Long-term (re)integration of persons trafficked for the purpose of sexual exploitation

This paper focuses on the recovery and (re)integration processes of women victims of trafficking for the purpose of sexual exploitation in Europe. It looks at their life not just following a trafficking experience, but for several years afterwards, answering the questions: Are some factors more important than others, in the short and long run? What are the overall dynamics of the (re)integration process? How do the relevant influencing factors interact? What factors are crucial for a positive (re)integration immediately after the experience and how do they differ from what becomes important as the years go by? And what is crucial in order to ensure sustainable (re)integration? Fifty-two semi-structured, in-depth interviews were conducted with service providers, trafficked persons, and family members of trafficked persons. A variety of factors influencing the (re)integration process were identified, such as: (a) the background of the individual; (b) trafficking experience – who the trafficker was and its severity; (c) the role of institutions, NGOs, and service providers; (d) economic factors; (e) the personal characteristics, challenges, motivations, and coping mechanisms of the victim; and finally (f) social support. However, what was identified as particularly important for the sustainability of the (re)integration process was relationships built with service providers, relationships rebuilt with existing family members, or relationships built with new families that were established after the trafficking experience.


Introduction
The focus of this paper is the recovery and (re)integration process of women trafficked for the purpose of sexual exploitation. Current assistance programmes monitor the (re)integration progress of their beneficiaries, most often for up to three years after their identification as a victim of trafficking (Surtees, 2010). Thus, it is this initial three-year period, which in the context of this article will be considered as the short run, that is academically most familiar. Nonetheless, some questions remain, not only in regard to this initial (re)integration period, but also in regard to (re)integration efforts in the long run. Are some factors more important than others, in the short run and long run? What are the overall dynamics of the (re)integration process and how do the relevant influencing factors interact? What factors are crucial for a positive (re)integration immediately after the experience, and how do they differ from what becomes important as the years go by? What is crucial in order to ensure sustainable (re)integration? These are the questions that this article addresses.
In the context of this research, the definition of human trafficking, as outlined in the United Nations Protocol to Prevent, Suppress, and Punish Trafficking in Persons, Especially Women and Children, is used: The recruitment, transportation, transfer, harboring or receipt of persons, by means of threat or use of force or other forms of coercion, of abduction, of fraud, of deception, of the abuse of power or of a position of vulnerability or of giving or receiving of payments or benefits to achieve the consent of a person having control over another person, for the purpose of exploitation. Exploitation includes, at a minimum, the exploitation of the prostitution of others or other forms of sexual exploitation, forced labour or services, slavery or practices similar to slavery, servitude or the removal of organs (Protocol to Prevent, Suppress, and Punish Trafficking in Persons to the UN Convention against Transnational Organized Crime, 2003: 2) The respondents in this research were service providers and victims who came from both origin and destination countries in Europe. This research is relevant, as it focuses on the issues trafficking survivors face in the short term and long term. In addition to identifying the factors that influence the (re)integration process, it will also discuss its dynamics, and distinguish those that are more from those that are less important. In turn, this could inform policymaking and practitioners in the field and orient them toward adequately addressing the needs of trafficked persons immediately after, but also many years following the trafficking experience.
The article begins with an overview of literature that will be an important reference considering the research questions. Thereafter the methodology of this article will be discussed. The main results will be presented in the following sections, reflecting the influencing factors of the (re)integration process, namely (a) background of trafficked person, (b) trafficking experience, (c) role of institutions, NGOs and service providers, (d) economic factors, (e) personal characteristics, and (f) role of family and friends. The first three sections have to do with the past of the trafficking victim or are relevant to the initial post-trafficking period. The last three sections are factors that influence the present-day situation of the trafficked person. In the concluding section of this article, the dynamics of the interactions of all of the above outlined factors will be discussed, the relative importance of some over others will be noted, and finally, those factors found to be of great importance for the long-term sustainability of the (re)integration process will be identified.

Existing literature
One of the most comprehensive overviews of the factors influencing the (re)integration process of victims of sex trafficking is offered by Rebecca Surtees (2010) through her research and reports on monitoring anti-trafficking re/integration programmes as well as research on post-trafficking situations in the Greater Mekong Subregion in 2013. Surtees has perhaps provided the most exhaustive list of factors which influence the (re)integration process of women trafficked for the purpose of sexual exploitation to date (Surtees, 2010). The identified 'impact indicators' are (1) safe and affordable accommodation; (2) legal status; (3) professional and employment opportunities; (4) education and training opportunities; (5) security and safety; (6) a healthy social environment; (7) social well-being and positive interpersonal relations; (8) the economic situation; (9) physical well-being; (10) mental well-being; (11) access to services and opportunities; (12) motivation and commitment to the reintegration process; (13) legal issues and court proceedings; (14) assistance to secondary beneficiaries (family members) (Surtees, 2010). In her study 'After trafficking experiences and challenges in reintegration in the Greater Mekong Sub-region', Surtees (2013) outlines the challenges to the (re)integration process, which often have to do with assistance provided (or not provided to victims), lack of individualised support, lack of accommodation, legal and administrative issues, economic challenges, poor physical health and well-being, psychological challenges such as stress, anxiety, depression, and trauma, being unsafe and insecure, and finally, the many challenges when working with families of victims of trafficking. She does note that (re)integration is a long-term process and where it is possible to conduct monitoring of individual cases, this may be beneficial to the victims.
However, questions still remain about the particular dynamics and interactions of identified factors that influence (re)integration processes. In addition, more research is needed on the direction of factors that contribute to the sustainability of the (re)integration process. It should be noted that some studies particularly focus on the importance of the family in the (re)integration processes of women after a trafficking experience (Brunovskis and Surtees, 2013). However, the primary emphasis here is mostly on (re)integration dynamics that occur when a woman goes back to the family that she had formed before the trafficking experience, or the (re)integration dynamics for children born while the woman was in a trafficking situation. The role of families formed after a trafficking experience remains to be explored in greater detail. This research is one small step in that direction.
Jyoti Sharma (2015) examines the issue of (re)integration of female sex trafficking victims in Nepal. The focus is on exploring how women who are survivors of sex trafficking experience the process of (re)integration, and thus, identifying the barriers to (re)integration as well as the supporting factors which promote (re)integration. What is of particular importance concerning this research is that through the experience of fieldwork, it is concluded that (re)integration is an 'ongoing process that can span decades' and thus, the time distance from the trafficking experience for the women on which this study is based ranges from one month to 20 years (Sharma, 2015: 45).
Some of the identified barriers to reintegration are the social construction of gender in Nepalese society, negative community attitudes, physical and emotional health problems, and the NGOs' lack of a victim-centred approach to (re)integration. Factors which support the process of (re)integration are family support, increased autonomy, resilience, and independence (although it should be noted these factors were more relevant for women that chose to leave their village of origin and settle in Kathmandu). Overall, stigma and social discrimination by the family and community are overwhelmingly distinguished as some of the primary challenges to (re)integration of women who have been trafficked for sexual exploitation (Gjermeni et al., 2008;Brunovskis and Surtees, 2012;Gan et al., 2014;Da-hal et al., 2015). Additional factors identified as influencing the (re)integration process are financial instability and lack of economic and job opportunities, as well as health and mental problems (Gan et al., 2014). Resilience has been identified as a personal characteristic of trafficking victims, which aids the process of (re)integration (Sharma, 2015;Le, 2017). Finally, marriage has been noted as a factor which contributes towards the sustainability of the (re)integration process (Crawford and Kaufmann, 2008;Sharma, 2015;Le, 2017).
One factor that influences the (re)integration process and should be singled out is the issue of trust, as identified from the work of Surtees, but also from the work of Walsh and colleagues (1999) and Koser and Pinkerton (2002) on the repatriation of refugees to Bosnia Herzegovina in the 1990s and 2000s. Trust needs to be in the information that trafficking victims or returnees receive from the service providers that are in touch with them throughout the (re)integration process, as well as trust in the service providers themselves. Brunovskis and Surtees (2012) identify trust as crucial in decisions victims make as to whether or not to accept assistance throughout the (re)integration process. The work of Walsh and colleagues (1999) and Koser and Pinkerton (2002) on the other hand focuses on the lack of trust in information that returnees receive from government agencies and the trust they have in information received from migrant and refugee community organisations. This is a factor that comes through in this research as well, relevant for both the short-and long-term (re)integration of the trafficking victim and will be discussed in detail later on.

Methods
The data collection was conducted in Albania, Bosnia Herzegovina, Bulgaria, Montenegro, Serbia, the Netherlands, and Italy from 4 November 2013 to 30 December 2015. A total of 52 semistructured interviews were conducted. Interviews ranged from 20 minutes to over 2 hours in length. Interviews with service providers (N ¼ 40) were mostly conducted in offices of assistance organisations, while interviews with victims were in locations where they felt most comfortable, such as offices of assistance organisations, cafes or in one case, the home of the victim, where the family of the victim (mother, brother, and sister) were also present and the sister participated in the conversation. A total of nine victims of trafficking (8 female and 1 male) were interviewed, all victims of trafficking for purpose of sexual exploitation. Four of the victims (3 female and 1 male) were from Bulgaria trafficked to the Netherlands, Spain, and an undisclosed country of destination, two of the victims were from Albania and trafficked to Italy and Greece, two from Romania were trafficked to the Netherlands, and one from Bosnia Herzegovina was trafficked internally. Ages ranged from 22 to 42, while the duration of the trafficking experience ranged from 14 days to 3 years. Although it was not always possible to ask or understand how much time had passed since the trafficking experience, for those victims who made it clear, distance from the trafficking experience ranged from several months to ten years. In addition, two women were sisters, who as young children were identified as 'at risk' of being trafficked, and as such were placed in a shelter until they reached adulthood.
Different interview protocols and questionnaires were used for trafficking victims, those at risk of trafficking, and service providers. The questionnaire for trafficked persons covered several general areas, focusing on (1) life before the trafficking experience; (2) the trafficking experience itself -how it happened and what helped the person to get through it; (3) how identification as 'trafficked' occurred; (4) description of the period immediately following trafficking; (5) description of the interviewee's economic situation at the time of the interview; (6) description of social life, and mental and physical health at the time of interview; and (7) description of how the person envisions the future. A selection of the above presented questionnaire areas was used for those at risk of trafficking, omitting any inquiry about the trafficking experience.
A different interview protocol was used for service providers. Service providers were asked about their daily work and tasks; about how they came into contact with trafficked persons (how victims are identified); what was their initial approach when they come in contact with trafficked women for the first time (what are the needs of the women, what do they want, what do they tell the service provider, how does the service provider interact with them); what the challenges were during these initial contacts; how interactions proceeded as time went by (how do the needs and wishes of the trafficked women change with time; how long do service providers follow up each case; what are some of the challenges in later interactions); and what, according to the service provider, constitutes successful reintegration (with examples given of successes and failures of the reintegration process).
The interviews were conducted in English, Bosnian, Bulgarian, Montenegrin, Serbian, and Albanian. For the interviews conducted in Albanian, a professional translator was used, or in certain cases an employee of the organisation that arranged the interviews. All interviews were recorded, after permission to do so was granted by the interviewee. The English-language interviews were then transcribed verbatim, while the interviews conducted in languages other than English were translated and transcribed directly into English.
The data analysis was conducted with the use of QSR Nvivo 11.2.2 (1707) for Mac. There were multiple levels of analysis. Initially, themes were identified based on the distinctive sections of the questionnaires. The second level of analysis produced in vivo and descriptive codes (types of codes described in Saldaña, 2009) within each theme. The third level of analysis entailed designing mind maps based on the themes and codes within each theme, and producing categories on the topics covered within this article. The mind maps were further used to draw relationships between categories and connections of codes within each category, and among different codes from different categories identified. All text from the interviews was coded.
The guidelines of the World Health Organization were followed in conducting interviews in the context of this research. The study was reviewed and approved by the Ethical Committee of the Faculty of Psychology and Neuroscience of Maastricht University. Informed consent was received from each interviewee, prior to conducting the interviews, and in addition, permission was sought and granted from every participant to digitally record the interviews.

What factors influence the (re)integration process?
The various factors that influence the (re)integration process of sex trafficking victims can be grouped according to the time period in which they belonged in the life of the trafficking victim. Namely, these included factors stemming from the background of the individual, prior to the trafficking experience, factors related to the trafficking experience, factors having to do with the identification process as well as the role of different service providing institutions, and the factors from the time of the interview in terms of economic and social aspects, as well as personal characteristics of the victim. Some factors influenced the (re)integration process in a positive way, some in a negative way, and each will be discussed in regard to how they shaped the life of the trafficking survivor and determined the presence or absence of violence, exploitation, and possibility of re-trafficking or, in other words, in regard to how they determined the success or failure of the (re)integration process.

Background factors
There are various ways in which the background of the individual not only influences the (re)integration process at present but may have been one of the causes of the trafficking experience.
The social group to which some women belong has been identified as a possible factor that contributes toward the vulnerability of becoming a victim of trafficking. Respondents noted that women that come from communities which are usually socially isolated, discriminated against, and poor, such as the Roma, may be especially vulnerable to becoming trafficking victims. As one respondent noted: It is often that in Roma neighbourhoods, where people that are in social need and at risk live, that according to our experience we find risk groups that may be vulnerable to trafficking (because of early marriage, forced marriage, begging, family violence, and sexual abuse). (Service provider, Montenegro, 7 December 2015) Another interviewee stated: I've seen, especially with the Roma women, in their own country they are looked down upon so much, if they go to a supermarket they are even shut out. For them to be treated as a human being is for some of them so exceptional, if their whole life has been cast away and nobody has ever looked at them as a person. (Service provider, The Netherlands, 14 March 2014) It was also found that victims may have come from communities where the 'business' for the girls, from a young age, was prostitution. In all such instances, the background of the victim should be considered as a negative influence on the (re)integration process, or in this case, integration process, as it would not necessarily be advisable to seek the return of a woman to her community in these situations.
Migration is another component of the background of women who have been found to fall victim to sex trafficking. Persons interviewed for this study reported falling victim to trafficking when moving from village to city, when moving out of the country of origin in search of employment, or when simply following a partner abroad who thereafter exploited them. However, it should be noted that in all cases encountered, it was not the migration process itself that precipitated the trafficking experience, but rather the unsafe conditions under which it occurred, as many women were misled or simply lied to about where they were going, what they would be doing, or the conditions in which they would be doing it. Thus, women even after the trafficking experience did not show themselves to be discouraged from migrating again. As one victim stated to her English language teacher: Teacher, I want to learn English, because I see it as very necessary for my life, because I plan in my life to not live here in Albania, but to live outside Albania, and that's why I think it is very useful for me to learn it, that's why I want to learn it, really. (Service provider, Albania, 23 October 2015) Background economic factors such as poverty and joblessness, which are sometimes related to low levels of education, are also an active influence on the success or failure of the (re)integration process of victims. In this section, what is taken into consideration is the situation of the victim in regard to these issues prior to the occurrence of trafficking, not the situation at present. Namely, it has been found through this research that many of the victims of trafficking had low levels of education or low-paying jobs that pushed them to seek other possibilities. In these cases, aiming for the return of the victim to such situations or conditions may not have a positive influence on the (re)integration process. As one interviewee noted, while explaining why she would not consider returning to the country of origin: I have too much things not nice in past. You know. I was starting to go working, when I was in school I had ten years, and my mom send me in the work. I had no child [meaning I had no real childhood], and the work, for me was not well. And Respondents also noted having lives filled with problems and struggles to make ends meet prior to the trafficking experience: The educational background of the victim of trafficking may be another factor that influences the (re)integration process. There are cases where women who had received only a very rudimentary education then chose to make the continuation of their education one of their goals and aims, which gives them the motivation and energy to go on, thus positively influencing the (re)integration process. However, as some service providers point out, having an education does not guarantee a job and financial stability, thus women should not be pressured to continue their education.
In these cases, training and specialisation in different professional fields may be of greater importance.
Finally, perhaps the most significant factor from the past that influences the (re)integration process is family background. As already observed, many of the victims came from families with difficult relations and, in some cases, a history of violence or situations where the parents are the traffickers. As one respondent noted: Depends on the life they had earlier. There was a girl that was a victim of violence, from her parents, since she was little. She learned that for her, the way you express love is through violence. When someone hits her, it's not violence, because her mom and dad were hitting her, and in that way were showing their love. She connects these things. So, then, when she enters a situation, a situation that was traumatic, she needed some time to get out of that. (Service provider, Serbia, 2 November 2015) In another case, a victim had been rejected by the family early on in life: First it was mom and dad, until I was 23, I was with my parents. Then, it was stressful, the stress came. My mom came, and she said, I will throw you out of the house, all because of their problems. I said, no, don't fight. (Trafficked person, Bosnia Herzegovina, 1 October 2015).
It is clear that in cases where the victim experienced family violence and abuse, family reunification would not have a positive influence on the (re)integration process of the victim. However, it should be noted that in certain situations, when the victim was not physically abused but emotionally rejected, reunification was still sought after by the service providers as they evaluated that overall, if achieved, it would have a positive influence on the psychological recovery of the victim. Cases were also reported, however, when the victim was trafficked as a minor by their family, where despite past abuse, the victims craved reunification with their families of origin.
Another family-related factor from the background of victims interviewed for this study was that they had lost a parent or caretaker at various moments, some in a violent manner, prior to the trafficking experience. Of the nine trafficking victims and two at risk of trafficking individuals interviewed for this study, three had a mother who was murdered by another family member, three had a mother who had died through natural causes, and one person only spoke of her father when talking about family. Of course, no conclusions can be drawn as to whether or not this could have been a factor that may have precipitated the trafficking experience in some way.
If family relations were good in the past, the family becomes one of the crucial factors contributing toward the (re)integration process of the victim at present. It is in these cases that return to the family environment may be one of the most significant factors in bringing about not only successful (re)integration, but also a sustainable one in the long run. One of the victims interviewed for this study was precisely such a case. As emphasised by her case worker: That is the family of origin that is very strong. So they welcomed her. In difference with other families, they did not accept, they wanted to accept her ( . . . ) we saw that she took lots of dependence and she now became dependent in our shelter and sometimes she got out a lot, maybe we saw it even as a risk to stay for more time in X [town in Albania omitted] because of . . . she could get in contact with somebody . . . That is why we said OK, now is the right time. She was ready psychologically because, you know, she has passed every period and every stage in a normal way and that is why . . . we saw that the family is ready so we decided now is time. (Service provider, Albania, 29 November 2013) In conclusion, there are various factors from the background of the individual that may influence the (re)integration process in a positive or negative way. Those factors stem from belonging to a vulnerable community, different paths of migration, employment and education history, and most importantly family background.

The trafficking experience
The way that the trafficking experience occurred, who the trafficker was, as well as the severity of the experience, had a significant influence on the (re)integration process. The duration of the trafficking experience has not been included as an influencing factor. First, its duration was not clear for all victims of trafficking. In addition, taking into consideration the overall context of the trafficking experience, it was found that severity took precedence over duration.
It was found in the research that there were instances when the trafficker had been a family member or an in-law. The exploiter of one of the interviewees, who was trafficked while in the later part of her pregnancy, was her mother-in-law. As she noted: And there she was talking with one man, Turkish, I don't know him, I don't understand, when I was there, I did not understand what she talked with him. I just understand, she said to him, she can have sexual contact with you for money. My mother-in-law, yeah. I said to her, I cannot do that, I am pregnant, I don't go. And later, she said for me, you have to do that, because we don't have choice. There are many different factors that may damage the trust trafficked women have in other people. However, it should be noted that in the case where the trafficker was a person that had in some way been close to the victim, then the trust issues they may have become increasingly severe. Since building trust is an essential element of creating long-lasting healthy relationships, cases where the trust of the individual has been betrayed by someone close to them may then take more time and effort in order to recover and (re)integrate.
The nature and severity of the trafficking experience as well as how it occurred may also have a significant impact on the (re)integration process of victims. Based on this research, three distinct types of sex trafficking can be identified.
The first group of victims were those who were either misled by and forced into sex work by a 'loverboy', or were migrating to find work and in the process were forced into sex work. Some of the women in this group were subject to rape, drugged, and beaten in the attempt to force them to become sex workers. The traffickers would have total control, taking away any documentation and offering no financial compensation for the work done. No contacts outside of the traffickers and clients were allowed. They would have daily money quotas that they would have to reach and would be subject to extreme mental and physical violence and abuse. In the two cases where the women had a child, in both cases an infant, they were threatened that the child would be taken away unless they complied with the wishes of the traffickers. At least two of the women interviewed that belonged to this group had visible physical marks that they were still recovering from, in one case a permanent injury that was evident ten years after the trafficking experience. One of the interviewees described her experience: Then, he starts to really pressure me [to perform sex work]. To try to influence me. I said, this will simply not happen. I said, then I will go home. I will pack up and go. And that is when everything started. He said, you are not going anywhere. . . . That is how it all started. We started to fight, he started to beat me, more and more often. Every single day. He was hitting me with things, with wood . . . with a chair. I didn't have a white spot on my body. Everything was blue. Everything was blue. The head. Every single day. I said, no, no, no, I don't want. Every single every day, he was beating me. With parts of tables, he would hit me. Four times, I collapsed. . . . He locked me up in a room with just a closet, and nothing else. He said, scream as much as you like, nobody will hear you. Every single day, for 25 days. 25 days, I could not move, go anywhere. The doors were locked. My ribs were broken, five ribs broken. My head was full of bumps. Four times I fell in the bathtub. . . . One day, simply . . . it hurt me when I was breathing. When he sees me throwing up, he comes again, he beats me again. He wanted to cut my hair. I have very long hair, he wanted to shave my hair. Horrible things I lived through. When he would close me up in the bathroom, it was horror. It was horror. (Trafficked person, Bulgaria, 15 October 2015) Another of the victims interviewed noted: The women who have been victims of sex trafficking with the severity described above would not only take more time to recover and (re)integrate, but would also need more types of services. Primarily, it should be noted that the women needed extensive medical assistance as well as psychological assistance. One of the victims interviewed for this study who would be classified in this group had not accepted any of the services offered by institutions so far, as she has had strong family support and two children who she said had given her the strength and energy to go on. However, she reported being extremely nervous, regularly having nightmares, and that she had increased her smoking. As the trafficking experience was recent in this case, it cannot be said if family support was sufficient to help her recover and (re)integrate.
The second group of victims are persons who knew that they would be working in sex work or were somehow persuaded to work in sex work. However, they were thereafter either misled about the working conditions or were taken advantage of and exploited financially, as well as having had their freedoms limited. Some of the victims in this group noted that they were fully aware that they would be working in the sex industry. However, one victim pointed out how she explicitly asked repeatedly to use a condom but was either not permitted or was manipulated and persuaded into not using one. The behaviour of the trafficker towards these women may have been verbally, but usually not physically, aggressive. Victims reported hearing threats against their family or threats that they will be exposed to their family in order to convince them to continue working. Their freedom of movement was limited and often constrained by the threats that they had received in case they tried to leave the trafficker. Some of the victims received some financial compensation, however they noted that it was much less than expected, and that a large share of the total fee from the client went to the trafficker. Although victims who have been classified in this group did not report explicit physical violence against them, one victim reported that she had various medical problems, including potentially suffering from sexually transmitted diseases. However, she was never given the opportunity to receive any kind of treatment until she exited the situation. As she explained: Women that would be classified in this group of victims of trafficking, as with the first group, would need urgent medical attention, as well as additional (re)integration services such as counselling. One of the victims, who had recently testified against the trafficker in her case, also reported being extremely worried about her safety, although the trafficker was convicted and was serving a six-year sentence. Another one of the victims reported that she would not go back to sex work because she is certain the traffickers would find her again, among other reasons. Apart from the immediate medical concerns, women in this group had security concerns and concerns about their economic survival in the future.
Finally, the third group of trafficking victims are those that took some time in identifying and seeing themselves as trafficking victims. From those interviewed for this study, only the male victim would be classified in this group. However, service providers spoke extensively of such cases that they encountered throughout their work. Such cases would be persons that have accepted and wanted to do sex work, however, were sharing profits with their pimps. Even though for some of the victims such arrangements were acceptable, they are still considered, legally, as victims of human trafficking. In the words of one of the police officials: There is also difference between legal victim and feeling like a victim. . . . So, it's common that they don't feel directly as a victim. It's like building up, it's like water in a bucket, and eventually the water is high enough and will flow over the bucket, and that's the moment the woman is willing to step forward and say, hey, this is not right, I feel like I'm a victim. But until that period, it's difficult, she has to in that moment, she is still under the influence of the pimps or under the influence of the trafficker. Another service provider noted the following in describing persons who would belong to this last group of trafficking victims: Especially when you look at the situation of women from the Balkans, quite a few of them already worked in prostitution in their country and they say 'well, it is just a deal. He takes half of the money.' That is just a business arrangement they made. So then . . . I have seen them also working in Budapest, in the middle of winter, I was there in January and it was really cold and I saw them working in the street with skirts and having sex in cars. Well, if they are then transferred to this country and they have room where is warm and also they have, in their country, they were used to give away their money so that is not any different, so for them, there has been an improvement to come here. And then we really need to explain 'well, this is not a business arrangement, this is cold exploitation'. (Service provider, The Netherlands, 14 March 2014) As some of the victims that would belong to this group would need to realise that they have been victims of trafficking, their (re)integration process would differ from that of the other two groups, in that the focus would then be on counselling, and thereafter the possibilities of financial compensation to right the material exploitation they were subjected to during the trafficking experience. What may be crucial in these situations is to make sure that individuals are protected from recurring exploitation, especially if they consider going back to sex work. In these cases, legislation that exists in regard to sex work and the protection sex workers have under the law, may be extremely relevant. For the male trafficking victim who would belong to this group of victims, the biggest challenge in the (re)integration process seemed to have been accepting that testimony against the traffickers was the right thing to do. He noted the following: The work with the psychologist helped me a lot to get positive things from everything. Because maybe you agree with me, but if you have this situation with four different people, when everything is finished, and went out, someone thinks, oh my God, was this good or not? Did I make a mistake? Or I think it was not good to come here . . . for me was like, I share experience, I talk about things people don't talk about. I give you good information, for me is positive, I know I am helping in some way. I know that if I am not telling you that, maybe you will not find that on internet. This is not a recipe for soup or cake. This is not what people share, and it's, maybe it makes a little bit angry, people share what is not necessary and don't share the important things. (Trafficked person, Bulgaria, 14 October 2015) To conclude, the influence of the trafficking experience itself is significant on the nature and the manner in which the (re)integration proceeds, as well as on the longevity of the (re)integration process. Depending on who the traffickers were, as well as the severity of the experience, the needs of the victims may change, and thus, the (re)integration process may proceed along different paths and timelines.

After the trafficking experience: institutions, NGOs, service providers, and their role
Another group of factors that influence the (re)integration process comes from the interactions between the victim and official institutions, NGOs, and other service providers that they come into contact with. In this regard, how identification is conducted, the initial exchanges with service providers, the experience of victims in the shelter, as well as how the contact dynamics with service providers change over time, are all relevant topics that will be explored in greater detail in the next part of this article. By looking at the longer-term contact dynamics between victims and service providers, the life of the trafficked persons several years after the experience will also be discussed in order to be able to get an insight into the progress of their (re)integration. In this context, experience from victims interviewed with some years of distance from the trafficking event will be taken into consideration as well.
Service providers noted that the majority of identifications of persons as trafficking victims are conducted by the police. However, in addition to the police, women have also been identified by government social service officials, NGOs, SOS hotline calls, doctors, clients, and self-identification. What was emphasised was that services should be offered to victims, regardless of whether or not women would agree to participate in the criminal proceedings against the trafficker. Of course, some victims choose not to take advantage of these possibilities, in particular in cases when they wanted to return to their families immediately, as was the case with one of the trafficked persons interviewed for this study. It should be noted, however, that the victim in question had strong family support, but was still suffering from nervousness and nightmares, and had increased her consumption of cigarettes.
Upon identification, it is the first impressions the victim has of the service provider that were important: Sometimes, the victims, they say the first contact with people from those institutions is very important. And they say, their impression depends, a lot depends on what the initial contact is. Depending on what the contact is, you may ask for help. But, if the person starts to abuse you, or put you in a position of being blamed, you don't achieve anything. The person feels they are to blame, that they caused what happened to them. (Service provider, Bulgaria, 16 October 2015) Consequently, the way the initial interviews and conversations with victims are conducted will have a significant impact on the trust the victim begins to build towards institutional figures. Thus, interviewees noted it is important to give information to the victim with regard to their rights and options immediately, in order to be transparent and reference all the services that they would have access to. Service providers from NGOs and shelters that accepted victims and offered them services or shelter, in particular, noted that often they required very little information from the victim herself and did not 'dig deeper' than what the trafficked person chose to share.
While some victims liked to talk to the service providers, others were quiet in their initial contact: In any case, we do not ask questions about the situation of trafficking at all, not at any moment. We don't think that there is need for this from our side. . . . First, you have, it's called the victim that is quiet. And you have victims that talk. Each person has their own dynamic. They don't have strength. They don't have strength to talk, some of them. There are those that talk, but completely negate what happened. (Service provider, Serbia, 2 November 2015) The immediate needs of the victim which were usually addressed were physical, such as offering food, clothing, medical assistance, legal assistance, and if needed, shelter. Service providers reported that what victims needed was a period of stabilisation in a place and environment that was warm. A risk assessment for their safety is conducted, as fear is one of the most common emotions expressed by victims upon identification. In addition, victims were described as being anxious, mistrustful, stressed, depressed, with an irregular biorhythm, low self-esteem, and no real plan for the future. At this initial phase, service providers reported that the victims: Need space to come to themselves, they are in an acute state, when they are still under the initial state, of going out of the trafficking situation. So, we leave them a bit of space, so that they deal with themselves, their own thoughts, their own feelings. (Service provider, Serbia, 2 November 2015) Next, there are several aspects of the accommodation experience and experience with shelters that victims have immediately after identification, which then may shape their (re)integration process. It should be noted that shelter practices were not uniform. In most cases, victims had a choice as to whether or not they would like to remain at a shelter or acquire their own accommodation upon identification. However, some service providers did mention that, in certain cases, the police were bringing the women to the shelter by force: Since the first moment there have been plenty of cases where these girls were taken by force from the police there, and brought here. They were unclear of what was happening. (Service provider, Albania, 25 November 2013) Still, it should be stressed that this report was the exception rather than the rule based on the information from those interviewed for this study. Service providers usually reported that it was important that the victims chose to stay at the shelter themselves: because the only way to ensure the safety of the house is that she also voluntarily comes to the house. (Service provider, Serbia, 29 October 2014) One of the victims interviewed commented that she simply did not see any other choice for herself but to be at the shelter: Another difference in practice was that some shelters had personnel who would remain at the location at all times, some going even further in offering in-house medical services. On the other hand, at other shelters women lived at the location on their own and were simply informed of the house rules, which they were asked to respect. Some shelter rules permitted communication with persons from the outside, however, other guidelines noted that mobile phones should be surrendered. Nonetheless, at all shelters, participating in sex work was not allowed and was one of the strict conditions for staying at the shelter.
Shelters also differed from one another in regard to the group of victims they tended to. In some shelters, women victims of trafficking were placed together with women who were victims of domestic violence. Shelter staff reported that they believed such models work well. However, victims who were placed in such environments reported negative experiences, noting that they felt discriminated against by the victims of domestic violence. In the words of one of the trafficked persons interviewed for this study: There are foreigners there and national ones and the prejudices among each other are too much. Sometimes even developed from the social workers and the staff. You see, they see with another eye. They see victims of domestic violence, OK, they see this softness, victims of trafficking they see in another way. And the same happened either even maybe not in a big amount, in X [city in Albania omitted], but in X [town in Albania omitted] as well. Not from the staff, because our services mixed, but from the beneficiaries to each other. (Trafficked person, Albania, 29 November 2013) Finally, shelter rules varied regarding the recommendations given to victims concerning sharing their past with one another. It was more common to find shelters where the staff recommended exchanging experiences, guiding one another, group therapy sessions, or peer support: We notice that they share. They share with each other, the clients at the shelter. But more often, the good practices, how they dealt with a certain situation, we have a support group, where they tell how they dealt with a certain situation. It's very hard to talk about the survival from the violence. (Service provider, Bulgaria, 16 October 2015) What we saw gives the best results, is the peer to peer. We empowered some of the girls that are here for many years. And that has managed to in some way close the traumatic experience, and they have managed to live in a functional way, make some dreams and wishes come true, to be happy the way they want. So, we took some of those ladies, and from time to time, they expressed the need to help others that are in a similar situation. We have people that have passed through similar or same experience, so, from their position, they approach persons that have just entered the programme. When they come to the shelter, they can say, I understand, and I am here for you, you can count on me, from today, that I can help you in everything. We think that this is a very equal relationship. Because all the relationships that we build, are still relationships of power, we are not equal. When we talk every day, we realise this. (Service provider, Serbia, 2 November 2015) However, not all shelter rules supported exchanges between beneficiaries. Namely, one victim noted: No, here it's banned to talk about that. There are problems later, if you do this. I don't talk about that. Sometimes, by mistake. (Trafficked person, Bosnia Herzegovina, 1 October 2015) A psychologist working at the shelter clarified the rule: We told them that the intimate things, they should not share with each other. Because there is a lot of turnover from the safe house. So, when someone exits, they would have all the information of the person. Sometimes they joke around, with the kids, in front of the kids, so we want to avoid this. They mostly know what the situation of the others are, but we avoid explicit talking. (Trafficked person, Bosnia Herzegovina, 1 October 2015) In any case, conflict among beneficiaries while at the shelter was also reported: Conflicts happen. Someone doesn't clean the dishes, the glasses. But a small thing is then enlarged, becomes something big, something personal. We are all people, we should be tolerant. Some of them manage quickly, others no. For others it's hard to learn to live with other people. (Service provider, Bulgaria, 16 October 2015) However, one practice uniform in all shelters that were the focus of this study is that staff saw it important to organise various kinds of social activities for beneficiaries in which they could participate once the initial period of stabilisation had passed. Even further, shelter staff pointed out that it is extremely important, once the victim becomes acclimated to the environment, to have a structured schedule, things to do, and tasks outside as well as inside the shelter, where possible. Crucially, it was seen as counterproductive to be inactive: What my thing is, or what I think we really do good, is that I think we have a really strong or really complete daily activity programme. We have the vision that laying in your bed, and not feel good, is not helping you. You have to get up, you have to get up in the morning, you have to get out, to see people, have contact with people. . . . So, we have training, self-defence, biking lessons, cooking, making soup. All kinds of stuff. And I think it helps on many levels, because you get a distraction. (Service provider, The Netherlands, 28 March 2014) It was also expressed that victims often want to be noticed and may crave attention. Thus, in situations where they complete even small daily errands and tasks, it was found important to give positive reinforcement, encouragement, and compliments.
Overall, taking into consideration the services offered to victims and the options for help they have, whether they stay in a shelter or they have their own accommodation, what seems to be of crucial importance is establishing a relationship of trust with a service provider, be it a social worker, psychologist, or shelter staff. If established, this relationship carries importance not just in the initial stages of (re)integration, but also later on in life. It may be years after the trafficking experience that service providers report re-establishing communication with victims, at the initiative of the beneficiary. This re-establishment of contact is important not only for monitoring purposes, but also because victims may ask for help with possible current problems they face, and thus reoccurrence of abuse can be prevented, a point elaborated on in greater detail later in this article. In establishing a relationship with victims, service providers have described it as an interaction which is not just a consequence of a human trafficking experience, but it becomes a part of life.
The establishment of trust and the initial positive first impressions victims get from service providers are relevant even for those victims that have not yet sought any professional assistance. A victim interviewed for this study, who had reported returning to her family immediately after the trafficking experience but was at the moment experiencing financial and psychological challenges, noted that she had a good first impression from the service provider that conducted the intake upon her return in the country of origin. She stated that she may get in touch with this person, precisely because she felt she could have trust in her, in order to inquire about the possibilities of financial compensation, as well as possible therapy.
Following the initial periods of stabilisation, again, regardless of whether victims were staying at a shelter or had their own accommodation, two significant turning points can be identified, which may be taken as signs that the victim is making a leap forward and is ready for the next phase of the (re)integration process. The first is when a victim begins to think more about the future and less about the past. As noted by one of the psychologists interviewed for this study: So, at the moment when we passed to the group sessions, it is noticed, that they are psycho-emotionally more stable, and they think more about the future, than about the past. . . . After the beneficiary has passed a three-month period in the shelter, and conducted these individual sessions, so you can understand that her psycho-emotional situation is not unstable as before, so it is more stable now, now she tells her story as being a third person, and not as she has been the one that has had this experience. And her concern now is closely related only to the future. (Service provider, Albania, 23 October 2015) It is usually at this moment that possible employment options are discussed with the victim. It is investigated if the woman would like to continue her education or not, what kind of profession she would like, as well as the training she can possibly attend. Again, this would be the case for women who are staying in shelters and for those who are on their own. It should be noted that in many instances where a woman could not find employment, she was hired to do some tasks such as cooking at the shelter itself. However, this was not seen as an ideal situation by the women in particular, as it was never certain how long the shelter would continue to exist.
The second turning point and important leap of progress in the process of (re)integration is the conscious decision to leave the shelter and look for their own, independent accommodation, and obviously, this step is of particular relevance to women who were staying at the shelter following their identification as trafficking victims. However, it is reported that this decision is also accompanied with fears -fears not only about the economic struggles they may face, but also in regard to how society, as well as their own families, would accept them. In certain cases, fear of the trafficker can also be present. In this regard, the support of institutions is again important, as organisations were found to offer payments of rent in certain instances, until the woman finds a job, as well as give small business loans for small start-up enterprises.
Throughout this research, one case was encountered where a woman did not make her own decision to leave the shelter, but to the contrary had become more and more dependent on shelter staff. In this situation, it was precisely this occurrence that prompted service providers to make the decision, in cooperation with the family of origin of the woman, to return the woman to her home. This case, which was observed ten years after the trafficking experience had occurred, was one of a successful and sustainable (re)integration process, primarily due to support from the family of origin, even though clear dependency issues were identified.
From this second turning point of realisation of the need for greater independence onward, once again, the relationship built between victim and service provider becomes relevant and significant. Namely, while service providers did report that some victims simply cut contact and did not want to be followed, thus no follow-up to monitor their progress was conducted, others did reach out with a shift in intensity of contact, as time went by. Service providers reported that women continued contact and communication with them throughout the criminal proceedings against the trafficker, wanting to be informed on the progress with the case or in situations where they were asked to give further testimony. Some women wanted financial assistance or business start-up funds, so again, would contact their service providers. Others simply needed ongoing assistance with orienting themselves through the system, either in regard to jobs, attaining legal personal documents, social assistance, or other official tasks. Others still would simply need someone to talk to, to receive advice, encouragement, or simply confirmation and affirmation of what they are doing. Some would need a check on the decisions they were making, or simply need to share their everyday problems and dilemmas. Service providers noted that in particular, mothers with children would reach out once they gained greater economic independence and ask for assistance in caring for their children: If they have children, they might have problems with children. For the payment of kindergarten, of school, for school materials, for clothing of children, for food, for meat. And to be sincere, for a mother it is very difficult to bring them up, only on the generation of income that she has, from the one job that she has. And even in the case when they might have two jobs, then there is the problem, where to leave the children. They should get a person to care about the children, when they are absent. (Service provider, Albania, 23 October 2015) Overall, what is of particular significance is that women, even years after the trafficking experience, reached out to service providers that they trusted, in cases when they were either facing problems within their newly formed families or had fallen into abusive relationships with a partner. For example, a service provider described a situation of a woman who was clearly considered a success case; she had been a part of the (re)integration programme of the institution, stayed at the shelter, found a job, began to live independently, and eventually found a partner and married. However, her mother-in-law and sister-in-law had found out about her past and began putting pressure on her husband to abandon her. It was at this point that she reached out to her case worker once again and asked that they help her out: And she calls me one night, crying, saying to me, that I need to meet you. I go and meet her, and she was close to my [place] she was standing there, saying I am [unclear] and she tells me that my sister-inlaw is obliging my husband to get divorced from me. And they will come into the centre, and they will ask about me. But please notify the executive director, the former executive director of X [name of assistance organisation omitted], Ms X [name of former director omitted], not to tell about me. I calmed her down, and then she left. I called the executive director and told her about this thing. And after some days her sister-in-law together with her mother-in-law come here in the centre. And they have been received by the executive director, and the executive director told to them that we do not remember this girl at all, it has not been our case. That's why even the prejudice exists in the city. Now, she has even another child, and lives happily with her husband. We say hello to one another. She has two wonderful children. (Service provider, Albania, 23 October 2015) In some reported instances, women simply asked for advice on their romantic relationships: During the time she was here in X [town in Albania omitted], she made the acquaintance of a guy, here in X [town in Albania omitted], but she was afraid to decide about her life. She talked even with us. And I had a coffee with the girl and the guy she had met. Because we were afraid that he might be a trafficker too. But he was a good boy. And to say the truth, I intimidated a bit this guy, because I told to him, that you must be very careful, because this girl is monitored even by police. So, that he was very careful with her. But, that guy, he was very interested in her, and he knew that she was accommodated in the shelter, and he knew that there were girls, even trafficked girls, but he loved her. And when she went to X [city in Albania omitted], he went and met her there, met her family. They got engaged and married, and now they live in X [town in Albania omitted]. (Service provider, Albania, 23 October 2015) However, in other examples, victims reached out to their service providers in situations where they were once again being exploited or in a violent relationship: So, depending on the problem, it has happened that the victim of trafficking, our clients, through the telephone inform us of the current violence they are experiencing from their partners. So, this has nothing to do with human trafficking. There is violence in the family, so the contact with us still helps. We put them in touch with organisations that are dealing with this problem. We also report it. So, we were also in urgent situation, when the violence was happening. So, we had to call the police, and were intervening, we had to inform the centre for social work, etc. So, it really depends on the client. (Service provider, Serbia, 30 October 2014) In conclusion, what seems to be crucial over time as far as the institutional assistance programmes for victims are concerned is that the relationship built with service providers is one based on trust, so that the woman may feel confident enough to reach out in situations of difficulty, but in particular in situations of recurring violence and exploitation.

After the trafficking experience: economic factors
Factors related to the present-day situation of the victim in regard to education, employment, and accommodation also have a significant influence on the (re)integration process. Not having any financial means for survival puts women at risk of being exploited once again.
As has already been noted, some victims of trafficking have only rudimentary education, which one could argue limits their employment options. However, based on the interviews conducted as part of this study, it should be noted that service providers expressed doubt as to the importance of education in these cases. As one interviewee acknowledged: We had a client that we all thought that it's best to go to school. But after the trauma she lived through, she said, it's not even on my mind to go back to school. So, you say to yourself, OK, I will try to understand this decision, I understand. So, when the cases last many years, three, five, you think, OK, I will convince her on the importance of education during this time. But how to do that, in a country where you know that even people who have gone to university, have studied, they still may not have a job, or a person with no education, for whatever reason, may manage to get a job before someone that is educated. So, how do you make a case for education? (Service provider, Serbia, 2 November 2015) One of the interviewees who was a victim of trafficking noted that although she had higher education and had finished university, it was very difficult to find a job based on her educational background. However, what is of particular interest is that although victims may be doubtful with regard to the practical usefulness of their own education, those who had children certainly wanted them to have the opportunity to receive higher education and stated that they would do everything in their power so that their children have a chance to go to university.
Regarding employment, some victims explicitly expressed that the type of job they have does not matter, that they would do any job that gives them some kind of financial security. However, service providers often pointed out that some victims become disappointed by the low financial benefits from jobs they find after trafficking and would rather go back to sex work due to the greater economic returns: There is this stigma about money. The money they used to have, to be able to afford their life. So, now, when they find a job, for 150 dollars a month, they feel offended, they say, what, I used to have 150 dollars for two days. They are used to a different type of life. They forget they are in Albania, and there is a different way of life here. (Service provider, Albania, 25 November 2013) Some women, through the training offered to them by shelters or NGOs, could specialise in a skill that they could then use to find a job. One example that came up often throughout this research was cooking lessons. One of the victims interviewed, whose ideal job was to be a cook, received appropriate training but could not find a job. In this case, she was hired by the shelter to prepare food for the beneficiaries. Of course, as already mentioned, the fear in these situations is that the job is there for as long as the shelter is there, and that is dependent on acquiring external grants and funding.
Finally, it can be said that although employment was mentioned as one of the most important components that lead to successful and sustainable (re)integration, it should be noted that if unemployed, the (re)integration process should certainly not be seen as a failure, but that it just makes the women potentially more vulnerable to exploitative situations in the future. Victims interviewed as part of this research who were at the time unemployed were not in a situation of violence or exploitation, due to a variety of different factors, such as family and institutional assistance.
In conclusion, the impact of education on the (re)integration process needs further study and exploration; however, having employment certainly has a positive impact. Still, unemployment should not be seen as a reason to mark a (re)integration process as a failure.

Personal characteristics, challenges, motivations, and coping
There are some personal characteristics of the trafficked person which may contribute toward a successful (re)integration process. Service providers noted that being smart, having the ability to think, being emotionally developed, open, honest, persistent, consistent, principled, and stubborn were characteristics of women who have been successful in their (re)integration process. It was commented that women should also have the will to change their quality of life, take advantage of the help offered, and fight to continue forward.
However, based on the interviews with women for whom the trafficking experience was recent and the reports from service providers, most women following the trafficking experience report feeling dirty, used, not human, nervous, ugly, lonely, disrespected, and as if they deserved what happened to them: It had to happen, something had to happen to me in life, so that I can value, and examine the little things I have. Because until something happens, people don't realise about what they have in their life, the little things. Something very bad had to happen, I paid a very high price. But, the higher the price, the more you value the little things, you accept the little things, that you have in life. (Trafficked person, Bulgaria, 15 October 2015) Women also reported feeling fear for the well-being of their children and fear of the trafficker from exposure, as well as in relation to the possibility of the same exploitation happening again.
Thus, what are some of the ways in which the personal characteristics of success can be reinforced rather than the negative feelings women experience, in particular fears and selfblame after the trafficking experience? One of the primary motivating factors mentioned, which will be discussed in greater detail in the next section, is family and children. Moreover, women noted that having a job was also of help, as was counselling with professional therapists. Service providers noted that the primary goal of therapy is to make sure that the victim no longer blames herself for what happened, to increase self-esteem, or simply provide release. Another important issue for victims of sex trafficking is loss of trust. Victims interviewed for this study stated that they either trusted nobody, or only trusted a small intimate circle of family and friends. Thus, trust is another issue addressed in therapy, and overcoming trust issues may have a positive influence on the (re)integration process.
Service providers observed that working through the trafficking experience itself with a professional therapist is also important, in particular so that after such therapy sessions, the women can close that element of their life and not think about it any longer, as far as that is possible. This is in fact how one of the women interviewed for this study, with the longest time distance from the trafficking experience, looked upon it at the time of interview. Others noted that they were either too busy to think about it, tried to keep busy so as not to think about it, or fought their urge to think about it. One woman noted that remembering what had happened is always extremely difficult: I don't want to think about the past. Sometimes it comes in my dreams, and I want to strangle myself. Sometimes, I wanted to strangle my own son. But I hope to God he is good and healthy, and I hope I remain healthy too. Now, I am OK, thank God. (Trafficked person, Bosnia Herzegovina, 1 October 2015) In conclusion, women may have some inherent personal characteristics that determine if they manage to recover and (re)integrate successfully. However, following the trafficking experience, and for quite some time afterwards, many women may have a negative self-image. The presence of such feelings should not be considered a determining factor of success or failure of the (re)integration process, as a negative self-image can be improved by means of cognitive-behavioural therapy. Finally, women may have difficulties in fully overcoming what has happened to them, thus, it is important that once they work through the experience and realise they are not to blame, they should not be reminded of the experience nor asked to talk about it against their will.

Social support: family and friends
The influence of the family of origin on the (re)integration process of women has already been discussed in the section covering the background of the woman. However, in addition to the family of origin, what seems to have a significant influence on the (re)integration process are also the families that are formed by the victim, whether prior to the trafficking experience or newly formed families after the trafficking experience. All the women who reported having children stated that they are one of the primary motivating factors for them to do well. Women who were currently separated from their children, as they were recovering in the country of trafficking, voiced their wish to be reunited. Those who were currently with their children but residing in an institutional setting mentioned that being with their child is what brings them happiness.
Furthermore, what received particular emphasis as a significant stabilising factor for trafficking victims was finding a partner, getting married, and forming their own family based on healthy relations.
Then, she got married, she has a child. So, everything ended in a very good way. (Service provider, Bulgaria, 13 October 2015) Many of them we consider them as successful cases the ones that have created their own families. . . . I would define it if she has created a family, a sound family, and if her past it does not constitute a problem for her husband and for the relatives of her husband. (Service provider, Albania, 23 October 2015) Ideally, and most successful (re)integration, when the person that has survived an experience, they enter into the normal flow of life, they find a job, form a family, they have their most intimate family surrounding, a partner, children, and they live some kind of a normal life . . . those cases with foreign victims, girls, that have married. And here, that is the best (re)integration. (Police official, Serbia, 30 October 2014) Finally, one of the trafficked persons interviewed for this study expressed the following wish for the future: In regard to the role of friends in the (re)integration process, women reported that they either had no friends or very few friends, and while some admitted to not being social at all, the one case where the woman reported that she was social, she still perceived that she did not make good friends: I have many acquaintances, no friends. . . . I don't want. I have been burned many times. If someone wants to sit for a coffee, and chat, OK. But I don't have friends. I never got anything good. I've always given a lot, a lot, never gotten anything good in return. Better not to have, than . . . acquaintances, you sit for a coffee, then bye-bye. So that nobody knows what you are doing, what is really happening in your life. People know a lot, and then they become very jealous, they are invasive. Why should I also create these problems for me? I talk to my mom. With her, with her I talk. Also with the children. My children know everything. I don't hide anything. (Trafficked person, Bulgaria, 15 October 2015) In conclusion, the role of children and reunification with children and family following a trafficking experience where the members of the family were not involved in the trafficking experience has a significant, positive influence on the (re)integration of women. However, based on information presented by service providers as well as on wishes expressed by victims themselves, what seems to be seen as an ultimate goal of the (re)integration process, and the most significant stabilising factor in the long run, is finding a trustworthy partner, marriage, and the formation of a new family based on healthy relationships.

Discussion
A variety of factors that influence the (re)integration process was explored in this article: (1) the background of the individual, (2) the trafficking experience -who the trafficker was and its severity, (3) the role of institutions, NGOs, and service providers, (4) economic factors, (5) the personal characteristics, challenges, motivations, and coping mechanisms of the victim, and finally (6) social support. Identifying the relevance of economic factors is commonplace in research focusing on (re)integration following a trafficking experience (Surtees, 2010(Surtees, , 2013Sharma 2015). In regard to social factors, although complex issues of reunification with children have been outlined by other researchers (Brunovskis and Surtees, 2013), in all cases in this research, children were a positive, motivating factor and the women did not delve deeper into the complexities of these relationships. The reason may be that the questionnaire did not go deeper into this issue. But it may also be that, for some of the victims, the children were still very young and not aware of what the mother was going through. Motivation throughout the (re)integration process (and as already noted in the context of this study, children were often mentioned as one of the primary motivating factors for victims) has also been identified as a relevant factor for (re)integration in other research (Surtees, 2010). However, the importance of the trafficking experience, in particular the exploration of how its longevity versus severity may influence (re)integration, which has been discussed in this article, has not been dealt with in other work to the best knowledge of the researchers.
The identified factors that influence the (re)integration process can be categorised based on the ecological model of sexual assault recovery (Neville and Heppner, 1999), at the micro, meso, and macro levels. Within this model, the meso system consists of factors related to building and rebuilding social relations (family of origin, newly formed families, and friends) as well as institutional factors (support from NGOs, government and other institutions, as well as factors influencing the formation of relationships with service providers). Economic factors mostly belong to the meso level. Some factors that are related to the background of the individual (the wish to migrate, the background economic situation, and educational and family background) belong to the micro level of the ecological environment. All personal characteristics (challenges, motivations, coping) as well as all factors related to the trafficking experience (means of trafficking, the identity of the trafficker, the severity of the trafficking experience) belong to the micro level of the ecological environment. As with the elements of (re)integration, some influencing factors from the area of economic well-being as well as some elements of the background of the individual (belonging to a specific social group) belong to the macro level of the ecological model. The general economic situation of the country in which the survivor resides will determine some aspects of her economic functioning, regardless of her own role within that context. However, overall, two factors can be highlighted as being particularly important for long-term recovery and (re)integration: building healthy social relationships and, relatedly, rebuilding the ability to trust others. Both are discussed in greater detail in the next section.

The importance of forming healthy social relationships
Having outlined all of the influencing factors found through the course of this study, a few conclusions can be drawn regarding the relative importance of each. The background of the individual is significant in as much as it means that the victim may or may not have a social support system in place. It may also have an impact on the ability of the person to form healthy relationships in the future. The trafficking experience may have a significant influence on the (re)integration process, particularly in regard to the physical and mental recovery of the victim. And the feelings the victim has toward herself may have a significant influence on the recovery aspects of the (re)integration process. However, all of the issues noted can be dealt with in the initial interventions through health assistance, as well as therapy. Pursuits of the victim that have to do with economic aspects of her life may be positive influencing factors, if they are driven by the autonomous decision-making of the victim. What seems to underline and supersede all of the above are the social factors -relationships built with service providers, relationships rebuilt with existing family members, or relationships built with new families that were established after the trafficking experience. As long as a relationship based on trust is built with service providers, challenges -economic or psychological -that may arise in the future may be dealt with in a way that keeps the woman out of potentially exploitative situations if she feels she can come to the service provider for help. Along the same lines, if a support system based on healthy relationships is in place in the form of a family (whether the one of origin, one formed before the trafficking experience, or one that is formed following the trafficking experience), most challenges can be dealt with in such a way as to not endanger the victim again.
As already noted in the literature review of this article, other scholars have dealt with the role of the family in the (re)integration process of trafficking victims and its potential positive or negative influences (Surtees, 2010(Surtees, , 2013Brunovskis and Surtees, 2013). However, what existing research seems to focus on is the different challenges that family reconciliation poses. What comes out of this current research is that when exhibiting positive influence, such as the situations where the family has understanding for what the victim went through or when the victim has the capacity to form a new family, based on healthy relationships, that positive influence seems to be the most significant factor leading to successful and sustainable (re)integration. Of particular note is the creation of new families after the trafficking experience, an aspect that has not been explored in depth. The significance of these new families can be seen here through the focus of service providers on the importance of marriage. At first sight, it may seem that service providers are promoting for these women a replacement of one situation of dependence with another. However, the researchers believe this is not how service providers see 'marriage' for trafficking victims. To understand what a new, healthy 'marriage' means in the context of (re)integration of trafficking victims, a reference to literature on the 'need to belong' and self-determination theory (SDT) is necessary.
The belongingness hypothesis states that 'human beings have a pervasive drive to form and maintain at least a minimum quantity of lasting, positive, and significant interpersonal relationships' (Baumeister and Leary, 1995: 497). According to Baumeister and Leary, the two main conditions of a relationship that must be satisfied for it to fulfil the belongingness need is that contact between the persons involved is frequent and that the bond itself is stable and based on mutual care. They further explored such relationships and came to some conclusions that are of relevance for this study. Namely, such bonds can be created in adverse conditions, that is, in situations where people live through a crisis together. Once formed, there is an innate resistance to breaking such bonds. Finally, such bonds create positive emotions, while the deprivation from such bonds may bring about pathological consequences, such as mental and physical illnesses (Baumeister and Leary, 1995;Leary and Allen, 2011). All of the above are just some aspects of the need to belong that position it as a fundamental social motive, which should explain much of human behaviour (Leary and Cox, 2008).
Having said that, given that for a relationship to fulfil the belongingness need it must include frequent contact between the two parties and be based on stability and care, the discussion inevitably leads to the issue of marriage. Marriage in this context is seen as a positive turning point, when a bond receives a permanent status (Baumeister and Leary, 1995). Thus, marriage becomes 'an institutional means of satisfying the desire for acceptance by offering a sanctioned way to promote long-term belongingness' (Leary and Cox, 2008: 35). Further on, the inclination to marry, even if seen as an attempt to conform to societal expectations, in addition to being a way of solidifying the longevity of a caring bond, may not be seen as a loss of autonomy, but in this case, conformity may be natural and adaptive in the pursuit of acceptance from others, and thus satisfaction of the most basic social need to belong (Leary and Cox, 2008).
The issue of trust and its importance has been explored by other scholars as well (Walsh et al., 1999;Koser and Pinkerton, 2002;Brunovskis and Surtees, 2012). However, previous studies have focused more on the trust persons have in the information they receive from service providers, or on the importance of establishing trust between service provider and victim, so that the victim accepts assistance. This research places emphasis on the importance of trust between a beneficiary and the service provider, and the significance of building strong personal relationships because of what that would mean for future (re)integration efforts. The establishment of a more personal relationship based on mutual trust is the key for the (re)integration process and its sustainability in the future. Service providers, in particular case workers and social workers, are among the first to face the victim after identification as a trafficked person. This contact is crucial. If the victim gets the impression that they can trust the service provider, they will ask for help, not only in the initial (re)integration period, but also later on. It may be that in the future life the victim builds, she decides not to share her past experiences with her new family. Thus, in this regard, the service provider remains as a contact that knows her entire story, that she may talk to about anything, at any time. Brunovskis and Surtees (2012) talk about the importance of the 'monitoring' phase of the (re)integration process and how it can be very helpful but is not always feasible that a service provider closely follows the progress the victims make after they exit the phase of services offered by their assistance organisations. However, monitoring becomes unnecessary in certain cases if the woman feels she herself can turn to the service provider in a time of need, rather than being tracked down and observed by the service provider on a regular basis. It has been found that monitoring is in many cases too costly for the service organisation, and in others, the victim does wish to cut ties with these organisations. Thus, establishing a relationship built on trust, where the victim can always herself refer to her case worker in times of need, may make monitoring beyond a few years unnecessary.

Limitations and implications
Having reviewed the primary findings of this research, some of the limitations should also be discussed. The primary limitation of this research is the small number of victims who have been interviewed and, within this group, the lack of examples of women who have been primarily financially exploited and have chosen to return to sex work, following a trafficking experience. However, it should be noted that this group is difficult to access and would require methods that were beyond the scope of this study. In addition, it should be said that service providers are also very knowledgeable and more willing to openly share their experiences (although their views may not reflect those of the women). This study has taken advantage of this knowledge in particular, thus also minimising the negative impact on the victim themselves that may be caused by discussing the trafficking experience. Finally, a strength of this article is that it has tried to identify some factors that may influence (re)integration in the long run -a topic that has not been studied thoroughly so far. Trust built between service providers and victims, as an important asset in sustaining the (re)integration process in the long run, is one of those factors.

Future directions
This article stemmed from the identified need to look at what factors influence the (re)integration process in practice, the overall dynamics of the (re)integration process, and the need to distinguish the more important from the less important factors, influencing (re)integration not just immediately after the trafficking experience, but also several years down the line. Studies focusing on the short-term (re)integration processes identify the importance of trust established between victim and service provider (Brunovskis and Surtees, 2012). However, what would be useful going forward is trying to explore what the relationship built on this trust may imply for the future. The importance of families and the importance of rebuilding intimate relationships with spouses from before the trafficking experience have been studied previously (Brunovskis and Surtees, 2013). However, more focus must be placed on the role of newly established relationships and families formed following a trafficking experience and their importance for the (re)integration process in the long run.
Thus, there are significant policy implications based on the results of this current research. It has been found that one of the primary factors that may have a positive influence on the (re)integration process of victims in the long run is the trust built between service providers and victims, during their very first interactions. With this in mind, training that would teach service providers how to best build this trust from the first moments of interaction would be greatly beneficial. However, what also warrants attention is emphasis on building long-lasting relationships between service providers and victims. Such relationships would ensure access to services and help for the victims not just immediately following a trafficking experience, but also several years after, thus lowering the chances of recurring exploitation.
One additional policy implication should be the importance to be placed on building new, healthy relationships after the trafficking experience. It may be that this issue is tackled between victim and therapist, but perhaps there can also be other ways in which to ensure that women have the capacity to establish new and healthy bonds. For instance, the establishment of a relationship built on trust with a service provider as the first person of contact after the trafficking experience may contribute toward building other healthy social relationships in the future.
Finally, based on this research, friendships seem to have a small role in the (re)integration process. The reason could be that victims have persistent trust issues and still face difficulties forming relationships outside of family or outside of the circle of service providers who are aware of their past experiences. What does this mean for the (re)integration process in the long run? Is it significant? Or is it the case that research failed to capture individuals for whom friends may play an important role in their (re)integration? These questions may be reasons for further exploration of the role of friendships in the (re)integration process of trafficked persons.