Exploring the Effectiveness of Diversion Programs for Women Involved in Commercial Sex: A Comparison of Sex-Trafficked and Non-Trafficked Individuals

Abstract

Diversion programs are increasingly used as alternatives to criminal penalties for women involved in commercial sex, yet limited research has examined how such programs support behavior change across diverse subgroups, particularly between sex-trafficked and non-trafficked participants. This study evaluates changes in readiness for change among 131 women who participated in a court-ordered diversion program led by survivors of sex trafficking. Participants were classified as sex-trafficked or non-trafficked based on self-reported age of entry and experiences of third-party control. The program offered a range of trauma-informed services aimed at fostering holistic well-being and facilitating a pathway out of sex trafficking and prostitution. Participants engaged in group classes focused on job interview skills, emotion regulation, substance use awareness, and psychoeducation related to trauma. Life skills workshops addressed financial literacy, relationship dynamics, and conflict resolution. In addition, participants received referrals to GED programs, career training, mental health services, and emergency housing as needed. Program duration typically ranged from 12 to 16 weeks, adjusted for individual needs. Results from a repeated-measures Analysis of Variance (ANOVA) revealed a significant increase in readiness for change (p < 0.05) from program entry to completion. However, women with trafficking histories demonstrated smaller gains than their non-trafficked peers, suggesting that trauma-related and systemic barriers may limit the impact of short-term interventions. These findings underscore the importance of tailoring diversion programs to address the complex needs of sex-trafficked individuals and support the development of differentiated trauma-responsive strategies within diversion frameworks.

1. Introduction

Sex trafficking, often referred to as a contemporary form of slavery, has emerged as one of the most pressing global issues in the realms of human rights, public health, and social justice (Zimmerman and Kiss 2017). In general terms, it involves the exploitation of people—especially women and minors—for the purpose of commercial sex, achieved through methods such as force, deception, or coercion (Ngwe and Elechi 2012). Although lawmakers and advocacy organizations have implemented robust measures to combat this crisis—including the adoption of international frameworks such as the United Nations Protocol to Prevent, Suppress and Punish Trafficking in Persons (Bingaman 2024; Worden 2018; Wright 2021) and national legislation like the U.S. Trafficking Victims Protection Act (Tiefenbrun 2004)—the global prevalence of sex trafficking continues to reach alarming levels (Goździak and Vogel 2020).

Experts and frontline professionals identify several interrelated factors that contribute to the persistence of this issue. Among the most prominent are widespread poverty, systemic gender inequalities, and socio-political instability, all of which create conditions that leave vulnerable individuals at greater risk of exploitation (O’Brien et al. 2013). Furthermore, the persistent demand for commercial sex fuels a market that provides traffickers with financial incentives to exploit individuals for profit (Connell 2012; O’Brien et al. 2013). These underlying factors frequently intersect and reinforce one another, making it challenging for existing laws and policies to completely eliminate sex trafficking (Naik 2018). Consequently, scholars and practitioners argue that an integrated approach—encompassing economic, legal, social, and cultural strategies—is essential to effectively reduce and ultimately eradicate this form of modern slavery (Khowaja et al. 2012). Additionally, poverty, gender inequality, and limited employment opportunities serve as critical “push” factors that heighten individuals’ vulnerability to trafficking (O’Brien et al. 2013).

In addition to widespread concerns about trafficking, there has been growing attention to women working in the commercial sex industry who do not strictly fit the legal definition of being trafficked. Even though they may not be officially classified as trafficking victims, these women often face considerable risks to their physical health, psychological well-being, and social standing within their communities (Simkhada et al. 2018). In other words, being labeled as either ‘trafficked’ or ‘non-trafficked’ does not shield them from the harmful consequences of the sex trade. Many continue to struggle with a range of challenges, such as exposure to infectious diseases, financial instability, and social stigma or marginalization (Antwi et al. 2023). Additionally, psychiatric morbidity among women in the sex industry is alarmingly high, with many facing major depressive episodes, PTSD, substance abuse, and anxiety disorders (Iaisuklang and Ali 2017). These challenges highlight the need for a broader approach to addressing the vulnerabilities of all individuals involved in the commercial sex industry, regardless of their legal classification.

To overcome these obstacles, diversion initiatives have been implemented as a substitute for conventional criminal prosecution and penalties. These programs seek to address the underlying factors that push individuals into the commercial sex trade, including prior trauma, addiction, restricted job opportunities, and wider socioeconomic hardships (Beaujolais and Dillard 2020; Hickle and Roe-Sepowitz 2017). Instead of imposing legal penalties, diversion programs focus on therapeutic support, counseling, and life skills training to promote long-term stability (Koegler et al. 2020; Roe-Sepowitz et al. 2014b). By prioritizing rehabilitation over punishment, these programs strive to reduce recidivism in commercial sex exchange and support participants in rebuilding their lives (Lindquist-Grantz et al. 2021; Magaña et al. 2022). While they have demonstrated potential, challenges persist in maximizing their effectiveness and overcoming barriers to lasting reintegration (Beaujolais and Dillard 2020; Koegler et al. 2020; Lindquist-Grantz et al. 2021; Magaña et al. 2022).

A key element in diversion programs is the concept of ‘readiness for change’. Rooted in the Transtheoretical Model (Prochaska and DiClemente 1983; Prochaska et al. 1992; Gonzalez et al. 2019; Wiese 2017), this concept refers to an individual’s motivation and preparedness to alter behaviors that contribute to their challenges. The Transtheoretical Model (TTM) was selected for this study because of its capacity to conceptualize change as a dynamic, non-linear process that unfolds in stages. This framework is particularly relevant for women in the commercial sex trade (Hefner 2019; Kinnish and Hopper 2024; Lloyd 2018), many of whom navigate cycles of ambivalence, trauma, and constrained agency. Rather than assuming that individuals are either ready or not ready to change, the TTM allows for a more nuanced understanding of where participants fall along a spectrum—from precontemplation to contemplation, action, and maintenance.

Given its wide application in clinical and community-based interventions involving substance use, trauma recovery, and behavioral health, the model offers a valuable lens for examining change among a population with diverse lived experiences and barriers.

Research suggests that individuals with a higher readiness for change are more likely to actively participate in treatment and, as a result, demonstrate greater long-term improvements (Krebs et al. 2018; Maldonado and Murphy 2021; McCarthy et al. 2024). Moreover, studies indicate that the readiness of treatment providers and organizations to implement change can impact client engagement and treatment success (Billsten et al. 2018; Kelly et al. 2018). Additionally, interventions designed to strengthen readiness for change, such as motivational interviewing and solution-focused therapy, have been found to enhance participation and improve treatment outcomes (de Paula Araujo et al. 2024; Preble et al. 2023).

However, researchers have noted that women who have been coerced into the commercial sex trade often face greater obstacles in changing their situations than those who entered the industry through other means (Jedrzejewski et al. 2017; Wiese 2017). Theories behind trauma-informed care (Orme and Ross-Sheriff 2015; Scott et al. 2019) offer insights into why this might occur, emphasizing how prolonged abuse, constant fear of retaliation, and entrenched patterns of coercion can undermine an individual’s belief in their own capabilities and foster deep mistrust of support systems (Freemire 2017; Hopper and Gonzalez 2018; McGuire 2018). One theoretical lens that deepens this understanding is trauma bonding—an emotional attachment that can develop between victim and abuser under conditions of coercion, isolation, and intermittent reinforcement (Dutton and Painter 1993; Carnes 2019). In the context of sex trafficking, trauma bonding may explain why some women maintain emotional ties to their exploiters, even in situations where abuse and control are present. These attachments, often reinforced through manipulation, dependency, and cycles of fear and relief, can diminish a woman’s sense of agency and reduce her engagement with potentially life-changing interventions. Combined with the psychological wounds of trafficking—such as learned helplessness (Casassa et al. 2023; Foster 2018; Woehler and Akers 2022)—this dynamic may significantly hinder readiness for change (Ravi et al. 2017).

Building on the issues identified in previous research, this study aims to determine whether participation in a diversion program can effectively enhance readiness for change among women who are involved in the commercial sex industry. Another key aspect of this study is to assess whether any observed improvements in readiness for change differ based on a woman’s trafficking status. In other words, the primary research question is: “Does taking part in a diversion program lead to meaningful increases in readiness for change among commercially sexually exploited women, and do these increases vary between those who have experienced trafficking and those who have not?”.

Drawing on trauma-informed frameworks and empirical data that underscore the deep psychological barriers faced by individuals who have been trafficked (Casassa et al. 2023; Hopper and Gonzalez 2018; Hopper and Hidalgo 2006; Jedrzejewski et al. 2017; McGuire 2018) this study anticipates that women with trafficking backgrounds may exhibit smaller gains in readiness for change compared to non-trafficked women. These barriers often include enduring trauma, lack of trust in systems of support, and emotional ties to traffickers, all of which may reduce the likelihood of fully engaging in the change process. Consequently, the results from this work can help determine whether a one-size-fits-all diversion strategy is sufficient or whether more tailored and comprehensive support services are necessary to meet the needs of trafficked women (Hopper and Hidalgo 2006). Ultimately, clarifying these differences will aid policy makers, service providers, and other stakeholders in designing more effective intervention programs for all women who have been drawn into commercial sex.

2. Literature Review

2.1. Structural Causes of Sex Trafficking

Sex trafficking is a widespread problem that has been the focus of extensive inquiry among both academic researchers and policy making organizations. Global estimates from entities such as the International Labour Organization (International Labour Organization 2022) and the United Nations Office on Drugs and Crime (United Nations Office on Drugs and Crime 2024) reveal that millions of people, most of them women and girls, are forced into commercial sexual exploitation every year (Reap 2019). Scholars consistently link sex trafficking to structural factors like pervasive poverty, ongoing gender-based violence, and inadequate legal systems (Crawford 2017). Moreover, research underscores that consumer demand for commercial sex fuels the continued growth of illegal markets, creating economic incentives for traffickers (Rahman 2011; Wheaton et al. 2010). Adding to these challenges, traffickers operate through various channels—ranging from online platforms and massage parlors to street-level operations—making it even harder for law enforcement and service providers to identify and support victims effectively (Puigvert et al. 2021). These covert modes of operation allow traffickers to evade detection, thus hindering timely interventions and complicating the task of offering protection or assistance to vulnerable individuals.

Adding to these challenges, traffickers operate through various channels —ranging from online platforms and massage parlors to street-level operations—making it even harder for law enforcement and service providers to identify and support victims effectively (de Vries 2020; Farley et al. 2013; Morris 2017). These covert modes of operation allow traffickers to evade detection, thus hindering timely interventions and complicating the task of offering protection or assistance to vulnerable individuals.

2.2. Harms of Sex Trafficking and Commercial Sexual Exploitation

Beyond its legal and logistical complexities, sex trafficking inflicts significant harm on individuals, families, and entire communities. From an economic perspective, studies indicate that traffickers earn billions of dollars each year by forcing people, especially women and girls, into the commercial sex trade (Horning et al. 2020; Shelley and Bain 2015). This massive illegal income not only enriches criminal networks but also often finances other unlawful activities such as drug trafficking and money laundering. Consequently, legitimate economies can suffer, local neighborhoods may become destabilized, and corrupt practices have more opportunities to flourish (Shelley and Bain 2015).

Looking beyond economic factors, sex trafficking also deepens social inequalities and exacerbates existing patterns of discrimination (Zimmerman and Kiss 2017). By turning marginalized populations into commodities, the practice primarily victimizes women and girls from lower-income backgrounds, perpetuating harmful stereotypes and power imbalances (Grittner and Walsh 2020). Moreover, survivors of trafficking face a range of mental health challenges, including post-traumatic stress disorder (PTSD), depression, and anxiety (Hossain et al. 2010). These psychological stresses are frequently intensified by enduring stigma, which can cut survivors off from essential support systems such as family, friends, and community services. In doing so, the stigmatization process creates an environment in which exploitation is more easily repeated or prolonged, further entrenching the cycle of harm (Office of the Assistant Secretary for Planning and Evaluation 2008).

Although individuals involved in commercial sex—whether trafficked or not—are more likely to encounter violence (Oram et al. 2012; Raphael et al. 2010), substance abuse (Aljadeff and Titchen 2024; Dell et al. 2024), and infectious diseases (Vanwesenbeeck 2001), numerous studies highlight that trafficked survivors often experience especially severe and prolonged forms of abuse, beginning at an early age (Fedina et al. 2019). Many of these individuals are coerced or recruited into commercial sex when they are still minors, which can derail their healthy development, weaken or sever family connections, and restrict their educational and professional prospects (Choi 2015). Further compounding these problems, traffickers commonly employ manipulative tactics—such as physical intimidation, emotional blackmail, or threats to harm loved ones—to instill fear, thereby making it exceedingly difficult for victims to break free (Barrick et al. 2024; Haviv and Roe-Sepowitz 2025).

One particularly troubling outcome of these tactics is trauma bonding, a psychological response in which victims paradoxically develop strong emotional ties or loyalties to their traffickers (Casassa et al. 2022). This deep sense of attachment complicates outside attempts to help, as survivors may feel conflicted or fearful about seeking assistance. Consequently, individuals with trafficking backgrounds may remain guarded or resistant to change, even when diversion programs and other interventions offer comprehensive support (Casassa et al. 2024).

2.3. Trauma-Informed Approaches to Intervention

To address the challenges raised, many professionals advocate a trauma-informed approach, recognizing that interventions must systematically acknowledge and address the lasting effects of trauma (Levenson et al. 2020). Within this framework, service providers seek to create environments of safety, offer survivors meaningful choices in their recovery process, and use collaborative strategies to foster trust (Clawson et al. 2007; Judge et al. 2018). However, diverting survivors from the criminal justice system into effective support programs often demands far more than short-term counseling or basic psychoeducation. Instead, many survivors need continuous therapeutic support, participation in peer-led groups, and wraparound services like safe housing and ongoing case management to address the full spectrum of their needs (Ide and Mather 2019; Twigg 2017). In addition, legal advocacy is often critical, as trafficked individuals may face ongoing legal problems, real or perceived threats from traffickers, and immigration-related barriers—all of which can significantly limit their ability to engage in any recovery or rehabilitation process (Heffron 2018).

2.4. Diversion Programs and Readiness for Change

Within the broader efforts to provide effective support for women involved in the commercial sex trade, diversion programs have attracted growing interest among scholars, policy makers, and service providers (Haney et al. 2020; Parker 2017; Roe-Sepowitz et al. 2014a). Rather than imposing punitive measures such as fines or jail time, these initiatives generally offer a multifaceted package of legal advocacy, mental health counseling, substance abuse treatment, and skill-building opportunities (Beaujolais and Dillard 2020; Roe-Sepowitz et al. 2014a). By integrating these components, diversion programs aim to create a pathway toward long-term well-being and independence, enabling participants to move away from commercial sex.

A fundamental principle guiding these programs is the strengths-based approach, as emphasized by Saleebey (1996, 2023). This method, also applied in the context of trafficking, prioritizes identifying and enhancing individuals’ existing abilities, resilience, and support systems rather than solely addressing their challenges or deficiencies (Crisp and Johnson 2024; Sobon 2014). One commonly used metric for assessing whether this strengths-based approach is effective is “readiness for change”, typically measured through validated scales such as the University of Rhode Island Change Assessment (URICA). The Transtheoretical Model on which URICA is founded outlines several stages of behavioral change—ranging from “precontemplation” to “contemplation”, “action”, and ultimately “maintenance” (Prochaska et al. 1992). Progress along these stages is strongly associated with a person’s ability to sustain new and healthier behaviors.

2.5. Critiques of Carceral Logic in Diversion

While diversion programs represent a valuable alternative to criminal prosecution, researchers and human rights organizations have emphasized that these interventions must be designed carefully to avoid reinforcing the harms of criminalization. According to Amnesty International (2016), criminalizing the consensual exchange of sexual services between adults often pushes sex sellers to the margins of society, increases their exposure to violence, and limits their access to legal protection and health care. In these situations, the laws themselves—rather than the act of selling sex—can become a primary source of harm. Feminist scholars such as Bernstein (2010) have also raised concerns about “carceral feminism”, a trend in which anti-trafficking and gender-based interventions become closely aligned with punitive systems. These efforts, though well intentioned, can unintentionally expand criminal surveillance of marginalized women without addressing the structural barriers they face. These critiques highlight the importance of creating diversion programs that are grounded in trauma-informed, harm-reduction, and rights-based principles. Such programs should recognize the diverse reasons individuals enter the sex trade and prioritize support strategies that promote dignity, safety, and self-determination for all participants.

Building on this critical framing, scholars have highlighted how many diversion initiatives—particularly those tied to the criminal legal system—can reproduce forms of coercive control, even when labeled therapeutic or trauma-informed (Musto 2016; Shdaimah et al. 2023). Dewey and St. Germain (2016) note that such programs often rely on narrow assumptions about trauma and choice while ignoring broader structural conditions like poverty, housing insecurity, and racism. The program examined in this study was not fully voluntary; it was court ordered and offered as part of a plea agreement, meaning participants chose it in lieu of incarceration. As such, while the program emphasized trauma-informed, holistic support, its legal framework still reflects the constraints and pressures typical of criminal legal interventions. Engaging with critiques of court-affiliated diversion programs remains essential, as they shape both public perception and the lived realities of participants. By examining a court-ordered model that, while legally mandated, seeks to reduce coercion and prioritize well-being within a constrained legal context, this study contributes to ongoing discussions about how diversion programs can more ethically and effectively serve diverse populations involved in the sex trade. Notably, research on therapeutic communities for substance use treatment suggests that programs offered as alternatives to incarceration may actually enhance retention through external motivation—particularly when participants are supported in rebuilding familial, social, and occupational ties (Haviv et al. 2024).

3. Existing Evidence and Research Gap

Existing evidence suggests that individuals who score higher in readiness for change are more likely to exit the sex industry successfully. However, many studies fail to distinguish between women who have been trafficked into commercial sex and those who have entered it under different circumstances (Twis et al. 2024). This distinction is critical, as trafficked survivors often endure prolonged coercion, trauma bonding, and psychological control, which create additional barriers to engaging in interventions (Casassa et al. 2023; Woehler and Akers 2022). In contrast, non-trafficked women, who generally retain greater autonomy, may be more prepared to transition out of commercial sex (Wiese 2017). The severity and duration of trauma among trafficked individuals can weaken their capacity to progress through diversion programs at the same rate as their non-trafficked counterparts, necessitating further investigation into whether traditional models adequately meet their needs (Hopper and Gonzalez 2018; Orme and Ross-Sheriff 2015).

Despite the growing body of research on diversion programs, most studies treat participants as a homogenous group. As a result, there is limited knowledge on whether existing diversion services provide adequate support for sex-trafficked individuals or if specialized interventions—such as intensive trauma therapy, legal protection, and ongoing case management—are necessary. Clarifying these differences is essential for developing strategies that effectively support all women seeking to exit the commercial sex trade.

4. The Current Study

This study aims to address this gap by examining whether diversion programs foster readiness for change among women in the sex trade and whether these effects vary based on trafficking status. Using trauma-informed theory (Hopper and Gonzalez 2018; Orme and Ross-Sheriff 2015), this research hypothesizes that trafficked women, due to their histories of sustained abuse and distrust of institutional support, may show weaker gains in readiness for change compared to non-trafficked women. While interventions such as motivational interviewing and trauma-informed care have been shown to enhance engagement in diversion programs (de Paula Araujo et al. 2024; Preble et al. 2023), it remains unclear whether these approaches are equally effective for trafficked and non-trafficked participants.

By integrating the Transtheoretical Model of Behavioral Change (Prochaska and DiClemente 1983; Prochaska et al. 1992) with trauma-informed care principles, this study hypothesizes that diversion programs will generally increase readiness for change among all participants. However, the effect may be more pronounced among non-trafficked women, who may face fewer psychological and structural barriers to participation. Ultimately, this research will provide critical insights for policy makers and service providers, determining whether a standardized diversion strategy is sufficient or if more tailored, trauma-responsive interventions are necessary for trafficked survivors. By addressing this gap, this study will contribute to a deeper understanding of diversion program effectiveness and offer evidence-based recommendations for improving intervention strategies for women exiting commercial sex.

At the same time, it is important to situate this intervention within the broader socio-legal discourse around sex selling. Diversion programs, particularly those tied to the criminal legal system, have been critiqued for reinforcing the harms of criminalization by framing all forms of sex selling as inherently harmful or in need of correction. While the program examined in this study was court ordered and offered as an alternative to incarceration, it sought to mitigate coercive dynamics by adopting a trauma-informed and harm-reduction framework. Rather than imposing a singular narrative of victimhood or criminality, the program supported participants—regardless of how or why they entered the sex trade—in identifying personal goals related to safety, stability, and well-being. This model recognizes the complex and varied pathways into sex selling, including coercion, structural inequality, and survival-based decision making, while still operating within the constraints of the criminal justice system.

5. Method

5.1. Study Design

This study investigates the impact of a specialized diversion program designed to support women with documented histories of involvement in commercial sex. Participants entered the program as part of a court-mandated diversion agreement, which provided psychosocial support, legal advocacy, and medical referrals. Each participant underwent a structured intake process that included self-report questionnaires and intake interviews to collect demographic data, document their experiences in commercial sex, and assess their motivation and readiness for change.

Data collection was conducted by trained social workers employed by the community agency operating the program. These staff members were trained in trauma-informed engagement and used standardized instruments as part of routine program evaluation.

Although the present study involved secondary data analysis, the researchers recognize the ethical importance of reflexivity and positionality. The analysis was informed by a participant-centered, trauma-informed epistemological framework that values women’s lived experiences and resists imposing prescriptive narratives about harm, recovery, or agency.

5.2. Participants

A total of 131 women enrolled in the program, with a mean age of 30.8 years (SD = 10.9; range = 18–66). Participants were categorized into two groups: sex-trafficked (n = 36) and non-trafficked (n = 95). Classification was based on two self-reported indicators: (1) entry into commercial sex before the age of 18 and/or (2) experience working under the direction or control of a third party, such as a pimp or trafficker. These criteria are consistent with the Trafficking Victims Protection Act (TVPA), which defines any minor engaged in commercial sex as a victim of trafficking and also classifies adults as trafficked when force, fraud, or coercion—including third-party control—is present (Trafficking Victims Protection Act 2010). Among participants with available race data (n = 118), 39.8% identified as White, 27.1% as Black, 16.1% as Hispanic, 16.1% as mixed race, and 0.9% as Asian.

Our classification also draws on prior research, including Fedina et al. (2019), who operationalized trafficking risk among sexually exploited youth using underage entry and third-party involvement as core indicators. However, we acknowledge that trafficking experiences occur along a continuum and are not limited to formal pimp-controlled arrangements. Some individuals may experience significant coercion or exploitation without third-party intermediaries, while others may engage in more autonomous or negotiated relationships. Although our binary categorization reflects prevailing legal and empirical standards, it remains a simplification of more complex realities. This limitation is further addressed in the discussion section.

5.3. Program Components

The diversion program examined in this study is a court-ordered program led by survivors of sex trafficking. It provided a range of trauma-informed services aimed at fostering holistic well-being and a pathway out of sex trafficking and prostitution situations. Participants engaged in group classes that covered interviewing for jobs, managing emotions, substance use awareness, and psychoeducation about past trauma. Life skills workshops addressed financial literacy, relationship dynamics, and conflict resolution. In addition, participants received vocational, mental health, and educational referrals, connecting them with GED programs, job placement services, mental health support, and career training opportunities. For those facing immediate safety risks, the program offered referrals to emergency housing and relocation support. Participation typically ranged from 12 to 16 weeks, though individualized needs influenced the program duration.

While the program was legally mandated and offered as an alternative to incarceration, it emphasized trauma-informed and strengths-based approaches to support participant engagement and reduce coercive dynamics. The structure was influenced by Herman’s (1992) trauma recovery framework, particularly the first stage focused on establishing safety and stabilization, as well as the Transtheoretical Model of behavioral change (Prochaska and DiClemente 1983), which views readiness for change as a gradual, stage-based process. Group sessions followed a psychoeducational format similar to the Esuba model (Roe-Sepowitz et al. 2014b), aiming to build insight, enhance coping strategies, and promote self-efficacy. Facilitators, many of whom were survivors themselves, were trained to foster a supportive environment centered on trust, empowerment, and individualized care, even within the constraints of court-mandated participation.

5.4. Study Measures and Sample Characteristics

Data were collected at two primary time points: initial enrollment (Time 1) and program completion (Time 2), with an interval of approximately 12 to 16 weeks. This multi-timepoint design allowed for an analysis of changes in the key outcome variable, readiness for change.

To assess participants’ motivation and stage in the behavior change process, this study utilized the University of Rhode Island Change Assessment (URICA), a 32-item self-report instrument grounded in the Transtheoretical Model of Change (Prochaska and DiClemente 1983). The Transtheoretical Model posits that change occurs through a series of psychological stages, rather than as a binary shift. These stages include

• Precontemplation—the individual is not yet considering change or may not recognize a need for it.
• Contemplation—awareness emerges and the person begins to weigh the pros and cons of change.
• Action—concrete steps are taken to alter behaviors or circumstances.
• Maintenance—efforts are made to sustain the change and avoid relapse.

URICA items reflect attitudes and behaviors associated with these stages and are summed to yield a composite score indicating the participant’s overall readiness for change. The measure has been validated in diverse populations, including those engaged in substance use treatment, trauma recovery, and sex trade exit programs. In our study, the URICA scale demonstrated excellent internal consistency at both measurement points. At program intake (Time 1), Cronbach’s alpha was 0.91, and at program completion (Time 2), reliability remained high with an alpha of 0.89. These findings indicate that the measure was stable and internally consistent across the duration of the program.

In this study, “readiness for change” was not interpreted narrowly as the desire to exit sex trade. Rather, it was conceptualized more broadly as a proxy for participants’ motivation to engage in any meaningful life changes, as defined by the individual. This might include seeking sobriety, building coping skills, reducing exposure to violence, improving parenting, pursuing housing stability, or exiting commercial sex—all depending on the participant’s personal goals and perceived barriers.

This person-centered interpretation is aligned with the program’s trauma-informed philosophy, which avoids prescriptive judgments about what “change” should look like. Thus, URICA scores reflect movement through psychological readiness, not necessarily progress toward a single behavioral endpoint.

Although additional information—such as mental health indicators, socioeconomic background, and duration of involvement in the sex trade—was collected through separate instruments, these variables were excluded from analysis due to missing data and limited statistical power. Moreover, given this study’s within-subject design focusing on change over time, controlling for these between-subject variables was not essential to addressing the primary research question. To maintain analytic clarity, we focused on readiness for change as measured consistently across the full sample.

5.5. Statistical Analysis

To examine changes in readiness for change, a repeated-measures Analysis of Variance (ANOVA) was conducted, comparing URICA scores at Time 1 and Time 2 across participants. This approach was chosen over a dependent t-test because it allowed for the detection of interaction effects between time and trafficking status, assessing whether the degree of change varied between sex-trafficked and non-trafficked participants. A dependent t-test, in contrast, would only test whether pre- and post-program scores significantly differed within the total sample or within each group separately, without analyzing how changes varied by trafficking status.

Mauchly’s test of sphericity was performed to confirm the homogeneity of variances; when assumptions were violated, Greenhouse–Geisser corrections were applied. Significant time-by-status interaction effects led to post hoc analyses to clarify how readiness for change evolved within each subgroup. An alpha level of 0.05 was used to determine statistical significance. Ethical guidelines were rigorously followed to maintain participant confidentiality and well-being.

By adopting this structured methodological approach, this study aimed to evaluate the effectiveness of a trauma-informed diversion program for women involved in commercial sex while also identifying unique challenges faced by sex-trafficked individuals.

5.6. Supplementary Analysis: Linear Regression

To complement the repeated-measures ANOVA, we conducted a linear regression to assess whether changes in readiness for change differed significantly by trafficking status after accounting for participant characteristics. Specifically, we regressed change in URICA score (Time 2 minus Time 1) on trafficking status, while controlling for age and race. Including these covariates allowed us to examine the robustness of trafficking status as a predictor of differential outcomes. This supplementary model was designed to address concerns about potential confounders and to evaluate whether readiness shifts were attributable to trafficking status independently of demographic background.

6. Results

A repeated-measures Analysis of Variance (ANOVA) was conducted to assess the impact of the diversion program on participants’ readiness for change, as measured by the University of Rhode Island Change Assessment (URICA). The primary objective of this analysis was to determine whether URICA scores exhibited significant variation from program entry (Time 1) to program completion (Time 2) and whether this variation differed according to participants’ sex trafficking status.

6.1. Main Effect of Time

The analysis revealed a statistically significant main effect of time on URICA scores, F(1, 129) = 9.173, p = 0.003, η² = 0.066. Across the total sample of 131 participants, mean URICA scores increased from 8.652 at the initial assessment (Time 1) to 9.344 at program completion (Time 2). This upward shift in scores suggests that, on average, participants demonstrated a greater readiness for change following their engagement in the diversion program.

• Mean URICA Score at Time 1 (Overall): 8.652;
• Mean URICA Score at Time 2 (Overall): 9.344.

This increase in URICA scores remained statistically significant at the conventional alpha level of 0.05. While the numerical change appears moderate, it was observed within a relatively short intervention period of 12 to 16 weeks, highlighting a meaningful shift in participants’ motivation to exit commercial sex.

6.2. Interaction Between Time and Sex Trafficking Status

The repeated-measures ANOVA also tested for a time-by-status interaction effect and revealed a statistically significant interaction, F(1, 129) = 5.857, p = 0.017, η² = 0.043. This result indicates that changes in URICA scores over time differed significantly between sex-trafficked and non-trafficked participants.

6.3. Non-Trafficked Participants

• Mean URICA Score at Time 1: 8.313;
• Mean URICA Score at Time 2: 9.556.

Among non-trafficked participants, mean URICA scores increased from 8.313 at Time 1 to 9.556 at Time 2. This change was statistically significant (p < 0.05), indicating a notable enhancement in readiness for change over the course of the program. These findings suggest that participants who were not classified as sex-trafficked experienced substantial gains in motivation to transition away from commercial sex.

6.4. Sex-Trafficked Participants

• Mean URICA Score at Time 1: 8.992;
• Mean URICA Score at Time 2: 9.131.

For participants classified as sex-trafficked, mean URICA scores increased from 8.992 at Time 1 to 9.131 at Time 2. While this change was also statistically significant (p < 0.05), the magnitude of the increase was more modest compared to that observed among non-trafficked participants. The significant interaction effect suggests that the program’s impact on readiness for change was not uniform across groups. Specifically, non-trafficked participants exhibited a more pronounced increase in readiness for change compared to sex-trafficked participants. This differential pattern may reflect unique challenges faced by individuals with trafficking histories, such as greater psychological barriers, trauma exposure, or coercive influences, which could mitigate the program’s effectiveness. These findings underscore the need for tailored intervention strategies to address the specific barriers encountered by sex-trafficked individuals in achieving sustained behavioral change. These results are presented in

Table 1. Mean URICA Scores at Program Entry and Completion by Trafficking Status (N = 131).

Trafficking Status	Time 1 (M)	Time 1 (SD)	Time 2 (M)	Time 2 (SD)	Δ Readiness (M)
Non-trafficked (n = 95)	8.31	2.27	9.56	2.18	+1.24
Sex-trafficked (n = 36)	8.99	2.62	9.13	2.52	+0.14
Total (N = 131)	8.65	2.42	9.34	2.31	+0.69

Note: Bold values in the Δ Readiness (M) column indicate the magnitude of change in readiness for change from Time 1 to Time 2.

, which summarizes the mean URICA scores at entry and completion by trafficking status.

6.5. Supplementary Regression Findings

To further investigate whether the program benefited sex-trafficked and non-trafficked participants differently, a linear regression was conducted with change in URICA score as the outcome. The model included trafficking status as the key predictor, while controlling for age and race. The overall model was statistically significant, F(6, 111) = 2.58, p = 0.022, R² = 0.122, indicating that these predictors collectively explained approximately 12% of the variance in change in readiness. Trafficking status remained a significant predictor of change in readiness (B = −1.19, SE = 0.50, p = 0.020), with trafficked participants showing smaller gains in URICA scores compared to non-trafficked participants, even after adjusting for covariates. Additionally, participants identifying as Black (B = −1.15, p = 0.046) or Hispanic (B = −1.44, p = 0.028) had significantly smaller gains in readiness compared to White participants. These findings reinforce the interaction effect observed in the ANOVA and suggest that sex-trafficked participants may face distinct barriers to change. Tailored programming may be needed to address these barriers and promote more equitable outcomes across demographic groups. See

Table 2. Linear Regression Predicting Change in Readiness for Change (N = 118).

Predictor	B	SE	t	p	95% CI
Sex Trafficked (1)	−1.19	0.50	−2.36	0.020	[−2.19, −0.19]
Age	−0.01	0.02	−0.37	0.714	[−0.05, 0.04]
Race (ref: White)
Black	−1.15	0.57	−2.01	0.046	[−2.28, −0.02]
Hispanic	−1.44	0.65	−2.23	0.028	[−2.73, −0.16]
Asian	−3.45	2.40	−1.44	0.153	[−8.21, 1.30]
Mixed Race	−0.57	0.69	−0.83	0.410	[−1.93, 0.79]
Intercept	2.23	0.87	2.58	0.011	[0.52, 3.95]

Note. B = unstandardized coefficient; SE = standard error; CI = confidence interval. The model examined predictors of change in URICA scores (Time 2 − Time 1), where higher values indicate greater increases in readiness for change. R² = 0.12, Adjusted R² = 0.07, F(6, 111) = 2.58, p = 0.022.

below.

7. Discussion

The purpose of this study was to explore whether participation in a diversion program increases readiness for change among women involved in the commercial sex trade and, specifically, whether such increases differ depending on trafficking status. Results demonstrated a significant main effect of time: overall URICA (University of Rhode Island Change Assessment) scores rose from baseline (Time 1) to the end of the program (Time 2), indicating that participants across the board reported higher motivation to exit the sex trade after completing the intervention. At the same time, the analysis also revealed a notable interaction effect, such that this upward shift was markedly greater for non-trafficked women compared to those who had been trafficked.

These findings align with prior theoretical and empirical work suggesting that, while diversion programs can be effective in enhancing readiness for change, the extent of that effectiveness may be tempered by the degree of trauma, coercion, and ongoing safety concerns that individuals bring into treatment (Casassa et al. 2023; Hopper and Gonzalez 2018). Specifically, women who have experienced sex trafficking frequently report long-standing emotional bonds to their traffickers (i.e., trauma bonding), heightened mistrust of support systems, and extensive trauma histories. These factors can hinder full engagement with program components (Freemire 2017; McGuire 2018). In contrast, non-trafficked individuals, who typically maintain more agency and fewer coercive constraints, appear better positioned to make greater strides during a 12- to 16-week intervention period.

Consistent with the Transtheoretical Model (Prochaska and DiClemente 1983; Prochaska et al. 1992), enhanced readiness for change is a positive indicator that individuals are moving from contemplation or preparation stages into action or maintenance. However, the more modest gains among trafficked participants underscore the critical need for trauma-informed strategies that address not just behavioral change but also the complex and multifaceted nature of exploitation. Research on trauma-informed care stresses creating safety, fostering trust, and providing long-term therapeutic support (Orme and Ross-Sheriff 2015; Scott et al. 2019). While the current program offered an array of supportive services—such as legal advocacy, counseling, and life skills workshops—the results suggest that survivors of trafficking may require a lengthier and more specialized approach that more directly addresses chronic trauma symptoms, legal vulnerabilities, and sustained mental health issues (Hopper and Hidalgo 2006).

Our findings suggest that these core program components—while valuable—may have had different impacts depending on trafficking status. Non-trafficked participants, who showed greater gains in URICA scores, may have been better positioned to engage with life skills workshops and counseling sessions that require emotional availability and forward planning. Their increased readiness may reflect a stronger sense of personal agency, fewer safety threats, and more stable support networks at the time of program entry.

For trafficked women, by contrast, trauma-related barriers such as mistrust, dissociation, or fear of retaliation may have limited their ability to fully utilize available services within the program’s short 12- to 16-week timeline. For instance, while legal advocacy was offered, participants with unresolved immigration concerns, active threats from traffickers, or outstanding legal issues may have required more intensive and sustained legal interventions to feel safe enough to consider behavioral change. Similarly, group-based counseling or workshops may have felt overwhelming for those managing complex trauma or hypervigilance. These dynamics likely contributed to the more modest improvements in readiness for change observed in the trafficked subgroup. These findings also complement prior qualitative and quantitative studies indicating that intensive, specialized support can yield better long-term outcomes for survivors with extensive trauma histories (Casassa et al. 2023; Woehler and Akers 2022). Indeed, the modest but statistically significant improvement among trafficked women shows that some benefit is being realized; however, the smaller magnitude of change compared to non-trafficked women points to persistent barriers that require more tailored interventions.

Additionally, our supplementary regression analysis revealed that race was a significant predictor of change in readiness for change. Specifically, Black and Hispanic participants showed smaller gains in URICA scores compared to White participants. These findings suggest that racial disparities may intersect with program engagement and outcomes (Haviv and Itzik 2024), even within a trauma-informed framework. While the current program sought to create a supportive and inclusive environment, it is possible that broader structural inequities—such as differential access to resources, prior experiences of institutional mistrust, or cultural misalignment with service models—may have influenced participants’ responsiveness to the intervention.

These patterns underscore the importance of incorporating a racial equity lens into diversion programming. Trauma-informed care must not only address individual trauma histories but also the systemic factors that shape how different racial and ethnic groups experience services and change. Future interventions may benefit from culturally tailored approaches, racially representative staff, and deeper community partnerships to build trust and relevance among historically marginalized populations.

7.1. Policy Implications

Given the evident differences in how sex-trafficked and non-trafficked participants respond to a standardized diversion program, policy makers and service providers should consider multiple strategies to improve outcomes. Standardizing trauma-informed protocols is crucial so that staff, volunteers, and legal advocates are adequately trained to address the deep psychological impacts of trafficking, a step that could be further strengthened by policies mandating or incentivizing specialized certifications. Funding extended or more intensive services is another essential component, as a 12- to 16-week timeline may not suffice for individuals who face severe trauma, sustained safety concerns, or entrenched power dynamics; offering longer-term counseling, more robust case management, and holistic aftercare services can be instrumental in supporting trafficked participants. It is equally important to incorporate comprehensive legal protections and advocacy—often in partnership with specialized anti-trafficking units or NGOs—to streamline protective orders, offer immigration relief, and potentially expunge prostitution-related charges for verified survivors, thereby improving their chances of meaningful engagement and reducing recidivism. Finally, effective diversion relies on multi-agency collaboration to ensure wraparound support that addresses interconnected health, legal, and social needs; policy directives that promote or require joint efforts among law enforcement, healthcare providers, housing agencies, and victim services can help create a cohesive network, one capable of providing sustained assistance to women seeking to exit commercial sex.

7.2. Limitations and Future Directions

Although this study provides valuable insights, certain limitations warrant consideration. First, the reliance on self-report measures may introduce biases related to social desirability or inaccuracies in recall. Second, the relatively short intervention period and lack of long-term follow-up limit the conclusions about sustained behavioral change. Third, classification into sex-trafficked versus non-trafficked groups was largely based on self-report and may not capture the full complexity of individuals’ experiences. Furthermore, while we included a regression analysis controlling for race and age, other unmeasured variables—such as socioeconomic status or prior criminal justice involvement—may also influence outcomes. In addition, drawing the sample from a single diversion program may constrain the generalizability of the findings.

Future research should incorporate larger, more diverse samples and longer follow-up windows to assess whether the observed increases in readiness for change are maintained over time. Including control or comparison groups could also strengthen causal inferences, while qualitative methods—such as interviews and focus groups—would provide a more nuanced understanding of participants’ experiences and the factors that shape their readiness for change. Additional research should also examine whether core components of diversion programs—such as counseling, legal advocacy, and life skills training—impact trafficked and non-trafficked participants differently, and whether adjustments in timing or delivery could improve outcomes for more vulnerable subgroups.