_____________________________ Recognizing and Responding to Human Trafficking in Texas, 2nd Edition
• Paying cash or having no health insurance • Lacking control of identification documents (e.g., state-issued ID or passport) • Having few or no personal possessions • Due to large debt, being reticent when asked to consent for additional testing or services • Inability to: ‒ Leave home or place of work ‒ Speak for oneself or share one’s own information ‒ Feeling helplessness, shame, guilt, self-blame, and humiliation • Experiencing a loss of sense of time or space; not knowing where they are or what city or state they are in • Feeling emotional numbness, detachment, disassociation Self-Assessment Question 2. All of the following are potential indicators that a patient is a victim of human trafficking except: A) Presenting with frequent and repeated injuries. B) Being accompanied by an individual who frequently accompanies other individuals for similar acute illness/ injuries. C) Presenting for reproductive care with a history of several STI screenings and multiple terminated pregnancies. D) None of the above. RESPONSE AND FOLLOW-UP Victims of trafficking do not often disclose their trafficking situ- ation in clinical settings (Alpert et al., 2014). Research indicates that up to 88% of victims interact with healthcare providers while they are in a trafficking situation (Smith, 2022. Many healthcare systems and facilities do not have policies in place that standardize screening and response protocols. One study found that only 39% of healthcare centers, departments, hos- pitals, and clinical settings such as dental and OBGYN offices in Michigan and Texas had screening policies in place, and only 62.5% had response protocols in place (Munro-Kramer et al., 2022). Healthcare providers must be thoughtful and careful about engaging with patients if human trafficking is suspected. Before beginning any conversation with a patient, assess the potential safety risks that may result from asking sensitive questions. Recognize that the goal of your interac- tion is not disclosure or rescue, but rather to create a safe, nonjudgmental place that will help you identify trafficking indicators and assist the patient (National Human Trafficking Resource Center, 2016).
A trauma-informed approach is crucial in rendering aid to individuals who may have experienced trauma, and includes an understanding of trauma and an awareness of the impact it can have across settings, services and populations (SAMHSA, 2020). A trauma-informed approach involves viewing trauma through an ecological and cultural lens, recognizing that context plays an important role in how individuals perceive and process traumatic events (SAMHSA, 2020). The three key elements of a trauma-informed approach include: realizing the prevalence of trauma, recognizing how trauma affects all indi- viduals within the health care system, and responding by put- ting this knowledge into practice (SAMHSA, 2020). Trauma- informed care is a strengths-based service delivery approach “that is grounded in an understanding of and responsiveness to the impact of trauma, that emphasizes physical, psychological, and emotional safety for both providers and survivors, and that creates opportunities for survivors to rebuild a sense of control and empowerment” (Hopper, Bassuk, & Olivet, 2010, p.82). Trauma-informed care is crucial when working with victims of human trafficking as it also involves vigilance in anticipating and avoiding processes and practices that could re-traumatize individuals (SAMHSA, 2020). Trauma-informed care can potentially provide a greater sense of safety for individuals who have a history of trauma as well as a space for preventing more serious consequences of traumatic stress (Fallot & Harris, 2002). While many individuals “may not identify the need to connect with their histories, trauma- informed services offer clients a chance to explore the impact of trauma, their strengths and creative adaptations in manag- ing traumatic histories, their resilience, and the relationships among trauma, substance use, and psychological symptoms (SAMHSA, 2020, p.8). Beyond utilizing a trauma-informed approach, some additional considerations when interacting with and caring for victims are: • Don’t ignore potential warning signs. Although
victims do not often make explicit disclosures about their trafficking situations, many will share some indications that partially speak to their trauma. Victims may casually or jokingly reveal information that suggests their situation, such as the number of sex partners—if they are victims of sex trafficking—to provide context about their current medical situation (Richie-Zavalet et al., 2021; Stocklosa et al., 2022). If a provider notices potential signs of human trafficking, they should take time to review the patient’s/victim’s medical record to determine if that individual’s acute health concerns fit a pattern consistent with previous encounters (Richie-Zavaleta et al., 2021).
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