At her primary care clinic, Dr. Ivelisse Rivera-Godreau plays the tongue drum in a gentle invitation to relax. Art made by her patients and inspirational words fill up the walls.
As a family medicine specialist, Rivera-Godreau treats everyone from babies to seniors. But in recent years, her Connecticut-based practice has seen a startling uptick in another type of patient: survivors of sex trafficking.
“Most of them have complex trauma, and complex trauma not only speaks about what happens in your mind, but what happens in your body,” Rivera-Godreau said. “[Survivors] can get triggered by anything. For example, we had a little object that reminded the patient of what happened to her. So we had to remove the object from the room. It was a tripod.”
Sex trafficking is a form of exploitation in which victims are coerced into providing sex for the trafficker’s commercial gains. Officials say it often goes unseen because victims fear both their traffickers and law enforcement, and don’t reach out for help.
But at Rivera-Godreau’s medical practice, and in agencies across Connecticut, health care providers said they are seeing more adult survivors of the crime.
Referrals to the state’s child welfare agency for suspected trafficking cases involving minors have also doubled in recent years, according to records reviewed by Connecticut Public.
From 2020 to 2022, calls to the Human Anti-Trafficking Response Team on alleged child sex trafficking increased from 149 to 310, according to the Department of Children and Families (DCF), which houses HART.
“There’s a strong belief that a lot of it’s due to the internet,” said Tammy Sneed, director of HART. “When COVID hit, we sent kids home. And those bad actors really picked up their game.”
The number of referrals to Rivera-Godreau’s practice from state and nonprofit agencies, primarily for adults, is up by 50% compared with six years ago when she first started seeing survivors, she said.
Child and youth anti-trafficking organizations like Love 146 in New Haven are also receiving more DCF referrals, and the needs of survivors are more acute, said Erin Williamson, chief programs and strategy officer. Close to 80% now require long-term services, she said, up from about half before the pandemic.
“We’re seeing more acute mental health from this population,” Williamson said. “And we have had a number of providers close their doors through the pandemic.”
‘There is a gap’
Connecticut passed its first anti-trafficking statute in 2006, and enacted other laws that target trafficking, with a focus on prevention, prosecution, and protecting victims.
Medical providers are one component of that strategy, which includes increasing public awareness of the signs of trafficking. However, research suggests many opportunities to disrupt trafficking are missed when victims visit emergency rooms, clinics and other health care settings.
A survey of pediatric nurse practitioners found that while most believe they might encounter a trafficking victim in the health system, few are confident in their ability to identify a child at risk for trafficking.
Yvette Young, associate vice president of training and advocacy at The Village, a nonprofit based in Hartford, said if doctors don’t ask victims the right questions, they won’t get the right answers.
Or they may not “even have the time to ask the right questions, to be able to discern that this is what’s going on with this child,” she said.
Anna Cerra, chief nursing officer at Greenwich Hospital, said across the field, health care providers should be better trained to recognize key indicators.
“There is a gap, absolutely,” she said.
In response, Greenwich Hospital implemented a new annual training program for ER staff to help them recognize key indicators of human trafficking, such as showing up without identification, showing signs of emotional trauma, a history of substance use disorder, paying for the consultation in cash, or being accompanied by someone who is constantly answering questions for the patient.
Cerra trains graduating nurses about what to look for too. This education — about seeing when things look off — should be mandatory, she said.
“Whatever tools we can give the providers, the physicians and nurses, all the better,” Cerra said. “The focus has to be the entry point where these victims will come, if they’re injured, or if something happened, that’s where they’ll come. That’s the first open door, the ED.”
‘I never thought this was happening here’
At her clinic in Rocky Hill, Rivera-Godreau is also developing a curriculum to train health care providers on how to identify and treat sex trafficking victims.
“God knows how many sex trafficking survivors I saw, and I couldn’t identify because I didn’t have the knowledge,” she said.
Rivera-Godreau first started seeing survivors after her husband, Ivan Tirado, who has a PhD in education and specializes in applied psychology, was helping an organization caring for sex trafficking victims in Cambodia.
“I became curious,” she said. “I just started reading about it and said, ‘Wow, I never thought this was happening here.’”
“I learned, after I started seeing them, most of them have been abused since they were little, and either they think that’s their only option in life, or they find somebody, a trafficker, right, who is in charge of making sure that they bring clients and money.”
Often, victims develop substance use disorder as traffickers use drugs as a means to exert control, which is why healing is a process that requires patience, Rivera-Godreau said.
A doctor may think of someone as “the difficult patient. They don’t want to stop using drugs, or they don’t want to take their medication, or why why? But listen, maybe that’s not what they are able to do,” she said.
Rivera-Godreau’s practice offers integrated care, a contrast to the assembly-line approach to health care she sees elsewhere.
“Medicine cannot be, prescribing medication, let me adjust your medication, here’s your labs, here’s your MRI … let’s send you to the specialist.” she said. “I feel like serving burgers. I didn’t go to school for this.”
Rivera-Godreau discusses her patients’ care with an in-house psychologist to determine how their life experiences and emotions affect their bodies.
This trauma-informed care offers a personalized approach that delves into the root cause of physical diseases. Art and music also complement talk therapy as part of the treatment process.
“It’s not your regular 15-20 minute visit,” Rivera-Godreau said. “If they need to stay for an hour, then we stay for an hour.”
A call to action
Getting to the why is like unraveling a ball of thread. By the time survivors get to see a primary care physician, they have already developed diseases as a result of their trauma that was untreated.
Trauma can produce physical illnesses ranging from gastrointestinal disorders, diabetes and arthritis to asthma and heart diseases, data shows.
In New Haven, Love 146 treats child victims of sex trafficking typically between the ages of 12 and 17, and more youth are in need of long-term trauma therapy, food, housing, and re-engagement with schools. And that requires more staff and more resources, Williamson said.
“It’s not that we couldn’t hire staff, we just need the money to do so,” she said. “We need the state to recognize that they have some responsibility here. I think they’ve historically relied on the federal government to fund victim services.”
Williamson is concerned that the situation could get worse.
“I worry that after June of 2025, when we expect significant slashes in some of this federal funding, many of our victim service providers have to lay off staff, have to close their doors, and we ourselves may experience an even greater wait list.”
There are 35 child and youth victims of sex trafficking currently on Love 146’s list who are waiting to receive trauma care and long-term services.
Williamson said nearly every organization serving this population statewide also has a waitlist, but there is no database to track exactly how many.
The DCF is launching CT-KIND in 2025, a new system aimed to help officials efficiently collect data on victims of sex trafficking, including data on a victim’s status as an unaccompanied minor.
Processing and healing
At Rivera-Godreau’s clinic, art, talk therapy and medication are put to use to help patients heal.
There’s even kickboxing and martial arts, which Rivera-Godreau’s husband, Tirado, demonstrates and explains can help heal trauma.
“That rhythm connected to your movement is matching the normal heartbeat, which allows your brain to start relaxing and regulating.”
From there, he said, patients can “process emotions and process information, process experiences.”
One patient with post traumatic stress disorder (PTSD) began to startle less. Another who kept her back to the wall began to move closer to the center of the room, Rivera-Godreau said.
It’s a treatment built on trust, and that trust paves the way to healing.
“Finally, I can practice medicine the way I wanted to practice medicine, the way it’s meant to be,” she said.
Connecticut Public’s Maysoon Khan and Jim Haddadin of The Accountability Project contributed to this report.
This story was first published Dec. 17, 2024 by Connecticut Public.