The intervention would target foster youth transitioning to adulthood beginning at age 17. The program would be based on an intensive case management model and MST approaches and would involve the assessment of service needs across a number of domains, advocacy for the provision of services, coordination of service provision, and monitoring of service delivery. Small caseloads and frequent contact between case managers and youth would be important to keep youth who lack support from family members or other adults from falling through the cracks and because the quality of the client-case manager relationship is a key predictor of successful outcomes (Casey Family Programs, 2005; Thompson et al., 2006).

Youth would generally be referred to community resources, but program staff could provide services that are not available as well as direct funds to support independence (e.g., rent money to avoid eviction). In addition to service provision, the program would focus on empowering youth to make responsible life decisions. Toward this end, case managers would use a person-centered approach that emphasizes youth’s strengths and preferences as well as motivational interviewing (Miller & Rollnick, 2002), a therapeutic technique that seems to be effective in promoting positive change behavior seven among multi-problem populations such as low-income, African American substance abusing mothers (Ondersma et a., 2005). Toro et al. (2006) have also recommended that the intervention be evaluated using random assignment within a longitudinal design, with data collected at baseline and then again at 6-month intervals for 18 months in total. It is hoped that this intervention will be implemented and evaluated starting in late 2007.

Although independent living programs have been described (e.g., Hoge & Idalski, 2001), there is very little in the way of empirical data regarding their effectiveness. Due to another provision in the FCIA, states will soon be required to track the outcomes of current and former foster youth at ages 17, 19, and 21 and report those outcomes to the National Youth in Transition Database. Homelessness is one of the six outcomes about which they will be required to report.

Several other issues related to research on the prevention of homelessness among youth aging out of care also merit attention. First, findings from the Midwest study indicate that some foster youth, including those who run away repeatedly, are at even greater risk. Targeting those youth for preventive interventions both before and after they leave care would seem to make sense, and the impacts of those interventions should be formally evaluated. Second, the Midwest study also found that feeling close to at least one family member reduced the likelihood of becoming homeless. This has important practice implications for child welfare agencies. Specifically, it suggests that more attention should be paid to maintaining relationships between foster youth and members of their biological family, including grandparents and siblings. Such attention may, perhaps, even be appropriate when the family is somewhat dysfunctional, because, if we wish to prevent homelessness, some (even imperfect) support from family may be better than no support at all. What is not yet clear, and merits further investigation, is why closeness to family has what appears to be a protective effect. One possibility is that family members are a resource to whom foster youth can turn if there is no other place for them to stay. Another is that strong family ties reflect underlying individual or environmental resources that function to protect youth. In any event, interventions aimed at promoting family ties, where doing so is in a youth’s best interest, should be developed and their ability to reduce the risk of homelessness should be explored.

Third, one of the most striking findings to emerge from the Midwest study was that the foster youth who were still in care at age 19 seemed to be faring better than their peers who had left. There were statistically significant differences across a number of domains, including college enrollment, access to health care, and criminal justice system involvement, and they consistently favored the 19-year-olds who were still in care. It remains to be seen whether those differences will persist once the foster youth who were still in care at age 19 have also exited. A third wave of survey data being collected from the foster youth when they are 21 years old will begin to address this question. For now, at least, the results suggest that one way to reduce the percentage of youth who become homeless after aging out of care would be to extend their eligibility until age 21, as is already the case in a few states like Illinois.

Fourth, an often overlooked provision of the FCIA requires states to use some of their federal training funds to assist foster parents, group home workers, and case managers do a better job of preparing foster youth for the challenges they face during the transition to adulthood. With respect to preventing homelessness, this means educating foster parents, group home workers, and case managers about how to help their foster youth find housing and remain housed. To this end, Casey Family Programs (2005) has published  It’s My Life , a series of guides, including one focused on housing, that contain practical strategies and on-line resources for adults working with these youth. Researchers could examine whether educating foster parents, group home workers, or case managers about these or other strategies leads to more stable housing and lower rates of homelessness.

Finally, although the FCIA requires states to use a portion of their Chafee funds to provide supportive services to foster youth after they age out, at least some research suggests that young adults may not take advantage of such services even when they are available (Lindblom, 1996). Just why this is the case is not well understood. It may be that young adults are reluctant to participate in services that they associate with foster care or that they object to the conditions of participation. It is also possible that such services are perceived to be of little help.

Preventing homelessness among youthful offenders.  As explained above, youthful offenders can become trapped in a cycle of homelessness and incarceration. If they return to the streets after their release, there is a strong chance they will become involved in the same behaviors that initially led to their arrest (National Alliance to End Homelessness, 2001). Thus, programs that assist youthful offenders to find housing and stay housed have the potential not only to prevent homelessness but also to reduce recidivism in the criminal justice system.

Unfortunately, although a number of programs have been developed to help youthful offenders with the process of reentry, not much is known about their effects on homelessness prevention. One exception is the young adult component of the Going Home Reentry Grant in Polk County, Iowa. This program targets youthful offenders, aged 17.5 to 20 years, who are leaving state training schools. A Community Transition Team works with the youthful offender to create an individualized wrap-around plan that addresses housing and other service needs. In some cases, this plan involves reunification with parents or other family members. In other cases, housing is secured using project funds. Although there has been no formal evaluation of the program, there are outcome data for the 47 youthful offenders (32 males and 15 females) who were served during a three-year grant period. Seventy-nine percent of the females and 84 percent of the males were able to establish a stable residence.

The housing needs of youthful offenders have also been addressed by programs that target youth aging out of foster care. For example, Lighthouse Youth Services in Cincinnati, Ohio, runs an independent living program that focuses on foster youth between the ages of 16 and 19 as well as a transitional living program that targets homeless youth between the ages of 18 and 25 (Kroner, 2005). However, a number of youthful offenders are also served each year. Referrals come from child welfare agencies, homeless shelters, juvenile courts, and community-based organizations. Lighthouse's housing continuum includes several housing options for youth: scattered-site apartments, supervised apartments, shared homes (for four or five youth), host homes, and boarding homes. Youth move from more structured to less restrictive living arrangements, depending on the level of support and services they need. Unfortunately, no formal outcome data have been collected to date.

Employment programs as a prevention strategy.  Although preventing homelessness is usually not a primary goal of employment programs, it stands to reason that youth and young adults are less likely to become homeless if they are self-sufficient and stably employed. From this perspective, several programs funded by the U.S. Department of Labor (DOL) could be considered preventive interventions. One example of this approach involves programs funded under the Workforce Investment Act (WIA). Low-income youth between the ages of 14 and 21 are eligible to receive WIA-funded services if they face one or more recognized barriers to completing school and attaining economic self-sufficiency. These services allow youth to continue their education and pursue employment. Youth aging out of foster care, homeless youth, and youth who have been involved with the juvenile justice system are among WIA's target populations.

In addition to these WIA services, DOL also funds a number of other workforce development and support services that can help prevent homelessness among at-risk youth. Job Corps is the largest and most comprehensive residential vocational training and education program for at-risk youth between the ages of 16 and 24. Youth aging out of foster care and runaway or homeless youth are among the target populations of Job Corps. In a multi-year evaluation of the program, eligible youth were randomly assigned to a treatment group that received Job Corps services or a control group that did not. They were interviewed at the time of enrollment and then again at 12, 30, and 48 months after random assignment. The researchers did not look specifically at homelessness. However, Job Corps participation was related to independent living at the 48-month interview. A slightly smaller percentage of program group members were living with their parents, and a slightly larger percentage were living with a partner and reported being the head of the household (Burghart et al., 2001; Schochet, Burghardt, & Glazerman, 2001).

Likewise, DOL's Youth Offender Demonstration Program (YODP) is a labor-focused reentry program for youth ages 14 to 24 returning to their communities from detention or incarceration and who are already involved in the juvenile/criminal justice system, are gang members, or are at risk of gang or court involvement. Of particular relevance to homelessness prevention, some YODP sites are working with nonprofit housing programs. Unfortunately, no formal evaluation of the YODP has ever been completed.

Theoretical Developments

Haber and Toro (2004) provide a thorough review of various theories that have been applied in recent research on homeless children and youth. The theories most relevant to homeless youth include variants based on social learning theory (Bandura, 1977; Patterson, 1982). The Risk Amplification Model (RAM), one of the most widely applied of these variants, posits that noxious early environments, including poor parenting practices in the home, put youth at risk for homelessness and that being homeless further "amplifies" the risk for poor outcomes among such youth (Paradise et al., 2001; Whitbeck & Hoyt, 1999). The RAM suggests that risk is amplified by homelessness through victimization on the streets, engagement in subsistence strategies (e.g., stealing food, prostitution), association with deviant peers and adults, and other negative experiences.

Cross-sectional studies provide some empirical support for the RAM. For example, homeless youth tend to come from more deleterious home environments and experience higher rates of victimization compared to matched housed youth (Robertson & Toro, 1999). In a more direct test of the RAM, Whitbeck, Hoyt, and Yoder (1999) found that affiliation with deviant peers, deviant subsistence strategies, risky sexual behaviors, and substance use amplified the effects of a negative family environment on victimization and depressive symptoms among homeless female youth (but not among homeless males).

There is also some support from longitudinal studies. Using the Detroit-based dataset described earlier, Lombardo and Toro (2005) found that family conflict was related to heightened self-reported symptomatology and deviant peer associations, and that both of these were associated with risky sexual behaviors and substance abuse six months later. Analyses testing the RAM over longer periods of time (up to 6.5 years) are currently being conducted by Toro and colleagues.

Much has been learned since Robertson and Toro reviewed the literature on homeless youth for the 1998 National Symposium on Homelessness Research. Yet many important questions remain unanswered. Several areas, in particular, could be the focus of future research.

• Many risk factors associated with youth homelessness have been identified. Examples include family conflict, aging out of foster care, and identifying as GLBT. What is not well understood is how these factors operate. That is, what are the pathways leading to homelessness among youth with these risk factors? Future research needs to explore these pathways and consider how other factors (e.g., access to and quality of services received during childhood or early adolescence, growing up in a family that experienced homelessness) either aggravate or mitigate those risks.
• Although many interventions have been developed to address the diverse needs of homeless youth, the vast majority have not been evaluated. As a result, we know relatively little about what works. Closing this gap will require methodologically sound studies that include control (or at least comparison) groups in experimental (or at least quasi-experimental) research designs.
• Researchers should examine whether certain types of interventions are more effective with some homeless youth than others (e.g., runaway youth vs. throwaway youth vs. systems youth; street youth vs. shelter youth; rural youth vs. urban youth; youth homeless with their families vs. youth homeless on their own). Groups that are likely to have unique needs and hence for whom unique interventions may be merited include LGBT youth and youth who are pregnant or parenting.
• Broadly speaking, there are two types of prevention strategies: universal approaches that seek to promote positive youth development, and more targeted approaches that focus on youth thought to be at greatest risk. Research is needed on both types of strategies to determine whether both can prevent homelessness and other negative outcomes among youth.
• Because so many homeless youth cite family conflict as the reason for their homelessness, more attention should be paid to prevention and intervention strategies that focus on the family. Strategies might involve improving communication, developing conflict resolution skills, and increasing understanding of adolescent development. It is important for social workers and others assisting homeless youth and those at risk for homelessness (such as youth aging out of foster care) to help these youth connect with family members who might assist them in the future (often after the workers end their assistance). It is also important that "family" be broadly defined to include not only biological relatives but also others (e.g., fictive kin, close friends) who youth regard as part of their family.
• Although interventions may benefit from tapping into familial resources, reunification may not be a good option for certain homeless youth. More research is needed to determine the individual and environmental circumstances that argue for and against familial reunification. Interventions should be developed using this information.
• Not much is known about why so few homeless youth, whether in shelters or on the streets, use human services available to them (aside from short-term use of shelters for some). Similar to recent studies of homelessness among adults (e.g., Acosta & Toro, 2000), future research needs to ask the homeless youth themselves about their experiences and satisfaction with various services. Most likely, attention will be needed to alter approaches used by existing programs and services to make them more accessible and "user friendly."
• Most existing research on homeless youth has focused on the "literally homeless," those who have spent at least some time in homeless shelters, on the streets, or living in other unconventional settings (Toro, 1998). Future research should also focus on youth who "couch surf" or who are otherwise precariously housed. This group may be larger than, and at equal risk as, those who are literally homeless.
• Developing effective prevention and intervention strategies requires a clearer understanding of what youth experience before and after they become homeless. Toward that end, we need more quantitative and qualitative research to explore the outcomes of homeless youth, including the pathways through which they exit, or fail to exit, homelessness. More longitudinal studies are also needed to examine how environmental, family, and individual factors affect both their short-term and long-term outcomes. Disentangling the effects of these different types of factors will also require multivariate data analytic techniques.
• Preventive interventions with youth aging out of foster care and youthful offenders should be expanded. Although some programs exist, little firm empirical evidence exists on what works. Broader and better designed preventive interventions are needed.
• It appears that few if any of the studies reviewed above directly involved homeless or other at-risk youth in the research process. We believe that such youth should, ideally, be consulted at every stage, including the design of the study, the development of survey instruments or interview protocols, the collection of data, the interpretation of results, and the dissemination of findings. Not only can involving homeless or other at-risk youth in the research process improve the quality of the research (Jason et al., 2004), but it may increase the likelihood that the research leads to better policy and practice. Similarly, there should be more collaboration between service providers and researchers, both to improve the quality of the research and the ability for the research to be applied to policy and intervention.
• With regard to theoretical approaches, there is a need to move beyond the pervasive deficit orientation in much of the research toward more positive, resilience-based frameworks. There is also a need to more carefully consider the developmental contexts in which youth who are homeless or at risk for homelessness exist and to develop a better international understanding of homeless youth.

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[1]   In the U.S. and other developed nations, relatively few homeless families (12 to 20 percent) include children age 12 or older (Buckner, Bassuk, Weinreb, & Brooks, 1999; Burt et al., 2001), and children under age 12 are rarely found homeless on their own (Robertson & Toro, 1999). In fact, many shelters for homeless families exclude children age 12 or older who shelter staff fear might prey upon the younger ones. As a result, homeless families with older children are often compelled to leave their older children with friends or relatives before entering a shelter.

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• 2024 Trafficking in Persons Report

A PDF accessible version will be posted as soon as the ongoing accessibility and accommodation updates are concluded. Your patience is appreciated.

If you have questions about the 2024 Trafficking in Persons Report, please email  [email protected] .

• Message From the Secretary of State

Dear Reader:

Human trafficking is a stain on the conscience of our society.  It fuels crime, corruption, and violence.  It distorts our economies and harms our workers. And it violates the fundamental right of all people to be free.

Around the globe, an estimated 27 million people are exploited for labor, services, and commercial sex.  Through force, fraud, and coercion, they are made to toil in fields and factories, in restaurants and residences.  Traffickers prey on some of the world’s most marginalized and vulnerable individuals – profiting from their plight.

The State Department’s annual Trafficking in Persons Report provides the world’s most comprehensive assessment of this abhorrent practice, as well as efforts by governments and stakeholders around the globe to combat it.  By measuring progress in 188 countries – including the United States – we are advancing President Biden’s commitment to prevent trafficking, prosecute perpetrators, and protect survivors.

Even as this resource covers long-standing forms and methods of trafficking, it also examines the growing role of technology in both facilitating exploitation and countering it.

Digital tools have amplified the reach, scale, and speed of trafficking. Perpetrators use dating apps and online ads to recruit victims.  They use online platforms to sell illicit sexual content.  They leverage encrypted messaging and digital currencies to evade detection.

At the same time, technology is also one of our most powerful tools to combat this enduring scourge.  Mobile phones, social media platforms, and artificial intelligence make it possible for advocates and law enforcement to raise greater awareness about the rights of workers and migrants, locate victims and perpetrators of online sexual exploitation, and analyze large amounts of data to detect emerging human trafficking trends.

As technology makes it easier for traffickers to operate across geographies and jurisdictions, those of us committed to rooting out this horrendous crime – in government, businesses, civil society – can and must work together and coordinate our efforts.

I am grateful to everyone who contributed to this report, especially the State Department’s Human Trafficking Expert Consultant Network, who helps ensure our findings and recommendations are informed by those with lived experience of human trafficking.

I also want to recognize our TIP Report Heroes who have been essential partners in this work.  For the past 20 years, the Department of State has honored more than 170 such champions of human dignity and decency from over 90 countries – survivors, government leaders, law enforcement officials, lawyers, social workers.  Many of them have put their own safety at risk to support victims and share their stories.

The courage and persistence of survivors and advocates like these humble and inspire us all as we continue working to build a safer and more just world.

Antony Blinken

• Message From the Ambassador-at-Large

Innovation drives successful anti-trafficking work.  As criminals continually adapt to take advantage of new vulnerabilities and opportunities to exploit others, we must persistently keep pace with a rapidly evolving trafficking landscape.  This year’s introduction examines the role of digital technology, which has had a profound impact on trafficking methods and trends in recent years.  Traffickers use online platforms to recruit, groom, defraud, coerce, and exploit victims, taking advantage of the potential for anonymity offered by online spaces.  At the same time, when harnessed effectively, digital technology can strengthen our anti-trafficking response, providing opportunities for stakeholders to strengthen prevention efforts, protect victims, and partner with survivors and other stakeholders to combat the crime.

In our fight against human trafficking, we must constantly strive to connect and unite through innovation, including optimization of our use of digital technology.  Traffickers take advantage of the ever-shifting nature of the internet to exploit others; it is imperative that we too embrace technology to counter this trend.   Digital technology has given us new ways to prevent trafficking, protect victims, prosecute bad actors, and forge global partnerships to combat this crime.  This year’s report highlights a range of successful and promising innovations that set us on that path.  Developing partnerships and empowering communities most affected by human trafficking are key to combating this crime.  This report examines, for example, how current efforts to prevent and address forced labor are buoyed by strategic partnerships with workers, including worker-led approaches to advancing labor rights and standards.

The internet can provide spaces to share information, for example to train and educate youth regarding online safety, empower workers to know and protect their rights, and educate vulnerable populations to recognize indicators of exploitation.  Digital tools can provide human trafficking victims with streamlined access to services such as hotlines, peer support and therapy, and other resources for technical training and financial literacy to help survivors navigate the exit and recovery stages of human trafficking.  Technological advances can increase the speed and accuracy of data collection, an area that when harnessed effectively can aid in the identification of trafficking patterns and trends.  Stakeholders can use technology to strengthen communication and information-sharing tools that incorporate workers’ voices, increase transparency and accountability in supply chains, and streamline collaboration and data-sharing among stakeholders.

This year’s introduction also covers a topic of personal importance to me as a former prosecutor.   Utilizing strategic investigative processes can effectively shift the burden of proof away from a reliance on victim testimony, which can endanger and retraumatize victims, and onto the prosecuting authority to both strengthen criminal justice procedures and better facilitate the safety and long-term well-being of victims and survivors.  Strengthening partnerships with survivors and innovating for greater inclusion of historically marginalized communities such as those with disabilities, are crucial to the anti-trafficking movement.  Survivors must continue to be consulted early and often in the development and implementation of anti-trafficking work.  Their firsthand knowledge of the ways in which traffickers are utilizing technology for exploitation is critical to ensure effective prevention, protection, and prosecution efforts.

Governments have a responsibility to guide and leverage efforts, including the use of digital technology, to protect the rights and safety of their citizens; however, governments cannot do this alone.  Collaboration and partnerships among stakeholders – governments, tech companies, NGOs, survivor communities, and financial institutions – are more important than ever to creating a safer world without human trafficking.  A fierce commitment to innovation has the power to renew and strengthen the deep connections that bind together all of us working to end human trafficking.  The United States is proud to work alongside our partners at home and overseas as we document and disseminate efforts to end this terrible crime while also recognizing the heroes whose work around the globe brings hope to victims, empowerment to marginalized communities, and motivation to continue our collective efforts.

• Human Trafficking Defined

The Trafficking Victims Protection Act of 2000, as amended (TVPA), defines “severe forms of trafficking in persons” as:

• sex trafficking in which a commercial sex act is induced by force, fraud, or coercion, or in which the person induced to perform such an act has not attained 18 years of age; or
• the recruitment, harboring, transportation, provision, or obtaining of a person for labor or services, through the use of force, fraud, or coercion for the purpose of subjection to involuntary servitude, peonage, debt bondage, or slavery.

A victim need not be physically transported from one location to another for the crime to fall within this definition.

Exploring the Role and Impacts of Digital Technology on Human Trafficking

In today’s rapidly evolving world, technology is often a double-edged sword.   While technology has provided innovative solutions to preventing and addressing human trafficking, it has also prompted complex ethical questions and created new opportunities for criminals, including human traffickers, to be increasingly sophisticated in exploiting individuals for profit.   Traffickers use technology to recruit, control, market and exploit vulnerable individuals while also evading detection.   Traffickers do this, for example, by using the Internet to advertise and sell children online for sex, advertise false jobs on social media platforms that are actually human trafficking schemes, transfer cryptocurrency to other traffickers, and perpetuate online scam operations.   At the same time, anti-trafficking stakeholders are using technological innovations to prevent human trafficking, protect victims, and prosecute traffickers.   The 2024 Trafficking in Persons Report (TIP Report) introduction explores the challenges associated with digital technology in the fight against human trafficking and highlights how it can be used effectively by the anti-trafficking community.

Defining “Digital Technology”

Digital technology refers to an ever-expanding set of electronic systems and resources that facilitate learning, communication, entertainment, and more.   Examples include hardware, such as computers, smartphones and mobile devices, and robotics; software, including mobile applications, geolocation, online games, financial databases, web-based and cloud-based systems, and artificial intelligence (AI); and other online services, such as websites, video streaming, blogs, and social media.   For the purposes of this report, digital technologies are explored through their use by traffickers as well as by key anti-trafficking stakeholders and beneficiaries.

The Intersection between Digital Technology and Human Trafficking

One way digital technology and human trafficking can intersect occurs when traffickers use online platforms to exploit victims.   While not a novel phenomenon, renewed attention was brought to the issue because many people shifted their daily activities online at the height of the COVID-19 pandemic.   Reports from several countries demonstrated drastic increases in online commercial sexual exploitation and sex trafficking, including online sexual exploitation of children (OSEC), and demand for and distribution of child sexual abuse material (CSAM).   Traffickers have continued to advance schemes to exploit individuals using digital tools to groom, deceive, control, and exploit victims.   Some of these schemes lure individuals hundreds of miles away, including across borders, while others do not require them to leave their homes.  Increasingly, victims and survivors of human trafficking have shared that they first connected with their traffickers online.   While traffickers continue to refine and advance their use of digital technologies, governments and other anti-trafficking stakeholders must do the same to combat human trafficking.

How Traffickers Use Technology to Facilitate Trafficking

Human traffickers use a wide range of tactics to manipulate and exploit victims—using technology at every stage of their criminal activities, from the initial planning and execution of the scheme to the way in which they coerce, monitor, and maintain individuals to further their exploitative purpose and increase their profits.

Traffickers use the Internet to facilitate the identification and grooming of potential victims.   Traffickers often target and victimize individuals in vulnerable situations such as those experiencing conflict, natural disasters, poverty, challenging home lives, systemic oppression, or a combination of hardships.   The UN Office on Drugs and Crime (UNODC) identified “hunting” and “fishing” as two common strategies perpetrators use to deceive and recruit victims.   According to UNODC, online platforms help traffickers search proactively and anonymously for a specific type of individual who they believe is particularly susceptible to further their scheme (the hunting process), or passively attract potential victims by posting online and waiting for a response (the fishing process).   Perpetrators may use social media, online advertisements, websites, dating apps, and gaming platforms – or fraudulent or deceptive duplications of such tools – to hide their true identity through fake accounts and profiles while interacting with potential victims.   Once potential victims are identified and contact is established, communication through the Internet serves as a powerful tool to deceive individuals with false promises of education, employment, housing, or romantic relationships only to lure them into labor and sex trafficking situations.   For example, a trafficker may create an online business website, perhaps posing as a talent recruiter, on which they often include realistic photos to gain a victim’s trust and make them believe the opportunity is authentic and will help advance their career or improve their life.   In these cases, traffickers trick the victim into believing they can legitimately earn income not only for themselves, but for their families as well.   As trust is established, the trafficker manipulates and traps the individual in an exploitative situation through force, fraud, or coercion.   Tactics such as threatening physical abuse or harm to an individual, their reputation, future employment, financial prospects, or their loved ones, are used by traffickers to foster fear.   The internet can also serve as a platform to escalate the exploitative scheme further, including via sextortion.

The Federal Bureau of Investigation (FBI) defines sextortion as a serious crime that occurs when a perpetrator threatens to distribute private and sensitive material if the victim does not provide images of a sexual nature, sexual favors, or money.   The perpetrator, who often poses as a love interest, entices individuals to send sensitive images, which the victim believes are being shared privately, but the perpetrator then uses the images to control and coerce their victims to produce more images, perform sexual favors, or give money in cases involving sex trafficking or forced labor.   In addition to blackmailing the victims for large sums of money, traffickers may also use the content to generate additional revenue by selling the sensitive material on illicit platforms.

Additionally, traffickers can use the Internet to facilitate forced criminality, an increasingly common mechanism involving traffickers coercing their victims to engage in or support criminal activities ranging from working as part of online scam operations to commercial sex.   In online scam operations, traffickers largely recruit victims through deceitful job listings online, confine them in gated compounds, and force them to engage in online criminal activity under threat of serious harm.   Online scam operations include illegal online gambling, cryptocurrency investment schemes, and romance scams, all of which involve the victim of trafficking forming relationships with individuals in order to defraud them of significant sums.   Some traffickers compel victims to continue to work by threatening that if they seek help, they will be prosecuted for the unlawful acts committed as a direct result of being trafficked; while others are simply unaware that they are trafficking victims.

In sum, traffickers use digital tools like the Internet to amplify the reach, scale, and speed of their trafficking operations.   While the methods and means may have evolved with technological developments, the exploitation at the heart of trafficking persists, underscoring the urgent need for comprehensive and innovative approaches to investigate and combat this crime.

Challenges and Risks Technology Presents for the Anti-trafficking Community

Digital technology has broadened the scope and scale of operations for traffickers as it allows the flexibility to target and exploit victims across the world while remaining hidden and more difficult to trace.   Traffickers adapt their schemes to take advantage of the obscurity available with new online tools, such as hiding behind anonymization tools or software, and benefiting from loose regulations of online platforms.   These challenges make it increasingly difficult for law enforcement and anti-trafficking stakeholders to identify and implement coordinated solutions fast enough to effectively combat technology-facilitated human trafficking.  Constant evolution in digital technology and the ways in which it is being used also makes it difficult to concentrate efforts or decipher trafficking indicators on a given platform, because law enforcement agencies must continuously adapt their tactics, develop technical expertise, and collaborate with technology companies to effectively combat trafficking.   Additionally, NGOs and service providers with data relevant to the field may struggle with how to effectively share information while considering data ownership and ensuring privacy is being maintained and protected.

Cross-Sector Coordination Challenges  

Traffickers have widened their reach by communicating with and recruiting victims globally, which has created a need for greater global coordination among anti-trafficking stakeholders and technology experts.   These stakeholders face several challenges to coordinating a global response, including navigating diverse legal frameworks to address technology-facilitated human trafficking that transcends borders.   It is often difficult to determine which jurisdiction has authority to investigate and prosecute perpetrators and coordinate international investigation efforts involving multiple countries.   Even when the jurisdiction is established, the necessary evidence gathering and coordination often results in lengthier processes, causing further strain on law enforcement agencies.   Traffickers also take advantage of and operate with impunity due to gaps, inadequacies, or loopholes in laws and regulations to address technology-facilitated trafficking and associated activities.

The lack of sufficient funding for research and training on traffickers’ exploitation of digital tools can leave the anti-trafficking field responding reactively rather than proactively.   Capacity and resources are particularly acute challenges for law enforcement in regions with limited access to advanced technology.  Several technology-based anti-trafficking tools exist for data mining; however, many regions are unable to take advantage of these resources due to a lack of technological infrastructure and digital literacy.   Victims may also find themselves isolated and unable to easily seek help in geographical areas with limited technological capabilities, and poor internet connectivity or coverage may affect their ability to receive information and services from anti-trafficking NGOs in a timely manner.

Data Privacy, Protection, and Access

Data protection, data analysis, and data sharing are crucial methods of using digital technologies to prevent, identify, and reduce instances of human trafficking, but practitioners must consider potential negative effects on the safety and well-being of victims and survivors.   Collecting and sharing data on human trafficking cases, including victims’ personally identifiable information (PII) can be essential for law enforcement and victim support efforts, but could raise serious data privacy concerns for victims and survivors should their information be inadvertently released to the public through data breaches, which has become a common issue with digital technology in general.   NGOs and technology companies often use data mining techniques to support law enforcement in investigating offenses but may lack appropriate security protocols to properly safeguard the data and protect victims’ PII from bad actors.   Different standards for ensuring data privacy and protections across countries and concerns around national security hinder effective information sharing between governments.   Frameworks for data collection, storage, and sharing of personal data are often different, complicating international cooperation.   Governments should consider strengthening digital literacy and infrastructure, where possible, to improve data security standards and procedures, while listening to the recommendations from anti-trafficking stakeholders, including those with lived experiences of trafficking, to assess the best mechanisms for gathering, analyzing, and sharing data related to victims and survivors.    

Encryption & Anonymity

Encryption systems are one way to safeguard data in digital interactions including in web browsing, messaging apps, and financial transactions.   Such systems prevent third parties from accessing data by turning readable data into a scrambled code that can only be recovered by the receiver’s system, ensuring that only authorized parties can access the original data.   Anonymizing technology provides a high level of privacy and obscures the connection between an individual’s online activity and their real identity.   Encryption systems found in many online platforms are designed to protect the privacy and security of all online users; however, these systems and anonymizing technologies such as virtual private networks (VPNs), can also offer protection to bad actors, allowing them to avoid detection and accountability.

As with any crime, heightened anonymity may pose a major challenge for law enforcement and anti-trafficking stakeholders in identifying traffickers and their co-conspirators, whether it is the creator of a fraudulent social media account or author of an online advertisement scam.   Traffickers increasingly benefit from and rely on the protection that digital tools offer as it amplifies an offender’s ability to anonymize themselves through the entire transactional process – from the recruitment and the solicitation to the management of the transactions and relationships to the payment.  Virtual currency has even enabled a distance between those making and receiving payments and the movement of the money.  Traffickers may also hide their IP addresses and encrypt their communications, such as emails, chat messages, and file transfers.   Together this allows greater physical separation between the offender and the offense, impacting the crime itself and law enforcement’s ability to intercede.

Media or Misinformation

The proliferation of social media and online forums have increased the potential for false narratives and misinformation about human trafficking to circulate online and skew public perceptions of the crime.   Even accurate reporting on human trafficking cases and issues may unintentionally minimize the wide range of potential trafficking experiences.   Unfortunately, the most sensationalized and misleading stories tend to attract the most attention and mispresent what human trafficking is while also shifting focus away from more prevalent forms of trafficking and from marginalized populations whose exploitation may not receive the same coverage.   Such reports may also create a singular or limited perception within communities of what human trafficking looks like, perpetuating stereotypes and interfering with prevention efforts or victims’ ability to self-identify.

The Promise of Technology in Monitoring and Combating Human Trafficking

Technology also plays an important role in investigating and countering human trafficking.   Digital technology, including mobile applications, social media campaigns, and online hubs, can be used to further share information, resources, and training on human trafficking.   It can also be used to improve access to online support services for victims, survivors, and vulnerable populations.   Organizations are using data analytic tools to help identify current trends in fraudulent recruitment, map complex supply chains for links to forced labor, and detect emerging human trafficking schemes.   These tools help support information sharing used to bolster identification, investigation, and prosecution efforts by providing means to integrate and analyze data from multiple sources.

Enhancing Education and Outreach Efforts

Digital technology and literacy expand the reach of prevention efforts to raise awareness and educate the public on human trafficking globally.   Given the increase in online activity among children, governments and parents should even further prioritize education around online safety for children and youth, and could take advantage of online tools to inform children of the risks related to the internet.   Fortunately, there are already a number of beneficial training tools for young people using social media and mobile applications, as well as for parents and guardians, that help support early interventions to prevent technology-facilitated trafficking of youth.   One example of how technology is being used for public awareness is through online campaigns including the Can You See Me? campaign administered by A21, a global anti-trafficking organization in the United States, aimed at informing the general public on how to spot signs of human trafficking and where to report it.

Technology is also being used to improve awareness and outreach efforts to support worker engagement and empowerment.   Commonly used messaging apps and social media platforms, as well as specially designed worker engagement and empowerment platforms, are used to educate workers on their labor rights, including the right to organize; access legal and social services; and connect with legitimate employers and jobs.   Some tools also offer responsible employment training for managers, provide secure grievance mechanisms for workers, aggregate worker survey responses, and provide feedback opportunities, allowing workers to share information about their recruitment and work experiences.   One promising example comes from Polaris, an NGO based in the United States.   Through its Nonechka project, Polaris collaborated with technology partner Ulula on a platform that allows farmworkers in Mexico and now in the United States to share their experiences, including information on risky recruitment and employment processes.   This information also helps Polaris formulate prevention strategies, as well as inform workers about their rights, wages, and working conditions and how to access general services locally including emergency, transitional, or long-term services.

Victim Services

Digital technology tools can aid victims during the exit and recovery phases of a human trafficking experience.   Technology can play a pivotal role in victim identification, employing various methods and platforms for finding victims online and allowing for self-reporting exploitation.   For example, the Canadian NGO Center for Child Protection (C3P) operates Project Arachnid , a web crawler that searches for known CSAM.   When such material is detected, C3P sends a notice to the provider asking that the material be removed. The NGO Thorn also has an AI-powered tool that detects CSAM and tools that aid law enforcement in child sex trafficking investigations.   While digital investigative techniques, including those that make use of AI, can assist in trafficking detection, investigation, and successful prosecutions, basic communication tools such as messaging apps, SMS and text, and phone channels also offer lower-tech and straightforward avenues for victims to communicate with service providers in real time.   Successful tools to advance victim services include those that facilitate and increase access to victim resource hotlines, virtual peer community spaces, and financial inclusion resources.   There are also online tools to bolster training and technical assistance for professionals who wish to support victims and survivors during the aftermath of victimization and to navigate the criminal justice system.   Most of these tools are mobile applications and leverage web- and cloud-based solutions for victim services.   The GraceCity App, for example, developed by anti-trafficking advocates in Sacramento, California, is a mobile application that offers victims and survivors details on the community resources in their area.   The app can canvass thousands of first responders and provide users with useful resources including nearby NGOs, medical professionals, social workers, and therapists.   Technologically enhanced interventions can be instrumental in overcoming challenges to victim identification, outreach, and intervention, providing real-time communication channels that are accessible, secure, and more efficient in providing immediate assistance tailored to the individual’s situation and unique needs.

Data Collection and Sharing Efforts

As mentioned earlier, data collection, data analysis, and data sharing are crucial components of using digital technologies to prevent, identify, and reduce instances of human trafficking.   Anti-trafficking stakeholders have created tools and established new initiatives to improve their data collection and sharing to support investigation and prosecution efforts.   For example, social media and communication platforms are rich sources of information for law enforcement investigations, but combing through large-scale datasets can be time consuming and labor intensive.   A diverse group of stakeholders, including governments, international organizations, civil society organizations, private sector businesses, and information technology professionals developed technology tools to assist in anti-trafficking efforts.   These tools help anti-trafficking stakeholders collect and analyze vast amounts of qualitative and quantitative data through techniques such as data mining, machine learning, and natural language processing.   These digital tools not only enhance the utility and speed of traditional data collection methods used for case management and investigative purposes, but also make it easier for anti-trafficking actors to analyze the data to share real-time insights that better equip the field to address and combat trafficking.   Despite this potential, reports show that NGOs have traditionally underutilized such tools due to lack of knowledge, access, expertise, and funding, and more information is needed to better understand barriers to use.    

Anti-trafficking applications can help investigators perform pattern analyses from big-data searches encompassing structured and unstructured data from sources including social media.   These analyses allow investigators to understand traffickers’ online activities as well as their most frequently used platforms and profiles used to target and mislead victims.  For example, the Counter Trafficking Data Collaborative (CTDC), developed by the International Organization for Migration, brings together anti-trafficking organizations from around the world to make human trafficking data publicly available in a central, accessible online platform.   The goal of CTDC is to break down information sharing barriers and equip the anti-trafficking community with reliable data. CTDC offers primary, individual-level data scrubbed of personally identifiable information on victims of human trafficking that can be used to track human trafficking trends globally.

From identifying trafficking patterns to increasing accountability within supply chains to prevent forced labor, the multifaceted nature of data collection and sharing requires multidisciplinary partnerships for the benefits of data-related solutions to fully materialize.   Data collection and sharing among several anti-trafficking stakeholders is key to effectively developing anti-trafficking policies, identifying victims, prosecuting the perpetrators, and mapping where and how traffickers and transnational criminal networks operate.   Collaboration on data collection and sharing should particularly be encouraged between sectors and stakeholders equipped with capabilities to collect data and gather intelligence and insights.   Such stakeholders should include NGOs, survivor-led organizations, individuals with lived experience of human trafficking, and intelligence or investigative agencies.   The Traffik Analysis Hub is another example of a global solution that supports joint analysis of large AI-generated data sets, providing partners with the ability to pool data assets to generate new insights into patterns and hotspots of trafficking incidents.   Information from the Traffik Analysis Hub, which was developed with the support of IBM, is also shared with law enforcement so actions can be taken to disrupt trafficking operations.   The ability to use large quantities of data and data analytics also helps to minimize the use of individual victim information and victim testimony to support trafficking prosecutions.

However, the collection and analysis of large data sets present several significant risks and challenges including privacy and data security concerns, misuse of data, and bias and inaccuracies that could result from reliance on large data collections.   To mitigate these risks, it is crucial to implement data protection measures to ensure ethical data collection practices and protect individual’s right to privacy.

• Lessons Learned and Looking Ahead

The Role of Government

Governments have the responsibility to regulate the use of technology, including in anti-trafficking efforts, such as disincentivizing the abuse of online resources for trafficking.   Efforts to legislate and regulate tech companies to better prevent and address human trafficking will have broader impacts in areas such as privacy, security, and innovation, so careful consideration with a wide range of stakeholders will be needed.

Right now, government approaches to addressing emerging issues in the digital era continue to be fragmented, in part due to the scale and speed at which digital technology evolves.   Inconsistent policies make it difficult to combat tech-facilitated crimes due to their transnational and multi-jurisdictional elements.   Some governments are recognizing the importance of regulating digital platforms to protect and further national security, economic development, and human rights priorities and many have begun developing policies around the production, deployment, and use of digital technologies.   Collaboration and coordination at the international and national level will make it harder for perpetrators to continue their illicit activities.

Globally, government investment in digital technologies for anti-trafficking efforts remains low, despite significant potential.   Private sector and civil society stakeholders, including those with lived experience, will be critical to identifying additional government-funded research and development necessary to channel the positive aspects of technology and protect those who use it.   An OSCE and Tech Against Trafficking analysis found that out of 305 technology tools readily available to combat human trafficking, only 9 percent were developed through government investments.   Consideration should also be given as to how best to develop and share existing tech tools in regions of the world that lack such tools.    

The Role of Law Enforcement

Law enforcement agencies are tasked with combating technology-facilitated human trafficking by monitoring online platforms, investigating suspicious activity, and prosecuting perpetrators.   Law enforcement agencies can continuously look for new ways to proactively investigate trafficking cases by harnessing technological innovations to collect evidentiary material.   For proactive investigations, agencies can focus on increasing internal capacity to integrate data analytics and artificial intelligence tools into casework, as well as collaborate and coordinate with NGOs and technology companies in tool development, training, and information sharing – with due regard to privacy safeguards.

Law enforcement agencies have found ways to leverage technology to help identify, track, and monitor illicit activity by following its digital footprint.   A digital footprint could include online activity, from websites visited to social media posts published, and can help paint a clearer picture of a trafficker’s identity, location, and criminal activity.   Such publicly available digital evidence is often helpful in building a trafficking case.

Examples of law enforcement leveraging online data to support criminal investigations include:

• In September 2023, The Netherlands, supported by EUROPOL, coordinated a 3-day investigation targeting online criminal activities that enable human trafficking.   Law enforcement from 26 countries alongside representatives from European Labor Authority, European Police College (CEPOL), INTERPOL, OSCE, and International Justice Mission, focused on identifying online platforms and social media to recruit victims for sexual and labor exploitation.   This led to identifying 11 suspected human traffickers and 45 potential victims.
• In 2023, Operation Synergia led by INTERPOL, targeted human trafficking rings linked to cyber scam centers.   Partnering with a leading creator of cybersecurity technology, Group-IB’s Threat Intelligence and High-Tech Crime Investigation teams collected and shared information with INTERPOL and other law enforcement agencies to locate over 2,400 IP addresses associated with cybercrime, leading to the removal of the servers.   Over 60 law enforcement agencies from 50 countries participated in the search and seizure of 1,300 malicious servers and electronic devices, shutting down 70 percent of identified cybercrime command servers while the remaining 30 percent are under investigation.

Law enforcement agencies must be better resourced to combat technology-facilitated human trafficking or use technology for human trafficking investigations.   This can be achieved through greater investment in staff, training, and software.   Law enforcement officers must be trained on monitoring and evaluating online platforms and developing technical knowledge.   Law enforcement agencies can deepen their capabilities by establishing cybercrime units tasked with data analysis and decryption technology.   Cooperation protocols with NGO and private sector partners will further data sharing and the design and deployment of new tools that are victim-centric and trauma- and survivor-informed.   Multilateral knowledge exchange should also be considered when developing technology tools to prevent traffickers from exploiting the gaps in capacity and legislation between law enforcement agencies.   Governments should also focus on implementation of the UN Convention against Transnational Organized Crime and its Protocol to Prevent, Suppress and Punish Trafficking in Persons, Especially Women and Children to address legislation gaps.   Lastly, law enforcement agencies with access to victims’ personal data must have protection standards in place on the collection and storage of such personal data.

The Role of the Financial Sector

The financial sector also plays a vital role in combating human trafficking.   According to the International Labour Organization, human trafficking is responsible for an estimated $236 billion in illicit profits annually.   All forms of currency, including both traditional and digital assets (e.g. cryptocurrency), can be laundered, requiring a multidimensional approach involving legislative measures, collaboration between justice and financial sectors, technological innovations, and ethical considerations to detect their use in criminal enterprises.   The financial sector’s role extends beyond upholding regulatory frameworks, often guided by promising practices in the area of corporate responsibility.  As illicit proceeds from human trafficking can intersect with formal financial systems at any stage of a human trafficking crime, it is essential that financial institutions proactively manage the risk of technology-facilitated human trafficking and train staff on the financial indicators and techniques used by human traffickers to launder money.   Coordination in this area should also include financial institutions working with law enforcement, technology companies, and survivors to inform their efforts, including on the development of training programs to enhance the ability of frontline staff and other industry professionals to detect transactions connected to human trafficking, how and when to intervene, and how to determine when a third party is benefitting from the exploitation of another.

Globally, the Financial Action Task Force (FATF) is the standard-setting body for anti-money laundering and countering the financing of terrorism and weapons proliferation.   More than 200 countries have agreed to implement FATF recommendations, which provide guidance for member countries to identify, assess, and understand money laundering and illicit finance risks and to mitigate those risks.   Since 2019, the FATF has included guidance on how to assess and mitigate risks associated with digital assets and digital asset service providers, including recommendations on how member jurisdictions should regulate cryptocurrency transactions.   Countries are encouraged to adapt FATF recommendations to their specific context to establish or enhance efforts to tackle illicit financial transactions.

Following digital financial transactions human traffickers leave behind can identify broader criminal networks and make it more difficult to profit from human trafficking.   For this reason, responsible innovation in technology and proactive partnerships between governments, financial institutions, law enforcement, and civil society experts, including those with lived experiences are an important part of identifying illicit financial activity associated with human trafficking and safeguarding financial systems against human trafficking, money laundering, terrorist financing, and other serious financial crimes.

The Role of NGOs

NGOs are one of the primary users and drivers of the development of anti-trafficking technological tools, algorithms, and programs and use digital technology to provide survivors easier access to resources and support services such as online counseling and helplines.   NGOs are also well-positioned to build strong partnerships with and bridge the gap between technology companies, governments, survivors, and community organizations to enhance the creation and broaden the use of essential anti-trafficking application services.   NGOs can use these relationships to advocate for and consult on the creation of standardized response frameworks, data privacy for victims when using anti-trafficking technology tools, and solutions to other emerging concerns around technology.    

A result of a partnership between NGOs and international organizations (IOs) to advance work under the UN’s Global Compact on Decent Work in Global Supply Chains, the Interactive Map for Businesses of Anti-Human Trafficking Organizations was developed to be a user-friendly repository database that tracks global and local initiatives and organizations that businesses can partner with on anti-trafficking efforts.   The map provides NGOs an opportunity to optimize coordination, research, awareness, and prevention efforts through the ability to identify specific industry initiatives to combat human trafficking via a filter tool that organizes data based on industry, geography, or issue, among others.

The Role of the Technology Industry

The technology industry, while providing many benefits can also inadvertently create environments that facilitate trafficking and other crimes, including by creating a space that facilitates unsupervised access to children.  Many companies acknowledge that the popularity and simplicity of user-friendly application services contribute to unsafe environments by providing traffickers with easy access to communicate, advertise, and coordinate illicit activity. Some technology companies have taken steps to address these challenges, but ongoing efforts are needed to enhance security measures, improve content moderation, and collaborate with law enforcement to prevent technology from being used by bad actors for illicit activities. Technology can play several roles to include using data and algorithm tools to detect human trafficking patterns, identify suspicious and illicit activity, and report such activity to law enforcement.   Technology companies play a pivotal role in protecting victims and vulnerable individuals from being exploited through the use of their online platforms and must be part of the solution to combat human trafficking.

Some technology companies are increasingly investing in better language models and machine learning to allow computers to learn from and make predictions based on data trends.   These tools are a useful resource as they may provide law enforcement agencies with powerful tools to more efficiently target illicit activity and possible cases for investigation, but they are not required.   Language models can detect, translate, and categorize key words used by traffickers to identify trafficking communication patterns.   It can be used to aid international investigations and target traffickers since they often recruit individuals in different countries primarily communicating through technology and internet platforms in the victims’ native language.   Alongside language models, other machine learning tools have the ability to cross reference various data sets, such as combining law enforcement data and transit trends, to help stakeholders formulate specific algorithms that can trace traffickers’ patterns.   These tools can enhance collaboration between law enforcement agencies and other stakeholders, as well as quickly close the gap for countries that may not have established effective tools to track or investigate human trafficking.   As developers continue to build and enhance anti-trafficking applications for protection, prevention, or prosecution functions, they must be designed to tackle the unique challenges and scenarios that arise in the context of human trafficking.

Regardless of the progress provided by technology tools, it is crucial that anti-trafficking stakeholders be cautious of becoming overly reliant on using AI and facial recognition technology to identify victims of human trafficking and the traffickers.   These tools should enhance, not replace, existing methods.   Developers, policymakers, and anti-trafficking leaders seeking to improve anti-trafficking efforts with AI and facial recognition tools should prioritize establishing data privacy rights and ensuring individuals’ information is protected throughout data-sharing processes.

Taking Action: Considerations for Anti-Trafficking Stakeholders

Harnessing technology to advance the shared goal of governments, law enforcement actors, technology companies, and civil society to eliminate human trafficking will require proactive efforts by all actors to resolve the complex, often contradictory byproducts of technological progress.   Governments can adopt policies and legislation that recognize human traffickers’ use of technology and incentivize the positive use of technology tools to investigate and counter human trafficking, and must coordinate implementation of these policies through collaboration with the technology sector, the financial sector, anti-trafficking NGOs, and lived experience experts who can help build capacity to monitor online spaces, train staff, develop technology tools, and cultivate technical expertise.   Law enforcement entities can use technology to conduct data analytics on traffickers, their connections, and their modus operandi to inform human trafficking investigations and related money laundering activities, bolster the identification of victims online, and enhance safety nets.   Governments can also strengthen data security from unauthorized access to better protect victims and investigations and find technology-based solutions that further privacy, safety, and trust.   Multilateral forums offer important venues for governments to share best practices and develop new policies and standards that uphold current international frameworks but are also tailored to regional and local trafficking situations and existing technological capabilities.

NGOs can advocate for policies and tech solutions that empower vulnerable individuals, strengthen access to services, advance digital learning, and further privacy protections.   Local communities, NGOs, and those with lived experience know current trafficking trends and how technology is being used to facilitate crimes, and thus can recommend ways to enhance trauma-informed and victim-centric tech solutions and ways to get tech tools in the hands of those who most need them.   The technology sector should work to ensure their online platforms are being used for legitimate purposes and ensure privacy and safety for users.   The technology sector can also invest in new technologies that include detecting and countering child sexual abuse material, livestreaming trafficking offenses, and fraudulent cyber scams or job offers among other crimes occurring on their platforms.   Governments, anti-trafficking NGOs, companies, and innovators can also employ routine audits of technology tools as digital technologies evolve to limit negative consequences and better guarantee efficient, sustainable means to address human trafficking.

Collaborative efforts allow all relevant parties to inform and promote best practices for the responsible and safe use of technology by a variety of actors, including individuals vulnerable to technology-facilitated trafficking.   The challenge is immense, but political will, resource investments, innovation, and partnerships will help prevent traffickers’ use of technology for exploitation, and instead amplify and scale the best applications that assist all anti-trafficking stakeholders in meeting our obligations to combat the newest continuously evolving aspects of this pernicious crime.

• Understanding Human Trafficking

“Trafficking in persons” and “human trafficking” are umbrella terms—often used interchangeably—to refer to a crime whereby traffickers exploit and profit at the expense of adults or children by compelling them to perform labor or engage in commercial sex.  When a person younger than 18 is used to perform a commercial sex act, it is a crime regardless of whether there is any force, fraud, or coercion involved.

The United States recognizes two primary forms of trafficking in persons:  forced labor and sex trafficking.  The basic meaning of these forms of human trafficking and some unique characteristics of each are set forth below, followed by several key principles and concepts that relate to all forms of human trafficking.

More than 180 nations have ratified or acceded to the UN Protocol to Prevent, Suppress and Punish Trafficking in Persons (the UN TIP Protocol), which defines trafficking in persons and contains obligations to prevent and combat the crime.

The United States’ TVPA and the UN TIP Protocol contain similar definitions of human trafficking.  The elements of both definitions can be described using a three-element framework focused on the trafficker’s 1) acts; 2) means; and 3) purpose.  All three elements are essential to form a human trafficking violation.

Forced Labor

Forced Labor, sometimes also referred to as labor trafficking, encompasses the range of activities involved when a person uses force, fraud, or coercion to exploit the labor or services of another person.

The  “acts”  element of forced labor is met when the trafficker recruits, harbors, transports, provides, or obtains a person for labor or services.

The  “means”  element of forced labor includes a trafficker’s use of force, fraud, or coercion.  The coercive scheme can include threats of force, debt manipulation, withholding of pay, confiscation of identity documents, psychological coercion, reputational harm, manipulation of the use of addictive substances, threats to other people, or other forms of coercion.

The  “purpose”  element focuses on the perpetrator’s goal to exploit a person’s labor or services.  There is no limit on the location or type of industry.  Traffickers can commit this crime in any sector or setting, whether legal or illicit, including but not limited to agricultural fields, factories, restaurants, hotels, massage parlors, retail stores, fishing vessels, mines, private homes, or drug trafficking operations.

All three elements are essential to constitute the crime of forced labor.

There are certain types of forced labor that are frequently distinguished for emphasis or because they are widespread:

Domestic Servitude

“Domestic servitude” is a form of forced labor in which the trafficker requires a victim to perform work in a private residence.  Such circumstances create unique vulnerabilities.   Domestic workers are often isolated and may work alone in a house.  Their employer often controls their access to food, transportation, and housing.  What happens in a private residence is hidden from the world – including from law enforcement and labor inspectors – resulting in barriers to victim identification.  Foreign domestic workers are particularly vulnerable to abuse due to language and cultural barriers, as well as a lack of community ties.  Some perpetrators use these types of conditions as part of their coercive schemes to compel the labor of domestic workers with little risk of detection.

Forced Child Labor

The term “forced child labor” describes forced labor schemes in which traffickers compel children to work.  Traffickers often target children because they are more vulnerable.  Although some children may legally engage in certain forms of work, forcing or coercing children to work remains illegal.  Forms of slavery or slavery-like practices – including the sale of children, forced or compulsory child labor, and debt bondage and serfdom of children – continue to exist, despite legal prohibitions and widespread condemnation.  Some indicators of forced labor of a child include situations in which the child appears to be in the custody of a non-family member and the child’s work financially benefits someone outside the child’s family; or the denial of food, rest, or schooling to a child who is working.

Sex Trafficking

Sex trafficking encompasses the range of activities involved when a trafficker uses force, fraud, or coercion to compel another person to engage in a commercial sex act or causes a child to engage in a commercial sex act.

The crime of sex trafficking is also understood through the “acts,” “means,” and “purpose” framework.  All three elements are required to establish a sex trafficking crime (except in the case of child sex trafficking where the means are irrelevant).

The  “acts”  element of sex trafficking is met when a trafficker recruits, harbors, transports, provides, obtains, patronizes, or solicits another person to engage in commercial sex.

The  “means”  element of sex trafficking occurs when a trafficker uses force, fraud, or coercion.  Coercion in the case of sex trafficking includes the broad array of means included in the forced labor definition.  These can include threats of serious harm, psychological harm, reputational harm, threats to others, and debt manipulation.

The  “purpose”  element is a commercial sex act.  Sex trafficking can take place in private homes, massage parlors, hotels, or brothels, among other locations, as well as on the internet.

Child Sex Trafficking

In cases where an individual engages in any of the specified “acts” with a child (under the age of 18), the means element is irrelevant regardless of whether evidence of force, fraud, or coercion exists.  The use of children in commercial sex is prohibited by law in the United States and most countries around the world.

Key Principles and Concepts

These key principles and concepts relate to all forms of trafficking in persons, including forced labor and sex trafficking.

Human trafficking can take place even if the victim initially consented to providing labor, services, or commercial sex acts.  The analysis is primarily focused on the trafficker’s conduct and not that of the victim.  A trafficker can target a victim after a victim applies for a job or migrates to earn a living.  The trafficker’s exploitative scheme is what matters, not a victim’s prior consent or ability to meaningfully consent thereafter.  Likewise, in a sex trafficking case, an adult victim’s initial willingness to engage in commercial sex acts is not relevant where a perpetrator subsequently uses force, fraud, or coercion to exploit the victim and cause them to continue engaging in the same acts.  In the case of child sex trafficking, the consent of the victim is never relevant as a child cannot legally consent to commercial sex.

Neither U.S. law nor international law requires that a trafficker or victim move across a border for a human trafficking offense to take place.  Trafficking in persons is a crime of exploitation and coercion, and not movement.  Traffickers can use schemes that take victims hundreds of miles away from their homes or exploit them in the same neighborhoods where they were born.

Debt Bondage

“Debt bondage” is focused on human trafficking crimes in which the trafficker’s primary means of coercion is debt manipulation.  U.S. law prohibits perpetrators from using debts as part of their scheme, plan, or pattern to compel a person to work or engage in commercial sex.  Traffickers target some individuals with an initial debt assumed willingly as a condition of future employment, while in certain countries traffickers tell individuals they “inherited” the debt from relatives.  Traffickers can also manipulate debts after the economic relationship begins by withholding earnings or forcing the victim to assume debts for expenses like food, housing, or transportation.  They can also manipulate debts a victim owes to other people.  When traffickers use debts as a means to compel labor or commercial sex, they have committed a crime.

The Non-Punishment Principle 

A victim-centered and trauma-informed approach is key to successful anti-trafficking efforts.  A central tenet of such an approach is that victims of trafficking should not be inappropriately penalized solely for unlawful acts they committed as a direct result of being trafficked.  Effective implementation of the “non-punishment principle,” as it is increasingly referred to, not only requires recognizing and embracing the principle in regional and national laws, but also increasing proactive victim identification.

State-Sponsored Human Trafficking

While the TVPA and UN TIP Protocol call on governments to proactively address trafficking crimes, some governments are part of the problem, directly compelling their citizens into sexual slavery or forced labor schemes.  From forced labor in local or national public work projects, military operations, and economically important sectors, or as part of government-funded projects or missions abroad, officials use their power to exploit their nationals.  To extract this work, governments coerce by threatening the withdrawal of public benefits, withholding salaries, failing to adhere to limits on national service, manipulating the lack of legal status of stateless individuals and members of minority groups, threatening to punish family members, or conditioning services or freedom of movement on labor or sex.  In 2019, Congress amended the TVPA to acknowledge that governments can also act as traffickers, referring specifically to a “government policy or pattern” of human trafficking, trafficking in government-funded programs, forced labor in government-affiliated medical services or other sectors, sexual slavery in government camps, or the employment or recruitment of child soldiers.

Unlawful Recruitment or Use of Child Soldiers

Another manifestation of human trafficking occurs when government forces or any non-state armed group unlawfully recruits or uses children – through force, fraud, or coercion – as soldiers or for labor or services in conflict situations.  Children are also used as sex slaves.  Sexual slavery, as referred to here, occurs when armed groups force or coerce children to “marry” or be raped by commanders or combatants.  Both male and female children are often sexually abused or exploited by members of armed groups and suffer the same types of devastating physical and psychological consequences associated with sex trafficking.

Accountability in Supply Chains

Forced labor is well documented in the private economy, particularly in agriculture, fishing, manufacturing, construction, and domestic work; but no sector is immune.  Sex trafficking occurs in several industries as well.  Most well-known is the hospitality industry, but the crime also occurs in connection with extractive industries where activities are often remote and lack meaningful government presence.  Governments should hold all entities, including businesses, accountable for human trafficking.  In some countries, the law provides for corporate accountability in both the civil and criminal justice systems.  U.S. law provides such liability for any legal person, including a business that benefits financially from its involvement in a human trafficking scheme, provided that the business knew or should have known of the scheme.

Topics of Special Interest

• Trafficking in Persons for the Purpose of Organ Removal

Trafficking in persons for the purpose of organ removal is one of the least reported and least understood forms of trafficking – but one that experts believe may be growing.  Like sex trafficking and labor trafficking, it is ultimately a crime that exploits human beings for economic profit.  Trafficking in persons for the purpose of organ removal is “a form of trafficking in which an individual is exploited for their organ, including by coercion, deception and abuse of a position of vulnerability.”  The crime is sometimes confused with organ trafficking; however, organ trafficking refers more broadly to the illicit trade or exchange of organs for financial or other material gain.  In organ trafficking, the focus is on the organ itself; conversely, with trafficking in persons for the purpose of organ removal, the focus is on the individual.  The key global anti-trafficking instrument, the Palermo Protocol, defines exploitation to include at a minimum “the removal of organs,” alongside sexual exploitation, forced labor, and slavery or slavery-like practices.

Often, in cases of trafficking in persons for the purpose of organ removal, would-be donors are tricked into organ donation.  Common deceptions include being told human beings have three kidneys or that kidneys regenerate after being removed, or being falsely told they will experience no negative side effects from a kidney removal (in fact, kidney donors may face serious lifelong medical challenges and be unable to work).  Although kidneys are the most common organ involved, other organs and tissues, such as livers, corneas, or skin, are also sought, although notably the Palermo Protocol’s definition covers only exploitation for the removal of organs, not of tissues or cells.  Victims may not be paid at all, or they may receive some payment; importantly, an individual can still be a victim of trafficking in persons or other human rights abuses even if they received some form of payment.

The 2022 UNODC Global Report on Trafficking in Persons noted trafficking in persons for the purpose of organ removal constituted only 0.2 percent of detected victims of trafficking compared to the much higher numbers for sex trafficking and forced labor.  UNODC has warned “existing barriers to reporting suggest that the full scale of this phenomenon is not yet known.”  The report also noted an uptick in cases (from 25 in 2017 to 40 in 2018), though the overall numbers are small.  Between 2008 and 2022, UNODC reported 700 victims of trafficking in persons for the purpose of organ removal while noting “the scale of the problem is likely to be much larger.”

Trafficking in persons for the purpose of organ removal is difficult to detect for several reasons.  Data-collection efforts are scarce, and some instances of trafficking in persons for the purpose of organ removal may be mistakenly classified or prosecuted as organ trafficking.  Moreover, unlike sex trafficking and labor trafficking, which can take place over months or years, trafficking in persons for the purpose of organ removal usually involves a brief, often one-time, interaction.  Like other forms of trafficking, transactions have increasingly shifted online and become more sophisticated, facilitating the emergence of smaller networks, and even independent brokers and suppliers, which may be more difficult to track.

Both the 2020 and 2022 UNODC Global Report on Trafficking in Persons and a 2021 INTERPOL report suggest North Africa and the Middle East have the highest share of detected victims, in part due to the prevalence of large vulnerable communities, limited access to medical care, and corruption.  The media and some NGOs have also reported instances of trafficking in persons for the purpose of organ removal for ritual purposes.  However, instances of trafficking in persons for the purpose of organ removal can occur worldwide.  In a case recently prosecuted in the United Kingdom, the victim was recruited in Nigeria and brought to London, where the organ removal was to take place (see inset box for additional information).  In another case reported by the BBC in late 2023, revealing the connection between organ trafficking and trafficking in persons for the purpose of organ removal, Pakistani police arrested eight members of an organ-trafficking ring that “lure[d] vulnerable patients from hospitals” and conducted transplants “often without the patient knowing;” several people died from these procedures.

The government of the People’s Republic of China, in particular, has been accused of systematically forcibly removing organs from political prisoners.  For example, a group of UN human rights experts noted in 2021:

Forced organ harvesting in China appears to be targeting specific ethnic, linguistic, or religious minorities held in detention, often without being explained the reasons for arrest or given arrest warrants, at different locations.  We are deeply concerned by reports of discriminatory treatment of the prisoners or detainees based on their ethnicity and religion or belief.

(Note:  forced organ harvesting is not a term defined in the Palermo Protocol, but the phrase is commonly used to describe trafficking in persons for the purpose of organ removal.)

While there is a need for additional studies and reporting to thoroughly assess the geographic and numeric scope of trafficking in persons for the purpose of organ removal, stakeholders are taking steps to attempt to address the issue.  A number of regional instruments, including the Council of Europe Convention against Trafficking in Human Organs, the Council of Europe Convention on Action against Trafficking in Human Beings, and the ASEAN Convention against Trafficking in Persons, Especially Women and Children, recognize organ removal as a form of trafficking-related exploitation.

Experts have also proposed ideas to increase the supply of legally donated organs, with the intention of making trafficking in persons for the purpose of organ removal and organ trafficking less lucrative.  These ideas include transitioning deceased organ donation from an opt-in to an opt-out system; implementing paired exchanges matching donors and patients; creating awareness campaigns targeted at potential donors, including addressing barriers to altruistic organ donation and providing guidance on how to prevent trafficking in persons for the purpose of organ removal; building the capacity of law enforcement to detect and investigate these cases; and improving transparency and reporting around transplantation.

Twenty-one-year-old “Daniel” (not his real name) scraped out a living selling mobile-phone accessories at an outdoor street market in Lagos, Nigeria, but he thought his luck took a turn when he was offered a “life-changing opportunity” to work in the United Kingdom.   The people he believed were his employers instructed him to take a blood test, which he thought was required to secure a visa.   The people he had been working with put him on a flight and confiscated his passport.   Within days of arriving in London, Daniel was taken to the Royal Free Hospital, where doctors discussed the risks of the upcoming “operation” – something Daniel knew nothing about.   Seeing his confusion, the doctors sent Daniel away – but did not notify authorities.   Later, Daniel overheard a conversation among those who had brought Daniel to the UK speaking about sending him back to Nigeria to remove his kidney.   Scared, Daniel escaped, sleeping on the streets for several days until walking into a police station and telling his story.   Daniel’s bravery eventually led to the UK’s first prosecution of – and convictions for – human trafficking for the purpose of organ removal.   A prominent Nigerian politician and his wife who had arranged the trafficking scheme to provide their daughter with a kidney transplant, as well as a Nigerian doctor, were convicted in 2023.

This story was published by the BBC, Organ Harvesting:   Trafficked for His Kidney and Now Forced into Hiding , June 26, 2023 ( https://www.bbc.com/news/65960515 ); for additional details, see the Crown Prosecution Service, Updated with Sentence: Senior Nigerian Politician Jailed Over Illegal UK Organ-Harvesting Plot , May 5, 2023 ( https://www.cps.gov.uk/cps/news/updated-sentence-senior-nigerian-politician-jailed-over-illegal-uk-organ-harvesting-plot ).

• Connecting the Dots:  Preventing Forced Labor by Empowering Workers

Forced labor, a form of human trafficking, is universally condemned yet prevalent in nearly every industry globally.  The International Labour Organization (ILO) reports forced labor has grown in recent years – with no region of the world or private sector industry spared – and the majority of forced labor takes place in the private economy, meaning forced labor is connected to global supply chains.  These facts demand a re-examination of current efforts to prevent and address forced labor, including the need to elevate the voice and agency of workers and place them at the center of prevention efforts through strategic partnerships.  In addition, particular focus should be placed on vulnerable populations, such as migrant workers.  ILO research shows the rates of forced labor among migrant workers are higher if migration is irregular or poorly governed, or where recruitment practices are unfair or unethical.

Although prosecuting specific traffickers and assisting individual victims are critical for governments combating forced labor, successful interventions to prevent forced labor require a range of stakeholders willing to visualize and address broader systemic issues centered on worker’s labor rights, including those of migrant workers, as well as supply chain power imbalances.  For governments, this may require additional resources and oversight of workplaces, especially in key sectors where forced labor is often present; better monitoring of the labor recruitment industry; increased outreach to and protections for migrant workers; and improved screening measures by well-trained officials targeting populations at greater risk of exploitation.  For the private sector, it will mean proactively supporting workers and their ability to advocate for themselves, setting clear expectations of suppliers, and rooting out practices that create environments ripe for exploitation.

Worker-led Approaches to Prevent Forced Labor 

Over time, policymakers, academics, and other stakeholders have expanded their thinking to encompass worker-led approaches to address the vulnerabilities of workers and prevent forced labor.  Such approaches include advancing labor rights and standards – including freedom of association, collective bargaining, and the remediation of labor rights abuses – as well as worker-driven approaches that include migrants.  Research has demonstrated workers are most vulnerable to forced labor if they do not know their rights, are excluded from labor protection laws, and lack access to grievance mechanisms.  Workers in the informal sector and women and girls, who often face gender-based violence and harassment in the workplace, can be particularly vulnerable.  One of the most effective ways to prevent worker exploitation is to guarantee workers’ full rights to freedom of association and collective bargaining.  Independent and democratic labor unions, led by workers, are best able to represent workers’ collective interests at multiple levels, including at the national, subnational, regional, and international levels.  Collaborating with local workers, regional international organizations, and global union federations, these unions can reach the most vulnerable workers, organize across a labor sector, and advocate for key policy changes, including responsible migration management.  As a result, they are well positioned to engage powerful transnational companies to address forced labor in their supply chains.

According to ILO’s Director of the Bureau for Workers’ Activities, there have been positive developments over time with unions reaching outside of their traditional base to include the unionization of self-employed workers.  Many unions have also expanded to include more informal economy, migrant, and domestic workers, which is key as many of these workers are governed by a variety of working arrangements, including fixed-term and temporary contracts.

This diversification of representation is important as unions allow workers to negotiate for better working conditions, influence the laws and policies that impact them, and remediate labor rights abuses.  Unions play a pivotal role in securing legislated labor protections and rights, such as legally entitled wages and benefits, occupational safety and health protections, overtime pay, and medical leave.  Union-led efforts help raise the wages for the lowest paid and least skilled workers and lead to fewer hours of unpaid overtime work.  Unions play crucial roles in identifying labor rights abuses and enforcing rights on the job.  One of the most effective ways to prevent the exploitation of migrant workers is by guaranteeing their right to join unions in destination countries.  The multiplier impact is notable, as industries with strong union representation tend to have lower levels of labor rights abuse, the worst forms of child labor, and forced labor.

Where there is an absence of unions, there at least should be effective, secure mechanisms for worker communication and grievances.   Governments should strongly encourage employers to provide mechanisms so workers can advocate for their rights, discuss workplace issues of concern and interest, and communicate grievances, even if that takes place outside a formal union mechanism.  Such mechanisms are essential to preventing forced labor, as they position workers, including migrant workers, to better protect themselves against coercion, deception, discrimination, and other forms of exploitation.

Promising Practices in Improving Labor Conditions 

Several examples stand out as raising labor conditions for workers.  

Dindigul Agreement, India

Indian women and the Dalit-worker led union Tamil Nadu Textile and Common Labor Union (TTCU) signed in April 2022 a historic agreement with clothing and textile manufacturers and major fashion companies to end gender-based violence and harassment at factories in the southern state of Tamil Nadu.  This enforceable brand agreement resulted in multinational companies committing to support a worker- or union-led program at certain factories or worksites.  An assessment a year later by the multi-stakeholder oversight committee found that the workers are now effectively able to detect, remediate, and prevent gender-based violence and harassment.  In addition, the TTCU has conducted peer education training of more than 2,000 workers and management, held more than 30 meetings with management to resolve grievances, and recruited 58 workers as monitors to help remediate gender-based violence and harassment throughout the factory units.

Freedom of Association for Garment Workers, Honduras 

In the decade that has followed Honduran workers signing an agreement with major brand Fruit of the Loom, close to 50 percent of all Honduran garment workers are now employed at a factory where an independent union represents the workforce.  As a result of this signed collective bargaining agreement, workers have won increased wages and benefits and witnessed a reduction in verbal harassment and gender-based violence.

While unionization rates vary considerably across the globe, the ILO notes other encouraging examples.  In Uzbekistan, trade unions have organized seasonal workers and facilitated dual affiliation to different unions in other countries.  In Moldova, unions have begun to establish agreements with unions in destination countries so that migrants have protection when working abroad .  In Benin, Botswana, and Mauritius, trade unions have set up Joint Trade Union Councils, which have drawn up joint declarations, charters, and protocols on the modalities of working together in national social dialogue fora.  In Lithuania and Ukraine, unions have established structures of cross-border collaboration to improve the recruitment and representation of truck drivers in both countries.  

Overall, research has also shown that unionization has spillover effects that extend beyond union workers.  Competition means workers at nonunionized firms also often see increased wages and improved workplace safety norms.  Union members improve communities through heightened civic engagement and increased voter rates.  Unions can also boost business’ productivity by giving experienced workers more input into decisions that design better, more cost-effective workplace procedures.

Milestones, Momentum, and Motivation   

Over the last several years, government and private sector attention has become focused on resilient supply chains, and there are increasing supply chain transparency and due diligence policies, regulations, and laws globally.  In addition, various initiatives have been developed to raise the importance of workers’ agency.  It is notable that flower-sector leader Bloomia’s entire cut-flower supply chain, which encompasses farms in the United States, Chile, and South Africa, will now be certified for human rights protections by the Fair Food Program, pioneers in the worker-driven social responsibility model with its partnerships among retailers, growers, and workers.  Combined, the Partnership for Workers‘ Rights, launched by the United States and Brazil at the 2023 UN General Assembly; the Multilateral Partnership for Worker Organizing, Empowerment, and Rights (M-POWER), which is part of the U.S. Presidential Initiative for Democratic Renewal; and the 2023 U.S. Presidential Memorandum on Advancing Worker Empowerment, Rights, and High Labor Standards present a unique opportunity to proactively advance worker empowerment in the short and long term while simultaneously preventing labor rights violations and abuses, especially forced labor.  The independent UN Special Rapporteur on Contemporary Forms of Slavery made a key theme for 2024 the role of trade unions and worker organizations in preventing contemporary forms of slavery.

The timing is ideal for all stakeholders committed to preventing forced labor to fully embrace the importance of supporting, elevating, and improving labor standards, bringing workers’ voices to the policy formulation and decision-making table, and working to help the public and private sector enforce rules against unfair labor practices.  Governments should take every step to use a whole-of-government approach to advance worker rights and address gaps in labor rights protection and compliance, including for migrant workers; the private sector should see free and fair unions as critical partners in competing in the global economy while protecting workers; and other civil society  stakeholders should ensure that workers’ voices are incorporated early and often, especially when their equities are at stake.

• Human Trafficking in Cuba’s Labor Export Program

Each year, the Cuban government sends tens of thousands of workers around the globe under multi-year cooperation agreements negotiated with receiving countries.  While medical missions remain the most prevalent, the Cuban government also profited from other similarly coercive labor export programs, including those involving teachers, artists, athletes and coaches, engineers, forestry technicians, and nearly 7,000 merchant mariners worldwide.    According to a report published by the Cuban government, by the end of 2023, there were more than 22,000 government-affiliated Cuban workers in over 53 countries, and medical professionals composed 75 percent of its exported workforce.  The COVID-19 pandemic increased the need for medical workers in many places around the world, and the Cuban government used the opportunity to expand its reach by increasing the number of its medical personnel abroad through the Henry Reeve Brigades, which Cuba first initiated in 2005 to respond to natural disasters and epidemics.  Experts estimate the Cuban government collects $6 billion to $8 billion annually from its export of services, which includes the medical missions.  The labor export program remains the largest foreign revenue source for the Cuban government.

There are serious concerns with Cuba’s recruitment and retention practices surrounding the labor export program.  While the conditions of each international labor mission vary from country to country, the Cuban government subjects all government-affiliated workers to the same coercive laws.  Cuba has a government policy or pattern to profit from forced labor in the labor export program, which includes foreign medical missions.  The Cuban government labels workers who leave the program without completing it as “deserters,” a category that under Cuban immigration law deems them as “undesirable.”  The government bans workers labeled as “deserters” and “undesirables” from returning to Cuba for eight years, preventing them from visiting their families in Cuba.  It categorizes Cuban nationals who do not return to the country within 24 months as having “emigrated.”  Individuals who emigrate lose all their citizen protections, rights under Cuban law, and any property they left behind.  These government policies and legal provisions, taken together, coerce workers and punish those seeking to exercise freedom of movement.  According to credible sources, by 2021, the Cuban government had sanctioned 40,000 professionals under these provisions, and by 2022, there were approximately 5,000 children forcibly separated from their parents due to the government’s policies surrounding the program.

Complaints filed with the International Criminal Court and the UN indicate most workers did not volunteer for the program, some never saw a contract or knew their destination, many had their passports confiscated by Cuban officials once they arrived at their destination, and almost all had “minders” or overseers.  According to the complaints and survivors, Cuban heads of mission in the country subjected workers to surveillance, prevented them from freely associating with locals, and imposed a strict curfew.  Cuba also confiscated between 75 and 90 percent of each worker’s salary.  As a result of the well-founded complaints and information about the exploitative nature of Cuba’s labor export program, at the end of 2023, the UN Special Rapporteur for Contemporary Forms of Slavery filed a new communication outlining the persistent concerns with the program, particularly for Cuban workers in Italy, Qatar, and Spain.

While exploitation, including forced labor, of workers remains the primary concern with the program, Cuba’s practices can also negatively impact a host country’s healthcare system.  Survivors of the program have reported being forced by the Cuban in-country mission director to falsify medical records and misrepresent critical information to justify their presence and need to local authorities.  Some individuals reported discarding medications, fabricating names, and documenting medical procedures that never occurred.  When medical workers refused to comply with the demands of the Cuban in-country mission director, they faced punishment and retaliation.  While the Cuban government promotes workers as highly skilled medical professionals and specialists, these workers often lack adequate medical training to treat complex conditions.  These practices are unethical, negligent, exploitative, and risk the lives of those they serve.

Governments should make efforts to combat human trafficking, and this includes not purchasing goods or services made or provided with forced labor.  Governments that utilize Cuba’s labor export programs despite the serious concerns with the program should at a minimum conduct frequent and unannounced labor inspections to screen these workers for trafficking indicators and employ victim-centered interviewing techniques.  These host governments should ensure all Cuban workers are subject to the same laws, regulations, and protections as for other migrant workers and that they are not brought via a negotiated agreement with the Government of Cuba that limits these protections or exempts Cuban workers from Wage Protections Systems or other tools designed to strengthen transparency.  Officials should ensure workers maintain complete control of their passports and medical certifications and can provide proof of full salary payment to bank accounts under the workers’ control.  They should scrutinize medical reports produced by these workers, offer protection for those who face retaliation and punishment for terminating their employment, and raise awareness of trafficking risks for all foreign workers, including government-affiliated Cuban workers.

• Nothing About Us Without Us:   Human Trafficking and Persons with Disabilities

Human traffickers often take advantage of persons in vulnerable situations including individuals who lack access to services and programs or rely on the assistance of others.  Among this group of potential targets are persons with disabilities, who represent about 16 percent of the world’s population, or 1.3 billion people, according to the World Health Organization.

Of course, these 1.3 billion people are not monolithic.  Some people have a disability from birth; others experience disability later in their lifetime.  Some disabilities are life-long, and others may be temporary.  A disability can be visible, such as a physical disability, or non-apparent, such as an intellectual or psychosocial disability.  People with disabilities are of every age, race, sex and sex characteristics, sexual orientation, gender identity and expression, economic status, and nationality.

Professors Andrea Nichols and Erin Heil have noted the “heightened risk as well as heightened prevalence” of human trafficking involving persons with disabilities, although the authors acknowledged the paucity of existing research.  Even when research about persons with disabilities is conducted, it rarely addresses additional intersecting identities, such as race, ethnicity, age, gender, religion, sexual orientation, gender identity, gender expression, or migratory status, that can exacerbate marginalization.

The intersection between disability and human trafficking can be cyclical.  On the one hand, persons with disabilities are more likely to be targeted by traffickers; on the other hand, the experience of being trafficked can lead to or exacerbate existing disabilities through physical injuries or emotional trauma that in turn could heighten vulnerability.

Even with access to support, persons with disabilities face increased risk of exploitation.  A caregiver may exploit their position to victimize the person they are assisting.  Persons with disabilities who receive financial assistance may be exploited for those benefits.  As the Human Trafficking Legal Center has explained with respect to the situation in the United States:  “While persons with disabilities may be trafficked into sex or labor, many cases include one additional element:  the theft of Social Security or disability benefits.  The opportunity to steal government benefits provides an added incentive for traffickers to target persons with disabilities.”  Persons with disabilities across the globe who receive benefits face similar challenges.

In light of this situation, it is perhaps not surprising that the centerpiece of the United States’ statutory framework to combat trafficking, the Trafficking Victims Protection Act (TVPA), was promulgated in part as a reaction to the Supreme Court’s decision in United States v. Kozminski , 487 U.S. 931 (1988), a case involving two men with intellectual disabilities held in what justices referred to as “slave-like” conditions on a farm.  In the case, the Court held that the law banning “involuntary servitude” was limited to circumstances involving “the compulsion of services by the use or threatened use of physical or legal coercion.”  However, Congress subsequently passed the TVPA, which recognized that psychological coercion and threats of nonviolent coercion can be every bit as powerful as physical force in overcoming the will of targeted individuals.

In 2009, the U.S. Equal Employment Opportunity Commission brought a case involving Henry’s Turkey Service, which exploited 32 intellectually disabled men at a farm in Atalissa, Iowa.  For more than 30 years, the men endured physical and mental abuse and received virtually no pay.  The jury awarded the men what at the time was the largest-ever award in an employment-discrimination case – $240 million – although it was later reduced to $1.6 million due to a federal cap in the Americans with Disabilities Act.

Not only did the TVPA arise in part from trafficking crimes involving persons with disabilities, one of the first major trafficking prosecutions in the United States involved persons with disabilities.  In that case, dozens of immigrants with hearing disabilities, including young children, were forced to work 18-hour days as trinket vendors in New York City.  Traffickers targeted persons with disabilities who were also young migrants and did not speak English, exemplifying how disability can intersect with other forms of vulnerability.  Sadly, this form of exploitation of persons with disabilities continues to this day.

The TIP Report enhanced its coverage of the intersection of disability and trafficking, with the 2023 TIP Report referencing persons with disabilities in 65 country narratives, up from about 50 in the 2022 TIP Report.  These references also highlighted the existence or lack of specialized services for persons with disabilities who are victims of trafficking, and the particular challenges faced by persons with physical or intellectual disabilities.

The U.S. Department of State’s disability rights work is led by Special Advisor on International Disability Rights Sara Minkara.  In this appointed position, Ms. Minkara leads the comprehensive strategy to promote and protect the rights of persons with disabilities across U.S. foreign policy.  Special Advisor Minkara embodies the slogan “nothing about us without us,” which is often used by disability rights advocates to insist that persons with disabilities participate fully in policies affecting them.  The role of Special Advisor on International Disability Rights was first held by Judy Heumann, who served in the position from 2010 to 2017 and is widely regarded as the “mother of the disability rights movement.”  Sadly, Ms. Heumann passed away in March 2023, leaving behind an indelible legacy of disability advocacy in the United States and around the world.

From left:  Former Special Advisor on International Disability Rights (SAIDR) Judy Heumann, SAIDR Sara Minkara, and Special Assistant to the Special Advisor Hanah Nasri attend a celebration of the anniversary of the Americans with Disabilities Act at the official residence of the Vice President of the United States in July 2022.  Photo courtesy of Hanah Nasri. (Photo was published in State Magazine in March 2023:  https://statemag.state.gov/2023/05/0523office/ ) .

• Key Trafficking Issues in the Western Hemisphere Region

Human trafficking manifests itself differently around the world.  In the Western Hemisphere – North, Central, and South America and the Caribbean – there are broad commonalities in trafficking trends countries face and how their governments and authorities approach the crime.  Below is an overview of shared issues in the region to illustrate the overall situation and coordinate the anti-trafficking efforts of governments and other stakeholders .  These regional issues are extrapolated from the individual narratives for the countries in the region, including the United States.

Unprecedented irregular migration in the region affects all Western Hemisphere countries.  Migrants and asylum seekers are especially vulnerable to sex trafficking and forced labor, including by large and small organized criminal groups.  Migrants who rely on migrant smugglers are at particularly high risk of exploitation as many assume debt to pay migrant smugglers.  Irregular migration may also include individuals already exploited by traffickers, as victims may be motivated to migrate and seek protection elsewhere.  While some countries enacted policies aimed at reducing migrants’ vulnerability to trafficking by providing temporary residency and access to formal employment, education, healthcare, and other services, we encourage all countries faced with irregular migration challenges to prevent trafficking and prioritize screening among migrants.

Countries across the region generally have a good understanding of and response to sex trafficking, especially in identification of women who are victims.  Governments also undertake and emphasize the importance of law enforcement and criminal justice approaches to address trafficking, even if implementation is uneven.  Many governments seek to tackle both internal and transnational human trafficking.  In broad terms, there is political will in many countries to address human trafficking, particularly sex trafficking.

Weak efforts targeting forced labor remain a concern in the Western Hemisphere.  Governments generally focus on addressing sex trafficking and have weaker, poorly enumerated procedures to prosecute labor traffickers and protect victims of forced labor.  Labor inspectorates are underfunded and understaffed and typically have limited or no authority to inspect informal sector worksites where many victims are exploited, especially along changing migration routes.  Governments’ lack of attention to labor trafficking leaves victims unprotected in multiple sectors, including agriculture , mining , logging, maritime, and service .

Traffickers also exploit many victims in forced criminality .  Organized crime groups, including gangs and illegal armed groups, exploit girls in child sex trafficking, force children into street begging, forcibly recruit or use child soldiers, and coerce and threaten young men and women to transport drugs, commit extortion, act as lookouts, or commit acts of violence, including murder.  Organized crime groups target groups of migrants unable to enter a country due to border restrictions or awaiting asylum decisions, including at the U.S.-Mexico border.  State-sponsored forced labor is also a concern, specifically Cuba’s labor export program, including its medical missions – which the Cuban government continues to profit from by subjecting workers to forced labor and exploitation.

Gaps in trafficking victim protection are another broad concern in the Western Hemisphere.  For years governments have lacked (or failed to provide the necessary) financial and human resources to screen for and identify trafficking victims and provide them trauma-informed services.  Some governments have developed policies and protocols for screening victims and referring them to care, but implementation has been inconsistent or ineffective.  In addition, governmental interagency coordination is weak, with working groups often disjointed and disempowered, which is particularly detrimental to the cross-sectoral collaboration needed for victim protection efforts.  These problems are particularly notable among migrants, whom governments rarely screen for trafficking indicators.

Furthermore, governments make weak screening and identification efforts even with underserved populations and marginalized groups recognized as at high risk to trafficking, including Afro-descendant, Indigenous, and LGBTQI+ persons, as well as members of other ethnic and linguistic minorities, migrants, refugees, and displaced persons.  These populations also frequently experience discrimination from authorities, often making them fearful to report crimes or access care and justice.  Finally, there are insufficient trafficking-specific services for victims, particularly for men and boys, in most countries across the region.  Governments refer identified trafficking victims to support systems designed to serve other populations, such as migrants, individuals experiencing homelessness, or victims of gender-based violence, which do not meet the specific needs of trafficking victims.  Similarly, access to justice and services is concentrated in large urban areas, while the most vulnerable individuals frequently live in rural areas with limited government presence.  Lack of victim-centered and trauma-informed services can hinder victim identification, prevent healing, increase risk of re-trafficking, and fuel impunity by making survivors less likely to participate in the case against their traffickers.

Criminal justice responses and definitions of trafficking are concerning across the region.  Many governments have weaknesses in their legal systems and uneven judicial application of trafficking laws, including levying fines in lieu of imprisonment for trafficking crimes, imposing penalties not commensurate with those for other crimes, and failing to criminalize all forms of child sex trafficking.  Judges, in particular, may lack adequate training in applying trafficking laws and coercive methods traffickers use, which impacts their decisions and sentences.  Impunity for trafficking crimes fosters misperceptions about trafficking among both policymakers and the public.  Inadequate law enforcement efforts and insufficient capacity-building for law enforcement and other first responders hinders or impacts efforts in low-capacity countries , especially in the Caribbean.  Governments with limited resources often do not recognize or implement low-cost/high-impact anti-trafficking policies.  Official complicity within law enforcement, the prison system, and local government facilitates trafficking crimes across some governments, but criminal prosecution of complicit officials lags behind the already low number of convictions of other traffickers.  Child sex trafficking and extraterritorial commercial child sexual exploitation and abuse are also pervasive concerns, particularly due to the increased use of social media and online platforms to recruit victims.  Many officials conflate human trafficking with other crimes, including migrant smuggling, child labor, sexual violence against children, illegal commercial sex, and illegal adoption.  Because of this confusion, governments may misidentify trafficking victims, fail to give them adequate support, and therefore underreport trafficking crimes.  These problems lead to inadequate data collection and reporting on human trafficking and, therefore, an incomplete understanding of the extent of the crime in the hemisphere.

• A Framework for Balancing Prosecution, Prevention, and Victim Protection Priorities in Criminal Justice Systems

Holding human traffickers accountable is an essential component of the Palermo Protocol’s “3P” paradigm of prosecuting traffickers, protecting victims, and preventing the crime.   Prosecutions make powerful statements that human trafficking will not be tolerated, and perpetrators will be held accountable, and because it is important to recognize that prosecution, protection, and prevention efforts are all inextricably intertwined.   Victims are better able to assist in investigations and prosecutions when they have access to robust protections, and successful prosecutions protect individual victims from revictimization in addition to preventing the convicted trafficker from exploiting others.

Supporting victims throughout the criminal justice process is critical.   Cases often move slowly, leaving victims anxious about the uncertainty of the outcome, fearful of retaliation, re-traumatized by having to recount traumatic events, frustrated by proceedings that can disrupt their lives, and embarrassed, ashamed, or ostracized when information about their victimization becomes public.   These feelings of anxiety, uncertainty, trauma, frustration, and fear can be further intensified by the distrust of authorities that traffickers often instill and manipulate to compel victims’ silence and their compliance with the traffickers’ commands.   Victims often experience conflicting pressures from authorities encouraging them to cooperate, traffickers seeking to silence them, and their own efforts to put traumatic events behind them.   For some survivors, the opportunity to speak out, be believed, and play an active role in bringing traffickers to justice can be empowering and vindicating.   Yet for many, the process can be harrowing, especially when they do not receive sufficient services and support.

The difficulties victims often experience during investigations and prosecutions can further intensify the challenges authorities face when seeking to hold perpetrators accountable, protect their communities, and prevent traffickers from harming others.   In striving to bring traffickers to justice without unduly burdening, re-traumatizing, or endangering victims, prosecutors continually balance the interests of justice, public safety, and protection of the community with the rights and interests of individual victims.   Successful strategies for navigating these challenges will inevitably vary to some extent according to the relevant laws and criminal justice systems across various jurisdictions but the promising practices highlighted below can aid in effectively balancing these complex considerations in a wide range of contexts.   The end goal is to enhance support for victims and decrease the burdens they experience during the criminal justice process regardless of whether they are testifying — while also strengthening investigations and prosecutions to increase accountability for traffickers.

Vigorous Victim Protections at All Stages of the Criminal Justice Process

The best way for authorities to support human trafficking survivors is to ensure the provision and continuity of comprehensive services at all stages of the criminal justice process, including in coordination with civil society organizations who specialize in victim services.   Children survivors require specialized care and interventions.   Robust victim protections, including comprehensive victim-centered, trauma-informed services, are essential to support victims in rebuilding their lives, providing the security and stability they need to safely participate in the criminal justice process, and enabling them to recall and recount their experience.   Such services should include access to identity documents, mental health and medical services, housing, and other forms of relief to support physical and mental healing.   In addition, survivors should have access to legal support and services, ideally through an independent legal advocate.   This support should be tailored to assist the survivor with a range of legal needs, whether related to navigating the investigation and prosecution of the criminal case against the trafficker, to immigration relief, or other legal matters.

Investigators, prosecutors, and victim service providers should collaborate closely to ensure that the victim is stabilized and supported before expecting meaningful participation in the criminal justice process.   Trauma can impede a victim’s ability to recall and recount relevant events, so investigators and prosecutors should develop advanced expertise in victim-centered, trauma-informed, culturally appropriate methods for stabilizing survivors, building rapport, and conducting effective interviews.   Effective interviewing may entail consistent use of professional interpreters to ensure clarity of communication and often benefits from the use of specialized techniques that incorporate the expertise of survivor leaders.   These practices can make the victim’s participation in the process less burdensome and traumatic.   They can also strengthen prosecutions by eliciting more accurate statements, minimizing discrepancies that could later be used to attack the victim’s credibility, and enabling the victim to provide more detailed information that could lead to other sources of evidence.

Protection and services for trafficking victims should not be conditioned on whether the trafficker is charged or convicted.   In cases where a foreign victim chooses to return to their home country, relocation assistance should be provided and authorities should proceed with prosecutions involving repatriated victims when possible, by having them present evidence virtually where authorized by law or by funding their return travel for court proceedings as necessary.   Access to comprehensive support is not only in the best interest of survivors- it also increases the likelihood they will feel sufficiently safe and empowered to assist in the investigation and prosecution.   Whether survivors testify against the trafficker or provide more limited assistance to law enforcement, support for their long-term well-being should be a priority even after the case is closed.

Developing Evidence to Decrease Reliance on Victim Testimony

Another best practice in prosecuting trafficking cases is the use of strategic investigative processes to develop evidence that supports the statements or testimony of trafficking survivors.   In human trafficking prosecutions, every piece of evidence counts because each piece of corroborating evidence is important to reduce reliance on victim testimony, preventing undue credibility attacks, and to increase the likelihood of conviction.

All human trafficking victims who provide statements, declarations, or testimony are inevitably subjected to credibility challenges, whether by jurists in inquisitorial systems that decide whether the victim’s statements are sufficiently reliable or by the defense in adversarial systems.   Victims’ credibility is often scrutinized based on issues such as delays in reporting their victimization, trauma-related inconsistencies in recalling and recounting certain details, or involvement in unlawful acts related to their victimization.   Corroborating evidence can be essential to countering such credibility attacks, increasing the likelihood of the victim’s statements or testimony being believed, and leading to higher rates of convictions.   Investigators and prosecutors should engage in early and continuous collaboration to assess ways to pursue other sources of evidence beyond victim testimony and to corroborate available statements and evidence through sources such as electronic records, physical evidence, and other potential witnesses.

In some cases, other admissible evidence uncovered during a thorough investigation may minimize the need for victim testimony and can become essential to enabling a prosecution to proceed even if the victim is not able to participate in the trial.   Even evidence that provides only limited circumstantial corroboration of one small aspect of a trafficker’s conduct can, when combined with other evidence, provide significant substantiation of a survivor’s account.   Investigators and prosecutors should clearly communicate to survivors that they are not “responsible” for the successful investigation and prosecution, that services and protections are not dependent on the outcome of the criminal case, and that authorities are responsible for gathering relevant evidence from all available sources.   Such evidence can also significantly reduce the burdens felt by the victim and the risks of re-traumatization associated with participating as a witness.

Victim-Centered, Trauma-Informed Charging and Prosecution Practices

One of a prosecutor’s most serious responsibilities is to utilize all available avenues to protect the victim and prevent witness intimidation efforts that could compromise both the victim’s sense of safety and the integrity of the investigation.   Such avenues include seeking court orders, including restraining orders, orders of protection, and no-contact orders to prohibit the defendant from attempting to contact the victim either directly or indirectly.   They also include working with law enforcement and victim advocates to prepare a safety plan and document any attempted contact.   Prosecutors should encourage survivors to seek help from a trusted point of contact with the police or other authorities and to immediately disclose to the prosecutor or advocate any attempt by the traffickers to contact them.   Documented attempts to contact or intimidate the victim should be used in appropriate instances to bring additional obstruction-of-justice or witness tampering charges and may be relevant to explain a victim’s reluctance to cooperate as a witness or recant earlier statements.   Proof of the trafficker’s efforts to contact the victim may also allow the prosecutor to introduce otherwise inadmissible evidence.

Even if the survivor is able and willing to testify, the prosecutor should introduce corroborating evidence to bolster and support their testimony, which is especially important when a survivor’s trauma has caused inconsistency in their statements or memory.   Prosecutors may also consider using expert testimony in appropriate instances to explain the impacts of trauma on memory and recall.   Admissible evidence may include the survivor’s medical records, testimony from first responders or other witnesses to relevant incidents, certain statements made by the accused, electronic messages, physical evidence recovered from relevant locations, and video recordings.   Additional evidence gathered using well-designed and implemented strategic investigative processes can in some instances serve, when possible, as a substitute for the victim’s critical testimony, either completely or on select issues, if the victim becomes unavailable or has difficulty testifying effectively.

Unfortunately, despite all efforts to develop other evidence, some cases of the underlying trafficking offenses cannot proceed without the testimony of the victim.   In those instances, certain practices can be used to pursue prosecutions and accountability while minimizing undue burdens and adverse impacts on survivors.   Prosecutors can strategically focus charges on the most readily provable aspects of the criminal conduct such as assaults, threats, financial crimes, possession of illicit images, or witness tampering, which may be less reliant on victim testimony but may still provide significant opportunities to hold offenders accountable.   Prosecutors can also seek to resolve cases through guilty pleas in appropriate instances to secure substantial justice without the need for victim testimony at trial.

When a victim does need to testify, prosecutors should file all applicable motions to limit the scope of their testimony to relevant facts and preclude inappropriate cross-examination about the victim’s prior bad acts or sexual history.   When allowed by law, prosecutors should consider seeking the court’s permission to present the victim’s testimony virtually or in any other manner that preserves the defendant’s right to confront the accuser while physically separating the victim from the defendant.   Victim services and security should be provided throughout all stages of trial preparation, trial, and sentencing.

Human trafficking survivors with lived experience are uniquely positioned to provide insight, guidance, and expertise on establishing appropriate support systems, strategic investigative processes, and prosecutorial practices that allow victims to be heard and supported at all stages of investigations and prosecutions.   Incorporating survivor-informed expertise is essential to providing the security, stability, and support survivors need to participate safely and effectively as witnesses, while reducing the burdens and risks of re-traumatization often associated with the criminal justice process and strengthening efforts to hold traffickers accountable.

• The Intersection of Forced Marriage and Human Trafficking

The question of whether forced marriage constitutes a human trafficking crime is complex, and the answer can vary depending on the circumstances of the forced marriage and the applicable national laws.

Governments around the world have taken different approaches to the issue, both in terms of the laws they have enacted and of the way those laws are implemented in practice.   While the governing international law on trafficking in persons, the UN TIP Protocol, allows for flexibility in how State Parties criminalize human trafficking under domestic legislation, establishing exploitative intent is critical to considering whether the conduct constitutes trafficking in persons.

What is forced marriage?

The 2022 update to the U.S. Strategy to Prevent and Respond to Gender-Based Violence Globally defines forced marriage as a marriage at any age that occurs without the free and full consent of both parties, including anyone under the age of 18 who is not able to give full consent.   Forced marriage may occur when family members or others use physical or emotional abuse, threats, fraud, or deception to obtain an individual’s agreement.   In such cases, an individual cannot be considered to have consented to the marriage.   The terms “early marriage” and “child marriage” are often used interchangeably to refer to any marriage in which at least one of the parties has not attained the age of 18.   There is overwhelming evidence that child, early, and forced marriages can increase individuals’ vulnerability to future exploitation and abuse – with long-term consequences for their health, wellbeing, safety, and opportunities.

Is Forced Marriage a Form of Trafficking under International Law?

Article 3 of the UN TIP Protocol defines “trafficking in persons” to require three essential elements—an act, conducted using one or more means, for an exploitative purpose.   Article 3 does not list forced marriage explicitly as a form of exploitation; instead, it provides that “exploitation shall include, at a minimum, the exploitation of the prostitution of others or other forms of sexual exploitation, forced labor or services, slavery or practices similar to slavery, servitude or the removal of organs.”   Accordingly, when a forced marriage involves any of the acts, means, and purposes of exploitation listed in Article 3, it would be considered trafficking under the UN TIP Protocol.   For example, forced marriages that also involve forced labor or services, or slavery or practices similar to slavery would also be trafficking in persons if the relevant acts and means are present.   However, the non-exhaustive list of forms of exploitation in Article 3 allows State Parties to decide to expand the list of forms of exploitation within their own domestic definition of trafficking in line with the purpose and scope.

While the UN TIP Protocol does not explicitly include forced marriage within the definition of trafficking, many stakeholders argue that if all the elements of trafficking are present (i.e., there is an act, a prohibited means, done for the purpose of exploiting another person), it should not matter that the exploitation takes the form of a forced marriage.   These stakeholders point to the identical practices used by unscrupulous recruiters who are paid by business owners or prospective husbands to deceive and obtain the consent of individuals to marry “loving wealthy husbands” or accept “lucrative job offers,” in both instances only to leave victims trapped and exploited.

Countries that have chosen to include forced marriage within their domestic definitions of trafficking, either explicitly or implicitly, have taken three common approaches:

Forced Marriage Included as a Form of Exploitation

By leaving the list of forms of exploitation under Article 3 open-ended, the UN TIP Protocol allows State Parties to choose to expand the list of forms of exploitation included under domestic anti-trafficking laws.   As such, some countries have chosen to include forced marriage as an exploitative purpose under their respective anti-trafficking laws.   Several countries have taken this approach, including, but not limited to: Argentina, Australia, Botswana, Cambodia, Chad, Costa Rica, Croatia, Ecuador, El Salvador, Haiti, Kenya, Lithuania, Nicaragua, North Macedonia, Seychelles, and Uganda.

“Practices Similar to Slavery” Interpreted to Include Some Forms of Forced Marriage

Other countries interpret the inclusion of “practices similar to slavery” within Article 3 of the UN TIP Protocol to include certain forms of forced marriage.   “Practices similar to slavery” is defined in the Supplementary Convention on the Abolition of Slavery, the Slave Trade, and Institutions and Practices Similar to Slavery.   Under Article 1(c) of this convention, “practices similar to slavery” refers to, inter alia, “Any institution or practice whereby: (i) A woman, without the right to refuse, is promised or given in marriage on payment of a consideration in money or in kind to her parents, guardian, family or any other person or group; or (ii) The husband of a woman, his family, or his clan, has the right to transfer her to another person for value received or otherwise; or (iii) A woman on the death of her husband is liable to be inherited by another person …”   For countries that use this definition of “practices similar to slavery” to interpret the scope of the definition of trafficking in persons under the UN TIP Protocol, some, but not all, forms of forced marriage could constitute trafficking in persons.

Forced Marriage and Trafficking in Persons as Distinct Crimes .

It is also worth mentioning that there are many countries that choose to address forced marriage and trafficking in persons as separate offenses.   In its 2020 Issue Paper “Interlinkages Between Trafficking in Persons and Marriage,” the United Nations Office on Drugs and Crime (UNODC) acknowledges the viability of these different approaches and explains that there is “no one-size-fits-all approach to most effectively counter cases involving interlinkages between trafficking in persons and marriage.”

Establishing Exploitative Intent is Critical in All Approaches

At the heart of the question of whether a forced marriage constitutes a human trafficking crime is the question of whether the intention was to exploit a person or persons through the marriage.   Recently, the European Parliament and the Council of the European Union recognized the gravity of and increasing linkages between forced marriages and human trafficking. They formally adopted a directive noting that the exploitation of forced marriages “fall[s] within the scope of offenses concerning trafficking in human beings…to the extent that all the criteria constituting those offenses are fulfilled.”

While States that choose explicitly to include forced marriage within their definition of exploitation, or implicitly, through the inclusion of “practices similar to slavery,” consider “forced marriage as inherently exploitative,” such an interpretation is neither required nor shared by all States.   As UNODC explains,

…cultural and national contexts are relevant in determining exploitation, especially in relation to forced and servile marriage.   Cultural and other context-specific factors can play a role in shaping perception of what constitutes exploitative conduct for the purposes of establishing that trafficking has occurred.

Marriages generally involve domestic work and sexual relations between spouses, neither of which is generally understood to constitute abuse or exploitation.   However, there are circumstances in which individuals may be exploited in connection with each of these under the guise of marital obligations.   Taking into consideration the cultural and national contexts in which marriages transpire is a complex but necessary task when determining whether all three elements of a human trafficking offense are present in a case involving forced marriage.

While it is understood forced marriage is inherently harmful, rooted in gender inequality, and can often dramatically increase the risks of individuals to trafficking in persons, gender-based violence (GBV), and other abuses or crimes, it is important to acknowledge there may be circumstances in which a forced marriage has occurred, but the offense of human trafficking has not, because the purpose of the marriage was not to exploit another individual.   For example, in some communities, even an untruthful allegation of sexual indiscretion or promiscuity can irreparably damage a girl’s prospects of marriage or place her in physical danger.  Parents in these communities may attempt to protect their daughters by marrying them at a young age to avoid such allegations and safeguard their reputations.  Similarly, families who live in refugee camps or other unstable situations where there is high prevalence of multiple forms of violence, including GVB, may view marriage as a protective mechanism that will prevent their daughters from being victims of physical or sexual violence or offer them greater economic security.   In these instances, such marriages commonly occur without an individual giving their full, free, and informed agreement to marry.   By definition, such an arrangement would constitute a forced marriage and depending on the country, potentially a violation of domestic criminal laws.   However, if no one involved in arranging the marriage (not the spouse, parents, matchmaker, etc.) is participating for the purpose of exploiting the individual , then the necessary elements of trafficking in persons are not met.   Other crimes or human rights abuses may have occurred and should be addressed, but the specific crime of human trafficking has not occurred because the marriage was not for the purpose of exploitation.   To the contrary, taking into account the relevant cultural and social norms, these actors may believe they are acting in the best interest of the individual.   As in all criminal cases, the knowledge and intent of the individual matters and therefore, in the case of forced marriages as a potential trafficking crime, one must consider if an individual intended to exploit someone, or whether they intended, even misguidedly and mistakenly, to do what was believed to be in the individual’s best interest.   These complicated dynamics must be determined in other trafficking contexts as well.

Therefore, when allegations of forced marriage are presented, they must be evaluated on a case-by-case basis to determine whether they constitute trafficking in persons.   Such an assessment neither legitimizes forced marriage nor detracts from serious concerns around such practices.   Rather, it simply ensures the appropriate criminal prosecution, protection, and prevention responses are utilized to address the conduct in question because, as UNODC explains, “….qualifying a particular type of conduct as trafficking in persons has extensive consequences for both the alleged perpetrators and victims of the crime.”

* NOTE:   U.S. law does not explicitly recognize forced marriage as a “severe form of trafficking in persons” or reference it in criminal trafficking laws.   Therefore, forced marriage, per se, is not automatically considered a form of trafficking in persons under U.S. law.   The facts and circumstances of the forced marriage must be considered to determine whether the conduct falls under a relevant definition or legal provision.   Generally, if the person forced to marry is also compelled to work or to engage in commercial sex, then the forced marriage would likely fall within the definition of trafficking in persons and be a crime under U.S. law.   Because the definition of “severe forms of trafficking in persons” established under the Trafficking Victims Protection Act governs the Department’s minimum standard assessments for the purposes of the TIP Report, the Department accordingly includes governments’ efforts to combat forced marriage if there is credible evidence that those efforts address forced marriage in which the objective of the marriage was to exploit another person for labor or services or commercial sex.

An Example of When a Forced Marriage Involved Human Trafficking:   United States of America v. Zahida Aman, et al.

In United States of America v. Zahida Aman, et al., the United States successfully prosecuted and convicted three individuals for trafficking crimes relating to a forced marriage.   On January 24, 2023, the traffickers were sentenced to five, ten, and 12 years of imprisonment, respectively, and ordered to pay restitution to the victim.   The case serves as an example of how forced marriage and human trafficking can intersect and result in complex and devastating exploitation of vulnerable individuals, as abuse often goes undetected for long periods of time due to its hidden nature within the confines of familial relationships.

A federal jury sitting in Richmond, Virginia, found defendants Zahida Aman, Mohammad Nauman Chaudhri, and Mohammad Rehan Chaudhri guilty of conspiracy to commit forced labor for compelling the domestic labor of a Pakistani woman for 12 years.   The jury further found defendant Aman guilty of forced labor and document servitude, and defendant Rehan Chaudhri guilty of forced labor.

According to the evidence presented in court, defendant Zahida Aman arranged for her son’s marriage to the victim in 2001.   The victim moved to the United States and lived in a house in Midlothian, Virginia, with her husband and the three defendants (the husband’s mother and his two brothers).   The defendants compelled the victim to serve the family as a domestic servant, using physical and verbal abuse, restricting communication with her family in Pakistan, confiscating her immigration documentation and money, and eventually threatening to separate her from her children by deporting her to Pakistan.

The defendants slapped, kicked, and pushed the victim, even beat her with wooden boards, and on one occasion hog-tied her hands and feet and dragged her down the stairs in front of her children.   Even after the victim’s husband moved away, the defendants kept the victim in their Virginia home, often forcing her to perform increasingly laborious tasks… 

The evidence further showed that the defendants required the victim to work every day, beginning early each morning.   They restricted her food, forbade her from learning to drive or speaking to anyone except the defendants’ family members and prohibited her from calling her family in Pakistan.

Press Release, U.S. Department of Justice

• 2024 TIP REPORT HEROES

This year marks a major milestone—the 20th anniversary of the TIP Report Heroes awards program.   Each year, the Department of State honors individuals around the world who have devoted their lives to the fight against human trafficking.   These individuals include NGO workers, lawmakers, government officials, survivors of human trafficking, and concerned citizens.   They are recognized for their tireless efforts—despite some working in challenging environments where human trafficking concerns remain pervasive and facing resistance, opposition, or threats to their lives—to protect victims, punish offenders, and mitigate the underlying factors that cause vulnerabilities traffickers often target.

For more information about current and past TIP Report Heroes, please visit the TIP Report Heroes Global Network at www.tipheroes.org .

Al Amin Noyon Manager BRAC Migration Centre

Md. Al-Amin, or Noyon, is a welcoming first face to trafficking survivors and migrants as they return to Bangladesh.  As a fellow trafficking survivor, Noyon is uniquely qualified and motivated to help them rebuild their lives. In his capacity as manager of the BRAC Migration Welfare Centre onsite at the Dhaka airport, Noyon has supported more than 34,000 Bangladeshi trafficking survivors and migrants over the last 15 years.

Born to a family of modest means, Noyon’s dream of a better life turned into a nightmare when he was exploited in trafficking in Malaysia in 2007, beaten, tortured, and held captive in the jungle.  But as the 41-year-old now shares, that is not how his story ends.  His motivation to support fellow survivors has long motivated him to serve as a member of ANIRBAN (‘the flame that will not fade ‘ ), a trafficking support platform made up of survivors who raise awareness about human trafficking and advocate for survivors and their rights.

Noyon believes education is one of the best ways to insulate Bangladesh’s next generation from the perils of human trafficking.  He assists with safe migration campaigns at schools across Bangladesh and has supported thousands of students whose families are migrants or trafficking survivors secure academic scholarships.

Known by anti-trafficking stakeholders in the Bangladesh government, multilateral organizations, and likeminded partners, Noyon steadfastly supports others despite very real risks to his own safety.

Marcela Martinez Activist/Lawyer

Ms. Martinez is an accomplished Bolivian lawyer from La Paz and a leading anti-trafficking activist, who has demonstrably changed the direction of Bolivian and regional efforts to combat trafficking in persons, providing hope for families affected by human trafficking in Bolivia.

In 2017, Ms. Martinez formed the Social Responsibility Area of her law firm, from which the #RedAlertTempranaZar 🦋 hashtag operates.  This hashtag is modeled after the Amber Alert system in the United States to help activate searches for victims in Bolivia.  They also provide training, talks, workshops, and prevention webinars to schools, universities, neighborhood associations, and other civil society organizations.  To date, more than 18,000 volunteers participate in the network and have helped authorities locate more than 150 victims.

Ms. Martinez’s work has been instrumental in the prosecution of traffickers, protection of survivors, and prevention of victims.  She helped draft and lobbied for the passage of the first comprehensive Bolivian national law that gives law enforcement and prosecutors new tools and resources to combat trafficking in persons.  She also created the National Trafficking in Persons Council to coordinate all Bolivian government efforts to fight human trafficking.

She was part of the NinaSonko Heart of Fire Women’s Circle, which provides support and holistic and business coaching to survivors of trafficking and violence and supports social reintegration.  She has also served as a trainer through UNODC, training judges, prosecutors, and police officers on victim care at the national level.  Through her tireless efforts, Ms. Martinez has reduced human trafficking in Bolivia.

Maria Werlau Founder/Executive Director Free Society Project

Maria Werlau is co-founder and Executive Director of Free Society Project, also known as Cuba Archive, a non-profit think tank that defends human rights through information.  She began in 2009 researching, documenting, and denouncing exploitation and forced labor in Cuba’s labor export program and advocating for its victims and survivors.  In 2010, she published her first academic work on the issue and authored an opinion piece in The Wall Street Journal denouncing the labor export program as a trafficking scheme benefiting the Cuban government.  At the time, Cuba’s “internationalism” was mostly known from the slanted narrative of altruistic solidarity.

Since then, Maria has interviewed dozens of Cuban workers, mostly doctors coerced to work across the globe.  Through her work at Cuba Archive, she has exposed the dark aspects of Cuba’s medical missions, emphasizing the abuses faced by the workers: violence, sexual harassment, family separation, exploitation, forced labor, wage confiscation, restriction of movement, passport retention, repression, forced exile, psychological trauma, loss of life, and more.  She has also documented and exposed the labor export program’s lesser-known impact on the public health systems of Cuba and host countries, as well as its economic, political, and geostrategic value to the Cuban regime.

Maria has authored numerous works on Cuba in English and Spanish, including on healthcare, and provided expert testimony on Cuban labor trafficking to the U.S. Congress and at the OAS and the European Parliament.

Mustafa Ridha Mustafa al-Yasiri Director – Anti-Human Trafficking Directorate Ministry of Interior

Brigadier General Mustafa Ridha Mustafa al-Yasiri has courageously worked in Iraq’s Ministry of Interior (MOI) to combat trafficking in persons throughout a career dedicated to defending Iraq’s most vulnerable.  Brigadier General Mustafa vastly improved the Government of Iraq’s efforts to combat trafficking in persons and enhanced services for women trafficking victims, only months after being appointed in March 2023 as the Director of MOI’s Anti-Human Trafficking Directorate.  With support from the Minister of Interior, Brigadier General Mustafa immediately increased government resources dedicated to fighting trafficking in persons; appointed women Trafficking in Persons officers and employees to better assist trafficking victims; and appointed new investigative officers and officials knowledgeable on trafficking in persons, victim identification, and violence against women.  Together with the Iraqi judiciary, Mustafa established a strategy to identify victims more accurately and better address sexual exploitation and other forms of trafficking.

In addition, Brigadier General Mustafa worked with hiring companies to ensure they publish and display signs detailing Iraqi workers’ rights and the MOI’s Trafficking in Persons hotline.  On a weekly basis, he visited shelters to speak with victims, compile lists of needed food and hygienic and medical supplies, and help victims make calls to their families.  He also personally accompanied trafficking victims to court to help with their hearings and legal procedures.  Every day, motivated by personal conviction, Brigadier General Mustafa is realizing a professional goal to serve and protect many of the most vulnerable citizens of Iraq.

Edith Murogo Founder/Chief Executive Officer Centre for Domestic Training and Development

Edith Murogo is a beacon of hope on the frontlines of the fight against human trafficking and labor exploitation.  When Edith started training domestic workers more than two decades ago, she met victims of human trafficking and gender-based violence.  This experience prompted her to pioneer initiatives that transformed anti-trafficking efforts in Kenya.

After establishing the Centre for Domestic Training and Development (CDTD) in 2001, Edith became a leading advocate for domestic workers’ rights and lobbied the government for strengthened protections of migrant workers.  Edith initiated training to professionalize domestic workers and convinced the government to develop the curriculum and establish a certificate program for domestic workers seeking employment abroad.  Since opening, CDTD has assisted over 50,000 domestic workers with advocacy, skills, and knowledge to prevent them from becoming victims of trafficking.

In 2012, Edith opened the Talia Agler Girls Shelter (TAGS) – a safe house providing comprehensive assistance to girls and young women, especially for survivors of sexual and gender-based violence exploited in human trafficking. TAGS has assisted over 1,000 girls with removal from trafficking situations, recovery, and reintegration support services as well as education, mentorship, and leadership opportunities.

During the COVID-19 pandemic, Edith established Kenya’s National Shelters Network to coordinate shelter services across Kenya and ensure all survivors receive crucial protection services.  Edith is a tireless advocate working with government and civil society to strengthen anti-trafficking laws and responses.  The Department of Labor and BBC have highlighted her work in several documentaries about human trafficking.

Oumou Elkhairou Niaré Samaké Coordinator National Integrated Program for the Fight Against Drug Trafficking and Organized Crime; National Committee for the Fight Against Trafficking in Persons and Similar Practices

Oumou Elkhairou Niaré Samaké (Oumou), a well-known Malian magistrate, currently serves as the coordinator of Mali’s National Integrated Program for the Fight against Drug Trafficking and Organized Crime and as Coordinator of the National Committee for the Fight Against Trafficking in Persons and Similar Practices.  Oumou is a fierce advocate for human rights, gender-based violence, and trafficking in persons issues.  She has spearheaded Mali’s recent adoption of a new Action Plan to Combat Trafficking in Persons; championed the development of Mali’s new draft penal code to criminalize trafficking in persons; and fought to increase prosecutions over the past year of hereditary slavery cases.

In 2020 and 2021, the Trafficking in Persons Committee became relatively inactive.  However, upon her appointment in 2022, Oumou reinvigorated Mali’s anti-trafficking efforts.  First, she reestablished regular coordination meetings and published the Trafficking in Persons Committee’s overdue 2021 and 2022 annual reports.  Next, she spearheaded the development, drafting, and adoption of Mali’s new National Action Plan to Combat Trafficking in persons, launched in October 2023.  She has maintained high level standard of contacts with partners, donors, and national and international stakeholders in the fight against trafficking in persons and hereditary slavery.

Samson Inocencio Jr. Vice President International Justice Mission Philippines Program Against Online Sexual Exploitation of Children

Samson “Sam” Inocencio has dedicated over 20 years to combating trafficking in persons through his work with the International Justice Mission (IJM) Philippines.  He has contributed to 147 convictions for commercial sexual exploitation and 220 for online sexual exploitation (OSEC) crimes since 2005.  After becoming National Director of IJM in 2016, Sam assisted in the removal of 544 children from situations of commercial sexual exploitation and 1,237 children who were at risk of OSEC.

Sam led IJM’s efforts under the U.S.-Philippine Child Protection Compact (CPC) Partnership to combat OSEC crimes and advocated for a 347 percent budget increase for the Philippine National Police – Women and Children Protection Center.  As IJM’s representative to the Government of the Philippines’ Interagency Council Against Trafficking, Sam has assisted the Philippines in its efforts to combat the commercial sexual exploitation of children and OSEC related crimes, to hold offenders accountable in courts of law, and to safeguard Filipino children.

He collaborated with the Government of the Philippines in 2016 to develop a “roadmap to Tier 1” in the U.S. Department of State Trafficking in Persons Report.  The Philippines has been ranked Tier 1 for eight years due to the merits of its efforts.  Sam’s leadership and dedicated service have strengthened the government and civil society’s response to trafficking and protected thousands, especially children, from exploitation.

Marijana Savić Founder/Director Atina

Marijana Savić, the founder and director of NGO Atina, is an activist dedicated to advancing women’s and girls’ rights.  For over two decades, she has provided vital support and recovery programs for survivors of trafficking and gender-based violence in Serbia.  Her efforts have led to important progress in policy reform to combat human trafficking and support women and girls, who were victims of commercial sexual exploitation.

Under Marijana’s guidance, Atina has become a pivotal organization in Serbia’s anti-trafficking sector.  Marijana also actively contributes by helping integrates survivor experiences into law and human rights policies, in Serbia and abroad.  Her commitment extends to economic empowerment through the social enterprise Bagel Bejgl, which she founded in 2015.  This initiative – which provides employment to trafficking survivors – supports Atina’s sustainability by directing its profits to anti-trafficking programming.

Marijana works with international bodies, including the Council of Europe, as an expert in combating trafficking, especially labor exploitation.  An alumnus of the Human Rights Advocates Program at Columbia University, Marijana is also involved in global advocacy as a member of the Global Fund for Children’s board, Canada’s Equality Fund Investment Advisory Council, and the UN Voluntary Trust Fund for Victims of Human Trafficking board.

Marijana’s relentless activism and leadership have earned widespread acclaim and numerous awards for Atina, highlighting her role in shaping a safer, more equitable society for women and girls across Serbia and globally. Her work exemplifies a profound commitment to human rights and the empowerment of the most vulnerable groups.

Rosa Cendón Advisor – Human Trafficking and Gender-based Violence Catalonia Regional Ministry for Equality and Feminism

Rosa Cendón has devoted her life to assisting victims, raising awareness, and combating human trafficking in Spain.

As a social worker and educator based in Barcelona, Rosa has led advocacy and institutional relations for SICARcat, the largest anti-trafficking NGO in the Catalonia region, for 20 years.  SICARcat offers assistance to women and children survivors of trafficking by providing them with shelter and legal, psychological, medical, and social support.  Since 2022, Rosa has served as an expert advisor for combating human trafficking and gender-based violence at the Catalonia regional Ministry of Equality and Feminism.  She continues to promote change by raising awareness of human trafficking and designing public policy.

Rosa is at the forefront of anti-trafficking efforts in Catalonia.  Her victim-centered approach has influenced regional and national anti-trafficking and victim protection policies.  She contributed to designing the regional Catalonian and Barcelona city protocols for victim protection.  Under her leadership, SICARcat developed tools for the detection and intervention of human trafficking cases working closely with law enforcement agencies.  She regularly conducts specialized training for key actors.

During the height of the European migration crisis, Rosa helped found the ASIL.CAT network of human rights NGOs that coordinated shelter, protection, and services for the influx of refugees.  She worked to ensure that anti-trafficking efforts were included in the asylum reception system.  As a result of Russia’s invasion of Ukraine, Spain has received over 200,000 Ukrainian refugees and Rosa has been at the forefront in providing support to the refugees arriving to Barcelona.

Letitia Pinas Inspector of Police – Head of the Trafficking in Persons Unit Suriname Police Force

Inspector Letitia Pinas launched her career with the Suriname Police Force in 1998.  After serving in the Youth Affairs Department and the Public Relations Department, she was assigned the role of Acting Head of the 14-person Trafficking in Persons Unit in November 2020, to determine its continued usefulness.  Inspector Pinas overhauled the underperforming unit by drafting a strategic plan that improved the unit’s ability to investigate suspects and identify and serve victims, its presence in and outreach to the community, and the public’s trust in it.

With no NGOs working on human trafficking, Inspector Pinas assumed a disproportionate burden not only to investigate cases properly and effectively but also ensured efforts continued in the areas of protection and prevention, including expanded awareness.  Despite the government facing a multi-year financial crisis, she successfully lobbied for funds from the police to establish an emergency shelter within her office to house victims in the initial stages of an investigation.  She closely collaborated with the Prosecutors’ Office for funding to create a long-term shelter for both male and female victims.  Through improved collaboration with the Maritime Police and the Military Police, the Trafficking in Persons Unit actively participates in inspections of incoming vessels, while also checking for potential victims amongst incoming travelers at the airport.  These efforts have led to increased numbers of identified victims, including many who have trusted the police enough to self-report.  Her collaboration with senior police officials resulted in the development of a website that raises awareness on human trafficking and provides society with a tool to anonymously report suspected cases of trafficking.

• Child Soldiers Prevention Act List

Section 402 of the Child Soldiers Prevention Act, as amended (CSPA) requires publication in the annual TIP Report of a list of foreign governments identified during the previous year as having governmental armed forces, police, or other security forces, or government-supported armed groups that recruit or use child soldiers, as defined in the CSPA.  These determinations cover the reporting period beginning April 1, 2023 and ending March 31, 2024.

For the purpose of the CSPA, and generally consistent with the provisions of the Optional Protocol to the Convention on the Rights of the Child on the involvement of children in armed conflict, the term “child soldier” means:

•  any person under 18 years of age who takes a direct part in hostilities as a member of governmental armed forces, police, or other security forces;
• any person under 18 years of age who has been compulsorily recruited into governmental armed forces, police, or other security forces;
• any person under 15 years of age who has been voluntarily recruited into governmental armed forces, police, or other security forces; or
• any person under 18 years of age who has been recruited or used in hostilities by armed forces distinct from the armed forces of a state.

The term “child soldier” includes any person described in clauses (ii), (iii), or (iv) who is serving in any capacity, including in a support role, such as a “cook, porter, messenger, medic, guard, or sex slave.”

Governments identified on the list are subject to restrictions, in the following fiscal year, on certain security assistance and commercial licensing of military equipment.  The CSPA prohibits assistance to governments that are identified in the list under the following authorities: International Military Education and Training, Foreign Military Financing, Excess Defense Articles, and Peacekeeping Operations, with exceptions for some programs undertaken pursuant to the Peacekeeping Operations authority.  The CSPA also prohibits the issuance of licenses for direct commercial sales of military equipment to such governments. Beginning October 1, 2024, and effective throughout Fiscal Year 2025, these restrictions will apply to the listed countries, absent a presidential waiver, applicable exception, or reinstatement of assistance pursuant to the terms of the CSPA.  The determination to include a government in the CSPA list is informed by a range of sources, including first-hand observation by U.S. government personnel and research and credible reporting from various UN entities, international organizations, local and international NGOs, and international and domestic media outlets.

The 2024 CSPA List includes governments of the following countries: Please note that 2024 Child Soldiers Prevention Act-related determinations were not final at the time of releasing the 2024 TIP Report. This section will be updated as soon as possible.

• When the Government is the Trafficker: State-Sponsored Trafficking in Persons

While the TVPA Minimum Standards for the Elimination of Trafficking In Persons and the UN TIP Protocol call on governments proactively to address trafficking crimes, some governments are part of the problem, directly compelling their citizens or other individuals into sex trafficking or forced labor.   Some governments exploit individuals in forced labor in local or national public works projects, military operations, economically important sectors, as part of government-funded projects or missions abroad, or in sexual slavery on government compounds.   Governments extract this work or service by threatening the withdrawal of public benefits; withholding salaries; intentionally failing to adhere to limits on national service; manipulating the lack of legal status of stateless individuals and other minority groups; threatening to punish family members; or conditioning services, food, or freedom of movement on labor or sex.

In 2019, Congress amended the TVPA to acknowledge that governments can also act as traffickers, referring specifically to a “government policy or pattern” of human trafficking; human trafficking in government-funded programs; forced labor (in government-affiliated medical services, agriculture, forestry, mining, construction, or other sectors); sexual slavery in government camps, compounds, or outposts; or employing or recruiting child soldiers.   While the TVPA already directs the Secretary to consider the extent to which “officials or employees of the government have participated in, facilitated, condoned, or were otherwise complicit in” trafficking when determining whether the government is making significant efforts to meet the minimum standards, this section directly links a government’s “policy or pattern” of trafficking to a Tier 3 ranking.

The 2024 TIP Report includes the following 13 countries with a documented “policy or pattern” of human trafficking, trafficking in government-funded programs, forced labor in government-affiliated medical services or other sectors, sexual slavery in government camps, or the employment or recruitment of child soldiers:    

• Afghanistan*
• China, People’s Republic of
• Korea, Democratic People’s Republic of
• South Sudan
• Turkmenistan

* The TIP Report describes the state of human trafficking within a country and with respect to Afghanistan, assesses the actions of Afghan ministries, as well as the Taliban, without implying recognition of the Taliban or another entity as the government of Afghanistan.

• Methodology

The Department of State prepared this report using information from U.S. embassies, government officials, nongovernmental and international organizations, published reports, news articles, academic studies, consultations with authorities and organizations in every region of the world, and information submitted to [email protected] .   This email address provides a means by which organizations and individuals can share information with the Department of State throughout the year on government progress in addressing human trafficking.

U.S. diplomatic posts and domestic agencies reported on the human trafficking situation and governmental action to fight trafficking based on thorough research that included meetings with a wide variety of government officials, local and international NGO representatives, officials of international organizations, journalists, academics, and survivors.   U.S. missions overseas are dedicated to covering human trafficking issues year-round.   The 2024 Trafficking in Persons Report covers government efforts undertaken from April 1, 2023 through March 31, 2024, to the extent concurrent reporting data is available.

Tier Placement

The Department places each country in this report onto one of four categories.   This placement is based not on the size of a country’s problem but on the extent of government efforts to meet the Trafficking Victims Protection Act’s (TVPA) minimum standards for the elimination of human trafficking (see page XX), which are generally consistent with the Palermo Protocol.

While Tier 1 is the highest ranking, it does not mean that a country has no human trafficking problem or that it is doing enough to address the crime.   Rather, a Tier 1 ranking indicates that a government has made efforts to address the problem that meet the TVPA’s minimum standards.   To maintain a Tier 1 ranking, governments need to demonstrate appreciable progress each year in combating trafficking.   Tier 1 represents a responsibility rather than a reprieve.

Tier rankings and narratives in the 2024 Trafficking in Persons Report reflect an assessment of the following:

• enactment of laws prohibiting severe forms of trafficking in persons, as defined by the TVPA, and provision of criminal punishments for trafficking crimes;
• criminal penalties prescribed for human trafficking crimes which are sufficiently stringent and commensurate with those prescribed for other grave crimes;
• implementation of human trafficking laws through vigorous prosecution of the prevalent forms of trafficking in the country and adequate sentencing of traffickers;
• proactive victim identification measures with systematic procedures to guide law enforcement and other government-supported front-line responders in the process of victim identification;
• government funding and partnerships with NGOs to provide victims with access to primary health care, counseling, and shelter, allowing them to recount their trafficking experiences to trained counselors and law enforcement in an environment of minimal pressure;
• victim protection efforts that include access to services and shelter without detention and with legal alternatives to removal to countries in which victims would face retribution or hardship;
• the extent to which a government ensures victims are provided with legal and other assistance and that, consistent with domestic law, proceedings are not prejudicial to victims’ rights, dignity, or psychological well-being;
• the extent to which a government ensures the safe, humane, and, to the extent possible, voluntary repatriation and reintegration of victims;
• governmental measures to prevent human trafficking, including efforts to curb practices identified as contributing factors to human trafficking, such as employers’ confiscation of foreign workers’ passports and allowing labor recruiters to charge fees to prospective migrants; and
• governmental efforts to reduce the demand for commercial sex acts and extraterritorial sexual exploitation and abuse.

Tier rankings and narratives are NOT affected by the following:

• efforts, however laudable, undertaken exclusively by nongovernmental actors in the country;
• general public awareness events—government-sponsored or otherwise—lacking concrete ties to the prosecution of traffickers, protection of victims, or prevention of trafficking; and
• broad-based law enforcement or developmental initiatives.

A Guide to the Tiers

Countries whose governments fully meet the TVPA’s minimum standards for the elimination of trafficking.

Countries whose governments do not fully meet the TVPA’s minimum standards but are making significant efforts to bring themselves into compliance with those standards.

Tier 2 Watch List

Countries whose governments do not fully meet the TVPA’s minimum standards but are making significant efforts to bring themselves into compliance with those standards, and for which:

• the estimated number of victims of severe forms of trafficking is very significant or is significantly increasing and the country is not taking proportional concrete actions;
• there is a failure to provide evidence of increasing efforts to combat severe forms of trafficking in persons from the previous year, including increased investigations, prosecutions, and convictions of trafficking crimes, increased assistance to victims, and decreasing evidence of complicity in severe forms of trafficking by government officials.

Countries whose governments do not fully meet the TVPA’s minimum standards and are not making significant efforts to do so.

The TVPA, as amended, lists additional factors to determine whether a country should be on Tier 2 (or Tier 2 Watch List) versus Tier 3:

• the extent to which the country is a country of origin, transit, or destination for severe forms of trafficking;
• the extent to which the country’s government does not meet the TVPA’s minimum standards and, in particular, the extent to which officials or government employees have been complicit in severe forms of trafficking;
• reasonable measures that the government would need to undertake to be in compliance with the minimum standards in light of the government’s resources and capabilities to address and eliminate severe forms of trafficking in persons;
• the extent to which the government is devoting sufficient budgetary resources to investigate and prosecute human trafficking, convict and sentence traffickers; and obtain restitution for victims of human trafficking; and
• the extent to which the government is devoting sufficient budgetary resources to protect victims and prevent the crime from occurring.

In addition, the TVPA directs the Secretary of State to consider, as proof of a country’s failure to make significant efforts to fully meet the TVPA’s minimum standards, a government policy or pattern of: human trafficking; human trafficking in government-funded programs; forced labor (in government-affiliated medical services, agriculture, forestry, mining, construction, or other sectors); sexual slavery in government camps, compounds, or outposts; or employing or recruiting child soldiers.

The TVPA also provides that any country that has been ranked Tier 2 Watch List for two consecutive years and that would otherwise be ranked Tier 2 Watch List for the next year will instead be ranked Tier 3 in that third year.   The Secretary of State is authorized to waive the automatic downgrade only once, in that third year, based on credible evidence that a waiver is justified because the government has a written plan that, if implemented, would constitute making significant efforts to meet the TVPA’s minimum standards for the elimination of trafficking and is devoting sufficient resources to implement the plan.   The following year, a country must either go up to Tier 2 or down to Tier 3.   Additionally, the TVPA limits a country to one year on Tier 2 Watch List after that country received a waiver to stay on Tier 2 Watch List and was subsequently downgraded to Tier 3.

Funding Restrictions for Tier 3 Countries

Pursuant to the TVPA, governments on Tier 3 may be subject to certain restrictions on foreign assistance, whereby the President may determine not to provide U.S. government nonhumanitarian, nontrade-related foreign assistance as defined in the TVPA.   In addition, the President may determine to withhold funding for government official or employee participation in educational and cultural exchange programs in the case of certain Tier 3 countries.   Consistent with the TVPA, the President may also determine to instruct the U.S. Executive Director of each multilateral development bank and the International Monetary Fund to vote against and use their best efforts to deny any loans or other uses of the institutions’ funds to a designated Tier 3 country for most purposes (except for humanitarian, trade-related, and certain development-related assistance).   Alternatively, the President may waive application of the foregoing restrictions upon a determination that the provision to a Tier 3 country of such assistance would promote the purposes of the TVPA or is otherwise in the national interest of the United States.   The TVPA also authorizes the President to waive these restrictions if necessary to avoid significant adverse effects on vulnerable populations, including women and children.

Applicable assistance restrictions apply for the next Fiscal Year, which begins October 1, 2024.

• TVPA Minimum Standards for the Elimination of Trafficking in Persons

Trafficking Victims Protection Act of 2000, Div. A of Pub. L. No. 106-386, § 108, as amended.

(1) The government of the country should prohibit severe forms of trafficking in persons and punish acts of such trafficking.

(2) For the knowing commission of any act of sex trafficking involving force, fraud, coercion, or in which the victim of sex trafficking is a child incapable of giving meaningful consent, or of trafficking which includes rape or kidnapping or which causes a death, the government of the country should prescribe punishment commensurate with that for grave crimes, such as forcible sexual assault.

(3) For the knowing commission of any act of a severe form of trafficking in persons, the government of the country should prescribe punishment that is sufficiently stringent to deter and that adequately reflects the heinous nature of the offense.

(4) The government of the country should make serious and sustained efforts to eliminate severe forms of trafficking in persons.

Indicia of “Serious and Sustained Efforts”

1. Whether the government of the country vigorously investigates and prosecutes acts of severe forms of trafficking in persons, and convicts and sentences persons responsible for such acts, that take place wholly or partly within the territory of the country, including, as appropriate, requiring incarceration of individuals convicted of such acts.   For purposes of the preceding sentence, suspended or significantly reduced sentences for convictions of principal actors in cases of severe forms of trafficking in persons shall be considered, on a case-by-case basis, whether to be considered an indicator of serious and sustained efforts to eliminate severe forms of trafficking in persons.   After reasonable requests from the Department of State for data regarding investigations, prosecutions, convictions, and sentences, a government which does not provide such data, consistent with a demonstrably increasing capacity of such government to obtain such data, shall be presumed not to have vigorously investigated, prosecuted, convicted or sentenced such acts.

2. Whether the government of the country protects victims of severe forms of trafficking in persons and encourages their assistance in the investigation and prosecution of such trafficking, including provisions for legal alternatives to their removal to countries in which they would face retribution or hardship, and ensures that victims are not inappropriately incarcerated, fined, or otherwise penalized solely for un-lawful acts as a direct result of being trafficked, including by providing training to law enforcement and immigration officials regarding the identification and treatment of trafficking victims using approaches that focus on the needs of the victims.

3. Whether the government of the country has adopted measures to prevent severe forms of trafficking in persons, such as measures to inform and educate the public, including potential victims, about the causes and consequences of severe forms of trafficking in persons, measures to establish the identity of local populations, including birth registration, citizenship, and nationality, measures to ensure that its nationals who are deployed abroad as part of a diplomatic, peacekeeping, or other similar mission do not engage in or facilitate severe forms of trafficking in persons or exploit victims of such trafficking, a transparent system for remediating or punishing such public officials as a deterrent, measures to pre-vent the use of forced labor or child labor in violation of international standards, effective bilateral, multilateral, or regional information sharing and cooperation arrangements with other countries, and effective policies or laws regulating foreign labor recruiters and holding them civilly and criminally liable for fraudulent recruiting.

4. Whether the government of the country cooperates with other governments in the investigation and prosecution of severe forms of trafficking in persons and has entered into bilateral, multilateral, or regional law enforcement cooperation and coordination arrangements with other countries.

5. Whether the government of the country extradites persons charged with acts of severe forms of trafficking in persons on substantially the same terms and to substantially the same extent as persons charged with other serious crimes (or, to the extent such extradition would be inconsistent with the laws of such country or with international agreements to which the country is a party, whether the government is taking all appropriate measures to modify or replace such laws and treaties so as to permit such extradition).

6. Whether the government of the country monitors immigration and emigration patterns for evidence of severe forms of trafficking in persons and whether law enforcement agencies of the country respond to any such evidence in a manner that is consistent with the vigorous investigation and prosecution of acts of such trafficking, as well as with the protection of human rights of victims and the internationally recognized human right to leave any country, including one’s own, and to return to one’s own country.

7. Whether the government of the country vigorously investigates, prosecutes, convicts, and sentences public officials, including diplomats and soldiers, who participate in or facilitate severe forms of trafficking in persons, including nationals of the country who are deployed abroad as part of a diplomatic, peacekeeping, or other similar mission who engage in or facilitate severe forms of trafficking in persons or exploit victims of such trafficking, and takes all appropriate measures against officials who condone or enable such trafficking.   A government’s failure to appropriately address public allegations against such public officials, especially once such officials have returned to their home countries, shall be considered inaction under these criteria.   After reasonable requests from the Department of State for data regarding such investigations, prosecutions, convictions, and sentences, a government which does not provide such data, consistent with a demonstrably increasing capacity of such government to obtain such data, shall be presumed not to have vigorously investigated, prosecuted, convicted, or sentenced such acts.

8. Whether the percentage of victims of severe forms of trafficking in the country that are non-citizens of such countries is insignificant.

9. Whether the government has entered into effective, transparent partnerships, cooperative arrangements, or agreements that have resulted in concrete and measurable outcomes with –

a. domestic civil society organizations, private sector entities, or international nongovernmental organizations, or into multilateral or regional arrangements or agreements, to assist the government’s efforts to prevent trafficking, protect victims, and punish traffickers; or

b. the United States toward agreed goals and objectives in the collective fight against trafficking.

10. Whether the government of the country, consistent with the capacity of such government, systematically monitors its efforts to satisfy the criteria described in paragraphs (1) through (8) and makes available publicly a periodic assessment of such efforts.

11. Whether the government of the country achieves appreciable progress in eliminating severe forms of trafficking when compared to the assessment in the previous year.

12. Whether the government of the country has made serious and sustained efforts to reduce the demand for –

a. commercial sex acts; and

b. participation in international sex tourism by nationals of the country.

• Countries in the 2024 TIP Report that are not Party to the Protocol to Prevent, Suppress and Punish Trafficking In Persons, Especially Women and Children, supplementing the United Nations Convention against Transnational Organized Crime
• Congo, Republic of the
• Korea, Democratic People’s Republic of the
• Marshall Islands
• Papua New Guinea
• Solomon Islands

Between April 2023 and March 2024, Uganda became a State Party to the Protocol.

• Global Law Enforcement Data

The 2003 reauthorization of the TVPA added to the original law a new requirement that foreign governments provide the Department of State with data on trafficking investigations, prosecutions, convictions, and sentences in order to fully meet the TVPA’s minimum standards for the elimination of trafficking (Tier 1).  The 2004 TIP Report collected this data for the first time.  The 2007 TIP Report showed for the first time a breakout of the number of total prosecutions and convictions that related to labor trafficking, placed in parentheses.

The above statistics are estimates derived from data provided by foreign governments and other sources and reviewed by the Department of State. Aggregate data fluctuates from one year to the next due to the hidden nature of trafficking crimes, dynamic global events, shifts in government efforts, and a lack of uniformity in national reporting structures.

“As we work to help people disproportionately affected by human trafficking, including members of racial and ethnic minorities, women and girls, the LGBTQI+ community, and migrants, we remain committed to learning from and partnering with survivors to support their recoveries and to recruit their help in better spotting and preventing these too often overlooked crimes.”

President Joseph R. Biden Jr. President

“I believe history will show that this was the moment when we had the opportunity to lay the groundwork for the future of AI.  And the urgency of this moment must then compel us to create a collective vision of what this future must be.  A future where AI is used to advance the public interest.”

Vice President Kamala Harris, United States

“Combating trafficking requires a strong coalition of local and global partners to share resources and information, better equip front-line workers, and track and respond to evolving trafficking trends.”

Antony Blinken, Secretary of State

“The Intelligence Community in close partnership with law enforcement has been improving its production of detailed data analysis and reporting to better discern patterns and trends in human trafficking of migrants.  And with the help of new tools for conducting such analysis, we’re investing in these efforts, we think to good effect, as we also work to continually improve our connection to both local and federal law enforcement as well as the Department of Homeland Security to assist them in their work to countering the problem.”

Avril Haines, Director of National Intelligence 

“Survivors are the real experts.  Their experiences and their perspectives can help inform and motivate our policies so that we will do more, not less, and accelerate our efforts to combat this heinous cruelty.”

U.S. Representative Chris Smith   (R-NJ)

“Yet traffickers continue to operate with impunity.  Their crimes are receiving not nearly enough attention.  This must change.  We must invest much more in detection and protection.  We must strengthen law enforcement to bring criminals that commodify human beings to justice.  And we must do more to help survivors rebuild their lives.”

A ntonio Guterres, UN Secretary-General

“We need to step up our efforts to reach every trafficking victim, by strengthening detection, investigating cases, and prosecuting the criminals involved.  We also need to proactively identify, assist, and support survivors of this crime to truly leave no one behind.  This requires support from all sectors of society, from healthcare to social services to law enforcement.”

Ghada Waly, Executive Director of UNODC

“The scourge of human trafficking continues to evolve.  Civil unrest and war across the globe, natural disasters, climate change, and the advent and increasing reach of social media all pose significant challenges.”

Sameer Jain, Member of U.S. Advisory Council on Human Trafficking

“If we are to ever defeat trafficking, and this undoubtedly must be our shared ambition, effective approaches to prevention must be the bedrock upon which our anti-trafficking efforts are built.  Preventing trafficking in human beings from taking place is the best way to truly protect vulnerable groups and deprive traffickers of the illicit proceeds the crime generates.”

OSCE Secretary General Helga Maria Schmid

“Traffickers prey on the marginalized and most vulnerable.  But we are witnessing an emerging trend where the demographic profile of trafficking victims is also expanding, at pace with the digital developments in which we are living.”

Dr. Kari Johnstone , OSCE Special  Representative and Co-ordinator for Combating Human Trafficking

“We have to talk about those things that make us uncomfortable, especially if we want to work for an end to human trafficking.  Part of that is acknowledging that when we say nothing and do nothing in the face of many of these issues we are perpetuating the same violence that was done to us.”

Rafael Bautista, Member of the U.S. Advisory Council on Human Trafficking

“Building consensus around an affirmative vision is the first line of our tech diplomacy.  But the rules, the standards, the norms that societies follow are going to determine whether this technology is used for good or whether it’s used for ill.”

• Tier Placements List

A note on Kiribati:  Reports during the 2024 reporting period indicated human trafficking crimes may have occurred in Kiribati.  However, information on anti-trafficking efforts from the Government of Kiribati and the nature and scope of trafficking in persons in Kiribati were insufficient to undertake a full assessment for the 2024 Report.  The Department of State will continue gathering information in the coming year and assess appropriate reporting for the 2025 TIP Report.

• Regional Maps

The Regional Maps will be included in the PDF accessible online version.  Below includes the region-specific Global Law Enforcement Data.

• Stopping Human Trafficking and Sexual Exploitation and Abuse (SEA) by International Peacekeepers and Civilian Personnel

This section summarizes actions taken by the United Nations (UN), the North Atlantic Treaty Organization (NATO), and the Organization for Security and Co-operation in Europe (OSCE) to prevent trafficking in persons or the exploitation of victims of trafficking during calendar year 2023.

• Relevant International Conventions

The chart below shows the Ratification, Accession (a), or Acceptance (A) of relevant international conventions for those countries that have ratified, acceded to, or accepted any such conventions between April 2023 and March 2024.  A complete list that includes the status of all of the countries covered by the Trafficking in Persons Report is available at: https://www.state.gov/international-conventions-relevant-to-combating-trafficking-in-persons/

• International, Regional, and Sub-Regional Organizations Combating Trafficking in Persons

For the 2024 Trafficking in Persons Report, the Framework Documents and other Relevant Guidance section has been consolidated to show only documents published during the reporting year: April 1, 2023 – March 31, 2024.  If you would like to review documents from previous years, please refer to the 2023 Trafficking in Persons Report .

• Annual Report to Congress on the Use of Child Soldiers under Section 405(c) of the Child Soldiers Prevention Act of 2008

This report is submitted in accordance with section 405(c) of the Child Soldiers Prevention Act of 2008 (22 U.S.C. 2370c-2(c)) (CSPA).  Section 1 lists the countries identified as being in violation of the standards under the CSPA in 2023.  Section 2 provides a description and the amounts of assistance withheld pursuant to section 404(a) of the CSPA.  Section 3 provides a list of waivers or exceptions exercised under the CSPA.  Section 4 contains the justifications for such waivers.  Section 5 provides a description and the amounts of assistance provided to countries pursuant to such waivers.

Section 1. Countries in Violation of the Standards Under the CSPA in 2023.

The Secretary of State identified the following countries as having governmental armed forces, police, or other security forces or government-supported armed groups that recruited or used child soldiers within the meaning of section 404(a) of the CSPA during the reporting period of April 1, 2022 – March 31, 2023: Afghanistan, Burma, Central African Republic (CAR), Democratic Republic of the Congo (DRC), Egypt, Eritrea, Iran, Libya, Mali, Russia, Rwanda, Somalia, South Sudan, Syria, Türkiye, Venezuela, and Yemen.

Section 2. Description and Amount of Assistance Withheld Pursuant to Section 404(a).

No security assistance subject to section 404(a) of the CSPA was planned to be provided to Afghanistan, Burma, Eritrea, Iran, Mali, Russia, Rwanda, South Sudan, Syria, or Venezuela in fiscal year (FY) 2024.

Section 3. List of Waivers or Exceptions Exercised under Section 404(a).

On September 15, 2023, the President determined that it is in the national interest of the United States to waive the application of the prohibition in section 404(a) of the CSPA with respect to Egypt; to waive, in part, the application of the prohibition in section 404(a) of the CSPA with respect to Türkiye for International Military Education and Training (IMET) and Peacekeeping Operations (PKO) assistance, issuance of direct commercial sales (DCS) licenses, and support provided pursuant to 10 U.S.C. 331 and 10 U.S.C. 333, to the extent that the CSPA would restrict such assistance or support; to waive, in part, the application of the prohibition in section 404(a) of the CSPA with respect to Libya and Somalia to allow for the provision of IMET and PKO assistance, and support provided pursuant to 10 U.S.C. 331 and 10 U.S.C. 333, to the extent that the CSPA would restrict such assistance or support; to waive, in part, the application of the prohibition in section 404(a) of the CSPA with respect to the Democratic Republic of the Congo to allow for the provision of IMET and PKO assistance and issuance of DCS licenses in connection with the reexport of transport aircraft, to the extent that the CSPA would restrict such assistance; to waive, in part, the application of the prohibition in section 404(a) of the CSPA with respect to the Central African Republic and Yemen to allow for the provision of IMET and PKO assistance, to the extent that the CSPA would restrict such assistance; and to waive the application of the prohibition in section 404(a) of the CSPA to allow for the issuance of DCS licenses related to other U.S. government assistance for the above countries and, with respect to the Russian Federation, solely for the issuance of DCS licenses in connection with the International Space Station (ISS).  The President has further certified that the governments of the above countries are taking effective and continuing steps to address the problem of child soldiers.

Section 4. Justifications for Waivers and Exceptions.

Pursuant to section 404(c) of the Child Soldiers Prevention Act of 2008 (CSPA) (22 U.S.C. 2370c-1(c)), the President has determined that it is in the national interest of the United States to waive the application of the prohibition in section 404(a) of the CSPA with respect to Egypt; to waive, in part, the application of the prohibition with respect to the Central African Republic, the Democratic Republic of the Congo, Libya, Somalia, Türkiye, and Yemen, including to allow for the issuance of direct commercial sales (DCS) licenses related to other U.S. government assistance for these countries that is not subject to the prohibition in section 404(a); and, with respect to Russia, to waive, in part, the application of the prohibition solely for DCS licenses in connection with the International Space Station.  The President has further certified that the governments of the above countries are taking effective and continuing steps to address the problem of child soldiers.  The justification for this determination and certification with respect to each country is set forth in this Memorandum.

The Central African Republic (CAR)

The President has determined it is in the national interest of the United States to waive, in part, the application of the prohibition in section 404(a) of the CSPA with respect to CAR to allow for the provision of International Military Education and Training (IMET) and Peacekeeping Operations (PKO) assistance and has certified that the CAR Government (CARG) is taking effective and continuing steps to address the problem of child soldiers.

Armed groups in CAR continue to threaten civilians and pose a longstanding risk to stability.  The waiver for PKO and IMET assistance for CAR will support the professionalization of the military to better provide security to the people of CAR while respecting human rights and international humanitarian law (IHL).  Additionally, IMET programming allows the United States to invest in CAR military officers to promote professional military education and foster relationships with foreign military personnel rooted in democratic values.

The CARG is taking effective and continuing steps to address the problem of child soldiers through meaningful engagement with U.S. and UN officials in seeking assistance to eradicate trafficking in persons, including the recruitment or use of child soldiers by CAR security forces and armed groups.  Recent efforts have included the adoption of a national plan to counter trafficking in children, government directives prohibiting the presence of children around military bases, and collaboration with the UN and implementing partners to reintegrate children affected by conflict.

The Democratic Republic of the Congo (DRC)

The President has determined it is in the national interest of the United States to waive, in part, the application of the prohibition in section 404(a) of the CSPA with respect to DRC to allow for the provision of IMET and PKO assistance and issuance of licenses for DCS in connection with the reexport of transport aircraft and has certified that the Government of the DRC (GDRC) is taking effective and continuing steps to address the problem of child soldiers.

The proliferation of armed groups amidst ongoing conflict in eastern DRC continues to threaten security and stability for the people of the DRC.  IMET and PKO assistance for the DRC enables the United States to continue professionalization efforts of the Armed Forces of the Democratic Republic of the Congo (FARDC) by enhancing its capacity to provide security within its territory while respecting human rights and IHL.  IMET and PKO assistance provide mechanisms to support security sector governance reforms and training in areas such as military justice, civil-military relations, respect for human rights and IHL, military engineering, and resource management and logistics, which enhance security and help make the FARDC a more transparent, accountable institution.

The GDRC is taking effective and continuing steps to address the problem of child soldiers through sustained commitment to implement its 2012 Action Plan to end and prevent the recruitment and use of child soldiers in partnership with the UN.  Additionally, in 2022 the GDRC adopted a national strategy for the implementation of the Demobilization, Disarmament, Community Recovery and Stabilization Program, which signals an important step in prioritizing children affected by armed conflict, particularly in eastern DRC.

The President has determined it is in the national interest of the United State to waive, in full, the application of the prohibition in section 404(a) of the CSPA with respect to Egypt and has certified that the Government of Egypt is taking effective and continuing steps to address the problem of child soldiers.

Egypt is an important U.S. partner in counterterrorism, anti-trafficking, and regional security operations, which advance both U.S. and Egyptian security. The decades-long defense partnership is a pillar for regional stability and key to securing peace with Israel, supporting the Multinational Force and Observers missions, and enhancing security of the Suez Canal.  Since 1978, the United States has provided more than $54 billion in military assistance for Egypt, which has contributed to Egypt’s capabilities to protect and defend its land, air, and maritime borders and to confront an evolving terrorist threat, including in the Sinai Peninsula.

The Government of Egypt is taking effective and continuing steps to address the problem of child soldiers, even as the scope and intensity of the counterterrorism fight in the Sinai continues to see a significant downturn; 2023 is on track to report the lowest levels of violence in the Sinai since the conflict began in 2011.  The U.S. government is not aware of the Egyptian military, police, or other security forces recruiting or using child soldiers.  Consistent with Egypt’s domestic laws and its obligations under the Optional Protocol to the Convention on the Rights of the Child on the Involvement of Children in Armed Conflict, the Egyptian government effectively prohibits persons under the age of 18 from being forcibly recruited into the armed forces.  The Government of Egypt provides critical influence in addressing the recruitment or use of child soldiers by tribal militias, and the U.S. government will continue to engage the Egyptian government regarding reports of recruitment of child soldiers by government-supported Sinai tribal forces.

The President has determined it is in the national interest of the United States to waive, in part, the application of the prohibition in section 404(a) of the CSPA with respect to Libya to allow for the provision of IMET and PKO assistance and DoD support provided pursuant to 10 U.S.C. 331 and 10 U.S.C. 333 and has certified that the Government of National Unity (GNU) in Libya is taking effective and continuing steps to address the problem of child soldiers.

The U.S. government selected Libya as a priority country for implementation of the U.S. Strategy to Prevent Conflict and Promote Stability.  The Department of State further assesses that in Libya the most durable solution to the unlawful recruitment of child soldiers, including by GNU-aligned units and the self-styled Libyan National Army, is a negotiated political settlement that ends Libya’s instability and the cycles of conflict.  IMET assistance will facilitate English language proficiency to improve interoperability and promote civil-military relations, including civilian control of a unified military.  PKO assistance will build upon the October 2020 ceasefire and support U.N. efforts to advance Libya’s transition to a unified, democratically elected, and inclusive political system based on respect for human rights.  PKO provides the U.S. government a tool to support UNSMIL in its ceasefire monitoring function.  Department of Defense support will build the capacity of Libyan military institutions in support of progress towards civilian-controlled, accountable, defense institutions that uphold human rights, combat terrorism, and address security challenges.

The GNU is taking effective and continuing steps to address the problem of child soldiers through engagement with the UN and the U.S. government in the context of our recurring bilateral Security Dialogue.  Through cooperation with UNSMIL, representatives of the Libyan 5+5 Joint Military Commission, comprised of senior military officers from both the east and west, engage with UNICEF on preventing child soldier recruitment.  The U.S. government is not aware of the GNU’s military, police, or other governmental security forces recruiting or using child soldiers.  Further, GNU security sector leaders provide critical influence to prevent and end the recruitment or use of child soldiers by armed groups in Libya and mitigate the reliance on external forces or groups for internal security.

Russian Federation

The President has determined it is in the national interest of the United State to waive, in part, the application of the prohibition in section 404(a) of the CSPA with respect to the Russian Federation to allow for issuance of licenses for DCS solely in connection with the International Space Station (ISS) and has certified that the Government of the Russian Federation is taking effective and continuing steps to address the problem of child soldiers.

It is in the U.S. national interest to work with Russia to maintain the safety of ISS operations.  Maintaining longstanding U.S.-Russia ISS operations requires the ability to issue DCS licenses for defense articles and defense services in support of the ISS until the planned termination of its operation, which the National Aeronautics and Space Administration estimates will be in 2030.  This waiver will allow such activities to continue and will enable the issuance of licenses necessary to support the safe operation of the ISS, U.S.-Russia integrated crew missions to the ISS, and the safety of U.S. and other personnel onboard the ISS.

The Russian Federation is taking effective and continuing steps to address the problem of child soldiers.  In accordance with the Russian Federation’s Law on the Ratification of the Optional Protocol to the Convention on the Rights of the Child on the Involvement of Children in Armed Conflict of 2008, the Government of the Russian Federation effectively prohibits persons under the age of 18 from being forcibly recruited into the armed forces.

The President has determined it is in the national interest of the United States to waive, in part, the application of the prohibition in section 404(a) of the CSPA with respect to Somalia to allow for the provision of IMET and PKO assistance, and DoD support provided pursuant to 10 U.S.C. 331 and 10 U.S.C. 333 and has certified that the Federal Government of Somalia (FGS) is taking effective and continuing steps to address the problem of child soldiers.

Foreign terrorist organizations including al-Shabaab continue to threaten security and stability for the people of Somalia.  The waiver for IMET and PKO assistance for Somalia enables the United States to continue professionalization efforts of the Somali National Army (SNA) by enhancing their capacity to provide security within their territory while respecting human rights and IHL.  Further, a waiver for support provided by the Department of Defense pursuant to 10 U.S.C. 331 and 10 U.S.C. 333 will allow for U.S. government assistance to build the Somali military’s capacity to conduct effective, sustained counterterrorism operations against al-Shabaab and help reinforce U.S. values, including those related to preventing and ending the unlawful recruitment or use of child soldiers.

The FGS is taking effective and continuing steps to address the problem of child soldiers through sustained commitment to implement its 2019 “road map” to accelerate progress on its 2012 Action Plan on ending the recruitment and use of children by the Somali National Armed Forces in partnership with the UN.  The SNA’s Child Protection Unit continued to make progress in implementing screening procedures, training, and disseminating media to prevent the recruitment and use of child soldiers.  The FGS also continued implementation of standard operating procedures for the handover of children allegedly associated with armed groups.

The President has determined it is in the national interest of the United States to waive, in part, the application of the prohibition in section 404(a) of the CSPA with respect to Türkiye for IMET and PKO assistance, issuance of DCS licenses, and DoD support provided pursuant to 10 U.S.C. 331 and 10 U.S.C. 333 and has certified that the Government of Türkiye is taking effective and continuing steps to address the problem of child soldiers.

Türkiye has been an important U.S. security partner and valued NATO Ally since 1952, regulating passage, in accordance with international law, through the straits of the Bosporus and the Dardanelles, which link the Black Sea with the Mediterranean. Further, Türkiye’s military capability and geographic location are vital to the United States’ integrated deterrence strategy and ability to respond to regional events including with respect to counterterrorism, humanitarian assistance, and disaster relief operations. Türkiye’s support, including defense and security cooperation, to NATO Allies and partners deters malign influence in the region. This waiver will assist in maintaining NATO cohesion and continued interoperability, bolster regional security, and advance bilateral cooperation.

The Government of Türkiye is taking effective and continuing steps to address the problem of child soldiers, including those present in elements of the Syrian National Army receiving support from the Government of Türkiye.  The United States is not aware of the Turkish military, police, or other security forces recruiting or using child soldiers.  Consistent with Türkiye’s domestic laws and its obligations under the Optional Protocol to the Convention on the Rights of the Child on the Involvement of Children in Armed Conflict, the Turkish military effectively prohibits persons under the age of 18 from being forcibly recruited into the armed forces.  Further, the Government of Türkiye provides critical influence in addressing the problem of child soldiers with respect to the Syrian National Army.

The President has determined that it is in the national interest of the United States to waive, in part, the application of the prohibition in section 404(a) of the CSPA with respect to Yemen to allow for provision of IMET and PKO assistance and has certified that the Government of the Republic of Yemen (ROYG) is taking effective and continuing steps to address the problem of child soldiers.

It is in the U.S. national interest to support UN-led efforts to achieve an inclusive negotiated political resolution to the conflict in Yemen.  The waiver for IMET assistance for Yemen enables the United States to continue to support professionalization and interoperability efforts of the Yemeni Armed Forces (YAF) by enhancing their capacity to provide inclusive security within their territory while respecting human rights and IHL.  Further, this waiver will improve the YAF’s capacity to conduct effective, sustained counterterrorism operations, ensuring freedom of navigation through the Bab Al-Mandeb Strait, and securing the space for restoring effective governance institutions.

The ROYG is taking effective and continuing steps to address the problem of child soldiers through sustained commitment to implement its 2018 “road map” to accelerate progress on its 2014 Action Plan to end and prevent the recruitment of children by Yemeni Armed Forces in partnership with the UN.  The ROYG established child protection units within all military regions, issued directives banning child recruitment, and conducted numerous senior government field visits to monitor the implementation of screening procedures to prevent child recruitment and remove children from military units.

Section 5. Description and Amount of Assistance Provided Pursuant to a Waiver.

The information provided below only includes assistance obligated as of April 20, 2024.  Additional assistance will be obligated during FY 2024.

Central African Republic

International Military Education Training $101,124

As of April 20, 2024, IMET funding was obligated for the following activity: professional military education and training.

Democratic Republic of the Congo

International Military Education Training $177,238

International Military Education Training $1,352,782

International Military Education Training $31,284

Peacekeeping Operations $31,917,530.44

As of April 20, 2024, PKO funding was obligated for Somali National Army and Somali Ministry of Defense for the following activities:

logistical support; advisory support; equipment; and program oversight.

10 U.S.C. 333 $4 ,668,640.56

As of April 20, 2024, 333 funding was obligated for the following activities: training and equipment.

International Military Education Training $182,098

International Military Education Training $339,662

As of April 20, 20, 2024, IMET funding was obligated for the following activity: professional military education and training.

• GLOSSARY OF ABBREVIATIONS

Notes:  Local currencies have been converted to U.S. dollars ($) using the currency exchange rates reported by the U.S. Department of the Treasury on December 31, 2023.

• Acknowledgments

The Staff of the Office to Monitor and Combat Trafficking in Persons Is:

Mekhribon Abdullaeva

Sylvia Amegashie

Katrina Askew-Alston

Andrea Balint Garza

Shonnie R. Ball

Suzanne Balson

Matt Becker

Getoria Berry

Brooke Beyer

Caris Boegl

Michelle C. Bloom

Alexandria Boling

Katherine Borgen

Gregory Borgstede

Kelsey Brennan

Joshua Bull

Carla M. Bury

Renée Callender

Jessica Cisneros

Kate Cooper

Camila Crowley

Reena Dalwadi

Sarah Davis

Steven Davis

Anca DiGiacomo

Daniel Evensen

Anna Fraser

Lauren Frey

Mark Forstrom

Lucia Gallegos

Beatriz Garcia Velazquez

Brianna Gehring

Chauna Gibson

Natasha Greenberg

Andrew Grimmer

Takiyah Golden

Denise Harrison

Jocelyn Harrison

Emmanuel Hector

Caitlin B. Heidenreich

Ashley Hernandez

J. Brett Hernandez

Matthew Hickey

Crystal Hill

Megan Hjelle-Lantsman

Jennifer M. Ho

Marta Hoilman

Ariana Holly

Moira Honohan

Renee Huffman

Veronica Jablonski

Harold Jahnsen

Sarah Jennings

Devin Johnson

Maurice W. Johnson

Kari A. Johnstone

Chelsea Kaser

Patrick Kelly

Emily Korenak

Kendra L. Kreider

Mary Lagdameo

Valery Lavigne

James Lensen-Callas

Rebecca Lesnak

Abigail Long

Samantha Lord

Jean McAnerney

Cameron Malcom

Bryan Marcus

LaTina Marsh

Sunny Massa

Kerry McBride

Rendi McCoy

Tamara McCoy

Maura K. McManus

Leah F. Meyer

Rebecca Morgan

Ericka Moten

Ryan Mulvenna

Dan Muncaster

Cristina Narvaez

Amy O’Neill Richard

Zury Palencia

Lauren Parnell

Ashlei Perry

Marissa Pietrobono

Sanjana Polapragada

Justin D. Pollard

David Rabinovich

Patrick Read

Andrea E. Reed

Casey Risko

Angie Rivas

Amy Rustan Haslett

Manith Sarik

Aram Schvey

Tori Jamese Scott-Senghor

Adrienne Sgarlato

Jessica Singh

Stephen Shade

Kaela Shear

Soumya Silver

Cornelius Slayton

Susan Snyder

Megan Stalder

Latoshae Summers

Desirée Suo Weymont

Jamie Sutter

Francesca J. Tadle

Atsuki Takahashi

James Taylor

Anna Thiessen

Cecilia Thompson

Juan Jose Tierjo

Wanda Toney

Andrea Ugolini

Melissa Verlaque

Matthew Villemain

Myrna E. Walch

Frances Wallman

Bianca Washington

Pauline Werner

Danielle (Nikki) Wetsel

Terry Whenry

Sharifa White

Joshua Williams

Willow Williamson

Joshua Youle

Salia Zouande

Special thanks to Brian Piaquadio, Julia Maruszewski, LeGrand Latney, Kimberly Ross, and the creative services team at Global Publishing Solutions.  Special thanks also to the ECA Bureau and technical project managers Tasha Wilkinson and Ed Williams.

Special thanks to Bukola Oriola, Dawn Schiller, Christine Cesa, Jeri Moomaw, Harold D’Souza, Jessa Crisp, Jill Brogdon, Megan Lundstrom, Rafael Bautista, Tanya Gould, and other subject matter experts with lived experience of human trafficking from the Department of State’s Human Trafficking Expert Consultant Network for their contributions to the TIP Report.

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