sex and labor trafficking fear that if they escape their servitude and initiate investigations against their trafficker, the trafficker and his/her associates will harm the victims, the victims’ family members, or others. Additional patient situations, behaviors, or emotional states may suggest human trafficking: 2 ● Paying cash or having no health insurance. ● Lacking control of identification documents (ID or passport). ● Having few or no personal possessions. ● Being reticent for additional testing or services due to large debt. ● Inability to: ○ Leave home or place of work. ○ Speak for oneself or share one’s own information. ● Feelings of helplessness, shame, guilt, self-blame, and humiliation. ● Loss of sense of time or space, not knowing where they are or what city or state they are in. ● Emotional numbness, detachment, or disassociation (i.e., “flat affect”). Responding to victims of human trafficking Victims of trafficking do not often disclose their trafficking situation in clinical settings. 8 Health care providers must, therefore, be thoughtful and careful about engaging 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 of the patient. Recognize that the goal of your interaction is not disclosure or rescue, but rather to create a safe, non-judgmental place that will help you identify trafficking indicators and assist the patient. 2 This may be challenging in the context of busy, time-constrained schedules, but it is possible. Clinicians should: ● Allow the patient to decide if he or she would feel more comfortable speaking with a male or female practitioner. ● If the patient requires interpretation, always use professional interpreters who are unrelated to the patient or situation. ● If the patient is accompanied by others, try to find a time and place to speak with the patient privately. ● Take time to build rapport with potential victims, or if you do not have the time yourself, find someone else on staff who can develop rapport with the patient. ● Ensure that the patient understands confidentiality policies and practices, including mandatory reporting laws. ● Use multidisciplinary resources, such as social workers, where available. ● Refer to existing institutional protocols for victims of abuse/ sexual abuse. ● Contact the National Human Trafficking Resource Center (NHTRC) hotline (1-888-373-7888) for assistance. Information available at: https://humantraffickinghotline.org/ If a patient has disclosed that he or she has been trafficked: 2 ● Ensure that safety planning is included in the discharge planning process. ● Provide the patient with options for services, reporting, and resources. ○ Provide the patient with the NHTRC hotline number. If the patient feels it is dangerous to have something with the number written on it, have them memorize the
While not all victims of trafficking have physical indicators that aid identification, many victims suffer serious health issues, which may include: 2 ● Addiction to drugs and/or alcohol as a way to cope with or “escape” their situation, or as a method of control used by their traffickers. ● Symptoms of post-traumatic stress disorder, 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, which are spread in overcrowded, unsanitary environments with limited ventilation. ● Reproductive health problems, including sexually transmitted diseases, urinary tract infections, pelvic pain, and injuries from sexual assault or forced abortions. number or designate someone in your staff that they can call back to in order to provide that number. ● In situations of immediate, life-threatening danger, follow your institutional policies for reporting to law enforcement. Whenever possible, try to involve the patient in the decision to contact law enforcement. ● If the patient is a minor, follow mandatory state reporting laws and institutional policies for child abuse or serving unaccompanied youth. Most state laws require immediate intervention if the trafficked victim is a minor. ● Ensure that any information regarding the patient’s injuries or treatment is accurately documented in the patient’s records, recognizing that, similar to sexual assault examinations, the medical record serves both medical and legal purposes. Legal requirements regarding mandatory reporting of human trafficking differ from state to state, and situations may require mandatory reporting under related statutes even if the situation is not human trafficking (e.g., child abuse or domestic violence). State-specific information is available at: https://polarisproject. org/resources/state-ratings-on-human-trafficking-laws/ Refer to your local or state requirements for additional information regarding mandatory reporting. Four fundamental principles have been recommended for healthcare professionals who come into contact with people who have been, or are being, trafficked: 8 1. Use a trauma-informed, resilience-oriented, human rights- focused, and culturally sensitive approach to the care of all patients. 2. Collaborate with and seek advice from colleagues who have been engaged in anti-trafficking or other violence prevention work. 3. Partner with advocates, social service providers, case managers, and others from outside the health sector to improve referral services and achieve a more effective overall response to human trafficking. 4. Play an active role in self-directed education and training about human trafficking.
USING A TRAUMA-INFORMED APPROACH
At a glance, it is easy to appreciate the trauma of a massive motor vehicle accident, but a patient who is trafficked is experiencing a similarly powerful, but far less visible, traumatic event. The task for clinicians is to recognize trafficking when they see it and respond appropriately. The patient’s experiences can be dehumanizing, shocking or terrifying, can involve singular
or multiple compounding events over time, and often include betrayal of a trusted person or institution and a loss of safety. 24 These experiences can mean that ordinary medical procedures, such as asking a patient to undress for an exam, performing a gynecological exam, or even simply checking blood pressure, can be threatening or anxiety-provoking.
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Book Code: MTX1323
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