by victims as a result of the abuse by their perpetrators or the violence incurred in the workplace (Shandro et al., 2016). Substance use disorder is also a frequent outcome among people who are trafficked. Trafficked persons may have been using substances prior to becoming trafficked or begin to use substances as a means of coping with the extreme trauma and the chronic stress of their trafficking. Substance use may be an escape (Stoklosa et al., 2017). Evidence-Based Practice Research has shown that restricted freedom is both a core factor of human trafficking and a large risk factor for poor mental health (De Vries & Farrell, 2018; Kiss et al., 2015). Trafficked persons who were severely restricted in their activities were two times as likely to have symptoms of PTSD, anxiety, and depression compared with trafficked individuals with fewer restrictions. Shame, guilt, poor self-esteem, and fear for family members (based on threats by traffickers) create complex psychological stress that affects trafficked individuals negatively and can feed into the cycle of victimization and traumatization (De Vries & Farrell, 2018). Just as survivors can become re- trafficked and re-traumatized after the trafficking experience has ended, small circumstances can mimic the conditions experienced and trigger reactions even years after escaping. Physical Signs of physical violence are common among trafficking patients, ranging from broken bones to missing hair to bruising. Physical and sexual violence are prevalent among trafficked women. Injuries may appear to be at multiple stages of healing or untreated, suggesting chronic trauma and perhaps a delay in seeking care. Because social isolation is prevalent in this population, trafficked persons may not have access to healthcare for injury treatment. The trafficked person may present in the middle of the night for injuries from a trafficking-related trauma or for simple medical care. Pelvic inflammatory disease, STIs, ectopic pregnancies, and HIV/AIDS are a few common medical conditions seen in sex-trafficked individuals. Labor trafficking can cause physical injuries related to occupational exposures, including accidents related to poor personal safety equipment, abuse from supervisors, or ailments resulting from inadequate living conditions (NHTRC, 2015b). Poor ventilation, sanitation, and nutrition, as well as airborne and bacterial contaminants, are also health risks associated with labor exploitation (ICMEC, 2019). Additionally, working long hours with little rest can contribute to work-related injuries. Labor-trafficked women are at high risk for sexual violence and its consequences. In one international study of labor- trafficked men, women, and children, women experienced sexual assault in 43.9% of the cases, compared with their male counterparts at 1.3% and children at 21.5% (Kiss et al., 2015). Other common physical health symptoms seen with labor and sex trafficking include headache, fatigue, dizziness, back pain, and memory problems (Kiss et al., 2015).
Evidence-Based Practice Branding (e.g., intentionally inflicting burns or cuts to create symbols) is a common way for traffickers to demonstrate ownership (ICMEC, 2019). Those who are being trafficked may have their trafficker’s name, a pseudonym, or a bar code tattooed or etched into their skin to signify the trafficker’s permanent ownership (Shandro et al., 2016). Asking about a tattoo’s significance during a healthcare visit may illicit details about the patient’s social history. Social Some key contextual indicators for identifying patients who are being trafficked may seem unrelated to health, but they may help a provider identify trafficking as being possible. For example, clinicians should pay attention to who attends the patient’s appointments and how the patient behaves in the office or examination room. A “minder” (the person who is taking care of or in an ownership role) posing as an aunt, boyfriend, or other family member will often speak for the patient when questions are asked (ICMEC, 2019). Separating the patient and “minder” may free the patient to disclose information during an interview, which may be one of the best approaches a healthcare provider can take to aid the patient. Even when alone with a healthcare professional, a trafficked person may be fearful or hesitant to answer questions. In the case of foreign individuals who are being trafficked, English may be a second language, making it even more difficult to discover the trafficking through an interview. When interviewing a person who speaks English as a second language, clinicians should use a professional interpreter, not a family member or the minder (ICMEC, 2019). The National Human Trafficking Resource Center is an excellent resource for clinicians. This center may be contacted to report a tip or for training materials and information on resources. The center is available 24 hours a day, 7 days a week at 1-888-3737-888. It can also be reached by text between 3 and 11 p.m., Eastern Time, at 233-733. The website for the National Human Trafficking Resource Center is https://humantraffickinghotline.org. Evidence-Based Practice Children who have been exploited may act more self-confident or mature than their age, have access to possessions or money, and report that they are not attending school (Mather & Feldman- Jacobs, 2015). Women and girls who are exploited for sex do not always report physical abuse, but the coercion, threats of violence toward them or their families, and menacing control used against them is similar to the characteristics of torture (Department of Justice, 2017). A red flag for identifying these victims is when victims have difficulty describing when they work, when they sleep, what they usually eat, and how many clients they serve.
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Book Code: MFL1227
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