○ Have you ever received anything in exchange for sex (e.g., shelter, gifts, food)? ■ Has anyone at home or at work threatened you or your family? ■ Has anyone at home or at work ever hurt you? ○ Can you leave your job or living situation if you want? Are you free to come and go as you please? ○ Have you ever been afraid to leave or quit a work situation due to fear of violence or threats of harm to you or your family? ○ Have your identification documents been taken away from you? ● Document the encounter thoroughly. Along with carefully asking thoughtful and respectful questions, documenting the patient/victim encounter thoroughly and using only medically relevant information with necessary supporting details is vital to providing adequate care for victims (Stoklosa & Beals, 2022; Tiller et al., 2020). It is important to state information objectively, avoid subjective phrasing or terms, and be thorough when describing relevant findings on physical exams (potential findings pointing to abuse, complete skin exams, other pertinent details; Stoklosa & Beals, 2022). Lastly, it is important to remember that medical records may serve both medical and legal purposes if the victim seeks legal justice after making a disclosure. ● Provide resources and information for victims. Once a victim of trafficking has been identified and a conversation has been started, providers may be appropriately positioned to guide the trafficked person to safety. If the provider is appropriately trained and educated on the considerations regarding helping victims find safety, they may be able to assist with developing a plan to connect the victim with local supportive services to provide safety, housing, and other basic necessities. Providers may also offer assistance in other ways such as offering to contact the National Human Trafficking Hotline on behalf of the victim or connecting the victim with a social worker or case manager. Providers may submit tips about potential trafficking cases to the hotline online at https:// humantraffickinghotline.org/, send an email to help@ humantraffickinghotline.org, or call 1-888-373-7888. ● Utilize professional interpreters. When working with individuals who have limited English proficiency and/ or prefer communicating in a different language, it is critical to have trained and qualified interpreters on hand to help you communicate (National Human Trafficking Training and Technical Assistance Center, 2022). In the case for a potential trafficking situation, it is important not to use others accompanying the individual, family members or anyone who has a relationship with the individual as interpreters (National Human Trafficking Training and Technical Assistance Center, 2022). When selecting an interpreter, neutral and trained professionals Case Study 1 (continued) Continuing Rebecca’s visit, you are now ready to begin her physical examination. Derek insists he would like to stay in the room during the examination, and Rebecca consents to his presence. He remains standing at the head of the bed during the pelvic examination. The exam helps you determine Rebecca’s presentation is consistent with an outbreak of genital herpes, and microscopic examination of the discharge reveals trichomoniasis. These are two sexually transmitted infections. Derek seems unusually undisturbed by the diagnoses. You are concerned about Rebecca’s current living situation and would like to question her privately. While discussing the diagnoses with Rebecca and Derek, you inform them
from accredited agencies should be used, preferably in person; additionally, interpreters should be screened for conflicts of interest (National Human Trafficking Training and Technical Assistance Center, 2022). If possible, the potential trafficking victim should be asked for their preferences for an interpreter (e.g., gender or age of interpreter), and should told that they can refuse a particular interpreter if they are not comfortable speaking in front of them (National Human Trafficking Training and Technical Assistance Center, 2022). Once an interpreter has been selected, a pre-interview meeting should be held in which the interpreter is informed about the risk of hearing traumatic details about the potential victims’ life, is asked to apply a trauma-informed approach, use person- centered language, maintain neutral body language and facial expressions, and translate verbatim all questions and answers (National Human Trafficking Training and Technical Assistance Center, 2022).Be aware of mandatory state reporting laws. In Texas, healthcare providers who are concerned that their patient has been trafficked should provide medical care to the patient while also following mandatory state reporting laws and institutional policies regarding abuse to a child, elderly person, or person with a disability, or reporting that a child is unaccompanied by an adult (Texas Health and Human Services, 2024). A professional who becomes aware of child abuse must report it within 48 hours. This reporting duty cannot be delegated and must be made non-anonymously. Health care providers should follow institutional policies for reporting to law enforcement if the patient is in immediate, life-threatening danger but should work with the patient in deciding to contact law enforcement to avoid putting the patient in further danger (Texas Health and Human Services, 2024). In Texas, it is mandatory that health care practitioners report the abuse of those 65 or older and adults with disabilities to law enforcement and/or the Department of Family and Protective Services immediately. Victims of human trafficking may not want law enforcement contacted due to concerns for safety of themselves and their loved ones, fear of reprimand for crimes they have been forced to commit, mistrust of law enforcement, stigma and shame with reporting, and the emotional burden of the judicial system (Canadian Centre to End Human Trafficking, 2024; Palombi et al., 2019). Providers should also offer the patient the National Human Trafficking Hotline number, 888-373-7888, and text number, 233733 and should encourage the patient to call if they want help or to talk to someone (Texas Health and Human Services, 2024). A practitioner can report to the National Human Trafficking Hotline that they suspect an adult (not 65 or older and not disabled) is being trafficked, but they cannot provide identifying information without the adult’s consent. that you would like Rebecca to have a urine pregnancy test done before beginning treatment and request that she accompany you to the restroom to provide a urine sample. Derek states he will go with her and wait outside of the restroom. You explain that this is not possible because the route to the restroom passes other patients’ rooms and that this may result in an unintentional disclosure of protected patient information. Derek quickly replies that it is impossible for Rebecca to be pregnant and insists she has been compliant with her oral contraceptives and her periods are normal. Then he begins to question the necessity of the test. You inform them that she will not be treated until the test is complete, and Derek reluctantly agrees.
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Book Code: SWTX1525
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