(de Chesnay, 2013). It is important to note that a healthcare visit can derail efforts to help the victim if they perceive healthcare providers as judging them or if interactions trigger past traumas. Physical Signs of physical violence are common among trafficking patients, ranging from broken bones to missing hair to bruising. Physical and sexual violence are prevalent among trafficked women. Hossain et al. (2010) reported that 92.6% of trafficked women experienced sexual violence, and 77% experienced physical violence from being hit or kicked. Injuries may appear to be at multiple stages of healing or untreated, suggesting chronic trauma and perhaps a delay in seeking care. Because social isolation is prevalent in this population, trafficked persons may not have access to health care for injury treatment. Pelvic inflammatory disease, STIs, ectopic pregnancies, and HIV/ AIDS are a few of the medical conditions seen in sex-trafficked individuals. Labor trafficking can leave a person with physical injuries related to occupational exposures, including accidents related to poor personal safety equipment, abuse from supervisors, or ailments resulting from inadequate living conditions (NHTRC, 2015b). Poor ventilation, sanitation, and nutrition, as well as airborne and bacterial contaminants, are health risks associated with labor exploitation (IOM, 2009). Working long hours with little rest can also contribute to work-related injuries. Other common physical health symptoms seen with labor and sex trafficking include headache, fatigue, dizziness, back pain, and memory problems (Kiss et al., 2015; Oram, et al., 2012). Branding (i.e., intentionally inflicting burns or cuts to create symbols) is a common way for traffickers to demonstrate 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:
ownership (IOM, 2009; Oram et al., 2012). Those who are being trafficked may have their trafficker’s name, a pseudonym, or a bar code tattooed or etched into their skin to signify 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 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.
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Book Code: SWTX1524
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