Dr. Carli Richie-Zavaleta

Dr. Carli Richie-Zavaleta DrPh, MASP, MAIPS, is an adjunct faculty member at the University of New England, where she mentors students through their capstone projects and practicum experiences. Dr. Richie-Zavaleta’s Researchfocuses on the intersection of social and healthcare services with the goal of amplifying the voices of survivors to influence policy and best practices across the board. Additionally, Dr. Richie-Zavaleta supports the ResearchCommittee for the San Diego County Human Trafficking & CSEC Advisory Council as an alternate co-chair and a researchconsultant. She is also the co-chair of the programming committee for the American Public Health Association’s Human Rights Forum. Dr. Richie-Zavaleta’s passion for her vocation shines through her work.

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A Scoping Review of Resilience in Survivors of Human Trafficking

Logan Knight, Yitong Xin, & Cecilia Mengo 

Abstract

Resilience is critical among survivors of trafficking as they are mostly vulnerable populations who face multiple adversities before, during, and after trafficking. However, resilience in survivors of trafficking is understudied. This scoping review aims to clarify the current state of knowledge, focusing on definitions of resilience, how resilience has been studied, and factors associated with resilience among survivors. Five databases were searched using key words related to trafficking and resilience. Studies were included if they were published in English between 2000 and 2019 and focused on resilience with the study design including at least one of these four features: (a) use of standardized measures of resilience, (b) qualitative descriptions of resilience, (c) participants were survivors or professionals serving survivors, and (d) data sources such as case files or program manuals directly pertained to survivors. Eighteen studies were identified. Findings indicated that resilience was primarily described as emergent from interactions between the survivor and the environment. Resilience in trafficking appeared largely similar to resilience in other kinds of victimization. Nonetheless, trafficking survivors also may display resilience in alternative ways such as refusing treatment. Positive interpersonal relationships were the most commonly mentioned resilience factor. In addition, current research lacks studies featuring longitudinal designs, interventions, participatory methods, types of trafficking other than sexual trafficking, and demographic characteristics such as age, gender, and national origin. Future research needs to establish definitions and measures of resilience that are culturally and contextually relevant to survivors and build knowledge necessary for designing and evaluating resilience-enhancing interventions.
https://pubmed.ncbi.nlm.nih.gov/33468034/

Knight L, Xin Y, Mengo C. A Scoping Review of Resilience in Survivors of Human Trafficking. Trauma Violence Abuse. 2021 Jan 20:1524838020985561. doi: 10.1177/1524838020985561. Epub ahead of print. PMID: 33468034.

Going the Extra Mile: Sex Trafficking Survivors’ Recommendations for Healthcare Best Practices

Arduizur C. Richie-Zavaleta, Augusta M. Villanueva, Lauren M. Homicile OrcID and Lianne A. Urada 

Abstract

Human Trafficking (HT) persists in the US, despite multi-level measures designed to mitigate its societal costs. HT instruction for healthcare providers is growing, but there is a dearth of resources and training presenting obstacles for victims accessing suitable healthcare services. Voices of survivors are also scant in the literature, despite the fact that their recommendations would appear essential when designing best practices. This study aimed to methodically gather recommendations from sex trafficking (ST) survivors who sought medical care during their victimization. An exploratory concurrent mixed-methods design was used, and semi-structured interviews (N = 22) were conducted between March 2016 and March 2017, in San Diego, CA, and Philadelphia, PA. Data were analyzed through a coding system to identify meaningful analytical themes. Study participants were recruited through survivor-centered organizations, and their identification was kept anonymous and confidential. Findings included three main themes: (A) Red Flags; (B) supportive healthcare practices; and (C) resources for ST-patient study participants’ recommendations aimed to improve healthcare practice in response to their medical needs in a compassionate and caring manner, with trust building, rapport, and an opportunity to instill hope among ST-patients. Implementing Compassionate Care approaches when caring for ST-patients could positively impact patient–provider interactions, while creating opportunities for intervention.
https://www.mdpi.com/2411-5118/2/1/3/htm

Richie-Zavaleta, A.C.; Villanueva, A.M.; Homicile, L.M.; Urada, L.A. Compassionate Care—Going the Extra Mile: Sex Trafficking Survivors’ Recommendations for Healthcare Best Practices. Sexes 2021, 2, 26-49. https://doi.org/10.3390/sexes2010003

A Survivor-Derived Approach to Addressing Trafficking in the Pediatric ED

Carmelle Wallace, Yvette Schein, Gina Carabelli, Heta Patel, Needhi Mehta, Nadia Dowshen, Nancy Kassam-Adams, Kenneth Ginsburg, and Cynthia Mollen 

Abstract

OBJECTIVES: Our objective was to elicit the perspectives of survivors of child trafficking on addressing trafficking in the pediatric emergency department (ED) and, secondarily, to provide a survivor-derived framework to help pediatric emergency medicine (PEM) providers discuss trafficking with their patients.
METHODS: We conducted in-depth, semistructured interviews with young adults who experienced trafficking as children and/or as adolescents. In the interviews, we employed a novel video-elicitation method designed by the research team to elicit detailed participant feedback and recommendations on the pediatric ED through an interactive, immersive discussion with the interviewer. A grounded theory approach was employed.
RESULTS: Seventeen interviews were conducted revealing the following themes, which we present in an integrated framework for PEM providers: (1) fear is a significant barrier; (2) participants do want PEM providers to ask about trafficking, and it is not harmful to do so; (3) PEM providers should address fear through emphasizing confidentiality and privacy and encouraging agency; (4) PEM providers should approach the patient in a direct, sensitive, and nonjudgmental manner; and (5) changes to the ED environment may facilitate the conversation. Suggested wordings and tips from survivors were compiled.
CONCLUSIONS: Trafficking survivors feel that the pediatric ED can be a place where they can be asked about trafficking, and that when done in private, it is not harmful or retraumatizing. Fear is a major barrier to disclosure in the pediatric ED setting, and PEM providers can mitigate this by emphasizing privacy and confidentiality and increasing agency by providing choices. PEM providers should be direct, sensitive, and nonjudgmental in their approach to discussing trafficking.
https://pediatrics.aappublications.org/content/147/1/e20200772

Carmelle Wallace, Yvette Schein, Gina Carabelli, Heta Patel, Needhi Mehta, Nadia Dowshen, Nancy Kassam-Adams, Kenneth Ginsburg, Cynthia Mollen Pediatrics Jan 2021, 147 (1) e20200772; DOI: 10.1542/peds.2020-0772

At the Intersection of Method and Empowerment: Reflections from a Pilot Photovoice Study with Survivors of Human Trafficking

Sue Lockyer and Christopher J Koenig

Abstract

As human trafficking research increases, attention to ethical research methods with trafficking survivors is important to ensure equitable processes and reliable results for policy and social services. This article first describes Photovoice, a participatory research method that asks individuals to take photos and then to narrate the significance of those photos to develop critical consciousness, and second reflects on the Photovoice method for use with survivors of human trafficking. We outline a pilot Photovoice research project with survivors of human trafficking (n = 4) to consider the strengths, challenges, and opportunities that Photovoice offers for basic and applied research. When implemented as part of a trauma-informed and resilience-oriented framework, Photovoice promotes participants’ sense of empowerment, self-competence, and self-esteem. We discuss how Photovoice can support vulnerable populations, including survivors of human trafficking, while also generating rich and nuanced research data. Our reflections on the lessons learned conducting Photovoice research will support others to implement the method to empower individuals who have survived human trafficking and will promote researchcontributing to a more just, peaceful, and inclusive society.
https://www.tandfonline.com/doi/abs/10.1080/23322705.2020.1809300?af=R&journalCode=uhmt20

Sue Lockyer & Christopher J. Koenig (2020) At the Intersection of Method and empowerment: Reflections from a Pilot Photovoice Study with Survivors of Human Trafficking, Journal of Human Trafficking, DOI: 10.1080/23322705.2020.1809300

Multiplicity of Stigma: Cultural Barriers in Anti-Trafficking Response

Annie Isabel Fukushima, Kwynn Gonzalez-Pons, Lindsay Gezinski, and Lauren Clark 

Abstract
Purpose: The purpose of this study is to contribute to the social understanding of stigma as a societal and cultural barrier in the life of a survivor of human trafficking. The findings illustrate several ways where stigma is internal, interpersonal and societal and impacts survivors’ lives, including the care they receive.
Findings: The research team found that a multiplicity of stigma occurred for the survivors of human trafficking, where stigma occurred across three levels from micro to meso to macro contexts. Using interpretive analysis, the researchersconceptualized how stigma is not singular; rather, it comprises the following: bias in access to care; barriers of shaming, shunning and othering; misidentification and mislabeling; multiple levels of furthering how survivors are deeply misunderstood and a culture of mistrust.
Research Limitations/Implications: While this study was conducted in a single US city, it provides an opportunity to create dialogue and appeal for more research that will contend with a lens of seeing a multiplicity of stigma regardless of the political climate of the context. It was a challenge to recruit survivors to participate in the study. However, survivor voices are present in this study and the impetus of the study’s focus was informed by survivors themselves. Finally, this study is informed by the perspectives of researchers who are not survivors; moreover, collaborating with survivor researchers at the local level was impossible because there were no known survivor researchers available to the team.
Practical Implications: There are clinical responses to the narratives of stigma that impact survivors’ lives, but anti-trafficking response must move beyond individualized expectations to include macro responses that diminish multiple stigmas. The multiplicity in stigmas has meant that, in practice, survivors are invisible at all levels of response from micro, meso to macro contexts. Therefore, this study offers recommendations for how anti-trafficking responders may move beyond a culture of stigma towards a response that addresses how stigma occurs in micro, meso and macro contexts.
Social Implications: The social implications of examining stigma as a multiplicity is central to addressing how stigma continues to be an unresolved issue in anti-trafficking response. Advancing the dynamic needs of survivors both in policy and practice necessitates responding to the multiple and overlapping forms of stigma they face in enduring and exiting exploitative conditions, accessing services and integrating back into the community.
Originality/Value: This study offers original analysis of how stigma manifested for the survivors of human trafficking. Building on this dynamic genealogy of scholarship on stigma, this study offers a theory to conceptualize how survivors of human trafficking experience stigma: a multiplicity of stigma. A multiplicity of stigma extends existing research on stigma and human trafficking as occurring across three levels from micro, meso to macro contexts and creating a system of oppression. Stigma cannot be reduced to a singular form; therefore, this study argues that survivors cannot be understood as experiencing a singular form of stigma.
https://www.emerald.com/insight/content/doi/10.1108/IJHRH-07-2019-0056/full/html

Fukushima, A.I., Gonzalez-Pons, K., Gezinski, L. and Clark, L. (2020), “Multiplicity of stigma: cultural barriers in anti-trafficking response”, International Journal of Human Rights in Healthcare, Vol. 13 No. 2, pp. 125-142. https://doi.org/10.1108/IJHRH-07-2019-0056

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