the trafficker’s permanent ownership. Asking about a tattoo’s significance during a healthcare visit may elicit details about the patient’s social history. Social Contextual indicators are important to help the clinician identify potential trafficking. Clinicians should pay attention to who attends the patient’s appointments and how the patient behaves in the office or examination room. A minder posing as a partner or family member often will speak for the patient when questions are asked (Zimmerman et al., 2011). Separating the patient and minder may free the patient to disclose information during an interview. Even when alone with a healthcare professional, a trafficked person may be fearful or Screening for trafficking Once there is a suspicion of human trafficking, obtaining information from the patient can be vital in terms of providing the best quality care and empowering the patient by providing the most appropriate resources. It can be challenging to find a balance between asking important questions of the patient and limiting the risk of retraumatization. The provider should avoid yes/no response questions, as they do not provide enough accurate information. Questions should be open ended an allow victims plenty of time to respond. Several screening tools are available and can be personalized to the patient and his or her situation. At present, none are validated for a healthcare-specific setting. However, the Vera Institute of Justice (2014) created the Trafficking Victim Identification Tool for legal settings, which can be modified for a clinical setting. Table 2 gives more examples of the screening questions. Privacy is key when discussing sensitive matters with a patient suspected of being trafficked. The presence of others may retraumatize the patient and influence his or her answers (IOM, 2009). Therefore, the healthcare provider should limit the number of people present during the interview and asking the questions, especially limiting the presence of any persons who accompanied the patient to the appointment. Youth who are experiencing trafficking may present with a wide variety of health complaints, making it important always to consider the possibility that trafficking may be occurring. Despite the lack of a presenting profile, clinicians should consider the following signs and symptoms to be red flags:
hesitant to answer questions. Separating the trafficked individual from their minder may be difficult. One strategy is that an X-ray may be ordered when the suspected perpetrator is present; the order can be cancelled when the patient gets to the X-ray room if it is not needed. During X-ray procedures, health care providers have an excellent opportunity to separate the victim from anyone accompanying them, allowing the victim to answer questions. In the case of foreign individuals who are being trafficked, English may be a second language, making it even more difficult to discover the trafficking through an interview. In these cases, clinicians should use a professional interpreter, not a family member or the minder. ● Pregnancy/abortion issues or need for reproductive health care at a young age. ● Substance use, misuse, or dependency. ● Tattoos or brands. (Bohnert et al., 2017; Greenbaum, 2014; Lederer & Wetzel, 2014) Table 2: Screening Tool for Human Trafficking • Did anyone where you worked [or did other activities] ever make you feel scared or unsafe? • Did anyone where you worked [or did other activities] ever hurt you or threaten to hurt you (including physical, sexual, or emotional harm)? If so, could you tell me what they did or said? • Were you allowed take breaks where you worked [or did other activities], for example, to eat, use the telephone, or use the bathroom? If yes, did you have to ask for permission? What did you think would happen if you took a break without getting permission? • Did anyone where you worked [or did other activities] ever trick or pressure you into doing anything you did not want to do? If you are comfortable talking about it, could you please give me some examples? • Did you ever have sex for things of value (for example, money, housing, food, gifts, or favors)? Were you pressured to do this? Were you under the age of 18 when this occurred? • Were you ever injured or did you ever get sick in a place where you worked [or did other activities]? Were you stopped from getting medical care? If you feel comfortable, could you tell me more about what happened? • Have you ever felt you could not leave the place where you worked [or did other activities]? Could you tell me why you couldn’t leave? Note . Adapted from Vera Institute of Justice. (2014). Screening for human trafficking: Guidelines for administering the Trafficking Victim Identification Tool (TVIT) . New York, NY: Vera Institute of Justice.
● Unexplained injuries. ● Injuries due to assault. ● Delays in accessing health care.
● A suicide attempt. ● Signs of self-harm. ● Acute sexual assault. ● Signs of sexual abuse. ● Recurring STIs.
TRAUMA-INFORMED CARE
The Substance Abuse and Mental Health Services Administration (SAMHSA, 2014) defines individual trauma as follows: An event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or life threatening and that has lasting adverse effects on the individual’s functioning and mental, physical, social, emotional, or spiritual well-being. (p. 7) What is trauma-informed care? Trauma-informed care is a broad approach to treating all patients, many of whom have experienced trauma and its physical, emotional, and social repercussions. It is a lens to view all people encountered in the healthcare setting, because any individual may have experienced a trauma that is affecting his or her actions and decisions (National Technical Assistance Center for Children’s Mental Health, n.d.a.). As stated by
Trauma-informed care encompasses more than just trafficked individuals and is not limited to those who have diagnoses that are typically associated with trauma, such as PTSD. The healthcare professional must keep trauma-informed care in mind when deciding on appropriate interventions for a trafficking patient. Trauma-informed care is imperative for providing the best treatment of patients who have been trafficked and those who have other violence-related health concerns. the team at Georgetown University Center for Child and Human Development, trauma-informed care is changing the fundamental question from “What is wrong with you?” to “What happened to you?” (National Technical Assistance Center for Children’s Mental Health & JBS International, n.d.b.).
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