ANSWER
Approximately 40 million people worldwide, including many in the United States, are estimated to be victims of human trafficking — a form of modern-day slavery in which traffickers use force, fraud, or coercion to control both adults and children.1 Human trafficking can take many forms, such as forced and bonded labor, domestic servitude, and commercial sexual exploitation.
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Awareness about human trafficking and the factors that make individuals and communities vulnerable has increased, but prevention efforts designed to proactively address known risk factors are lacking. Instead, efforts typically address exploitation after harm occurs.2 These downstream interventions contrast with primary prevention, which aims to prevent trafficking before it occurs by addressing underlying risks. Thus, policies are needed to promote comprehensive primary prevention efforts that address known risk factors for victimization using multi-tiered strategies.

Highlight
Coordinated, community-based approaches that are customized to address a range of vulnerabilities across diverse groups may prevent human trafficking before it begins.
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To succeed, prevention strategies require a data-driven approach that guides collective action across local agencies and institutions (e.g., law enforcement, housing, schools) (e.g., law enforcement, housing, schools).
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Raising awareness alone is not sufficient to prevent human trafficking. It must be used as part of a comprehensive prevention strategy rather than in isolation.

Trafficking vulnerabilities occur at the individual, family/neighborhood, and societal levels (see table below).3-5 Lack of access to protection and justice make people vulnerable to trafficking.6 Traffickers tend to exploit the needs of potential victims, whether they are basic physical needs for housing and food or emotional needs, such as love and belongingness. The potential for exploitation is influenced by events across the life course, route of victimization,4 and gender.7 Prevention strategies can be tailored to the specific vulnerabilities and needs of individuals and communities.

Individual level3,4,8-10: Family/neighborhood level3-5: Societal level1,3-5:
History of adverse childhood experiences or trauma
History of sexual and physical abuse or neglect
Migrant status
Indigenous status
Runaway and homelessness
Involvement in child welfare
LGBTQ status
Gang involvement
Limited education and intellectual disability
Substance use disorder
Teen pregnancy
Need for basics including food and shelter
Low self-esteem
Lack of worker rights and enforcement of worker rights
Poverty and unemployment
Limited education
Family dysfunction
High crime
Lack of resources, such as affordable housing
Social norms tolerating exploitation
Adult commercial sex
Natural disasters
Ideologies of exclusion
Demand for cheap goods
Demand for purchased sex
Lack of awareness
Sexualization and devaluation of children and youth
Gender-based discrimination and violence
Labor exploitation
Political/social upheaval
Law enforcement/political corruption
Lack of resources to combat trafficking
Recommendations
Encourage human trafficking task forces to place greater emphasis on primary prevention.
Facilitate primary prevention efforts by supporting community stakeholders’ collaborative use of data and corresponding approaches for addressing known risk factors.
Promote rigorous evaluation of existing prevention programs through research grants and evaluation requirements for programmatic grant funding.
Coordinated Primary Prevention Efforts by Local Task Forces should use data-driven approaches that first assess vulnerabilities for human trafficking at all levels and then implement research-informed prevention strategies, such as those listed in evidence-based practice registries.11 These strategies should leverage the six characteristics of primary prevention: (1) strengthening individual knowledge and skills; (2) promoting community education; (3) educating providers; (4) fostering coalitions and networks; (5) changing organizational practices; and (6) influencing policy.12,13 To date, much attention has been given to awareness raising, which is applicable for many community-stakeholders. However, it should not be used in isolation, as raising awareness without further action has not proven effective.14

Free the Slaves is a particularly successful task force model for trafficking prevention that seeks to strengthen communities and help them overcome key vulnerabilities. This model uses a four-pronged, data-driven approach that brings stakeholders together to conduct contextual research, increase organizational capacity, foster community resistance and resilience, and ultimately reduce slavery/trafficking.15

Successful primary prevention strategies should employ multiple, concurrent approaches in a variety of levels and settings, as seen in the examples provided below. Although some of these examples are conceptually focused and do not meet the definition of evidence-based programs, several have been shown to be promising practices warranting further study. Overall, the limited evaluation of existing strategies and programs points to the critical need for funding to rigorously evaluate these efforts to ensure the most effective prevention outcomes.

1) Violence and crime prevention. Strategies to reduce violence and crime include:

Providing residents with training in restorative justice, peacemaking, and community organizing that is focused on developing areas of mutual self-interest, as this can facilitate residents’ ability to intervene in neighborhood problems.16
Creating safe places for neighbors to build connections with one another, such as voluntary associations and parks, which can support collective efficacy and willingness to help one another address crime and disorder.17,18 Strengthening social supports among adolescents exposed to violence can reduce the likelihood of violence.19
Using evidence-based strategies in violence prevention efforts, such as those included in The Centers for Disease Control and Prevention’s Technical Packages for Violence Prevention.20
Implementing a comprehensive gang strategy involving five core strategies to prevent and reduce gang violence: community mobilization, opportunities prevention, social intervention, close monitoring of gang youth, and organizational change and development.21 OJJDP offers a Model Programs Guide that contains information about similar evidence-based juvenile justice and youth prevention, intervention, and reentry programs.22
Evaluating crime-reduction strategies using police interventions. For a comprehensive list of studies, please consult the Center for Evidence-Based Crime Policy’s Policing Matrix.23
2) Housing and urban development. Addressing neighborhood-level risk factors, such as homelessness, may mitigate vulnerabilities for human trafficking. These strategies include:

Supporting implementation of universal, systematic strategies, such as guaranteeing affordable housing through policies that increase the low-income housing supply, protect tenants in rental housing, and expand permanent supportive housing; guaranteeing sufficient income through policies that establish a living wage and a livable income for those who are disabled; and guaranteeing access to comprehensive, affordable healthcare through the establishment of a universal healthcare plan. Opening Doors: Federal Strategic Plan to Prevent and End Homelessness is the first comprehensive plan to address homelessness and encompasses these strategies.24,25
Prioritizing federal investments in affordable housing and other efforts to improve economic conditions for low-income populations, as the lack of affordable housing combined with insufficient and stagnant incomes places many Americans in at-risk housing situations.26
Organizing interagency community collaborations that work to couple supportive services with permanent housing for individuals with serious mental illness.27
Connecting families to affordable housing or subsidies, budget and credit counseling, and mediation in housing courts.27
Early intervention that strengthens individuals’ self-efficacy to overcome obstacles, emphasizes their goals and preferences, provides the minimum assistance needed for the shortest time possible, and maximizes community resources.28
3) Businesses. Trafficking victims may be coerced into both labor or sex trades with exploitive labor practices, which can be reduced by:

Conducting investigations of forced labor and assisting with prosecutions via workers’ rights coalitions (e.g., the Coalition of Immokalee Workers, which was able to prevent labor trafficking on farms by educating workers about potential exploitation and provided subsequent legal support 29). (e.g., the Coalition of Immokalee Workers, which was able to prevent labor trafficking on farms by educating workers about potential exploitation and provided subsequent legal support 29).
Encouraging businesses and consumers to consult http://slaveryfootprint.org/30 and responsiblesourcingtool.org31.The Slavery Footprint group works to build awareness among individuals and businesses and create action against exploitation. This includes increasing their understanding of how they connect to modern-day slavery, encouraging companies to monitor and address slavery in their supply chains, and reward those companies with their purchase power. The Responsible Sourcing Tool introduces users to the issues and risks associated with human trafficking in supply chains and encourages users to explore the issues in more depth. For example, it contains a model compliance plan with downloadable templates to help companies combat trafficking in their global supply chains.
4) Healthcare. As trafficking victims interact with the healthcare system at all stages of their victimization, the healthcare workforce is an ideal space to identify and intervene with those at risk.32,33 For example, up to 88% of trafficking victims report seeking health care at some point during their exploitation, including emergency care, primary care, psychiatry, dentistry, obstetrics and gynecology, and plastic surgery.34 Strategies that can be implemented in the healthcare field include:

Preparing health professionals to identify patients at risk for trafficking and refer those patients for services.33 Moreover, some states have mandated training on trafficking as part of the credentialing process.35 However, no trafficking trainings have measured patient outcomes or prevention of trafficking as an outcome.36
Screening for youth substance use during pediatric well-child check-ups via a computerized questionnaire that assesses initiation and propensity to initiate substance use, since substance use disorder is a prominent trafficking risk factor.37
Identifying vulnerabilities during visits to Emergency Departments and substance use treatment facilities and making referrals (e.g., housing; social support networks).38
5) Schools and child welfare. Trafficking vulnerabilities involving educational challenges and substance use can be targeted within the school setting. Further, attending to the economic and social needs of children targets fundamental vulnerabilities such as childhood abuse, family disruption, and child welfare involvement.39 Examples of such strategies include:

Preventing child maltreatment using evidence-based strategies such as those listed in The Centers for Disease Control and Prevention’s Essentials for Childhood: Steps to Create Safe, Stable, Nurturing Relationships and Environments40, which is based on the best evidence available.
Youth programs that are designed to teach youth to recognize and effectively respond to signs of potential exploitation. These can be implemented in schools, organizations (e.g., detention centers, youth homes), child welfare systems, and juvenile justice systems.41-43 Although there is a great need to evaluate these educational approaches for youth, the Prevention Organized to Educate Children on Trafficking (PROTECT) program is one of the few that has demonstrated effectiveness and is one of the largest and most comprehensive.41
Integrated Student Supports, which is a promising approach for improving education and lifetime earnings and involves promoting student success by removing barriers to achievement.44
School-based behavioral interventions that improve socio-emotional wellbeing and teach coping skills.45,46,47 These interventions can reduce the likelihood of substance abuse, reduce delinquent behavior, and improve educational achievement, all of which may mitigate risks of victimization. Providing resources for teachers to implement voluntarily could support such interventions.
Surveillance of youth in unprotected areas such as school crossings or bus stops (e.g., cameras), which could monitor and prevent recruitment efforts, especially among vulnerable youth such as those with intellectual disabilities.48
Safety planning with youth at risk of running away, which includes an individualized, practical plan of who to call when in danger and where to go to find safety. This approach would ensure that youth have the knowledge necessary to find safety should they find themselves in a dangerous or unfamiliar setting.10
QUESTION
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