alert traffickers to suspicion. Protocols should incorporate trauma-informed care practices by respecting and informing patients of their right to refuse details or not allow photographic evidence. These practices may inflict retraumatization. (Dignity Health, 2019; ICMEC, 2019). Reporting agencies and resources The U.S. Department of Health and Human Services program Look Beneath the Surface has raised awareness of human trafficking while assisting the public in identifying these victims and the services/resources available to them (U.S. Department of State, 2017). Reporting human trafficking may be seen as intimidating or time consuming, making healthcare personnel reluctant to act. Personnel may also fear invading a person’s privacy or reporting cases that turn out not to be criminal cases. Victims sometimes ask for their information or situation to be kept confidential. In these cases, the healthcare professional is obligated to inform the patient of his suspicion of the situation. It should be shared that the clinician is concerned about the victim’s health and that this type of harboring—which may or may not be against the victim’s will—must be reported. It is also important to ensure that the victim’s identity is protected. Failure to report a crime is omission of a provider’s duty as well as something that may put the patient at risk of further injury or even death (Dignity Health, 2019; ICMEC, 2019). Some victims choose not to leave their situation, regardless of how abusive it may be, or even identify the situation as exploitive. Fear of retribution or threatened harm to their family may keep victims from divulging the true nature of the situation. If the person is an adult, this is the individual’s choice. This decision must be respected, although general information without the patient’s identity can be reported to authorities. In these cases, clinicians must provide safe care of the patient with a nonjudgmental attitude and provide information on resources or crisis centers (Dignity Health, 2019; ICMEC, 2019). Empowering is giving an individual or group the ability to make choices and turn these decisions into actions and outcomes (Dignity Health, 2019; US Department of State, 2019). The choice is that of trafficked persons, and it is through their voice that healthcare providers can increase awareness of trafficking, understand their needs on the path to reintegration, and help influence the care of other trafficked persons (SAMHSA, 2015). For example, a trafficked woman who is seen in the healthcare setting can benefit from information on how to leave her trafficker but may not be in the position to do so immediately. Assisting her to find the right time and method of escaping is the most beneficial and should be her decision. If the victim accepts the information, the clinician can provide just the phone number of the National Human Trafficking Resource Center on a small slip of paper that may be easily hidden in a pocket or a shoe, being careful not to label the phone number for fear that the trafficker or others might see it. Posting the human trafficking information with phone number, text messaging number, and the local crisis resources should be posted in the bathrooms where victims may be able to see the information in private (Dignity Health, 2019; ICMEC, 2019). Health Care Professional Consideration: Healthcare professionals have an ethical and legal obligation to guard the patient’s safety by reporting any suspected abuse or potential human trafficking. The patient’s identity can be kept confidential. The National Human Trafficking Resource Center can be reached 24/7 at 1-888-373-7888. Post this information where you work.
reassured that they can return. A nonjudgmental attitude will help them to consider further care and may save their life. The small piece of paper with the unlabeled trafficking hotline number can be given to the patient in a clandestine manner if the trafficker is present. Children who are obvious victims of abuse can be taken into protective custody. Documentation A comprehensive recording of the patient’s history and physical exam is critical in suspected cases of human trafficking. Descriptions may be used for future investigations or in legal proceedings. Exact information on the color and size of bruises, the number of wounds, tattoos, piercings, branding marks, or other evidence is important. Bruises and wounds should be annotated by color instead of estimated age of the injury because patients heal at different rates. Phrases such as, “This injury is not consistent with the patient’s reported history” should be used. Photographing should be done only with the patient’s express consent. Getting the patient’s consent helps to build trust and can allow the clinician to photograph the patient’s face to complete the evidence credibility (Edmonson et al., 2017). When the slightest doubt exists that the patient may be a victim of trafficking or domestic violence, photographs should be taken before wounds are treated, if at all possible. Securing permission for photographs may be difficult. Taking a few minutes to explain how careful documentation may help the patient with possible legal action for restitution in the future may encourage cooperation. Reassure the victim that the photos will not be shared and will be a part of the medical record. If the patient denies human trafficking or exploitation, the evidence should still be carefully recorded along with a statement such as, “Human trafficking is suspected.” When possible, the exact words of the patient should be documented. Physical reactions to touching, such as jumping or flinching, should also be documented. Many providers have not been formally educated on how to identify and assess these victims (Powell et al., 2016). Because victims are more likely to disclose trafficking or coercion to a healthcare person than to police, it is critical that professionals know what must be evaluated. Reporting and documenting each case is the place to start, but working with community resources and professional organizations and informing our politicians is also part of our professional responsibility. Documenting interactions with patients is standard in many healthcare settings and for all levels of professionals. These records are especially important and sensitive in cases of human trafficking, because documentation may be vital in tracking the health of a trafficked individual and future legal redress (ICMEC, 2019). Keeping secure, accurate, and unbiased records of quotes, oral disclosures, and written description provides invaluable information. For example, an alias may be needed for patients whose identities are sensitive and at risk of discovery by their traffickers; the healthcare system needs procedures to ensure the security of patient information. Specific considerations in documentation include written descriptions, sketches, and photographic evidence of injuries, with patient permission Initial and, if possible, serial follow-up documentation may be useful in following the progression of injuries. With the adoption of electronic medical records, it can be especially challenging to ensure that medical records aren’t accessible to the trafficker. While capturing information for the medical history and potential legal use, online access to medical notes could
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Book Code: MFL1227
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