_____________________________ Recognizing and Responding to Human Trafficking in Texas, 2nd Edition
While not all victims of trafficking have physical indicators that aid identification, many victims suffer serious health issues, which may include (National Human Trafficking Resource Center, 2016): • Addiction to drugs and/or alcohol to cope with or “escape” their situation, or as a method of control used by their traffickers • Symptoms of PTSD, phobias, panic attacks, anxiety, and depression • Sleep or eating disorders • Untreated chronic illnesses, such as diabetes or cardiovascular disease • Signs of physical abuse, such as bruises, broken bones, burns, and scarring • Chronic back, visual, or hearing problems from work in agriculture, construction, or manufacturing • Skin or respiratory problems caused by exposure to agricultural or other chemicals • Infectious diseases, such as tuberculosis and hepatitis, that are spread in overcrowded, unsanitary environments with limited ventilation • Reproductive health problems, including sexually
CASE STUDY 1 A young woman named Rebecca presents toa local urgent care requesting evaluation for genital sores and vaginal discharge. You notice on her intake information that she does not have insurance listed and indicates she is paying cash for this visit. Further review of her medical records shows that she does not have a permanent address listed and that she has presented on multiple occasions to this urgent care—in addition to other clinics/healthcare facilities—with similar symptoms. She is accompanied by a man named Derek, whom she claims to be her cousin, and who largely speaks for Rebecca, answering questions while she remains sitting quietly on the examina- tion table. Rebecca appears nervous and avoids making eye contact with you and other staff members. She has superficial abrasions and bruises around her eyes and mouth as well as on both upper extremities. Take a moment to consider any potential red flags that you, as the healthcare provider caring for Rebecca, notice that would indicate Rebecca is a victim of human trafficking. ORGANIZATIONAL PROTOCOLS Whenever possible, facilities should create trauma-informed organizational protocols to ensure that human trafficking survivors receive the best possible care. These protocols should include guidelines for appropriate assessment, documentation, reporting, intervention, and referral and may be incorporated into existing protocols for interacting with potential victims of child abuse, violence, and/or sexual assault.
transmitted infections, urinary tract infections, pelvic pain, and injuries from sexual assault or forced abortions
THE ROLE OF HEALTHCARE PROVIDERS As previously mentioned, healthcare providers have a unique position and ability to identify, assess, and respond on behalf of trafficking victims. The primary focus of any interaction with a potential or known victim of human trafficking should be to address the chief complaint (acute illness or injury), establish healthcare facilities and providers as allies and safeguards from trauma and/or exploitation, and to offer additional resources when appropriate. It is not the responsibility of healthcare providers to elicit/coerce a disclosure of human trafficking or to investigate/confirm human trafficking. The responsibility of healthcare providers is to provide patient-centered care; to empower victims to seek additional support when appropriate; and above all, to respect the autonomy of the patient.
IDENTIFICATION AND ASSESSMENT
IDENTIFICATION Many victims of human trafficking are not willing to disclose the nature of their situation due to trauma and fear stemming from oppressive conditions and lived experiences. However, many victims and traffickers exhibit signs that can be identi- fied. Potential red flags indicating a patient is a victim of human trafficking may be exhibited by both the patient and the patient’s guest/companion. Some potential patient-specific red flags include repeated physi- cal injuries and signs of physical abuse/neglect, sexual health concerns with repetitive STI screenings or reproductive care, body language, and delayed care (Richie-Zavalet et al., 2021; Stocklosa et al., 2022; Tiller & Reynolds, 2020). • A victim’s body language may convey that they are fearful, hypervigilant, and anxious. Victims may avoid eye contact with providers, may appear disoriented, may be unable to recall or report basic information such as their address, and may even be unable to produce identification documents.
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Book Code: ANCCTX2027
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