● Other potentially obvious red flags include a delay between injury/illness onset and seeking care or concerning prescription filling patterns. By taking a more nuanced history about the presenting complaint, along with a brief social history assessing home and work environments, providers may be able to discern a potential trafficking situation. Carefully reviewing medical records is essential and an effective way to supplement or clarify a patient-reported history when it is vague, misleading, or untrue. A study of sex- trafficking survivors from two major U.S. cities revealed that most participants who took part in the study reported visiting the same healthcare clinic on several different occasions for various injuries (Richie-Zavaleta et al., 2021). The authors use this to highlight the importance Assessment General considerations during physical exams are related to looking for signs of malnutrition, dehydration, and/or physical exhaustion (Stocklosa et al., 2022; Tiller & Reynolds, 2020). Signs may also be visible on the skin. Look for signs of burns, bite marks, ligature wounds, bruising, traumatic alopecia, and tattoos that are sexually explicit or suggestive of ownership (Richie-Zavalet et al., 2021; Stocklosa et al., 2022; Tiller & Reynolds, 2020). When possible, always speak to the patient alone and use an independent, trained interpreter if required. If trafficking is suspected, anyone with the patient could be a potential trafficker. Additional patient situations, behaviors, or emotional states may suggest human trafficking (National Human Trafficking Resource Center, 2016): ● Paying cash or having no health insurance. ● Lacking control of identification documents (e.g., state- issued ID or passport). ● Having few or no personal possessions. ● Due to large debt, being reticent when asked to consent for additional testing or services. ● Inability to: Response and follow-up Victims of trafficking do not often disclose their trafficking situation in clinical settings (Alpert et al., 2014). Research indicates that up to 88% of victims interact with healthcare providers while they are in a trafficking situation (Smith, 2022. Many healthcare systems and facilities do not have policies in place that standardize screening and response protocols. One study found that only 39% of healthcare centers, departments, hospitals, and clinical settings such as dental and OBGYN offices in Michigan and Texas had screening policies in place, and only 62.5% had response protocols in place (Munro-Kramer et al., 2022). Healthcare providers must be thoughtful and careful about engaging with 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. Recognize that the goal of your interaction is not disclosure or rescue, but rather to create a safe, nonjudgmental place that will help you identify trafficking indicators and assist the patient (National Human Trafficking Resource Center, 2016). A trauma-informed approach is crucial in rendering aid to individuals who may have experienced trauma, and includes an understanding of trauma and an awareness of the impact it can have across settings, services and populations (SAMHSA, 2020). A trauma- informed approach involves viewing trauma through an ecological and cultural lens, recognizing that context plays an important role in
of reviewing patients’ medical records when identifying patients who may be victims of human trafficking. Additional red flags may be seen in a victim’s companion/ guest and include behaviors such as refusal to leave when trying to conduct one-on-one patient interviews, insistence on speaking/translating for the patient, controlling/ interrupting the flow of care, having the patient’s documents in their possession, and an employer demanding access to medical information. Traffickers may employ strategies such as pretending to be the victim’s partner, family member, or close friend. Another potentially obvious red flag is a trafficker accompanying multiple victims to the same healthcare facility. Some traffickers may visit a certain healthcare facility so frequently that they try to build rapport with providers in order to deceive these of their “goodness.” ○ Leave home or place of work. ○ Speak for oneself or share one’s own information. ● Feeling helplessness, shame, guilt, self-blame, and humiliation. ● Experiencing a loss of sense of time or space; not knowing where they are or what city or state they are in. ● Feeling emotional numbness, detachment, disassociation. Self-Assessment Question 2 All of the following are potential indicators that a patient is a victim of human trafficking except: a. Presenting with frequent and repeated injuries. b. Being accompanied by an individual who frequently accompanies other individuals for similar acute illness/ injuries. c. Presenting for reproductive care with a history of several STI screenings and multiple terminated pregnancies. d. None of the above. how individuals perceive and process traumatic events (SAMHSA, 2020). The three key elements of a trauma- informed approach include: realizing the prevalence of trauma, recognizing how trauma affects all individuals within the health care system, and responding by putting this knowledge into practice (SAMHSA, 2020). Trauma-informed care is a strengths-based service delivery approach “that is grounded in an understanding of and responsiveness to the impact of trauma, that emphasizes physical, psychological, and emotional safety for both providers and survivors, and that creates opportunities for survivors to rebuild a sense of control and empowerment” (Hopper, Bassuk, & Olivet, 2010, p.82). Trauma-informed care is crucial when working with victims of human trafficking as it also involves vigilance in anticipating and avoiding processes and practices that could re-traumatize individuals (SAMHSA, 2020). Trauma-informed care can potentially provide a greater sense of safety for individuals who have a history of trauma as well as a space for preventing more serious consequences of traumatic stress (Fallot & Harris, 2002). While many individuals “may not identify the need to connect with their histories, trauma-informed services offer clients a chance to explore the impact of trauma, their strengths and creative adaptations in managing traumatic histories, their resilience, and the relationships among trauma, substance use, and psychological symptoms (SAMHSA, 2020, p.8).
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Book Code: MTX1325
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