Rebuilding Broken Routines: Occupational Therapy Emerges as a Lifeline for Sex Trafficking Survivors

Human trafficking remains one of the fastest-growing illicit enterprises on the planet, a grave human rights violation that victimizes millions of people through coercive exploitation for commercial sex or forced labor. Yet while medicine, psychology, and social work have long documented the devastating aftermath of such exploitation, one rehabilitation discipline has remained largely invisible in the anti-trafficking conversation: occupational therapy. A new scoping review published in the Scandinavian Journal of Occupational Therapy now maps, for the first time in a systematic way, how this profession contributes to the recovery of sex trafficking survivors, and the picture it paints is both promising and sobering. Drawing on sixteen studies published between 2000 and March 2025, the review reveals a field in its infancy, rich in trauma-informed innovation at the bedside but strikingly absent from the policy tables where survivors’ long-term futures are decided.

The research team, led by occupational therapists based in India and the Philippines, structured their analysis around Bronfenbrenner’s Social Ecological Model, a framework that examines how nested layers of environment, from immediate therapist-client interactions to national laws and cultural norms, shape health outcomes. This choice is more than academic decoration. Survivors of sex trafficking experience complex trauma that disrupts nearly every dimension of daily life, from self-care and sleep to employment and social reintegration, and they carry heightened risks of post-traumatic stress disorder, depression, and anxiety. By organizing the evidence across ecological levels, the reviewers could show precisely where occupational therapy is already active and where it vanishes from view. The answer, in short: the profession works intensely at the individual level and barely at all in the systems that surround the individual.

At the microsystem level, the level of direct therapeutic contact, the review found a consistent pattern of occupation-based, trauma-informed intervention. One study described a twelve-week group program for six women living in a shelter; by follow-up, all participants showed significant gains in self-rated performance and satisfaction on the daily occupations they had prioritized themselves. Another implemented an eight-month, occupation-based executive function training program with eight trafficked women, producing significant improvements in task performance. These are small samples, and the reviewers are candid about that limitation, but the technical logic of the interventions is coherent. Survivors practiced life skills, problem-solving tasks, goal setting, and communication within structured group sessions, rebuilding the cognitive and behavioral machinery that prolonged coercion systematically dismantles. Cognitive-behavioral techniques and established frameworks such as the Person-Environment-Occupation model and the Model of Human Occupation appeared as practical scaffolding for this work.

Perhaps the most revealing technical detail comes from a study that used the Canadian Occupational Performance Measure, a standardized instrument that asks clients to identify and rate their own occupational problems. When survivors of human trafficking self-reported their priorities, the most frequent areas were social and emotional health, leisure participation, sleep, and financial management. That list is a clinical fingerprint of trafficking’s damage: it is not only the dramatic trauma symptoms that need treatment, but the mundane architecture of a livable day. Practical life management interventions in the reviewed literature accordingly targeted financial literacy, sleep hygiene, leisure planning, and self-care, alongside peer support networks and survivor-mentor connections designed to foster relational trust after years of exploitation and institutional betrayal.

Moving outward to the mesosystem, the links between survivors’ immediate contexts and their service providers, the review found both promise and deficiency. Interdisciplinary collaboration was repeatedly identified as critical, with recommendations that occupational therapists work alongside social workers, legal advocates, and public health staff. Yet the evidence suggests the profession is not ready to fulfill that role. In a survey of sixty-seven occupational therapy doctoral students, researchers found limited knowledge and self-efficacy in assisting trafficking survivors, even though students could recognize the importance of identifying warning signs, assessing needs, and de-escalating trauma triggers in practice. On a more hopeful note, a human trafficking awareness module delivered to two hundred college students produced a 58.6 percent gain in awareness of trafficking risk factors, suggesting that targeted education can move the needle quickly.

The exosystem analysis, which examines the institutions and policies that indirectly shape survivors’ lives, produced some of the review’s most pointed findings. The U.S. Federal Strategic Action Plan for Human Trafficking makes almost no mention of occupational therapy, and subsequent national action plans have similarly omitted the profession from their frameworks. Survivors, the literature suggests, fall through the cracks between fragmented services: immediate shelter and medical needs may be met, but disjointed referral pathways hinder long-term recovery. Programs like Call to Freedom, which embeds occupational therapy within multidisciplinary teams including case managers, addiction specialists, and peer navigators, were highlighted as strong models of what integrated care could look like. Still, no included study directly reported on policy outcomes, and the reviewers conclude that institutional support for occupational therapy’s rehabilitative role remains minimal and largely unexplored.

At the macrosystem level, the review confronts the structural forces that make trafficking possible in the first place. Case study analyses cited in the review argue that trafficked people suffer forced occupation and deprivation of meaningful occupation, framing trafficking not merely as individual trauma but as collective social injustice. One particularly striking analysis applied an intersectionality lens to the case of a transgender sex worker, concluding that economic, political, and heteronormative systems create what scholars term occupational apartheid, a systematic segregation that pushes vulnerable people into exploitation. Survivors from indigenous and migrant backgrounds face compounded marginalization, and stigma, criminalization, and racialized narratives about survivors demonstrably shape how services are designed and delivered. These findings situate occupational therapy’s mandate within a human rights framework, where decriminalization and survivor agency are prerequisites for meaningful care.

The chronosystem, the layer capturing change over time, reveals a field in visible transition. Early occupational therapy writing on trafficking, published before 2015, focused almost exclusively on individual-level therapy. By 2018 to 2023, the conversation had expanded to include occupational justice and intersectionality, and virtually every recent intervention report explicitly integrated trauma-informed principles, reflecting broader shifts across healthcare. The profession appears to be moving from purely reactive models, treating already recruited survivors, toward preventive and systemic strategies that educate youth, communities, and peers. Yet the reviewers caution that rigorous outcome studies remain sparse, that most scholarship originates in the United States, and that research from the Global South, including the Asia-Pacific region where an estimated 29.3 million people live in conditions of modern slavery, is nearly absent.

The limitations of the evidence base are as instructive as its content. As a scoping review, the study mapped the breadth of literature rather than evaluating intervention quality or effectiveness, and the restriction to English-language publications may have omitted valuable insights from non-English-speaking regions where trafficking is highly prevalent. Many included studies had small samples, limited methodological detail, or no follow-up data beyond short intervention windows, leaving therapists without guidance on how to adapt care across recovery phases. The reviewers call for longitudinal, mixed-methods research that centers survivor narratives and measures occupational outcomes over time, alongside culturally appropriate practice guidelines developed with survivor input under the principle of nothing about us without us.

What emerges from this review is a discipline with the right tools arriving late to a crisis it is uniquely positioned to address. Occupational therapy’s core insight, that everyday activities are restorative and therapeutic, matters profoundly for a population whose daily routines, sense of identity, and community roles have been systematically dismantled. With trauma-informed practice as a starting point, the authors argue, the profession must now expand its reach through interdisciplinary collaboration, cultural humility, and survivor leadership. The alternative is a continuation of the status quo: skilled clinicians rebuilding one survivor’s morning routine while the policies, funding structures, and cultural narratives that enabled her exploitation remain untouched. The review’s message to the field is unambiguous. Rebuilding the everyday rhythms that trafficking destroys requires working at every ecological level at once, and occupational therapy has barely begun.

Subject of Research: The role of occupational therapy in the rehabilitation of sex trafficking survivors

Article Title: Sex trafficking and occupational therapy: A scoping review

Article References: Jose, A. A., S, A., E T, N., Lambor, P. D., & Delos Reyes, R. C. (2025). Sex trafficking and occupational therapy: A scoping review. Scandinavian Journal of Occupational Therapy, 32(1), Article 2580142. https://doi.org/10.1080/11038128.2025.2580142

Image Credits: AI Generated

DOI: 10.1080/11038128.2025.2580142

Keywords: occupational therapy, sex trafficking, human trafficking, trauma-informed care, scoping review, rehabilitation, occupational justice, survivor recovery, social ecological model, interdisciplinary collaboration, public health, human rights