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FY 2018 HHS Excerpts from the Attorney General's Annual Report on U.S. Government Activities to Combat Trafficking

HHS contributes to the Department of Justice Attorney General’s Annual Reports to Congress and Assessment of U.S. Government Activities to Combat Trafficking in Persons. This report provides recommendations to federal agencies and updates from each agency on anti-trafficking efforts.

HHS excerpts from the FY 2018 Report are available below.

Table of Contents

Benefits and Other Services under 22 U.S.C. § 7105(b) and (f)

Training of U.S. Government Personnel and State and Local Officials to Identify and Provide Protection for Victims

Activities or Actions to Enforce 22 U.S.C. 7104(g) (procurement termination and remedy clauses)

HHS Activities to Meet the Needs of Minor Victims of Domestic Trafficking

Other Training and Outreach

International Training and Outreach


Benefits and Other Services under 22 U.S.C. § 7105(b) and (f)

Federal agencies must extend specified benefits to human trafficking victims and are authorized to provide grants to facilitate such assistance.  See 22 U.S.C. § 7105(b).  Federal law requires the Secretary of Health and Human Services and the Attorney General, in consultation with the Secretary of Labor, to establish a program to assist U.S. citizens and aliens lawfully admitted for permanent residence who are victims of human trafficking.  See 22 U.S.C. § 7105(f).  This section describes the activities of federal agencies to meet these mandates to assist all victims of human trafficking.

Department of Health and Human Services

Benefits and Services for Foreign National Victims of Human Trafficking

The Department of Health and Human Services (HHS) issues Certification Letters to foreign national adults and Eligibility Letters to foreign minor human trafficking victims who meet specific eligibility rules.  These letters allow recipients to apply for benefits and services to the same extent as refugees, including financial assistance, medical care, food assistance, employment help, and housing assistance.  See 22 U.S.C. § 7105(b)(1)(E) and (G).  In FY 2018, HHS issued 412 Certification Letters to adults and 466 Eligibility Letters to children.  In the previous fiscal year, HHS issued 448 letters to adults and 507 letters to children.

Fiscal Year Number of Eligibility Letters Issued to Children Number of Certification Letters Issued to Adults Total Letters Issued
2014 217 528 745
2015 239 621 860
2016 332 443 775
2017 507 448 955
2018 466 412 878

The Office on Trafficking in Persons (OTIP) within HHS’ Administration for Children and Families (ACF) runs the Trafficking Victim Assistance Program (TVAP) to fund comprehensive case management and support services for foreign national adults and child human trafficking victims and certain family members.  In FY 2018, three grant recipients—the U.S. Committee for Refugees and Immigrants, the U.S. Conference of Catholic Bishops, and Tapestri, Inc.—provided full coverage for case management services in specific regions across the United States and U.S. territories.  In FY 2018, 1,612 individual clients received case management services through the three TVAP grants. 

If a foreign national minor, currently in the United States, is identified as a victim of trafficking, and receives an Eligibility Letter from HHS, the child is eligible to apply for HHS’ Unaccompanied Refugee Minors (URM) program, an ORR-funded foster care program that operates in 15 states.  In FY 2018, the URM program served 183 child victims of trafficking, including 92 new enrollments during the fiscal year.

Benefits and Services for U.S. Citizen and Lawful Permanent Resident Victims of Human Trafficking

OTIP’s Domestic Victims of Human Program (DVHT) funds comprehensive case management, direct services, and service referrals for U.S. citizens and Lawful Permanent Residents (LPRs) who are human trafficking victims.  In FY 2018, OTIP continued to fund 12 DVHT program grantees for a 36-month project period to address the needs of domestic human trafficking victims.  In FY 2018, DVHT grantees served 636 domestic victims of human trafficking.  Funded projects also expanded partnerships and collaborative efforts with law enforcement, local businesses, housing authorities, child welfare agencies, and Native American groups.

National Human Trafficking Hotline

The HHS-funded National Human Trafficking Hotline (NHTH) is a 24/7, confidential hotline that provides information and referrals in more than 200 languages for potential victims, survivors, and witnesses of human trafficking.  In FY 2018, the NHTH received 116,940 signals (phone calls, texts, chat conversations, emails, and online reports), 47,711 (41 percent) of which were substantive in nature.  During the same period, the NHTH received reports of 10,658 unique cases of potential human trafficking.

Types of Cases Received by NHTH Number of Cases Percent of Cases (Rounded)
Potential Labor Trafficking 1,296 12%
Potential Sex Trafficking 7,637 72%
Potential Sex and Labor Trafficking 632 6%
Other or Not Specified 1,093 10%
Total Number of Potential Trafficking Cases 10,658 100%

The NHTH received 7,136 signals—or 15 percent of the total substantive signal volume in FY 2018—directly from potential victims and survivors of human trafficking.  During FY 2018, the NHTH received calls, texts, chats, emails, and online reports from all 50 states, the District of Columbia, U.S. territories, and more than 80 foreign countries.

In 3,828 cases, the NHTH provided referrals for social services for human trafficking victims.  The most common referral requests were for emergency and transitional shelter, comprehensive case management, legal services, mental health services, and transportation assistance.  The NHTH also recorded 35,463 visits to the National Human Trafficking Referral Directory (www.humantraffickinghotline.org/‌training‌-resources/referr...), which provides information on anti-trafficking organizations and programs offering services to human trafficking victims.

The two most common primary reasons for contacting the NHTH in FY 2018 were high risk for trafficking/issues relating to trafficking and tips regarding possible human trafficking.

Primary Reason for Contacting the Hotline Number of Cases Percent of Cases (Rounded)
High Risk for Trafficking/Issues Related to Trafficking 9,682 31%
Tips Regarding Possible Human Trafficking 7,796 25%
Unrelated to Trafficking 6,101 19%
Requests for General Human Trafficking Information 4,122 13%
Request a Referral for Anti-Trafficking Services 2,628 8%
Crisis Involving Potential Victim of Human Trafficking 859 3%
Requests for Training and Technical Assistance 283 .9%
Total Number of Unique Cases 31,471 100%

In FY 2018, the NHTH reported 3,434 potential human trafficking cases to law enforcement. By the end of the fiscal year, the NHTH had received information regarding the law enforcement outcomes of 1,491 such reported cases of potential human trafficking.  Investigations were opened in 1,009 cases; in at least 76 cases, potential victims of human trafficking were located, removed from the situation, or provided with services; and in at least 11 cases, potential traffickers were located, arrested, charged with a crime, prosecuted, or convicted.

Training of U.S. Government Personnel and State and Local Officials to Identify and Provide Protection for Victims

Section 7105(c)(4) of Title 22 requires DOS, DHS, HHS, DOL, the Equal Employment Opportunity Commission (EEOC), and DOJ to train “[a]ppropriate personnel . . . in identifying victims of severe forms of trafficking and providing for the protection of such victims, including juvenile victims.”  The statute further requires the Attorney General and the Secretary of Health and Human Services, in consultation with the Secretary of Labor, to “provide training to State and local officials to improve the identification and protection of such victims.”  Training conducted by the federal agencies named above and other agencies is described below.

Department of Health and Human Services

Intra-agency Collaboration

In FY 2018, the National Human Trafficking Training and Technical Assistance Center (NHTTAC) continued to deliver training and technical assistance to inform and enhance the health care response to human trafficking.  HHS conducted 49 trainings for federal grantees and key stakeholders through regional partnerships that reached 4,094 individuals. These trainings were provided by NHTTAC to various communities and agencies as requested to increase trauma informed response to trafficking and access to trauma- informed services, educate healthcare and social services, school- based, and Native-serving professionals on how to identify and respond appropriately to individuals who have experienced trafficking or who are at risk of trafficking, and reduce vulnerabilities of those most at risk of experiencing trafficking.

A subset of that total includes 15 in-person trainings with the enhanced SOAR to Health and Wellness training that reached 778 individuals. SOAR is a standardized, accredited training that educates professionals across health care, behavioral health, public health, and social services disciplines on how to identify, treat, and respond appropriately to individuals who are at-risk for or who have experienced human trafficking and builds capacity within communities to identify and response to the complex needs of individuals who have experienced trafficking and understand the root causes that make individuals, families, and communities vulnerable to trafficking. SOAR training is available in-person and online. The total number of courses completed via SOAR Online within the free, publicly accessible Learning Management System (LMS) in FY 2018 was 4,254.

ACF – Children's Bureau

In FY 2018, the Children’s Bureau continued to fund the Child Welfare Capacity Building Collaborative, a partnership among the Center for States, Center for Tribes, and Center for Courts.  This partnership consolidates services previously organized by topical area and geographic region in an attempt to increase coordination, leverage resources, and provide more strategic service provision.  The Center for States provides ongoing support to constituency (or peer-to-peer networking) groups that are responsible for implementing the Preventing Sex Trafficking and Strengthening Families Act’s anti-trafficking provisions and currently has over 300 members.  The Center and its partners have also developed resources to help state and territorial child welfare agencies meet the law’s requirements.

In FY 2018, the Children’s Bureau updated the Human Trafficking section on the Child Welfare Information Gateway (www.childwelfare.gov/topics/‌systemwide/trafficking) that highlights publications and resources and connects concerned individuals to organizations addressing the issue, including two publications for child welfare staff and agencies.  The Human Trafficking and Child Welfare: A Guide for Child Welfare Agencies explores how child welfare agencies can support child trafficking victims as well as children who are at greater risk for future victimization.

HHS Regional Office Activities

The HHS Office of Regional Operations (ORO) is comprised of a headquarters office and 10 regional offices that guide the regional implementation of the Administration of Children and Families’ programs and high priority cross cutting initiatives to states, territories, tribes and grantees in their geographical areas.

Region 2 supported the development of Multidisciplinary Team/Task Forces in Puerto Rico and the U.S. Virgin Islands.  In addition, Region 2 worked with the DOJ Office for Victims of Crime (OVC) Training and Technical Assistance Center to provide consultation on how to address human trafficking in the territories.  A comprehensive need assessment was completed during the initial phase of this effort, and which confirmed support for in-person meetings for the development of human trafficking task forces in Puerto Rico and the U.S. Virgin Islands. Region 2 convened a meeting with OTIP and OVC to discuss building long and short-term capacity building strategies, including Human Trafficking 101, developing systemic supports to sustain a taskforce, SOAR training, and trainings through the Human Trafficking Capacity Building Center in 2020.  Discussions also included a request from USVI Department of Human Services to provide human trafficking training and support an awareness campaign for the USVI Children and Youth Task Force.  Region 2 facilitated connections between OTIP and USVI new leadership at USVI DHS and DOJ for HT follow-up.

Region 4 led the establishment of Human Trafficking Leaders Group convenings across multiple states and regions.  It also facilitated the establishment of similar groups in Region 6 and Region 8 and collaborated with OTIP.  Region 4 additionally supported the inaugural Conference to Battle Labor Trafficking in October 2018 that was hosted by Catholic Charities of Louisville, Kentucky, and included officials from 23 states.

Region 6 co-hosted a human trafficking training summit in partnership with the offices of the HHS Regional Director, Regional Health Administrator, Family and Youth Services Bureau, and Texas Health Resources Dallas at Presbyterian Hospital.  The summit, "Response and Resources in our Community Listening Session," highlighted the issue of human trafficking in North Texas with presentations from health professionals, trafficking survivors, law enforcement personnel, and service providers.  Sessions included a panel presentation, which addressed the intersection of youth homelessness and human trafficking; and the Stop, Observe, Act, Respond (SOAR) training.  Nurses received Continuing Education Units.  On-site and virtual attendance totaled 200 professionals from federal, state, and local agencies, non-profit organizations, and health care systems.

Region 6 also supported the launch of its first human trafficking workgroup hosted by the Texas Department of Family and Protective Services’ (DFPS) Human Trafficking and Child Exploitation Team.  Participants included ACF staff, the Texas Governor’s office, law enforcement officials, and representatives from national and state agencies that focus on all forms of human trafficking.

HHS – Health Resources and Services Administration

Beginning in FY 2017, HRSA’s Office of Women’s Health (HRSA OWH), in collaboration with the HRSA Bureau of Primary Health Care (BPHC) and the Administration for Children and Families (ACF), entered into a Memorandum of Understanding to support an interagency partnership titled “Project Catalyst.” Project Catalyst trains state-level leadership teams, comprised of Primary Care Associations, State Departments of Health, and State Domestic Violence Coalitions to engage in collaborative training and operationalization of screening, counseling and universal education for intimate partner violence (IPV) and human trafficking in HRSA-supported health centers. In addition to training, State Leadership Teams designed approaches to promote policies and practices that support ongoing integration of the IPV and human trafficking response into health care delivery statewide.  In FY 2018, the first phase of Project Catalyst was implemented in four states—Arkansas, Connecticut, Indiana, and Idaho—and additional funding was secured to implement a second phase of Project Catalyst to support expansion to Colorado, North Carolina, and Guam.

Additionally, using resources implemented in Project Catalyst, HRSA OWH and BPHC collaborated to write a Special Edition Digest on Human Trafficking, Intimate Partner Violence and Trauma Informed Care.  The Digest, which is a compilation of resources, best practices, and promising approaches that support health centers in improving services relating to intimate partner violence and human trafficking, reached an audience of 30,906 recipients.

In FY 2018, HRSA OWH served on the HHS Human Trafficking Symposium Planning Committee, led by ACF OTIP and HHS Assistant Secretary for Planning and Evaluation.  The symposium took place on November 28-29, 2018, with planning conducted in FY 2018.  The goals of the symposium were to recognize the ten-year anniversary of the 2008 National Symposium on the Health Needs of Human Trafficking Victims, highlight the progress made in training, coordination, and integration of survivor-informed and trauma-informed practices, and define goals for the role of healthcare to address trafficking.

Activities or Actions to Enforce 22 U.S.C. 7104(g) (procurement termination and remedy clauses)

Section 7104(g) of Title 22 provides that the President must ensure that federal grants, contracts, or cooperative agreements that provide funds to private entities include a condition that authorizes the federal government to terminate the grant, contract, or cooperative agreement, or take other remedial action if the grantee, subgrantee, contractor, or subcontractor engages in or uses labor recruiters, brokers, or other agents who engage in (1) human trafficking; (2) the procurement of a commercial sex act while the grant, contract, or cooperative agreement is in effect; (3) the use of forced labor in performing the grant, contact, or cooperative agreement; or (4) acts that directly support or advance human trafficking.

Department of Health and Human Services

HHS is working to fully conform to 22 U.S.C. § 7104(g), as implemented in FAR 52.222-50 (48 CFR § 22.17).  Individual HHS program offices have implemented this regulation on an ad-hoc basis, but HHS Acquisition Regulations do not include a companion regulation to FAR 52.222-50. However, HHS program offices are in the process of executing contract modifications to insert the contract language required to comply with FAR 52.222-50. In addition, HHS is currently developing guidance to advise HHS grantees, subgrantees, contractors, subcontractors, and their agents and employees of their obligations under FAR 52.222-50.

HHS Activities to Meet the Needs of Minor Victims of Domestic Trafficking

Department of Health and Human Services

HHS ACF collaborated with the HHS OIG Office of Investigations on a joint pilot initiative to address minors missing from care, including the foster care system in the Midwest.  Minor victims of domestic trafficking were assisted through referrals from the National Human Trafficking Hotline.  HHS also assists minor victims of domestic trafficking through many other systems of care, including the child welfare system, runaway and homeless youth programs, Federally Qualified Health Centers, and other health and human service programs.

Other Training and Outreach

Department of Health and Human Services

ACF – Office on Trafficking in Persons

OTIP built on the success of the Rescue & Restore Victims of Human Trafficking campaign and the Look Beneath the Surface (LBS) campaign through social media, launched in January 2017.  In FY 2018, the LBS campaign obtained 2,857,726 impressions on Twitter and Facebook.  It also increased average user time spent on the newly mobile-responsive HHS trafficking website by over five minutes.

In FY 2018, the OTIP Look Beneath the Surface Regional Anti-Trafficking Program continued the efforts of the previous Rescue and Restore Victims of Trafficking Regional Program to promote local responsibility for anti-trafficking efforts. The LBS Regional Anti-Trafficking Program provided grants to regional organizations to conduct public awareness, outreach, and identification activities for victims of trafficking. In FY 2018, LBS Program grantees identified 180 foreign victims and 351 domestic victims of human trafficking.

Administration for Native Americans

In November 2017, the Administration for Native Americans (ANA) and OTIP jointly published and delivered training on their “Combating Trafficking: Native Youth Toolkit on Human Trafficking.”  The toolkit is available as a PDF document at https://go.usa.gov/xEgAH.

In January 2018, the ANA presented on a panel sharing HHS federal resources to combat trafficking at the Office on Violence Against Women (OVW) Sex Trafficking in Indian Country Conference.  Officials from the DHS Blue Campaign and DOJ participated on the interagency panel with ANA.

HHS – Substance Abuse and Mental Health Services

On May 2-3, 2018, the HHS Substance Abuse and Mental Health Services Administration (SAMHSA) hosted an expert panel meeting, “Human Trafficking and Child Trauma.”  Participating experts represented mental health and substance use providers, youth serving organizations, child welfare, legal professionals, and survivors of human trafficking.  In addition to participating experts, USG personnel attended for training purposes.  This expert panel reviewed the current state of the field regarding child trauma and commercially sexually exploited children, gaps in resources, and current practices/promising practices in prevention, intervention, and provision of services.  The goal of the meeting was to provide SAMHSA with priority areas for advancing practice to improve outcomes for children and youth who have been victims of commercial sexual exploitation and other forms of human trafficking.  The meeting also provided a platform for discussing prevention among vulnerable children and youth.

International Training and Outreach

Agencies engaged in numerous activities in FY 2018 to provide training and outreach to foreign government officials and intergovernmental organization officials.

Department of Health and Human Services

HHS provided 13 briefings for international visitors sponsored by DOS’ International Visitor Leadership Program (IVLP).  Law enforcement officers, prosecutors, judges, nongovernmental leaders, and representatives from governmental ministries from 33 different countries received briefings from HHS’ anti-trafficking program staff on efforts to combat human trafficking and assist victims in the United States.

Last Reviewed: January 28, 2020

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