The Minnesota Department of Health (MDH) Safe Harbor Program promotes Love146’s Not a Number (NAN) human trafficking for youth. This collaboration reaches youth in a variety of settings through a multidirectional format that integrates issues familiar to young people while increasing their knowledge and skill for navigating situations where trafficking or exploitation is a risk or occurring. Safe Harbor prefers NAN’s curriculum because it is tailored to youth of all genders, is updated to reflect the lived experiences of youth, allows for cultural specificity, includes labor trafficking, and requires program fidelity. The partnership supports Minnesota’s public health, population-level strategies for preventing human trafficking and exploitation (sex and labor). NAN is also a means for responding to youth needs identified by the Minnesota Student Survey and other data to improve health, safety, and identification of protective factors.
The causes and harms of human trafficking include economic and health disparities, systemic oppression, racism, isolation, and historical trauma. In addressing human trafficking (both sex and labor), federal and state governments have implemented laws and practices with a focus on protecting youth through multidisciplinary prevention and intervention strategies spanning public health, public safety, human services, and human rights frameworks. The success of these strategies depends on public health principles promoting positive youth development and strengths-based, trauma-informed, and culturally responsive harm reduction approaches that are constantly evaluated and changed to reflect the ever-evolving experiences of young people.
In addition to these strategies, public health departments, working alongside other government agencies, tribes, nongovernmental organizations, community-based programs, and universities, use different modes of surveillance to improve prevalence data and tailor prevention responses to reflect youth realities. State laws, such as Safe Harbor, which curtail criminalization of sexually exploited youth under age 18 by ending arrests for prostitution, provide another path toward building education, services, and support systems designed to empower young people.
After its Safe Harbor law passed in 2011, Minnesota embarked on a three-year process to develop and implement “No Wrong Door,” a statewide plan for delivering services to youth trafficked by third parties or exploited by exchanging sexual activity for anything of value or the promise of anything of value. Now, a decade later, the statewide Safe Harbor network based upon “No Wrong Door” has nearly 50 grantees providing services to youth through age 24, including nine regional navigators and nine tribal nations, with expanded scope to labor trafficking and exploitation. The Safe Harbor Director is housed in the Minnesota Department of Health (MDH) reflecting the state’s commitment to a population-level approach based on prevention, and partners with the Minnesota Department of Human Services (child welfare, adult protection, shelter, housing, and street outreach) as well as the Minnesota Department of Public Safety Bureau of Criminal Apprehension (law enforcement investigations and training).
Meaningfully engaging youth is a top priority in Safe Harbor, so curriculum-based partnerships are crucial. Safe Harbor selected Not a Number (NAN) developed by Love146, an international human rights organization founded in 2002, because this human trafficking prevention curriculum is designed for youth of all genders, is updated regularly to reflect the experiences of exploited youth, allows for youth participation in shaping the educational experience, includes labor trafficking and exploitation, assures program fidelity, and is adaptable for various cultures. This sets it apart from other human trafficking prevention curriculum options that tend to focus exclusively on sex trafficking of cisgender girls, even though there is growing data showing that cisgender boys as well as LGBTQIA2+ youth experience trafficking and exploitation at significant rates. (Martin et al., 2020; Reid et al., 2019). The curriculum not only raises awareness but also provides skills to help youth recognize recruitment tactics, challenge harmful stereotypes and societal attitudes that support human trafficking, develop tactics to navigate potential exploitation, identify healthy relationships, and access community supports.
Additionally, this curriculum offers an action response to data showing the prevalence of trafficking and exploitation in youth. In turn, the curriculum generates more qualitative and quantitative data for evaluators and researchers to increase understanding of youth experiences. Since 2017, over 1,300 youth in Minnesota have received the NAN curriculum through a multidirectional format that empowers young people by sharing topics relevant to their day-to-day experiences. NAN is utilized in schools and other youth-focused community-based environments as well as in juvenile justice, shelters, and residential treatment facilities. It meets the requirements for comprehensive sexual health education under the National Sex Education Standards.
Love 146 developed NAN to address significant gaps in the field of human trafficking prevention. Specifically, boys were not discussed as potential victims, women were not being discussed as potential perpetrators, and LGBTQIA2+ youth were often left out of the conversation. It was not enough to say, for example, during a presentation, “This can happen to boys, too.”
In response, Love146 collaborated with experts to develop effective and innovative pedagogies to ensure that NAN’s teaching methods and activities respond to participants’ varying developmental levels. The activities, materials, and evaluation tools used in NAN have all been pilot-tested and refined from the original publication. One critique of NAN is that it is not open-source and free, however program fidelity decreases in such circumstances. Love 146’s training for facilitators focuses on being trauma-informed, meeting youth where they are at, and acknowledging, while also limiting, facilitator bias when working with youth. Without adherence to program fidelity, Love146 cannot guarantee that youth are receiving the information as designed by NAN. This includes consistent dosing of modules, pacing, and activities.
NAN builds upon students’ knowledge. This constructivist process encourages facilitators to tailor the curriculum to each youth. Throughout the program, youth collaborate with peers on activities to reach a consensus on ideas with the facilitator instead of following a traditional lecture model, which is a one-way flow of information. Youth are encouraged to contextualize the material from their life experiences, and engage in high-level learning through conversations, emphasizing the importance of social cognitive theory (Bandura, 2001).
The curriculum uses case studies representing a diverse group of individuals and the varying ways in which trafficking, and exploitation (including recruitment), occur within local communities to achieve the outcome of empowering youth with harm-reduction modalities that make sense in their daily lives. These case studies depict urban and rural perspectives and use names, identity markers, and situations that align across a spectrum of race, gender, sexual identity, gender identity, and socioeconomic status. These contexts promote explorations of how social justice concerns in a community intersect with personal experiences while challenging harmful stereotypes and societal attitudes.
This design creates space for all participants to understand how their realities connect with the learning modules. It also helps youth identify potential susceptibility, a tenet of the Health Belief Model which holds that cues to action (including perceived benefits and awareness of barriers) can prompt engagement in health-promoting behaviors (LaMorte, 2009). Overall, NAN seeks to increase youth resilience through empowering youth to discover their individual strengths and build cumulative protective factors through healthy support systems that connect with their lives. This empowerment is reflected in the experiences of youth with the curriculum.
For example, Love146 reports a statistically significant change in pre- and post-curriculum knowledge for youth participants in Version 2 of NAN using a Welch Two Sample t-test (1,108 entries with a mean of x: 2.9, mean of y: 3.3; t=-3.25; df = 9.5; 95% confidence interval -7.035, -1.035; alternative hypothesis true difference in means is not equal to 0). Pre- and post-test knowledge changes in Minnesota NAN delivery were apparent in Southwest Crisis Center (high schoolers) and Canvas Health (middle schoolers) measuring at 15% and 23% respectively.
Love146 designed NAN to allow for population-based modifications that do not compromise fidelity to the model. Through small changes to existing case studies or by drafting new ones, as well as offering materials in Spanish, Love146 works with certified facilitators to tailor scenarios that resonate with the youth they train. For example, Love146 and facilitators working with American Indian youth have collaborated to identify community-specific adaptations that align with the lived experiences and cultural contexts of youth living on tribal lands as well as in urban communities. These adaptations may include smudging or sharing a meal.
Love146 values diverse facilitators who are experts in the communities they serve. As NAN is an interactive facilitation-based curriculum, space is provided for facilitators to manage the conversation in a culturally responsive way that focuses on each group’s individual input, knowledge, experience, and developmental level. Additionally, when there is diversity in cultural identity and representation among facilitators, youth not only see themselves reflected they also see possibility for their futures.
Regarding andragogy, Love146 employs similar methods in its “Facilitator Certification Training” (FCT) and “Training of the Trainers” (TOT). In each training, Love146 encourages professionals to contextualize their experiences with the program. Role-playing allows professionals to posture themselves as the youth with whom they work. Lastly, professionals participate in a teach-back activity to practice their new skills with guidance and correction from their trainer.
In 2017, Love146 trained 28 Safe Harbor grantees through its NAN FCT. Both the facilitators and subsequent youth participants gave positive feedback, with some youth seeking to repeat the program. Next, Love146 brought its TOT program to Minnesota. As of 2020, four trainers have trained 160 facilitators. In 2019, 28 staff from 14 juvenile facilities were trained to facilitate. The COVID-19 pandemic suspended in-person training activities, but by late 2021 Safe Harbor estimates adding five trainers to train more facilitators with plans to offer more training to residential treatment programs. Love146 provides ongoing technical assistance to trainers and facilitators to assure program fidelity.
Public health promotes surveillance efforts to better understand a public health harm and then uses data to craft effective intervention and prevention programs. Towards this goal, MDH submitted a new question for the 2019 Minnesota Student Survey (MSS) about sexual exploitation of youth. Since release and analysis of the survey data, Love146 played a new role in the state response by collaborating to use this data to strategically direct NAN curriculum. MDH, working in partnership with researchers at the University of Minnesota School of Nursing, extrapolated that at least 5,000 youth (ninth and eleventh graders) statewide had experienced some form of sexual exploitation. (Martin et al., 2020). The data showed cisgender male and female youth were affected almost equally, while transgender and gender non-binary youth were overrepresented. Youth of color and youth with experience in juvenile justice and foster care settings were most impacted. Additional research indicated connections with other adverse health impacts such as alcohol and drug use (Martin, Rider, et al., 2020). This information led MDH to promote NAN further and reinforce the importance of sexual health education for building protective factors.
MDH also employs NAN as a complementary resource for the Minnesota Youth Trafficking and Identification (MYTEI) tool developed through funding from the Office for Victims of Crime in the United States Department of Justice. While the MYTEI tool is specifically intended to make appropriate referrals by providing indicators to help professionals recognize possible signs of human trafficking and exploitation, it also helps professionals proactively direct youth to settings where they can access the NAN curriculum. Validation of the tool is underway.
And finally, the NAN curriculum plays a role in MDH’s work with Project Catalyst through Futures Without Violence. Minnesota’s Project Catalyst leadership team includes MDH, Violence Free Minnesota, and the Minnesota Association of Community Health Centers. The project goal is to promote prevention while also improving health and safety outcomes for survivors of human trafficking and intimate partner violence. NAN can help increase youth awareness about relationship violence; in addition, health care providers may be trained as NAN facilitators.
In sum, NAN influences the way Safe Harbor grantee programs and partners in the state interact with youth. Service provision is one way to address the risks and harms youth encounter, but it is not sufficient on its own to equip youth with the skills they need to address the pressures, threats, and other factors challenging their health and safety. NAN helps youth identify and build upon the protective factors they know about – or may not have realized were there – to increase opportunities for prevention as well as intervention, if needed
The public health and education partnership between MDH Safe Harbor and Love146 NAN exemplifies the importance of tackling difficult issues like human trafficking through a curriculum specially designed and refined for today’s youth, no matter their gender identity, that is meaningful to their lived experiences. A multidisciplinary approach increases statewide delivery capacity in many settings – community-based, placement, educational, faith-based, and culturally-specific – and reaches youth in the places where they live, learn, and find support. This partnership also demonstrates the role that health departments can play in human trafficking prevention while increasing understanding of prevalence in previously underrepresented populations and promoting education. These efforts, combined with other public health strategies such as harm reduction, peer education, and comprehensive sexual health education, better prepare youth to recognize the risks and harms related to human trafficking and exploitation.
Bandura, A. (2001). Social cognitive theory: An agentic perspective. Annual Review of Psychology. 52:1-26. https://doi.org/10.1146/annurev.psych.52.1.1. Futures Without Violence (n.d.) Project Catalyst. https://futureswithoutviolence.org/health/project-catalyst/
Gies, S., Bobnis, A., Cohen, M., & Malamud, M. (2019). Safe Harbor laws: changing the legal response to minors involved in commercial sex. National Criminal Justice Reference Service. https://ojp.gov/pdffiles1/ojjdp/grants/253146.pdf
Greenbaum, Jordan. (2020). A public health approach to global sex trafficking. Annual Review of Public Health. 41:481-497. https://doi.org/10.1146/annurev-publhealth-040119-094335.
LaMorte, W. (2009). The Health Belief Model. Boston University, School of Public Health. https://sphweb.bumc.bu.edu/otlt/mph-modules/sb/behavioralchangetheories/behavioralchangetheories2.html
Love146 (n.d.) Not a number. https://love146.org/notanumber
Martin, L., McMorris, B., Johnston-Goodstar, K., & Rider, N. (2020, January 27). Trading sex and sexual exploitation among high school students [Press release]. https://www.nursing.umn.edu/research/research-projects/trading-sex-and-sexual-exploitation-among-high-school-students
Martin, L., Rider, N., Johnston-Goodstar, K., Menanteau, B., Palmer, C., & McMorris, B. (2020). Prevalence of trading sex among high school students in Minnesota: demographics, relevant adverse experiences, and health-related statuses. Journal of Adolescent Health, 68(5);1-3. https://doi.org/10.1016/j.adohealth.2020.08.021
Minnesota Department of Health (MDH) (n.d.). Safe Harbor Minnesota. https://www.health.state.mn.us/communities/safeharbor
Minnesota Department of Human Services (DHS) (n.d.). Safe Harbor/No Wrong Door https://www.mn.gov/dhs/partners-and-providers/programs/program-overviews/child-protection-foster-care-adoption/safe-harbor/
Minnesota Department of Public Safety Bureau of Criminal Apprehension (DPS BCA) (n.d.) Human Trafficking https://www.dps.mn.gov/divisions/bca/bca-divisions/investigations/Pages/human-trafficking-investigations.aspx
Minnesota Department of Public Safety Office of Justice Programs (DPS OJP) (2013). No wrong door: a comprehensive approach to Safe Harbor for Minnesota’s sexually exploited youth https://www.lrl.mn.gov/docs/2013/mandated/131002.pdf
National Advisory Committee (NAC) on the Sex Trafficking of Children and Youth in the United States (2020). Best practices and recommendations for states. https://acf.hhs.gov/otip/resource/national-advisory-committee-report-best-practices-recommendations
Ramsey County Attorney’s Office and Sexual Violence Justice Institute, Minnesota Coalition Against Sexual Assault (MNCASA) (2020). Safe Harbor protocol guidelines. https://mncasa.org/wp-content/uploads/2018/08/MNCASA_SHPG_JUN2020_Update_FINAL1.pdf
Reid, J. A., Baglivio, M. T., Piquero, A. R., Greenwald, M. A., & Epps, N. (2019). No youth left behind to human trafficking: Exploring profiles of risk. American Journal of Orthopsychiatry, 89(6):704-715. https://doi.org/10.1037/ort0000362.
The Future of Sex Education Initiative. (2020). National sex education standards: Core Content and Skills, K-12. https://seicus.org/wp-content/uploads/2020/03/NSES-2020-2.pdf
Caroline Palmer, JD is the Safe Harbor Director at the Minnesota Department of Health where she focuses on the statewide response to human trafficking. She is currently a Bloomberg American Health Initiative Fellow at the Johns Hopkins Bloomberg School of Public Health.
Beatriz Renee Menanteau is a human rights and public health attorney. As Supervisor to the Minnesota Department of Health’s (MDH) Violence Prevention Programs Unit, she oversees efforts to change systems that perpetuate sexual violence, domestic violence, human trafficking, and exploitation, and ensure appropriate system-wide responses to victims of exploitation and violence.
After graduating from Georgia Tech with her B.S. in biology, Erin moved to Houston and joined the Love146 prevention team in 2017. Since, she has relocated back to her first home of Atlanta, Georgia. During her tenure at Love146, she supports Facilitators and Trainers certified in Not a Number, coordinates national training, and collaborates with partners to expand their prevention efforts with the youth they serve.
Aria Flood, MPH has over ten years of experience in youth program planning, implementation, and management, with an emphasis on school-based public health programming. As the Director of U.S. Prevention at Love146, Ms. Flood is responsible for developing, promoting, and evaluating the trafficking prevention program to build protective factors in youth and effect systemic change.
Jennifer Miller leads the Systemic Prevention and Intervention programing with the Y’s Youth and Family Services at YMCA of the North. Focusing on serving young people navigating circumstances of foster care, involvement with the juvenile justice system, and/or sexually exploited trafficked survivors and victims. She and her team support young people in creating connections with caring adults and community resources, build skills for success, and instill hope for their future.
Paula M. Schaefer, MS, is the Safe Harbor Training Coordinator for the Minnesota Department of Health, she provides training d—and technical assistance for youth serving agencies and systems on working with children and youth who are sexually exploited/sex trafficked with a focus on prevention.
Emma R. Cook, MPH, MSW is a recent graduate from the University of Minnesota’s Schools of Public Health and Social Work. She hopes to use these degrees to ensure communities are heard by policymakers to improve the accuracy of the programs and policies that impact them.
Image is by Matt Orley, a Live Illustrator with Big Paper Strategy. Image was created during a workshop presentation by Aria Flood and Paula Schaefer at the 2020 Shared Hope International JuST conference. (Used with artist’s permission.)