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Kennedy School Review

Topic / Human Rights

Combatting Domestic Minor Sex Trafficking in the Child Welfare System


When a man promised to love and take care of ten-year-old Withelma “T” Ortiz Walker Pettigrew, she thought her luck had finally changed. Born to drug-addicted parents, T spent her life bouncing in and out of foster care. In ten short years, she lived through 14 placements; several unsuccessful returns home; and physical, emotional, and sexual abuse. Foster care, the very institution meant to protect her, instead made her more vulnerable. In care, she learned to accept being controlled and normalized the idea of adults using her for financial gain. When she was offered the love, support, and attachment she craved, she jumped at the opportunity.

Instead, the man who promised to love her began selling her ten-year-old body to be raped. For eight years, all across the western United States, he beat her and sold her on the streets, in massage parlors, and in the back pages of newspapers. She was arrested multiple times for solicitation and prostitution but always returned to her trafficker. Having escaped trafficking at 17, T is a powerful advocate for youth victims of trafficking, testifying before Congress and appearing in TIME’s “100 Most Influential People.” Many of her friends weren’t so lucky, serving lifetimes in prison or being beaten so badly that their bodies could only be identified by the tattoos that branded them as property of their pimps.[1],[2]

T’s story is too common. While awareness of sex trafficking in the United States is rising, it is still largely viewed as a problem in other countries—not our problem. On the contrary, experts estimate that the United States is the world’s second-largest sex-trafficking market. A staggering 40 percent of these cases involve domestic minor sex trafficking (DMST).

DMST refers to the commercial sexual exploitation of a minor, in their own country, to perform sexual acts in exchange for money or other items of value.[3] For children in the United States, this exploitation takes a variety of forms: sex slavery; pimp-controlled sex; youth-initiated trafficking; child pornography; and survival sex, in which youth exchange sex to meet basic needs, like food or shelter.[4] Calculating precise victimization rates is difficult because buying and selling the bodies of children is a necessarily secretive act, and victims are often too psychologically broken and ashamed to report their abuse.[5],[6] However, it is generally accepted that there are more than 100,000 DMST victims in the United States, with upper estimates ranging between 300,000 and 3 million.[7],[8],[9] Most studies place the average age of entry into trafficking between 12 and 16.[10]

While we don’t know the exact scale of child sex trafficking in the United States, we do have abundant evidence on the risk factors driving this problem. We also know that child welfare involvement complicates and heightens risk factors that drive DMST. Studies show that the majority of child sex-trafficking victims, as high as 86 percent,[11] were part of the child welfare system.[12],[13],[14] The most prominent risk factor is a history of physical, emotional, and sexual abuse. Victims of abuse are 28 times more likely to be arrested for prostitution than their non-abused peers.[15] “Abuse teaches children that they are of low worth and that those who are supposed to care for them will demean and disrespect them,” explains Susan Mapp, professor at Elizabethtown College.[16]

Despite the noble intentions of the child welfare system, its current structure can exacerbate youth vulnerability. Resource gaps force caseworkers to place many children in sub-optimal homes or residential treatment centers, where they are cared for not out of love, but for a paycheck. T explains, “what we began to do as youth in care is normalize that our purpose is of being a financial benefit of others.” As a result, children in care find it difficult to see “the difference in bringing in the finances into the foster home or of bringing money to an exploiter and their stable.”[17]

Further, being forced to move placements repeatedly robs children of connection, forcing them to adjust to new locations, schools, and parental figures.[18] This lack of connection traumatizes children, hindering their ability to form healthy attachment and causing them to seek love and consistency any place they can find it.[19] Would-be traffickers recognize this. They seek out foster children specifically, knowing that simply by providing shelter, food, gifts, and consistency, they can groom them for exploitation.[20]

To date, US legal responses have focused narrowly on rehabilitating survivors, making it easier for victims to come forward, and punishing perpetrators. Beginning with the passage of the Trafficking and Violence Protection Act of 2000 (TVPA), the federal government has sought to protect and support trafficked minors.[21] Subsequently, nearly three-fourths of all states passed Safe Harbor laws, under which minors caught trading sex are treated as victims and provided with extensive wraparound services. As a deterrent, states and the federal government have also ramped up prosecution of third-party traffickers and of those who purchase sex.

It is time for policy makers to emphasize violence prevention—to focus on those who are most at risk of being trafficked, those who have suffered abuse and neglect, and those who are currently in the child welfare system. For these children, the response must be three-pronged. First, it is vital that the child welfare system mitigate the consequences of childhood abuse through greater provision of trauma-informed care. Second, the system must work to prevent future trauma through a focus on permanency, both in placements and service delivery. Finally, we must acknowledge that while children in care are vulnerable, they also possess great agency, and the current system of protection as social control pushes youth toward sexual exploitation.

Trauma-Informed Care

Helping children heal is critical to preventing domestic minor sex trafficking, yet common therapies can actually make trauma worse for children who have suffered abuse.[22] States can help children by requiring both mental health service providers and foster families to use therapy methods that are developmentally appropriate, evidence based, and trauma informed. Trauma-informed care means understanding behavior through the lens of the trauma that caused it, acknowledging that negative behaviors are coping mechanisms, and focusing on building safety so that patients can address the root causes of those behaviors. Modalities like trauma-focused cognitive behavioral therapy and dialectical behavior therapy build on children’s natural resilience by offering strategies for self-regulation and health connections, alleviating a child’s toxic stress responses.[23],[24],[25] While many providers are beginning to incorporate trauma-informed services, this practice is not currently required for children in care. Requiring trauma-informed services, or at least requiring a baseline of training, would go a long way to helping children recover from complex emotional trauma.

To encourage trauma-informed care, states can set up infrastructure for the dissemination of new knowledge about evidence-based services. New York and South Carolina offer clear models. The Evidence-Based Treatment Dissemination Center in New York has trained hundreds of clinicians, completely free of cost, through in-person seminars. The state encouraged training by creating reimbursement systems that pay trauma-informed therapists above the base rate. The Trauma-Focused Cognitive Behavior Therapy Web in South Carolina took an Internet-based approach to reach more providers, especially those in rural areas. Through its ten-hour interactive online training program, the service has helped thousands provide evidence-based care.[26]

Many trauma-informed methodologies require caregiver involvement, acknowledging that a child’s caregiver is essential to their recovery. Methodologies like the trust-based relational intervention (TBRI) adapt trauma-informed principles specifically for foster and adoptive placements to help children heal complex developmental trauma.[27],[28] Adding therapeutic modalities to the required training for foster parents will help them improve child resilience.

By integrating trauma-informed care into the foster care system, we can help develop healthy, emotionally supported children. By focusing on healing the trauma they have suffered early in their lives—through removal from their homes and in the system—we address many of the risk factors that would lead them to DMST. Instead of being preyed upon or turning to the sex trade to meet their basic needs, they will have the tools and support to avoid commercial sexual exploitation.


In addition to mitigating the effects of early trauma, the child welfare system should focus on reducing its own traumatic impact. Instability for youth has been shown to increase runaway behavior, symptoms of emotional trauma, and vulnerability to trafficking.[29] Each time children are moved into a different home, they learn to not feel safe or stable. Particularly when children are not consulted about changes, these moves reinforce that their beliefs and desires are insignificant.[30] When children believe the system doesn’t care, they are more likely to turn to other places for consistency. “Due to the over 14-plus placements I have endured,” explains T, “the most consistent relationship that I ever had while in care was that of my pimp and his family.”[31]

It is imperative, then, that the child welfare system focus on continuity of care. One of the most effective ways to do this is through kinship placements.[32] Children long for a connection to their families. Relatives, due to the connection they already have with the child, are better able to meet a child’s emotional needs, are more likely to keep sibling groups together, and are less likely to give up when a child exhibits behavioral problems.

To this end, Congress passed the Fostering Connections to Success & Adoptions Act in 2008, which requires states to identify and work with family members of children in care. However, the requirements for states are loose, and overworked child welfare agencies cannot prioritize the often difficult work of finding kinship placements.

In some communities, nonprofit organizations have taken up the mantle, running intensive programs to search for homes the child welfare agency may have missed. These programs should be much more widely available. State child welfare agencies could solve this shortage by funding specialized staff at local nonprofits who have a baseline infrastructure for this work and are more likely to gain families’ trust, since they aren’t an official agent of the system.

Continuity of care extends beyond living situations. Turnover among overworked and underpaid caseworkers makes children more vulnerable to DMST as well. Knowing they can’t count on the people entrusted to look out for them to remain through their entire cases or devote the necessary time to them, children may seek adults who offer them consistency: traffickers. To help protect children from exploitation, child welfare agencies can improve service delivery and staff retention by decreasing workload.

The Child Welfare League of America recommends caseloads of 12–15 per caseworker,[33] but across the country caseworkers are often saddled with 30–50 cases. Ideally, agencies would create special units with ten or fewer cases to handle chronic runners or other children who exhibit multiple risk factors for DMST.[34] Knowing that this would raise costs for state agencies, the federal government could offer grants to support this work, as such a change will not only combat DMST but also improve child outcomes overall.

Youth Agency

Finally, preventing DMST will require a paradigm shift in the child welfare system—one that acknowledges the tension between vulnerability and agency. Throughout this text, I refer to youth who engage in sex trades as “victims,” but it is important when confronting the horrors of DMST to not erase the agency of youth who trade sex. While the dominant narrative of sex trafficking shows children being kidnapped or groomed, many youth do not see themselves as victims. In a recent study of DMST-involved youth, fewer than 30 percent understood that they were being exploited.[35] Still, we use the term “victim,” because regardless of what precipitated their involvement in the sex trades and regardless of their feelings about their involvement, sexually exploited youth suffer extraordinary physical and mental trauma, which can damage cognitive ability and lead to self-destructive behavior and an inability to form healthy relationships.[36]

Youth are not always forced into sex trades by a third party. Some, instead, are coerced by socioeconomic and cultural systems that make trading sex their most viable option.[37] For these children, trading sex is a sexual solution to a societal problem, allowing them to provide for needs that aren’t filled at home.[38] It is important to keep youth agency in mind, because thinking only of pimps and sex slavery focuses our anger and energy toward perceived figures instead of the very real structural and cultural factors that fuel sex trafficking.

However, rather than engage with youth in identifying and correcting these structural factors, the foster care system strips them of nearly all autonomy.[39],[40] This comes down to what Rutgers University researchers call “the dominant American belief that victimization and agency are mutually exclusive.” The focus of the child welfare system has always been on protecting children, but in doing so, it has “positioned [them] as passive recipients of services . . . unintentionally minimizing their agency.”[41] If children are not afforded the opportunity to identify their own needs and desires in the system and exercise agency over their own lives and treatment, the system is priming them to give away control.[42]

In order to prevent this, child welfare agencies can include youth in the process of deciding their own needs and determining their care plans. This practice has already been piloted in communities throughout the country, including Massachusetts, where the Foster Care Bill of Rights guarantees children in care of the state the right to “participate in the development and review of the service plan and have input into changes to the plan that affect permanence, safety, stability or well-being.”[43] Children who are 14 years of age or older get to approve and sign off on their official plan.

Not only have these child input processes helped empower children, they’ve reduced runaway behavior and ensured that the choices being made within the system keep the child’s agency in mind. By acknowledging children’s capacity for self-determination, the model shows youth that they don’t need to run away or be involved in sex trades in order to be valued.[44] By incorporating such models, states can shift the paradigm from one of social control to one that respects youth agency.


We are failing our most vulnerable children. Despite the intention to keep them safe, the American child welfare system is inadvertently making children more vulnerable to commercial sexual exploitation. Tens or even hundreds of thousands of kids, some just ten years old, like T, and even younger, are being sold to predators, beaten, and raped in our own backyard. It is crucial that the child welfare system reform to stop exacerbating child vulnerability to these unthinkable atrocities. By addressing the trauma and victimization that make children vulnerable, focusing on permanency, and promoting youth agency, state and federal governments can do just that. We’ve already let too many children be exploited and destroyed by traffickers. Policy makers need to act now to prevent these horrors.


Steven Olender is a second-year master in public policy student focusing on child and family policy. Prior to attending the John F. Kennedy School of Government at Harvard University, he worked for child welfare, domestic violence, and child abuse organizations in Austin, Texas.


Photo by Annie Spratt on Unsplash

[1] “NFCI Symposium: T. Ortiz Walker Pettigrew – Foster Care & Human Trafficking,”, accessed 16 February 2018,

[2] T Ortiz Walker Pettigrew, “2016 Children’s Summit Speaker,” The Nebraska Court Improvement Project, accessed 16 February 2018,

[3] Dawn Bounds, Wrenetha A. Julion, and Kathleen R. Delaney, “Commercial Sexual Exploitation of Children and State Child Welfare Systems,” Policy, Politics, & Nursing Practice 16, no. 1–2 (2015): 1.

[4] Jini L. Roby and Melanie Vincent, “Federal and State Responses to Domestic Minor Sex Trafficking: The Evolution of Policy,” Social Work 62, no. 3 (2017): 202.

[5] Jennifer E. O’Brien, Kevin White, and Cynthia Fraga Rizo, “Domestic Minor Sex Trafficking Among Child Welfare–Involved Youth: An Exploratory Study of Correlates,” Child Maltreatment 22, no. 3 (2017): 266.

[6] Beth Sapiro et al., “Supporting youth involved in domestic minor sex trafficking: Divergent perspectives on youth agency,” Child Abuse & Neglect 58 (2016): 100.

[7] Alexandra Lutnick, Domestic Minor Sex Trafficking: Beyond Victims and Villains (New York: Columbia University Press, 2016), 4.

[8] Roby and Vincent, “Federal and State Responses to Domestic Minor Sex Trafficking,” 202.

[9] Hearing on Preventing and Addressing Sex Trafficking of Youth in Foster Care, before the Subcomm. on Human Resources of the Comm. on Ways and Means, 113th Cong. (2013) (statement of Withelma “T” Oritz Walker Pettigrew, Board Member of the Human Rights Project for Girls).

[10] Hearing on Preventing and Addressing Sex Trafficking of Youth in Foster Care.

[11] O’Brien, White, and Fraga Rizo, “Domestic Minor Sex Trafficking Among Child Welfare–Involved Youth,” 265.

[12] Monica Landers et al., “Baseline Characteristics of Dependent Youth Who Have Been Commercially Sexually Exploited: Findings From a Specialized Treatment Program,” Journal of Child Sexual Abuse; Binghamton 26, no. 6 (2017): 692–3.

[13] Susan C. Mapp, Domestic Minor Sex Trafficking (Oxford: Oxford University Press, 2001), 11.

[14] Lutnick, Domestic Minor Sex Trafficking, 24.

[15] Elliot Gluck and Rricha Mathur, Child Sex Trafficking and the Child Welfare System (Washington, DC: State Policy Advocacy and Reform Center, 2014), 3.

[16] Mapp, Domestic Minor Sex Trafficking, 16.

[17] Hearing on Preventing and Addressing Sex Trafficking of Youth in Foster Care.

[18] Maddy Coy, “‘Moved around like bags of rubbish nobody wants’: how multiple placement moves can make young women vulnerable to sexual exploitation,” Child Abuse Review 18, no. 4 (2009): 260.

[19] Hearing on Preventing and Addressing Sex Trafficking of Youth in Foster Care.

[20] Noël Busch-Armendariz et al., Human Trafficking by the Numbers: The Initial Benchmark of Prevalence and Economic Impact for Texas (Austin, TX: Institute on Domestic Violence and Sexual Assault [IDVSA], The University of Texas at Austin, 2016), 24–5.

[21] Roby and Vincent, “Federal and State Responses to Domestic Minor Sex Trafficking,” 204–5.

[22] Bounds, Julion, and Delaney, “Commercial Sexual Exploitation of Children and State Child Welfare Systems,” 6.

[23] Karen Countryman-Roswurm and Brien L. Bolin, “Domestic Minor Sex Trafficking: Assessing and Reducing Risk,” Child & Adolescent Social Work Journal 31, no. 6 (2014): 528.

[24] Bounds, Julion, and Delaney, “Commercial Sexual Exploitation of Children and State Child Welfare Systems,” 6.

[25] Janice L Cooper et al., “Strengthening Policies to Support Children, Youth, and Families Who Experience Trauma,” (working paper no. 2, National Center for Children in Poverty, Mailman School of Public Health, Columbia University, New York, 2007): 20.

[26] Cooper et al., “Strengthening Policies to Support Children,” 24.

[27] Karyn B. Purvis et al., “Trust-Based Relational Intervention (TBRI): A Systemic Approach to Complex Developmental Trauma,” Child & Youth Services 34, no. 4 (2013): 360–86.

[28] Karyn B. Purvis, David R. Cross, and Jacquelyn S. Pennings, “Trust-Based Relational Intervention: Interactive Principles for Adopted Children With Special Social-Emotional Needs,” The Journal of Humanistic Counseling, Education and Development 48, no. 1 (2009): 3–22.

[29] Ching-Hsuan Lin, “Children who run away from foster care: Who are the children and what are the risk factors?,” Children and Youth Services Review 34, no. 4 (2012): 808.

[30] Coy, “’Moved around like bags of rubbish nobody wants’,” 260.

[31] Hearing on Preventing and Addressing Sex Trafficking of Youth in Foster Care.

[32] Shannan Wilber, Carolyn Reyes, and Jody Marksamer, “The Model Standards Project: Creating Inclusive Systems for LGBT Youth in out-of-Home Care,” Child Welfare 85, no. 2 (2006): 138.

[33] Hearing on Preventing and Addressing Sex Trafficking of Youth in Foster Care.

[34] Bounds, Julion, and Delaney, “Commercial Sexual Exploitation of Children and State Child Welfare Systems,” 6.

[35] Landers et al., “Baseline Characteristics of Dependent Youth Who Have Been Commercially Sexually Exploited.”

[36] Jennifer McMahon-Howard and Birthe Reimers, “An evaluation of a child welfare training program on the commercial sexual exploitation of children (CSEC),” Evaluation and Program Planning 40 (2013): 2.

[37] Lutnick, Domestic Minor Sex Trafficking, 25.

[38] Lutnick, Domestic Minor Sex Trafficking, 26.

[39] Mapp, Domestic Minor Sex Trafficking, 20.

[40] Sapiro et al., “Supporting Youth Involved in Domestic Minor Sex Trafficking,” 101–2.

[41] Sapiro et al., “Supporting Youth Involved in Domestic Minor Sex Trafficking,” 108.

[42] Lutnick, Domestic Minor Sex Trafficking, 118.

[43]  “Foster Child Bill of Rights,” Massachusetts Department of Children and Families, accessed 7 January 2018,

[44] Lutnick, Domestic Minor Sex Trafficking, 118.