Introduction

Human trafficking, including sex trafficking, is characterized by the coercive exploitation of individuals for commercial sex or forced labour, often through fraud, deception, or violence [1]. It is a grave human rights violation and an enduring global public health crisis. As the second largest and most rapidly expanding illicit enterprise, it victimizes millions worldwide [2]. Structural inequities, socio-economic vulnerabilities, and transnational migration patterns shape this phenomenon. The Asia-Pacific region harbours an estimated 29.3 million individuals subjected to modern slavery, including forced labour, forced marriage, and sexual exploitation, rendering it one of the most affected global regions [3].

Individuals who experienced sex trafficking frequently encounter significant disruptions in occupational participation, which encompass difficulties in securing stable employment or engaging in meaningful social interactions [4]. A trauma-informed, client-centred approach is paramount when addressing the rehabilitation needs of trafficking survivors, given their heightened risk for post-traumatic stress disorder (PTSD), depression, anxiety, and other psychological comorbidities [5]. Moving forward with this study, individuals who experienced sex trafficking will be referred to as survivors, which is a term that is empowering and highlights resilience.

As articulated by Townsend and Wilcock [6], occupational justice emphasizes an individual’s intrinsic right to access and engage in meaningful occupations that support their autonomy and well-being. By embedding the principles of occupational justice into survivor-centred care models, occupational therapy practitioners may deliver individualized therapeutic interventions to enhance long-term recovery outcomes. At the same time, critiques of occupational justice have highlighted that its focus often leans towards occupations associated with health and productivity, while overlooking those considered socially unacceptable or unhealthy [7]. Additionally, the unclear definition sometimes makes it challenging for therapists to apply it consistently in practice [7]. Recognizing these limitations helps inform more inclusive and adaptable frameworks when working with populations facing complex and stigmatized experiences, such as survivors of sex trafficking.

Many survivors experience social isolation, compounded by stigma and a pervasive distrust of institutional systems [8]. Occupational therapy led community-based rehabilitation, including peer support networks, structured group activities, and social skills training, may be vital for fostering relational trust and enhancing survivors’ sense of belonging within the broader ecosystem. Integrating occupational therapy into the survivor rehabilitation paradigm remains an emerging domain [9]. While some occupational therapists apply integrative, evidence-based methods to address the complex challenges faced by trafficking survivors, such efforts remain limited [9].

Also, to fully understand how the literature describes our role in broader contexts, we need a framework that accounts for multiple, interacting systems. Bronfenbrenner’s Social Ecological Model (SEM) provides that structure [10]. It helps us to understand how layers of environment influence therapeutic outcomes. Therefore, using the SEM, we described the specific aims of this study as: 1. To delineate and classify intervention strategies employed by occupational therapists in addressing the rehabilitation needs of sex trafficking survivors, 2. To identify research gaps and propose directions for future investigations in occupational therapy-based rehabilitation for trafficking survivors, and 3. To explore the roles of and challenges faced by occupational therapy in optimizing survivor support and recommendations. This review contributes to the scholarly discourse on trauma-informed rehabilitation by mapping current evidence for occupational therapy practitioners and researchers engaged in survivor advocacy.

Methods

This scoping review followed the methodological framework proposed by Arksey and O’Malley [11], with enhancements by Levac et al. [12]. A scoping review was chosen to explore the extent and nature of existing literature, clarify key concepts, identify the available evidence types, and map knowledge gaps [11,12]. The review process included key stages: identifying the research question, relevant studies, study selection, data charting, collating, summarizing, and reporting the results. The review reporting was guided by the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist to ensure transparency and rigour. The guiding research question was ‘What is the role of occupational therapy in the rehabilitation of survivors of sex trafficking, and what key themes and gaps exist within this literature?’

Search strategy

A comprehensive search strategy was developed and conducted across four databases: CINAHL (EBSCOhost), PubMed (NCBI), SCOPUS (Elsevier), and Web of Science (Clarivate), to ensure breadth and depth, grey literature was sourced through CORE, OpenGrey, World Health Organization – Institutional Repository for Information Sharing (IRIS), TROVE (NLA), and relevant organizational websites such as the World Federation of Occupational Therapists. All retrieved records were imported into Mendeley Reference Manager (Elsevier, v2.131.0) [13]. The search was conducted in March 2025, and reference lists from included studies were screened for additional sources.

Two keywords were used for the search strategy: ‘occupational therapy’ and ‘human trafficking’. Variations and words related to these were also used to expand the search. See an example of a search result using the terms and their variations in Appendix 1. This review considered qualitative, quantitative, mixed-method studies, case studies, conference abstracts, book chapters, doctoral theses, and dissertations published in English from January 2000 to March 2025. Non-academic websites, opinion pieces, and social media content were excluded.

Study selection

After searching various databases, the studies underwent title and abstract screening independently by the first four authors (AAJ, AS, NET, PDL). Following this, the same reviewers conducted a full-text review, and the fifth author (RCDR) was consulted when discrepancies arose in the selection process. All authors provided explicit agreement on which studies to include. To maintain confidentiality, no identifying details of individual authors or institutions were disclosed, and findings were reported in aggregate without attribution to specific sources.

Moreover, the whole team set up an inclusion and exclusion criterion to select appropriate studies that fit the review (Table 1). Articles were included when the population focused on survivors of sex trafficking (any age, gender, or nationality) and discussed in relation to occupational therapy.

Table 1 Inclusion and exclusion criteria.
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Data extraction and analysis

Data were extracted using Microsoft Excel. Information included publication details, study design, population, intervention type, context, and key findings. Four reviewers independently extracted data and met fortnightly with the broader research team to compare, contrast, and validate the findings. The data were analysed through a descriptive synthesis. A thematic analysis approach was applied to identify patterns in intervention strategies, target outcomes, populations, and conceptual frameworks. This process was guided by the Arksey and O’Malley [11] framework and enhanced by Levac et al.’s [12] recommendations for analytical depth.

Ethical considerations and positionality

This study analysed existing published data, which is publicly available. The study was reviewed and approved by the corresponding author’s departmental research committee and registered online on the Open Science Framework (OSF) [14]. The authors approach this work with professional and personal commitments to equity, inclusion, and trauma-informed care. The corresponding author is an occupational therapist and doctoral researcher with clinical experience in neurorehabilitation and a research focus on the intersection of occupational therapy, gender, and sexuality. Co-authors are occupational therapy educators and/or clinicians with expertise in community-based practice, mental health, and neurorehabilitation, including work with gender and sexual minority (GSM) groups and individuals affected by complex trauma or occupational injustices. While none of us are directly working within the field of human trafficking, as occupational therapists, we recognize how we are well-positioned to identify trauma, provide person-centred care, and support survivors of human trafficking.

Results

We identified 16 relevant occupational therapy-focused studies addressing the rehabilitation of sex‐trafficking survivors (Figure 1). Of the 16 included studies, most (N = 11) were conducted in the United States, while three did not specify the region. Single studies were reported from Chile and Canada, and one study described findings across global regions (Table 2). The following sections report the findings for each aim using Bronfenbrenner’s SEM as described earlier:

Figure 1
Figure 1
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PRISMA 2020 flow diagram.

Table 2 Matrix of included studies.
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Aim 1: Delineate and classify occupational therapy interventions

Microsystem

At the microsystem level, which encompasses survivors’ immediate experiences and therapist–client interactions, Studies described occupation-based, trauma-informed interventions [0015–0019]. For example, Cerny et al. [15] reported on a 12-week group program for six women in a shelter; by follow-up all participants showed significant gains in self-rated performance and satisfaction on prioritized occupations. Mangum et al. [16] implemented an 8-month, occupation-based executive function training with eight trafficked women, significantly improving task performance. Both interventions used client-centred, goal-directed activities (e.g. life skills practice, problem-solving tasks) to build competence and confidence. Ecklund et al. [17] noted that women exiting sex work faced social, emotional and physical challenges that disrupted daily routines; they highlighted occupational therapy’s role in providing services that help promote engagement in meaningful occupations. Mangum et al. [16] included occupation-based group sessions on routines, goal setting, and social skills training on communication. Boyanapalli [18] recommends that occupational therapists use cognitive-behavioural techniques and models like the Person-Environment–Occupation (PEO) and Recovery Models when working with trafficking survivors. Some interventions connected survivors with peers or survivor-mentors, fostering trust and social support [18,19]. Practical life management interventions often targeted financial literacy, sleep hygiene, leisure planning, and self-care. For instance, Wangberg and Cerny [19] utilized the Canadian Occupational Performance Measure (COPM) to document survivors’ self-identified occupational problems; the most frequently reported areas were social/emotional health, leisure participation, sleep, and financial management. To summarize, occupational therapy intervention strategies at the microsystem level were typically multi-component and occupation-centred. The content of interventions varied across studies, but most programs were tailored to survivors’ trauma histories and consistently emphasized trauma-informed, client-driven approaches and aimed to restore survivors’ routine and meaningful roles [0015–0019].

Mesosystem

At this level, links between survivors’ immediate contexts (family, community, service providers) are explored, and key themes were practitioner training and interdisciplinary collaboration. Boyanapalli [18] recommends that occupational therapy practitioners work alongside social workers, legal advocates, and public health staff to address the complex needs of survivors. They noted that occupational therapists must be prepared and call for enhanced education by creating opportunities for students to be involved in government- or NGO-run programs for the welfare of survivors and overall trafficking prevention measures [18]. In a cross-sectional survey and qualitative feedback, Bekmuratova et al. [20] found that occupational therapy doctoral students (N = 67) had limited knowledge and self-efficacy in assisting survivors of human trafficking; however, they could recognize the need for us to identify potential signs, ways to assess, recognize the triggers and de-escalate those during practice. Similarly, Hill et al. [21] implemented a human trafficking awareness module for college students (N = 200) and reported a 58.6% gain in awareness of human trafficking risk factors among them. In summary, studies called for more training on trafficking, outlined collaboration with other fields across the community and service mesosystem, including outreach, prevention, co-treatment, and advocacy [18,20,21].

Aim 2: Identifying research gaps and future directions

A few studies highlighted barriers within service systems [0020–0022]. Survivors had fragmented care pathways, and therapists noted difficulty in navigating referrals. For instance, Cerny [20] noted that occupational therapy can help address the needs of survivors by addressing both intrinsic and extrinsic barriers in their environments. However, the occupational therapist’s role remains under-recognized at institutional levels. Gorman and Hatkevich [8] agreed, observing that despite traffickers causing extensive trauma, the current role of occupational therapy in anti-trafficking networks is minimal and unexplored. They called for advocacy to embed occupational therapy in broader service models.

Chronosystem

The chronosystem captures changes and trends over time. The literature shows a growing emphasis on education and prevention in recent years. As noted, investigators are increasingly developing curricula and training interventions [20,21] and evaluating their impact. This shift suggests that the profession is moving from purely reactive models (treating already recruited survivors) towards preventive and systemic strategies (educating youth, communities, and peers). New conceptual themes have also emerged over time. If you examine early occupational therapy writing (pre-2015), which focused on individual-level therapy, by 2018–2023, the conversation will have expanded to include occupational justice and intersectionality. For example, George & Stanley’s analysis [22] indicates a trajectory towards framing trafficking as a human-rights issue. The introduction of trauma-informed care as a standard in all intervention reports is another trend; virtually every recent program described explicitly integrated trauma-sensitive principles, reflecting broader healthcare shifts. Finally, while the timespan of studies was short, a subtle pattern is that our profession’s involvement with trafficking survivors is increasing. A few years ago, the only mentions were in concept papers; by March 2025, several empirical studies and program evaluations had been published [0015–0022]. This upward trend addresses our second aim by identifying a research gap that is beginning to close but needs more work.

In summary, the temporal perspective reveals that occupational therapy for trafficking survivors is an evolving field: educational programs and broader social analyses are nascent trends, but rigorous outcome studies remain sparse. These emerging patterns suggest opportunities for future research, such as longitudinal follow-up studies. There is limited research from the Global South, which restricts our understanding of context-specific challenges and intervention strategies.

Aim 3: Roles, challenges, and policy impact

Exosystem

It encompasses larger institutions and policies that indirectly affect survivors. Cerny [23] emphasized that occupational therapy could help to dismantle extrinsic barriers by working within criminal justice, housing, and healthcare systems. However, these authors noted that occupational therapy is rarely included in current anti-trafficking policies. For example, the U.S. Federal Strategic Action Plan for Human Trafficking [24] makes almost no mention of occupational therapy; observers, such as Cerny et al. [23], thus argue that occupational therapists’ potential contributions are absent from the national strategy or task force.

Additionally, recent policy documents, such as the National Action Plan to Combat Human Trafficking, further underscore the omission of occupational therapy within current frameworks and the need for integration at the policy level [25]. Another frequent theme was fragmented referrals. Studies described how survivors fall through the cracks: immediate shelter and medical needs may be met, but disjointed services hinder long-term recovery. Gorman and Hatkevich [7] explicitly stated that although survivors require the services of several providers within the rehabilitation team, their role in coordinating this care remains unexplored. They urge occupational therapy practitioners to be more active in advocacy. Similarly, Bekmuratova et al. [20] noted a need for formal occupational therapy-led program development to help survivors transition back into communities. Interventions should not be isolated. Boyanapalli [18] emphasized the importance of collaborating across organizations, utilizing research-backed methods that community agencies can adopt and adapt. No included study reported on policy outcomes directly; however, the literature suggests limited institutional support. These findings thus underscore the need for broader system-level advocacy and reforms to support the rehabilitative role of occupational therapy.

Macrosystem

At the macrosystem level, we tried to consider cultural norms, social attitudes, and large-scale trends. The overarching message from several studies is that human trafficking is a violation of fundamental occupational rights, reflecting deep societal injustices. For instance, George and Stanley [22] used case studies to argue that across cultures trafficked people suffer forced occupation and a lack of meaningful occupation, leading to chronic health harm. They characterized trafficking as not merely an individual trauma but a collective social injustice; a view that situates survivors’ needs within the context of human rights and public policy. Similarly, Álvarez Franco et al. [26] applied an intersectionality lens to a case study of a transgender sex worker. Their narrative vividly illustrates macro-level oppression. The authors concluded that economic, political, and heteronormative systems create an occupational apartheid, pushing vulnerable people into exploitation. Overall, macrosystem findings emphasize that trafficking is embedded in broad socio-political contexts [0022–0026]. While occupational therapists work on individual skills, these studies remind us that laws, culture, and policy also shape survivors’ rehabilitation. Acknowledging these influences was part of answering our third aim, as it clarifies why interdisciplinary advocacy (e.g. for legal reform, housing policy) is an essential role for occupational therapy in these larger systems.

Discussion

This scoping review set out to examine how occupational therapy has started to respond to the complex, multilayered needs of survivors of sex trafficking. Drawing from 16 studies and organizing the findings within Bronfenbrenner’s ecological framework, our review offers a panoramic view of the structural, interpersonal, and individual dynamics in occupational therapy-based survivor support. The review also maps emerging directions in research and practice while underscoring gaps in evidence, implementation, and contextual understanding.

Using Bronfenbrenner’s ecological systems, organizing the discussion allowed us to understand how occupational therapy interventions and barriers operate across different layers of survivors’ environments. This approach also reflects how the profession’s work is currently concentrated at the micro level, with fewer contributions at broader systemic levels, a point highlighted by the limited results corresponding to aims two and three [0015–0025].

At the microsystem level, most included studies emphasized individualized interventions grounded in trauma-informed care [0015–0019]. Survivors engaged in activities targeting daily living skills, executive functioning, and sensory integration; all crucial for restoring a sense of agency and self-regulation [0015–0017]. As highlighted in the Call to Freedom program [24], the profession’s focus on occupation as a pathway to meaning-making aligns closely with survivors’ need for empowerment after prolonged coercion and trauma. Interventions such as trauma-informed sensory modulation, Model of Human Occupation (MOHO)-based assessments, and peer-led group sessions surfaced as practical tools, yet their application varied considerably across settings. These interventions remain rooted in therapeutic strategies that help individuals rebuild disrupted routines and mental health following trauma [0015–0019]. Due to sparse representation from the most affected global south, the applicability of these frameworks in those contexts remains unexplored with respect to trafficking survivors.

The mesosystem findings revealed both promise and limitations. Interprofessional collaboration was recognized as critical, but only a subset of studies [17,18,24] explicitly addressed how occupational therapy interfaces with legal, housing, or deaddiction services. This limited integration may reflect broader system fragmentation, a concern repeatedly flagged by survivors and practitioners alike [24,25]. Programs like ‘Call to Freedom’ are strong models that embed occupational therapy within multidisciplinary teams, including case managers, deaddiction specialists, and peer navigators [3,24,29]. While some interventions incorporated survivor voices into program design, suggesting emerging co-production models [0019–0021], most efforts lacked systematic coordination. This suggests an opportunity to strengthen our role in facilitating seamless partnerships across sectors, thereby enhancing care.

At the exosystem, policies and organizational structures emerged as barriers and opportunities. Trauma-informed care was a dominant approach in many interventions, but few studies discussed how institutions supported or limited this work structurally. For example, Mangum et al. [16] and Teske et al. [27] highlighted gaps in occupational therapy education and institutional preparedness. Many programs lacked dedicated training on trafficking-specific interventions, resulting in hesitancy or uncertainty among students and practitioners [20,21,28]. While broader social determinants of health (SDOH), advocacy, and systemic supports may be addressed outside the scope of the included studies, their limited presence within these interventions reflects a need for greater institutional backing [0019–0028]. The lack of sustainable funding, formal protocols, and structured collaborations may have contributed to inconsistent service delivery, pointing to critical areas for future investment and education.

The macrosystem captured cultural beliefs and structural inequalities, further complicating survivor care. We noticed that stigma, criminalization, and racialised narratives about survivors significantly shaped service design and delivery [26]. Survivors from indigenous or migrant backgrounds faced unique occupational injustices due to compounded marginalization [22,26]. These findings align with the broader human rights framework presented in Edwards et al. [29], who emphasize decriminalization and survivor agency as crucial to providing meaningful care. Profession’s role in advocating for survivors’ rights and integrating cultural considerations into practice remains an underdeveloped yet essential component [26,29]. We suggest that occupational therapists may work towards reducing systemic barriers and enhancing equity in care delivery by fostering culturally responsive and justice-oriented frameworks.

The chronosystem gave a bird’s-eye view. Longitudinal engagement is critical for building trust and supporting survivor transformation, yet only a few studies tracked outcomes beyond short-term intervention windows [16,0019–0022]. This gap may echo broader concerns in the literature regarding attrition, inconsistent data collection, and survivor readiness for sustained participation [0030–0032]. Capturing long-term outcomes is essential to understanding how survivors maintain progress and integrate new skills over time [33,34]. Without such follow-up, early improvements risk being short-lived, and therapists are left without guidance on how to adapt care across recovery phases.

The following key themes surfaced across these ecological levels [0019–0022,33,34]: 1. Intervention strategies were rich but sparse and unevenly distributed. While trauma-informed care and occupation-centred tools are well represented, their implementation varies widely 2. Practitioner readiness remains underdeveloped. Inclusion of survivors in program design sounds promising, but it is not yet widespread. Interprofessional collaboration is nascent. Survivors’ complex needs require integrated services; however, no study has described operational pathways connecting occupational therapists with legal, housing, or vocational assistance. Geographic concentration and methodological limitations constrain generalisability.

Limitations

  • As a scoping review, this study aimed to map the breadth of available literature rather than evaluate quality or effectiveness, which limits our ability to draw definitive conclusions.

  • We restricted our inclusion to English-language studies, potentially omitting valuable insights from non-English-speaking regions where trafficking is highly prevalent.

  • Additionally, while 16 studies were included, some had limited methodological detail or lacked outcome data, constraining synthesis across interventions.

  • We applied the ecological model to analyse the findings, but the limited number of included studies constrains the depth and breadth of interpretation, particularly concerning aims 2 and 3. Therefore, the insights presented should be viewed as preliminary.

Implications for occupational therapy

Future studies should prioritize longitudinal, mixed-method designs that centre survivor narratives and measure occupational outcomes over time. More work is needed to explore the intersections of occupational therapy with legal aid, economic empowerment, and systemic advocacy, as these linkages have been largely unexplored in the reviewed literature. Developing global, culturally appropriate guidelines for professional practice in trafficking contexts, grounded in both empirical data and survivor input, is essential. Remember ‘Nothing about us without us’. Likewise, the lack of trafficking-specific content within occupational therapy education is indicative of the requirement for an updated curriculum. We acknowledge that it may not be feasible to incorporate every facet of human experience into a curriculum. However, students must be exposed to different ways in which human rights can be violated. This learning would enable students to explore more specific topics, such as human trafficking, with the benefit of utilizing comprehensive resources developed collaboratively with survivor communities and shared through organizations and institutions.

Conclusion

Occupational therapy has tools and frameworks to support holistic recovery for sex trafficking survivors, but the profession must step into this space more intentionally. As a discipline that is unique due to its focus on the restorative and therapeutic nature of everyday activities, our expertise is vital for a population whose everyday life and sense of identity/roles within their community have been systematically dismantled. With trauma-informed practice as a starting point, the profession must expand its reach through interdisciplinary collaboration, cultural humility, and survivor leadership. In doing so, it can help rebuild the everyday rhythms and routines that trafficking seeks to destroy.

Appendix 1. Search strategies and results

Table 3
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