______________________________________ Human Trafficking and Exploitation: The Texas Requirement
SOCIAL CONSEQUENCES AND QUALITY OF LIFE When rescued and attempting to reintegrate into their com- munities, victims of human trafficking often experience stigma, ostracism, and marginalization [88; 91]. For example, in Nepal, community members perceived returning child soldiers who had performed acts such as carrying dead bodies or coed sleeping as in violation of Hindu cultural norms [88]. One documentary following former child soldiers living in a refugee camp in northern Uganda found that preconceived notions and myths about children soldiers often led to ridicule and ostracism after they were liberated from the army and returned home. However, girls who were recruited as soldiers, who were forced to have sex, or who return with children appear to be the most marginalized group [92]. In a qualitative study of former girl soldiers in Sierra Leone, researchers found that, compared to returning boy soldiers, girls were perceived to have violated gen- der norms and values about sexuality. Although psychologically and developmentally they were still children, the community perceived and treated them as “damaged” or “unclean” women. Their communities were not able to re-integrate them, despite the victimization they experienced. These girls lacked voice and experienced shame, marginalization, poverty, and powerless- ness upon their return [92]. In a study of former child soldiers in Uganda, the children reported having difficulty finding jobs or getting married when they returned home. Girls who had been raped were stigmatized and made to feel unwelcome in their communities. Others stated that their community perceived them as murderers [50].
Yet, many providers lack the training and confidence to identify and assist victims. In a survey of 110 emergency department physicians, nurses, and physician assistants, the majority (76%) reported having a knowledge of human trafficking, but only 13% felt equipped to identify a trafficking victim and only 22% were confident in their ability to provide satisfactory care for such patients [95]. Less than 3% had ever received any training on this topic. In a separate survey of healthcare and social service providers, only 37% had ever received train- ing on identification of trafficking victims [96]. This lack of healthcare provider knowledge is the root of some victim’s reluctance to disclose. Because human trafficking and exploitation are, by nature, covert processes, the identification and rescue of the victim can be difficult. As stated, traffickers often move victims from one area to another to reduce the risk of identification, and one of the main problems with the assessment of such individuals is that practitioners may only have a one-time encounter with the victim [97]. Other provider challenges include language barri- ers, the hidden nature of the crime, lack of self-identification as a victim, confusing or contradictory laws/regulations, lack of organizational protocols, and stereotypes/misconceptions [98]. Several barriers exist that prevent survivors from self-disclosing their experiences, including [98]: • Unable to self-identify • Lack of knowledge of services • Fear of retaliation • Fear of law enforcement/arrest/deportation
• Lack of trust • Shame/stigma
IDENTIFICATION AND ASSESSMENT
• Learned helplessness/PTSD • Cultural/language barriers • Lack of transportation
INTERACTION WITH VICTIMS Healthcare providers are often the most likely to encounter a victim of human trafficking under circumstances that provide an opportunity to intervene, and victims may be encountered in most mental health and healthcare venues. One study esti- mated that 30% to 87.8% of victims accessed medical services at some point during their trafficking [93]. Survivors may seek care in hospital emergency rooms, at local mental health authorities, urgent care facilities, family planning clinics, or outpatient medical settings for a variety of issues, including sexually transmitted infections, pregnancy, depression (includ- ing suicidality), injuries resulting from assault, substance abuse-related issues, and PTSD [94]. Because medical and dental appointments may allow for more privacy than a victim’s other encounters, they may represent a unique opportunity for healthcare providers to intervene.
TRAUMA-INFORMED CARE All interactions with patients, regardless of whether or not they are potential victims of trafficking, should be centered on the patient’s experiences, needs, and preferences. Providing patient-centered care means that care will be respectful of and responsive to individual patient preferences, needs, and values and will reflect the patient’s values. This should be considered at all stages of assessment, intervention, and continued care/ follow-up. It is important to use a trauma-informed approach when assessing and caring for potential victims, which requires that practitioners understand the impact of trauma on all areas of an individual’s life [99]. Physical, emotional, and psychological safety is at the heart of trauma-informed care. This approach allows for trust-building and continued communication, two factors that are vital to ensuring that patients receive the care and support they require.
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