BUILDING A PROTOCOL
Institutional protocols for human trafficking cases require flexibility to accommodate the wide variety of cases and a robust collection of resources to address trafficked individuals’ needs adequately. The level and type of response may vary by person, but all protocols need coordination between disciplines Documentation requirements Documenting interactions with patients is standard in many healthcare settings and for all levels of professionals. These records are especially important and sensitive in cases of human trafficking, because documentation may be vital in tracking the health of a trafficked individual and future legal redress (Alpert et al., 2014). Keeping secure, accurate, and unbiased records of quotes, oral disclosures, and written descriptions provides invaluable information. When creating a protocol, healthcare providers should consider standardized procedures for documenting and securing privacy for all records. Specific considerations in documentation include written descriptions, sketches, and photographic evidence of injuries, with patient permission (Alpert et al., 2014). Initial and serial follow-up documentation may be useful in following the progression of injuries. Protocols should incorporate trauma- informed care practices by respecting and informing patients of their right to refuse details or not allow photographic evidence. (These practices may inflict retraumatization.) Forensic evidence Documentation of forensic evidence is extremely important in cases that involve sexual assault. Medical personnel with specific forensic training – such as sexual assault nurse examiners or forensic nurse examiners– are ideal team members to collect forensic evidence. They specialize in collecting methods, facilitating postassault health care, and obtaining detailed and compassionate histories (Alpert et al., 2014). Protocols should include procedures for what agencies and collection processes will be used in cases of sexual assault. Security for both patient and healthcare professionals In some instances, angry individuals involved in trafficking may come to the establishment to which a trafficked individual has fled and attempt to use force or aggressive coercion to regain control and possession of the individual. Traffickers may use desperate and violent measures to obtain what they believe to be their property. Patient resources Having current patient resources available is a critical component to providing trauma-informed care. Taking a collaborative approach has several benefits, including increasing awareness of the toolkit throughout the workplace and developing a support team to help keep the resources up to date. Effective protocols are based on proactive coordination with a range of professionals, such as law enforcement and social services. This means creating and updating a list of national and local resources that will provide the highest quality of care and give trafficked individuals the best hope for recovery Conclusion Human trafficking occurs in countless ways. The law defines trafficking by the force, fraud, or coercion used to influence the trafficked person to meet the needs of the trafficker. Further examination of the process of trafficking reveals its elements of means, act, and purpose. A review of the means and purpose provide better insight into the atrocities that leave victims with serious health consequences. Traffickers are able to manipulate others by using psychological methods as well as recruitment, transit, and exploitation. Some of these exploitative measures involve techniques similar to those used in torture. Once a survivor is able to leave, the
and fields and a comprehensive approach (Alpert et al., 2014). Both immediate (nutrition and physical protection) and long- term (Legal services and permanent housing) needs should be considered. The general principles to help guide the creation of a protocol are discussed here. Mandatory reporting The awareness of trafficking has risen greatly over the past decade, and new laws address this crime. Some states mandate that professionals, including those in health care, report cases of child trafficking. Nearly all states require healthcare professionals to report child abuse and neglect (Child Welfare Information Gateway, 2019); however, whether human trafficking falls under the legal definition of these categories is determined at the state level. The National Conference of State Legislatures provides a list of human trafficking laws specific to each state (see Resources; National Conference of State Legislatures, 2020). At present, most states do not have a mandatory reporting requisite for human trafficking cases. As the public gains human trafficking awareness, more states are adopting legislation and mandates for reporting. Healthcare professionals must know the legal requirements of reporting within the state of practice and to proceed accordingly. Reasons for not wishing to report cases of human trafficking are complex and largely center on the need to maintain the patient’s trust. Trafficked individuals often have a powerful distrust of authority, especially law enforcement. They fear legal repercussions for themselves, especially when involved in commercial sex exploitation and may worry about potential retribution when their traffickers find out they contacted the authorities. Being aware of these complexities and the existing laws will aid in selecting the appropriate course of action. Healthcare institutions should have a protocol for aggressive persons. Common themes of safety protocols include fleeing from the aggressor when possible, hiding, and fighting only when absolutely necessary. The security protocol should establish which phone numbers to call in cases of emergency and the best escape routes from the building should an attacker become an active shooter. and integration. Organizations and themes mentioned in the Resources are a starting point for identifying what resources to incorporate in a protocol’s toolkit, including survivor network organizations. Once the toolkit is created, it is essential that it be regularly updated. New organizations can be created, and contact information for existing groups may change over time. Updated information is essential to providing good care and connecting victims with resources, possibility of retrafficking remains, as does the possibility of detention and its related horrors. These experiences, along with existing risk factors, are what drive the cycle of trafficking and traumatization. Identifying and providing care for a trafficked individual can be challenging at times. Even before confirming that a patient is being trafficked, trauma-informed practices should be in place to prevent retraumatization of patients. Healthcare systems such as a hospital or group practice can adopt trauma-informed care, as can individual health professionals.
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