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:
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. ● 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)
TRAUMA-INFORMED CARE
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. 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.). SAMHSA (2014) dissects trauma into the three E’s: event, experience of the event, and effect. Identifying these elements of trauma helps deepen the healthcare provider’s understanding of how trauma differs among individuals (see Table 3).
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 the team at Georgetown University Center for Child and Table 3: Human Trafficking Health Risks and Consequences Definition
Example
Event
Either single or recurring circumstances of actual or extreme threat of physical or psychological harm or neglect. The individual’s perceptions of the event(s); how he or she labels, assigns meaning to, and is affected physically and psychologically. The results and repercussions of the events, most frequently described as adverse effects, which negatively affect the individual who experienced the traumatic event.
Witnessing violence against others, being sexually violated, verbal abuse and/or threats, etc. Two siblings living in a toxic and abusive environment, one may view the experience as negative, and the other may not. Decreased ability to cope with normal stresses, developing a stress disorder such as posttraumatic stress disorder, etc.
Experience
Effect
Note . Adapted from Substance Abuse and Mental Health Services Administration. SAMHSA’s concept of trauma and guidance for a trauma- informed approach . (HHS Publication No. [SMA] 14-4884). Rockville, MD: Substance Abuse and Mental Health Services Administration, 2014.
EliteLearning.com/Physical-Therapy
Page 6
Powered by FlippingBook