Human Trafficking and Exploitation: The Texas Requirement _______________________________________
Being trauma-informed is a strengths-based approach that is responsive to the impact of trauma on a person’s life. It requires recognizing symptoms of trauma and designing all interactions with victims of human trafficking in such a way that minimizes the potential for re-traumatization. This involves creating a safe physical space in which to interact with survivors as well as assessing all levels of service and policy to create as many opportunities as possible for survivors to rebuild a sense of control. Most importantly, it promotes survivor empowerment and self-sufficiency. Survivors should also have access to ser- vices that promote autonomy and are comprehensive, victim- centered, and culturally appropriate. Additionally, trafficking survivors share that one of the most important steps to being trauma-informed is to be survivor-informed [100]. POTENTIAL RED FLAGS Bruises, scars, and other signs of physical abuse may be missed on examination, as victims are often beaten in areas hidden by clothing (e.g., the lower back) so as not to affect the victim’s outer appearance. Physical trauma symptoms may be present, commonly on the torso, breast, and/or genital areas [101]. Burns, broken bones, pelvic pain, and/or STIs (particularly in children) may also be red flags [102]. However, more common physical injuries are also typical with other circumstances, mak- ing physical exam of limited value. The entire clinical picture should be considered. It may also be helpful to assess for tattoos and/or other modifications (e.g., branding, piercings). Some perpetrators use tattoos to identify victims or to signify “ownership” [60]. With regard to episodic clinical encounters, recommendations for providing safe assessments in a culturally sensitive manner are lacking. The Department of Health and Human Services Administration for Children and Families maintains a useful website that addresses practical issues of human trafficking for allied professional groups, known as the Look Beneath the Sur- face Campaign [76]. Included are diagnostic and interviewing tips to help healthcare providers recognize and refer trafficking victims to appropriate services [76]. Emergency and primary care providers should be cognizant of clues that a patient may be the victim of trafficking and prepared to engage in a greater depth of inquiry with special attention to the following indica- tors [76; 102; 103; 104]: • Does someone, other than family, who behaves in a controlling manner, accompany the patient? Traffickers attempt to guard and control most every aspect of the victim’s life, while maintaining isolation from family, friends, and other common forms of human interac- tion. • Are there inconsistencies in answers to basic questions (e.g., name, age, address)?
• Does the patient speak English? If not, has he or she recently been brought to this country, and from where? Many victims of human trafficking have recently been trafficked from other countries. As discussed, common sending countries/regions include Eastern Europe, Asia, Latin America, Africa, India, and Russia. • If the patient is accompanied by someone other than a family member, who does the talking, and why? Attempt to interview and examine the patient sepa- rately and alone, using an interpreter if necessary. Probe in a sensitive manner for detailed information on the situation and relationship. • Does the patient show signs of psychosocial stress (e.g., appears withdrawn, submissive, fearful, anxious, depressed)? Can the individual account for this? • Are there visible signs of physical abuse (e.g., bruises, lacerations, scars)? How does the individual explain these? • Does the patient lack a passport or other immigration and identification documentation (e.g., driver’s license, social security number, visa)? If so, what explanation is given? To control victims’ movements, traffickers often take away passports and any legal identification docu- ments. • What is the patient’s home and work situation? Basic questions about what they eat, where they live and sleep, who else lives with them, and what work they do can be revealing. For example, “Can you leave your work or job situation if you wish?” or “When you are not working, can you come and go as you please?” • Is the explanation given for the clinical visit consistent with the patient’s presentation and clinical findings? • Does the victim appear fearful when asked questions about citizenship, country of origin, immigration status, or residence? This may indicate a fear of deporta- tion. • If the victim is a minor, is s/he in school? Living with parents or relatives? If not, what reasons are given for these circumstances? If answers to these questions indicate that an individual may be a victim of human trafficking, one should contact the National Human Trafficking Hotline at 1-888-373-7888. Under the child abuse laws, practitioners who are mandated reporters and who are suspicious that a minor is being abused should immediately report the abuse. For more information regarding specific states’ reporting requirements, please visit https://www.childwelfare.gov/resources/states-territories- tribes/state-statutes.
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