Lisbeth takes out her cellphone and flashes a picture of her foster daughter. Two years ago, the teenager was living on the streets near Miami. Her mother, who was addicted to drugs, would disappear for long stretches at a time, and her father was in jail. The 14-year-old girl would steal noodles and cold cuts from local bodegas to feed herself and her two half-siblings, aged 4 and 5. She wasn’t in school.
Eventually, she was found by staff at the Florida Department of Children and Families, who determined that she was being sold for sex. Her legs were pocked with cigarette burns. “She doesn’t talk about the past,” Lisbeth said.
After child welfare found her, she lived briefly in a group shelter before going to live with Lisbeth and her husband, Rolando (the couple’s last names are being omitted to protect the family’s privacy). Lisbeth and Rolando are courageous people. It’s hard to be a foster parent, harder still to parent a teenager and harder still to parent someone who has suffered the extreme trauma of being trafficked. But the family is part of a small group in Miami involved in Chance, for Citrus Helping Adolescents Negatively Impacted by Commercial Exploitation, one of the first child welfare programs in the country designed specifically for trafficked foster youth.
Miami is one of 13 cities considered by the F.B.I. to be a hub for child sex trafficking. While there are no reliable estimates of how many children have been trafficked in the United States — the most conservative estimates hover around 3,000 — it’s the most vulnerable children who are most often targeted. African-American, Latino, L.G.B.T.Q. and migrant youth are disproportionately victimized, as are children who are homeless or have spent time in foster care. These children are more likely to have histories of trauma, which makes them more susceptible to manipulation by traffickers.
“Over 80 percent of them have early childhood histories of sexual abuse,” said Dr. Kimberly McGrath, who oversees the Chance program as clinical coordinator for foster care services at Citrus Health Network, a nonprofit community mental health center in South Florida.
In 2013, Dr. McGrath was asked by the Florida Department of Children and Families to design a way to help sexually exploited foster youth. Between 50 percent to 90 percent of trafficked children have spent time in foster care.
Despite that staggering statistic, when Dr. McGrath went to look for what worked for these children, she found little. “In 2013, there was an incredible sparsity of research,” she said. “We knew programs were in existence, but there was no research on those programs, no independent evaluations, no outcome measures.”
In most states, trafficked youth are kept in residential group shelters, considered a last resort for children who have nowhere else to go. “At the time, the group home model was the model,” Dr. McGrath said. “It’s typically a staffed group home, so there’s shift staff that work in the home and then there’s five to maybe 12 youth in the home. And then clinical services are either brought to the home or the youth go out to their clinical services.”
But there are problems with this. “You would have some kids who would finally get stable and then you’d have a new child, and if that child had leadership skills and if they were using maladaptive behaviors, she or he would bring the entire group with them,” Dr. McGrath said.
In addition, while foster youth in group homes were generally receiving the best available treatment for abuse and other mental health conditions, no services addressed the distinct psychological dynamics of children who have been trafficked. Many, for example, believe they’re in a romantic relationship with their trafficker.
“That trauma treatment never took it to the next step where they were addressing the trauma of being sexually exploited,” Dr. McGrath said. “Are they bonded to their trafficker? Why were they? Are they being exploited? How did they become exploited? What did that process of grooming look like for them? Are they able to identify that they were being trafficked? And then if so, let’s start breaking that bond with that trafficker. That whole psycho-education piece was missing.”
Dr. McGrath’s team drew on existing research into childhood trauma and decades of experience working with sexually exploited children to create an intensive curriculum to educate foster parents and clinicians about child sex trafficking.
It showed, for example, how common it is for minor trafficking survivors to run away and that children often relapse repeatedly before finally breaking free of their trafficker. That training is now the blueprint for how to treat trafficked children.
Chance places trafficked children in what it calls specialized therapeutic foster homes, with parents trained to care for children with severe mental, emotional or behavioral health needs. “We had a specialized therapeutic foster care program already operational — just not specific to sexually exploited youth. So we modified our program,” Dr. McGrath said. One of those modifications was a strict one-child-per-home policy, so that each child gets the one-on-one attention needed from foster parents.
But the real test would be finding homes. There is a nationwide shortage of foster homes. That’s true even for children who have no serious behavioral or mental health issues, which tend to scare off would-be foster parents. Dr. McGrath needed to find foster parents willing to take in a child who had suffered the kind of complex trauma that comes from being sexually exploited — and from being under the control of a potentially dangerous trafficker.
“It did scare us,” Rolando said. “We were concerned that at 3 a.m. people would be banging on the door, beating the door down, ‘I want my girl out.’”
Chance’s training gave them valuable perspective. “These are traumatized youths and they’re no different than your average teen, except for their histories of trauma,” Dr. McGrath said. Occasionally, she said, a child will steal from the house or leave the door unlocked at night, and there have been a few cases of a child bringing a john home. But truly dangerous situations have been rare.
“We really haven’t had those very high-risk situations with our kids,” Dr. McGrath said. “What we were finding, unfortunately, is that our kids are dispensable to these traffickers. In general, if our youth are in homes and the trafficker knows that these children are being monitored and supported and they have people watching and helping them, they’re going to stay away.”
Chance foster homes are required to have alarm systems installed. “The alarm systems have really become more of a notification system for when our youth want to flee,” McGrath said. “So that foster parents can try to talk them down and intervene.”
Initially, Dr. McGrath recruited only families who had fostered before, but she has since rolled back that requirement, finding their training was effectively preparing even first-time foster parents, like Rolando and Lisbeth had been. (The couple’s current foster daughter is their second Chance child. Before her, they cared for another survivor, age 13, who is now back with her family.)
Every Chance family has a clinical team: an individual therapist, a family therapist, a life coach and a targeted case manager who provide counseling and crisis intervention, attend court dates and help coordinate services. To help build trust, therapists meet children wherever they’re most comfortable, even if that’s at the nearest McDonald’s.
Last year, Lisbeth and Rolando’s foster daughter broke safety protocol by revealing to her biological mother, who was in and out of her life, where the couple lived. The mother went to their house. The Chance team mobilized quickly to alert authorities. “The social worker called everybody,” Rolando said. “And then we’re getting calls from everybody. Except God, everybody called us.”
That immediate response was crucial to making the family feel safe again. “The child was very apologetic for what had happened, and they asked us what we wanted to do. ‘Do you want us to remove her temporarily or permanently?’ And just knowing that a system was put into action and it worked, we decided that we were just going to let her stay.”
It was a good decision. Lisbeth showed me a picture on her phone of a beaming young woman — now a camp counselor and honor student. “She got all As and a B on her last report card,” Lisbeth said proudly. “She wants to be a social worker.”
Researchers from the University of South Florida conduct regular evaluations of the program and have found statistically significant improvements in family functioning, behavior at school, respect for authority, leadership skills, ability to process trauma, propensity to run away and deliberate misbehavior. In the latest sample of 119 child-welfare-involved youth, 26 were readmitted to Chance within a year of discharge (some of them had run away before completing the program).
Those results cost the county far less than the average residential treatment model. Unlike most group homes, Chance bills Medicaid for about half of its costs — a bureaucratic and time-consuming process that many group homes, especially those run by nonprofits, can’t manage. “It is very, very easy to say that this model is less expensive than a psychiatric inpatient treatment program or any kind of residential model,” said Dr. Mary Armstrong, a University of South Florida researcher who has studied the program. “But it’s important to also put on the table that it’s not a cheap program.”
Chance also runs a 14-bed locked residential facility for youth with mental health issues that prevent them from functioning in the community, as well as a community response team that provides services to an additional 40 youth (there are specific clinical criteria for admission to Chance’s residential programs, but children in regular foster care or who are housed outside of the child welfare system can receive services too). More than 200 children have been through the program in the past five years.
Chance is an alternative for children who have been sexually exploited, and the first real study of what works for these youth. And it does something else: reduce the stigma associated with children who have been exploited, Dr. McGrath said. “They really are just traumatized kids.”