The signs can be ambiguous. A tattoo, or "brand," with a man’s name or initials. Inappropriate clothing. Anxiety. Bruises or burn marks. A controlling "boyfriend" who won’t leave her side even in the examining room. As a nurse practitioner, Jessica Munoz encounters teenage girls in hospital emergency rooms who are victims of sexual exploitation, but it often escapes detection, she said. The teens are coached to conceal their situation, and depend on and even identify with the people who are selling their bodies for profit.

"I started seeing these young girls coming into the emergency rooms, and no one was asking what was going on," Munoz said in an interview. "We don’t have any aftercare specific to this population. That’s what got me interested in wanting to start a residential facility."

Her dream to open a therapeutic home for girls who are victims of sex trafficking just moved closer to reality with the state’s approval in principle to lease a 12-acre property on the North Shore to Ho‘ola na Pua, a new nonprofit founded by a group of passionate volunteers.

It would be the first facility in Hawaii to provide long-term residential care for girls who have been pressed into prostitution, many of whom are runaways from abusive home situations.

Some youth are groomed over the Internet, lured with gifts of clothing and jewelry or the promise of love. Some are exploited by their own relatives, she said.

"People don’t even realize this is a problem," said Munoz, president of Ho‘ola na Pua. "Everyone assumes that sex trafficking happens overseas, in Cambodia, Thailand, Korea, Africa."

She added, "When we’re talking about trafficking of our local children, there is a lack of understanding. It’s often hidden. They might assume she is just a runaway or a troubled kid or a kid who’s just always getting involved with the legal system."

There are no comprehensive numbers on how many children are exploited sexually for profit, the Congressional Research Service concluded in an August report, "Juvenile Victims of Domestic Sex Trafficking." The federal government considers juveniles involved in prostitution as victims of sex trafficking, regardless of the use of coercion or force.

The National Center for Missing & Exploited Children estimates that at least 100,000 American children become victims of sex trafficking each year. One out of 7 endangered runaways reported to the center in 2013 were likely sex trafficking victims, it said.

Hawaii has no solid data on how many underage girls are induced into commercial sex here, but runaways are considered vulnerable. Across the state, 3,471 youth were reported as runaways in 2012, according to the Department of the Attorney General’s Juvenile Justice Information System.

"Oftentimes these kids come into the juvenile justice system under truancy charges, delinquency charges, and yet the root is exploitation," Munoz said. "There has been increased identification and recognition of the crime, and yet we don’t have any sort of location that provides a comprehensive approach to healing and restoration."

Girls would be referred to the home through social service providers and the Judiciary. Munoz pursued the project under the umbrella of a Cali­for­­nia charity, Courage Worldwide, before setting up the independent Hawaii nonprofit.

"We get calls all the time asking, ‘When are you going to be building? We have girls for you,’" said Jody Allione, a development project manager who volunteers as vice president of Ho‘ola na Pua.

The nonprofit, whose name means new life for our children, got approval as a tax-exempt charity from the IRS in May. In July the state Board of Land and Natural Resources agreed in principle to offer it a lease, choosing it over a competing proposal from a would-be charter school.

Last week the state issued a right of entry to Ho‘ola to the site so it can pursue licenses and permits, and get ready to lease and renovate the property, Allione said. The property has a vacant, vandalized 24,000-square-foot building with a leaky roof. Its specific location on the North Shore is not being published at the request of Ho‘ola na Pua since it will shelter underage victims.

The proposed home, to be licensed by the Department of Health, could serve up to 32 girls at a time, ages 11 to 18. It intends to meet all their needs in a homey atmosphere, including on-site schooling, trauma therapy, physical and mental health care, and healing activities such as art, music, dance and gardening. Girls are expected to stay for at least a year.

"They haven’t lived in a normal situation for much of their teenage years, so we have got to restore these children, and it’s not something you just do overnight," Allione said.

The group, which has hundreds of volunteers and no paid staff, plans to raise $2.5 million to rehabilitate and launch the facility, and an additional $1 million for the first year’s operating costs, Allione said. It will pursue grants, foundations, philanthropists and in-kind donations, she said.

It has close to $110,000 on hand, she said.

Volunteer Tammy Bitanga heard about Ho‘ola na Pua’s mission at a women’s conference, and it struck a chord.

As a child she was sexually molested by her hanai father and put in a foster home in Kai­lua at age 13. It was a nurturing environment, she said, yet she ran off to Wai­kiki two years later and wound up in the sex trade.

"Once I got into it, and I saw the evil and I saw the abuse and the girls getting beaten, and my own life got threatened, I realized that I can’t do this," she said. "We get caught up in drugs, and we hide our feelings and we hide the pain and we die because we haven’t gotten help."

Now a bookkeeper, she feels lucky to be alive and wants to help others in the same situation. She gives her time as Ho‘ola na Pua’s community outreach and event director.

Along with its efforts to open the home, the nonprofit pre­sents a prevention program, known as Smart Courage, at schools to help students recognize signs of sex trafficking before it happens to them or someone they know. It also offers training to medical and social service professionals and others.

Nick Sensley, a former police chief for Truckee, Calif., and a national anti-trafficking strategist, said people tend to see runaways as "bad girls or bad boys out there for the wrong reasons," although most are victims who left abusive homes and are "looking for love in all the wrong places."

He is based in Nashville, Tenn., but has been volunteering for Ho‘ola na Pua because he sees it as a model.

"If this facility is successful, it will be the largest in the country that provides a response to this population of teen girls," Sensley said. "Hawaii is positioned to be in a tremendous leadership role around this."

"As much as we may train for people to understand this problem and remove children from this atrocity," he added, "if they don’t have anywhere to go, it becomes part of a vicious circle of trauma and abuse."

In Hawaii’s tourist center the Youth Outreach Center run by Wai­kiki Health welcomes a steady stream of young people from the street who are looking for support. It offers a caring atmosphere where kids can get a hot meal, take a shower, be seen at a clinic, do their laundry and build up trust.

Although it is open just four afternoons a week, 529 different people flocked to it over the course of 2013, for a total of 4,519 visits, according to its manager, Carla Houser. She noted that many youth are easy prey for predators who offer them a place to stay, new clothes and a sense of belonging.

"We don’t know the number of kids who are victims of abuse or sex trafficking, because of confidentiality," she said. "It’s not something we track. It’s very prevalent with the homeless, runaway, street-identified youth — survival sex, sex in exchange for drugs, sex in exchange for a place to stay."