Human Trafficking and Exploitation: The Texas Requirement _______________________________________
SAFETY MEASURES While it may be necessary to modify the approach depending on the situation, the Advocates for Human Rights recommends that safety plans for trafficking survivors [111]: • Are personalized, realistic, involve friends and family that the victim trusts, and cover every aspect of the victim’s life • Focus on improving safety in the victims’ environment • Assess the current risk and identify current and poten- tial safety concerns • Create strategies for avoiding or reducing the threat of harm • Outline concrete options for responding when safety is threatened or compromised, including: – Determining who victims will call in an emergency and memorizing those phone numbers or prepar- ing a small card listing the numbers – Identifying where victims will go if there is an emergency – Identifying what victims will do if the trafficker contacts them after they leave the trafficking situ- ation (e.g., retain messages, contact the police or a victim advocate) – Assessing how to handle safety issues when victims have family or friends, including those in another country, who are at risk of harm from the trafficker • Are re-evaluated at various stages of the trafficking situ- ation • Reflect changing circumstances in the victim’s life and changes in support or services (e.g., victims may have felt safe with a particular situation at the time of prepar- ing the safety plan, but they may not feel safe in that same situation in the future) • Address what victims will do in response to flashbacks or triggers, including those in any new workplace • Strategize how to address and replace technology, such as cell phones, that the trafficker provided or had access to (e.g., leaving phones in places victims are allowed to be or providing phones just for calling 911) In addition, non-U.S. citizens should have access to an emer- gency contact in the United States (potentially a legal services provider) and plans for young children (i.e., a decision-making proxy). Youth victims may require housing assistance [111]. DOCUMENTATION Ideally, the victim of human trafficking should be offered a formal forensic evaluation; this requires written documenta- tion of informed consent. Injuries should be documented in photographs, diagrams, or sketches. A growing number of hospitals now employ dedicated forensic nurses as part of a multispecialty sexual assault team [112]. Often, however, these trained specialists are not the first professionals to interact with the patient. Consequently, all healthcare professionals,
particularly those in an emergency care setting, should have an understanding of the principles that govern proper collec- tion and preservation of evidence during the examination of an assault victim. The initial clinical assessment includes a careful history and physical examination, followed by selected laboratory testing and radiographic studies as indicated by clinical findings. Examination of the forensic patient is conducted in a thorough head-to-toe or toe-to-head manner, with the intent of docu- menting every indication of injury related to the incident (no matter how insignificant and involving every part of the body) using a body-map or wound chart. The entire body surface should be palpated to identify areas of bruising that may not yet be visible. Documentation and collection of evidence typi- cally occurs at the same time as the physical exam—as evidence is detected it should be collected. Forensic documentation includes a written component, a dia- grammatic component, and a photographic component. Each should accurately inform the other. The written component must be detailed, accurate, and objective; the diagrammatic component must be thorough and legible; and the photo- graphic component must include a measurement scale, be representative of the evidence, and remain objective.
RESPONSE AND FOLLOW-UP
HEALTHCARE PROVIDERS’ ROLE Care and services provided to victims can be organized into three distinct categories: immediate and concrete services at the time of rescue; services related to recovery; and long-term services pertaining to reintegration [113]. When trafficking victims are rescued, a great deal of counseling services and practical, day-to-day assistance will be required. Housing, trans- portation, food, clothing, medical care, dental care, financial assistance, educational training, reunification (for those who wish to return to their homeland), and legal aid are some of the concrete services needed [24]. Practitioners should connect, coordinate, and case manage these services as much as possible. During this stage, it is also important to understand victims’ needs, their strengths, and their risks and vulnerabilities [82]. Safety planning is also crucial in the immediate rescue stage. Traffickers may be continuing to try to locate some victims; placing victims in safe houses may be necessary [86]. The National Human Trafficking Hotline encourages that safety planning be based on the unique needs and circumstances of the individual. One should also take steps to ensure that one’s own safety is also protected. During the recovery and reintegration stages, as discussed, human trafficking victims experience an array of mental health and psychological issues. Mental health counseling is vital, but it is important to remember that the concept of counseling or talk therapy may be foreign to victims from non-Western cul- tures [70]. The expression of emotions may be in opposition to cultural values of emotional restraint, which can be intensified
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