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COURSE CODE
PT - 28
PTA - 18
Recognizing and Responding to Human Trafficking in Texas (Mandatory)
1
1
PTTX01HT-H
Aging Process: What is Happening to the Body and What Does it Mean?
3
3
PTTX03AP-H
Differential Diagnosis for PT: Hematological, Cardiovascular, Immune and Digestive System Disorders Differential Diagnosis in Physical Therapy: Upper Extremity and Lower Quadrant
3
3
PTTX03HC-H
3
3
PTTX03UE-H
Evaluation and Treatment of the Shoulder Complex
4
4
PTTX04SC-H
Instrument-Assisted Soft Tissue Mobilization (IASTM) to the Lower Quarter
2
2
PTTX02LQ-H
Instrument-Assisted Soft Tissue Mobilization (IASTM) to the Upper Quarter
2
2
PTTX02UQ-H
Optimizing Outcomes in Rehabilitation: Motor Learning Principles and Beyond
6
PTTX06ML-H
Return to Sport: Running Injuries in Student-Athletes
2
PTTX02RU-H
Sports Massage: Enhancing Training, Participation and Recovery for Today’s Athlete, 2nd Edition
2
PTTX02SM-H
INCLUDED IN THIS BOOK
1 Recognizing and Responding to Human Trafficking in Texas (Mandatory) [1 contact hour] This course focuses on how human trafficking occurs, ways to identify those who may be trafficked, safety protocols, and victim resources. It meets the 1-hour Texas requirement for nurses. 10 Aging Process: What is Happening to the Body and What Does it Mean? [3 contact hours] This course is intended to instruct the professional of the physiological, structural and functional changes that occur in the body over time so that functional outcomes can be maximized. 19 Differential Diagnosis for PT: Hematological, Cardiovascular, Immune and Digestive System Disorders [3 contact hours] This course is intended to instruct the professional on screening multiple body organ systems for diseases and syndromes that are not of musculoskeletal origin. 33 Differential Diagnosis in Physical Therapy: Upper Extremity and Lower Quadrant [3 contact hours] This course is intended to instruct the professional on screening the multiple body organ systems for diseases and syndromes. 54 Evaluation and Treatment of the Shoulder Complex [4 contact hours] The course provides a general overview of the shoulder complex anatomy before moving into the primary purpose of the course, evaluation and treatment of the shoulder complex through entry-level introduction of manual evaluation techniques of the connective tissue surrounding the shoulder complex. 66 Instrument-Assisted Soft Tissue Mobilization (IASTM) to the Lower Quarter [2 contact hours] This course provides the clinician with an understanding of the treatment concepts, as well as specific techniques, in order to effectively incorporate Instrument-Assisted Soft Tissue Mobilizations (IASTM) to common musculoskeletal disorders of the lower quarter. 74 Instrument-Assisted Soft Tissue Mobilization (IASTM) to the Upper Quarter [2 contact hours] This course provides the clinician with an understanding of the treatment concepts, as well as specific techniques, in order to effectively incorporate Instrument-Assisted Soft Tissue Mobilizations (IASTM) to common musculoskeletal disorders of the upper quarter. 83 Optimizing Outcomes in Rehabilitation: Motor Learning Principles and Beyond [6 contact hours] By the end of this course, participants will gain a knowledge and understanding of how to optimize rehabilitation outcomes in their patients by using current and evidence-based application of motor learning concepts and principles of neuroplasticity, including contemporary evidence for autonomy support and the effects of improving patient motivation and focus. 97 Return to Sport: Running Injuries in Student-Athletes [2 contact hours] This course focuses on commonly presented running injuries in student-athletes and how to effectively treat those injuries for return to sport. The course is designed for athletic trainers and allied health professionals who work in sport settings, particularly with youth and student-aged athletes. 107 Sports Massage: Enhancing Training, Participation and Recovery for Today’s Athlete, 2nd Edition [2 contact hours] The purpose of this course is to inform massage professionals of techniques known to help improve preparation for, participation in, and recovery from sports participation. James Menz guides you through the recommendations and contraindications of each stage of an athlete’s training program. He also discusses common sport injuries and the implications for massage therapy.
Unless otherwise indicated, all PT courses meet continuing competence requirements for license renewal in Texas. The course Recognizing and Responding to Human Trafficking in Texas has been approved by the Texas Health and Human Services Commission (HHSC)
FREQUENTLY ASKED QUESTIONS
License Expires
CE Hours Required
Mandatory Subjects
Must complete a Human Trafficking Prevention Training course approved by Texas Health and Human Services Commission. 2 CCUs of Texas Jurisprudence Assessment Module (TX JAM) which is available on the board website.
Physical Therapists (30) 28 CCUs are allowed through home-study Physical Therapy Assistants (20) 18 CCUs are allowed through home-study
Biennial renewal. Licensees are required to renew by the end of their birth month every two years.
Are you a Texas board-approved provider? Texas Physical Therapy Association (Provider #2411048TX; expires 11/30/2024). The assignment of Texas CCUs does not imply endorsement of specific course content, products, or clinical procedures by the TPTA or TBPTE. Unless otherwise indicated, all PT courses meet continuing competence requirements for license renewal in Texas. The course Recognizing and Responding to Human Trafficking in Texas has been approved by the Texas Health and Human Services Commission (HHSC). Are my credit hours reported to the Texas board? No. The Texas Board of Physical Therapy Examiners performs random audits at which time proof of continuing education must be provided. How do I complete the TX JAM? Individuals renewing their license will be required to take the Texas Jurisprudence Assessment Module (TX JAM). This will cover both the Jurisprudence Exam and the Ethics/Professional Responsibility requirement. To complete this requirement you will need to go to the board website www.ptot.texas.gov and follow the link for registration and access. Is my information secure? Yes! We use SSL encryption, and we never share your information with third-parties. We are also rated A+ by the National Better Business Bureau. What if I still have questions? What are your business hours? No problem, we have several options for you to choose from! Online at EliteLearning.com/Physical-Therapy you will see our robust FAQ section that answers many of your questions, simply click FAQs at the top of the page, e-mail us at office@elitelearning.com, or call us toll free at 1-888-857-6920, Monday - Friday 9:00 am - 6:00 pm EST, Saturday 10:00 am - 4:00 pm EST. Important information for licensees: Always check your state’s board website to determine the number of hours required for renewal, mandatory topics (as these are subject to change), and the amount that may be completed through home-study. Also, make sure that you notify the board of any changes of address. It is important that your most current address is on file. Implicit bias in healthcare: Implicit bias significantly affects how healthcare professionals perceive and make treatment decisions, ultimately resulting in disparities in health outcomes. These biases, often unconscious and unintentional, can shape behavior and produce differences in medical care along various lines, including race, ethnicity, gender identity, sexual orientation, age, and socioeconomic status. Healthcare disparities stemming from implicit bias can manifest in several ways. For example, a healthcare provider might unconsciously give less attention to a patient or make assumptions about their medical needs based on race, gender, or age. The unconscious assumptions can lead to delayed or inadequate care, misdiagnoses, or inappropriate treatments, all of which can adversely impact health outcomes. Addressing implicit bias in healthcare is crucial for achieving equity in medical treatment. Strategies to combat these biases involve education and awareness programs for healthcare professionals. These programs help individuals recognize and acknowledge their biases, fostering a more empathetic and unbiased approach to patient care. Additionally, implementing policies and procedures prioritizing equitable treatment for all patients can play a pivotal role in reducing healthcare disparities. Ultimately, confronting implicit bias in healthcare is essential to creating a more just and equitable healthcare system where everyone receives fair and equal treatment regardless of their background or characteristics. Disclosures: Resolution of conflict of interest Colibri Healthcare, LLC implemented mechanisms prior to the planning and implementation of the continuing education activity, to identify and resolve conflicts of interest for all individuals in a position to control content of the course activity. Sponsorship/commercial support and non-endorsement It is the policy of Colibri Healthcare, LLC not to accept commercial support. Furthermore, commercial interests are prohibited from distributing or providing access to this activity to learners. Disclaimer: The information provided in this activity is for continuing education purposes only and is not meant to substitute for the independent medical judgment of a healthcare provider relative to diagnostic and treatment options of a specific patient’s medical condition. ©2024: All Rights Reserved. Materials may not be reproduced without the expressed written permission or consent of Colibri Healthcare, LLC. The materials presented in this course are meant to provide the consumer with general information on the topics covered. The information provided was prepared by professionals with practical knowledge of the areas covered. It is not meant to provide medical, legal, or professional advice. Colibri Healthcare, LLC recommends that you consult a medical, legal, or professional services expert licensed in your state. Colibri Healthcare, LLC has made all reasonable efforts to ensure that all content provided in this course is accurate and up to date at the time of printing, but does not represent or warrant that it will apply to your situation nor circumstances and assumes no liability from reliance on these materials. Quotes are collected from customer feedback surveys. The models are intended to be representative and not actual customers.
1 Recognizing and Responding to Human Trafficking in Texas: Summary Recognizing and Responding to Human Trafficking in Texas 1 Contact Hour
ACCESS THE FULL ONLINE PRESENTATION
Scan the QR CODE to start online presentation or visit https://uqr.to/trafficking
Author John Makopoulous, MD
Emergency department attending physician in Philadelphia, chair for the healthy system’s credentialing committee, member of the American Medical Association, Pennsylvania Medical Society, and American Academy of Emergency Medicine.
LEARNING OUTCOMES • Describe the types and venues of human trafficking in the United States (U.S.) • Discuss communication strategies to assist with identification of trafficked persons
• Discuss the importance of safety planning and protocols • Identify resources for reporting suspected victims of human trafficking
S ELF-ASSESSMENT QUESTIONS
1. General safety measures as well as those specifically applicable to healthcare workers who may help victims of human trafficking include all of the following EXCEPT: a. Review emergency plans periodically b. Improve lighting at entrances and parking areas c. Install security cameras, mirrors, and panic buzzers d. Allow easy access to all doors except the main entrance 2. An example of a probing question, once the clinical professional has established a safe space and rapport, is: a. Do you drive your own vehicle? b. Do you live with family or friends? c. Do you have to ask permission to eat, sleep, or go to the bathroom? d. Do you have multiple kinds of shoes?
3. Risk Factors for being vulnerable to human trafficking include: a. Extreme poverty b. Minimal education c. A history of abuse or family instability d. All of the above 4. What is an example of a situation that suggests human trafficking? a. A woman only can only pay with her credit card
b. A child who can recite their address fully c. A person who has no form of personal identification on them d. A child who takes out various toys from their backpack to play with while waiting for the doctor
ANSWERS: 1: D
2 : C
3 : D
4 : C
2
Recognizing and Responding to Human Trafficking in Texas: Summary
technically be prostitutes or sex workers because they cannot legally consent to commercial sex) Many victims of human trafficking are forced to engage in sexual practices through threats or other types of coercion, but trafficking also occurs as labor exploitation in urban, suburban, and rural areas. Many victims are lured with false promises of well-paying jobs or manipulated by people they trust. They are forced or coerced into prostitution, domestic servitude, or other types of forced labor (e.g., in agriculture, construction, fisheries, or mining industries). Victims can be found in legitimate and illegitimate labor industries, including sweatshops, massage parlors, agriculture, restaurants, hotels, street peddling, door-to-door sales, begging, and domestic service. Risk factors for being vulnerable to human trafficking include: • Extreme poverty • Minimal education • A history of abuse or family instability • Being disabled • Belonging to a marginalized or stigmatized gender, ethnic, or cultural group Traffickers use various techniques to control their victims and keep them enslaved • Isolation from: family and friends • Control: of the victims' money • Intimidation/threat: use or threat of violence toward victims or their family members The life situations of people who are trafficked are almost always complicated, whether they are under a trafficker’s control, trying to leave, or already out of a trafficking environment. Human trafficking became a federal crime with passage of the Trafficking Victims Protection Act of 2000 (TVPA), which was revised and updated in 2015. The goals of the TVPA were to prevent severe forms of human trafficking, both in the U.S. and overseas; to protect victims and help them rebuild their lives in the U.S.; and to prosecute traffickers and impose federal penalties. Prior to enactment of the TVPA, no comprehensive federal law existed to protect
INTRODUCTION Human trafficking has been called a form of modern-day slavery. It is a crime involving the exploitation of someone for the purpose of compelled labor or a commercial sex act through the use of force, fraud, or coercion. Victims can be women or men, adults or children, citizens or noncitizens, and it occurs across the U.S. and throughout the world. Human trafficking does not require crossing international or state borders. For clinicians and healthcare workers, human trafficking can be viewed as a serious health risk associated with significant physical and psychological harms. The abuses suffered by people who are trafficked include many forms of physical violence and abuse (e.g., beating, burning, rape, confinement) as well as many psychologically damaging tactics such as threats to themselves or their family members, blackmail, extortion, lies about the person’s rights, and confiscation of vital identity documents. DEFINITIONS Human trafficking : “The recruitment, transportation, transfer, harboring or receipt of persons by means of the threat or use of force or other forms of coercion, of abduction, of fraud, of deception, of the abuse of power or of a position of vulnerability or of the giving or receiving of payments or benefits to achieve the consent of a person having control over another person, for the purpose of exploitation” Human smuggling : Involves the provision of a service—typically transportation or fraudulent documents—to an individual who voluntarily seeks illegal entry into a foreign country Sex trafficking : When an adult takes part in the sale of sex through threat, abduction, or other means of coercion Consensual commercial sex : Willing and consensual exchange of money for sex; does not infringe on the human rights of the participants (Baldwin et al., 2011; note that children cannot
3 Recognizing and Responding to Human Trafficking in Texas: Summary
victims of trafficking in the U.S. or to prosecute their traffickers. Congress has reauthorized and amended the TVPA several times, but its fundamental purpose and legal authorities remain the same.
Task Force and other organizations working to reduce human trafficking. An Essential Role for Healthcare Providers The American Medical Association (AMA) said: “Physicians should be aware of the definition of human trafficking and of resources available to help them identify and address the needs of victims.” Healthcare professionals are uniquely positioned to identify and intervene on behalf of trafficking victims.
LEARNING TIP!
The terms victim and survivor can both be used to refer to individuals who were trafficked.
Victim : Has legal implications within the criminal justice process and generally means an individual who suffered harm because of criminal conduct. Survivor : Term used by many in the health services field to recognize the strength it takes to continue a journey toward healing in the aftermath of a traumatic experience. HUMAN TRAFFICKING IN TEXAS In 2009, the Texas legislature created the Texas Human Trafficking Prevention Task Force to respond to the growing human trafficking crisis and designated the attorney general as the presiding officer. The Task Force develops legislative recommendations to attack the crime as well as policies to protect victims. A 2016 report by the University of Texas at Austin School of Social Work estimated that there are approximately 79,000 minor and youth victims of sex trafficking and 234,000 workers who are victims of labor trafficking. Of the 1,080 cases of human trafficking in 2019, most were for sex trafficking (739 cases), with labor trafficking being the next most common (116 cases). Most victims were female (824 cases vs. 131 for men), and adult (659 cases vs. 216 cases involving minors). An important caveat to all statistics about human trafficking is the difficulty of obtaining accurate data, which is a limitation of research into this issue that has been pointed out in the reports of the Texas Human Trafficking Prevention
LEARNING TIP!
In a study of 98 sex trafficking survivors, 88% had at least one encounter with a healthcare provider while they were being trafficked, with 63% of these encounters happening in an emergency department.
Unfortunately, studies have demonstrated that medical care providers are often unprepared to identify trafficking victims. Identifying Potential Victims of Human Trafficking Certain patient behaviors and/or companion behaviors can alert healthcare professionals to a potential human trafficking case. • The presence of a person who seems to control both the patient and the situation • The physical proximity of the traffickers perpetuates their coercion and control of the victims, preventing them from communicating with healthcare personnel directly • The presence of an overbearing or controlling companion should trigger concern
4
Recognizing and Responding to Human Trafficking in Texas: Summary
• Being reticent to undergo additional testing or receive services due to large debt • Inability to: ○ Leave home or place of work ○ Speak for oneself or share one’s own information • Feelings of helplessness, shame, guilt, self- blame, and humiliation • Loss of sense of time or space; not knowing where they are or what city or state they are in • Emotional numbness, detachment, or disassociation (e.g., “flat affect”) Responding to Victims of Human Trafficking Victims of trafficking do not often disclose their trafficking situation in clinical settings. Before starting any conversation with a patient, assess the potential safety risks that may result from asking sensitive questions of the patient. 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. • Allow the patient to decide if they would feel more comfortable speaking with a male or female practitioner • If the patient requires interpretation, always • If the patient is accompanied by others, try to find a time and place to speak with the patient privately • Take time to build rapport with potential victims, or if you do not have the time yourself, find someone else on staff who can develop rapport with the patient • Ensure that the patient understands confidentiality policies and practices, including mandatory reporting laws • Use multidisciplinary resources, such as social workers, where available • Refer to existing institutional protocols for victims of abuse/sexual abuse use professional interpreters who are unrelated to the patient or situation
Most recommendations suggest that in order to allow patients the opportunity to speak for themselves, clinic or hospital staff should attempt to interview and assess all patients privately. This may require the use of an independent interpreter, since many survivors have limited English proficiency . Multilingual nonclinical staff who may share a common language with trafficked persons of limited English proficiency may be able to develop rapport with trafficked persons that facilitates trust and frank communication based on their language and/or cultural commonalities. It is recommended, therefore, that healthcare organizations think broadly about the types of employees who are appropriate to receive training about human trafficking to enhance opportunities for identification of and response to potential trafficking situations.
LEARNING TIP! Trained nonclinical workers, such as receptionists, security guards, and accounting personnel, could be instrumental in helping to maintain separation during potential victim identification interviews in a manner that does not alert potential traffickers to victim identification efforts.
Many victims of both sex and labor trafficking fear that if they escape their servitude and initiate investigations against their trafficker, the trafficker and their associates will harm the victims, the victims’ family members, and/or others. Additional patient situations, behaviors, or emotional states may suggest human trafficking. • Paying cash or having no health insurance • Lacking control of identification documents (ID or passport) • Having few or no personal possessions
5 Recognizing and Responding to Human Trafficking in Texas: Summary
• Contact the National Human Trafficking Resource Center (NHTRC) hotline (1-888-373-7888) for assistance. Information is available at https:// humantraffickinghotline.org/ Legal requirements regarding mandatory reporting of human trafficking differ from state to state, and situations may require mandatory reporting under related statutes even if the situation is not human trafficking (e.g., child abuse or domestic violence). State- specific information is available at https:// polarisproject.org/resources/state-ratings-on- human-trafficking-laws/ Four fundamental principles have been recommended for healthcare professionals who meet people who have been or are being trafficked. • Use a trauma-informed, resilience- oriented, human rights–focused, and culturally sensitive approach to the care of all patients • Collaborate with and seek advice from colleagues who have been engaged in antitrafficking or other violence prevention work • Partner with advocates, social service providers, case managers, and others from outside the health sector to improve referral services and achieve a more effective overall response to human trafficking • Play an active role in self-directed education and training about human trafficking Using a Trauma-Informed Approach Trauma-informed care (also known as trauma-sensitive or trauma-aware care) is one way to provide effective and compassionate care for patients who may be trafficked or are otherwise traumatized. The Substance Abuse and Mental Health Services Administration (SAMHSA) defines trauma-informed care as a program, organization, or system that:
• Realizes the widespread impact of trauma and understands potential paths for recovery • Recognizes the signs and symptoms of trauma in clients, families, staff, and others involved with the system • Responds by fully integrating knowledge about trauma into policies, procedures, and practices • Seeks to actively resist re-traumatization Trauma-specific intervention programs generally: • Acknowledge the survivor's need to be respected, informed, connected, and hopeful regarding their own recovery • Address the interrelation between trauma and symptoms of trauma such as substance abuse, eating disorders, depression, and anxiety • Collaboratively work with survivors, family and friends of the survivor, and other human services agencies in a manner that will empower survivors and consumers Taking a History Though there are no evidence-based recommendations at this time, practice- based evidence has been used to generate recommendations for screening and inquiry in these situations. Survivors of trauma report that disclosure may be more likely if healthcare providers are perceived to be knowledgeable about abuse and violence, nonjudgmental, respectful, and supportive, as well as if they use a trauma-sensitive approach to evaluation and treatment. Once rapport has been developed with the patient and confidentiality (along with its limits) has been communicated clearly, questions about possible human trafficking and other forms of coercive control can be asked. If you suspect human trafficking, try to start with indirect questions. Attempt to interview the patient alone without raising suspicions. You may need to be creative in finding
6
Recognizing and Responding to Human Trafficking in Texas: Summary
opportunities to interview the patient alone, as traffickers may accompany patients to their visits and insist on staying with them throughout the encounter. Requesting that the patient leave the room for specific tests, such as x-rays, or urine testing, even when not necessary, may provide time away from the escort to ask questions in a confidential environment. Examples of probing questions: • Has your identification or documentation been taken from you? • What are your working or living conditions like? • Where do you sleep and eat? • Can you leave your job or situation if you want? • Do you sleep in a bed, on a cot, or on the floor? • Do you have to ask permission to eat, sleep, or go to the bathroom? • Can you come and go as you please? • Have you ever been deprived of food, water, sleep, or medical care? • Are there locks on your doors and windows? Do you lock them or does someone else (e.g., so you cannot get out)? • Have you been threatened if you try to leave? • Have you been physically harmed in any way? • Is anyone forcing you to do anything that you do not want to do? • Has anyone threatened your family? Physical Examination A physical examination should be performed carefully and sensitively, guided by the clinical presentation and by information gleaned from the history. In cases involving sexual violence and other forms of trauma, forensic evaluation and evidence collection should be offered when appropriate (e.g., if the most recent sexual assault has occurred within 120 hours of presentation, and with the patient’s consent or in conjunction with mandated reporter responsibilities; Alpert et al., 2014).
Abuse and violence, including that resulting from human trafficking, should be suspected when any of these physical findings are noted. • Bilateral or multiple injuries • Evidence consistent with rape or sexual assault • Evidence of acute or chronic trauma, especially to the face, torso, breasts, or genitals • Pregnant woman with any injury, particularly to the abdomen or breasts; vaginal bleeding; or decreased fetal movement • Body tattoos that are the mark of a pimp or trafficker • Occupational injuries not clearly linked to legitimate employment Documentation Clinicians should carefully and accurately document all injuries and findings in the medical record, not only because this is standard care for all patients but because such data may be valuable if the patient seeks legal redress . Photographic documentation of physical findings may be appropriate, with the patient’s permission. Images should contain the patient’s face and the injury or lesion measured with a ruler or other common object (such as a coin). Patients should be informed that they have a right to refuse photographic documentation altogether or to restrict photographic documentation to certain specific areas if they so choose. The words suspected human trafficking as a finding, diagnosis, or problem should be included in the chart when appropriate. The Clinical Goal The healthcare provider should work to create a climate that allows every patient to feel safe, secure, cared for, validated, and empowered to disclose if they choose to. Disclosure might occur later if the patient does not feel ready to disclose in the immediate clinical setting. Therefore, each individual clinical encounter should be viewed as a step on a pathway to safety for at-risk patients.
7 Recognizing and Responding to Human Trafficking in Texas: Summary
Risk Assessment and Safety Planning If trafficking has been disclosed, clinicians can help the patient by: • Having the patient assess their own personal risk • Making an independent judgment about that risk and communicating this opinion to the patient • Talking about safety planning • Making referrals to appropriate case management services for more detailed safety planning and case management “Red flag” signs of heightened risk include: • More frequent or severe threats or assaults • New or increasingly violent behavior by the perpetrator • Increasing or new threats of homicide (or suicide by the trafficker) if the patient discloses • The presence or availability of lethal weapons in the residence Safety and Training of Healthcare Workers Since traffickers may be involved in various criminal enterprises, protecting and training healthcare workers is essential. Quality improvement programs of various kinds can create and support policy changes regarding safety and high-quality healthcare systems. One training program specific to human trafficking is SOAR to Health and Wellness Training. SOAR is an acronym for Stop, Observe, Ask, and Respond to Human Trafficking. The program is available at https://www.acf.hhs.gov/otip/training/soar- to-health-and-wellness-training Legal Considerations “Healthcare providers are not required to—and in fact may not—report suspected instances of human trafficking that involve a competent adult victim, without the patient’s express consent.” Clinicians should not involve law enforcement and/or social service providers (e.g., housing/shelter services, legal services, and case management) without first obtaining the explicit informed consent of the patient, or
unless otherwise required under relevant law. Privacy breaches can erode the provider–patient relationship and remove the autonomy patients deserve and need for making informed decisions for their own safety and future. Domestic as well as international victims of human trafficking have specific legal rights under federal and state law but may not know of these rights or be able to exercise them. If the patient is willing, a referral to law enforcement, attorneys, or legal service providers is appropriate. Conclusion Clinicians, as “first contacts,” have an imperative to make a difference for their patients. Human trafficking poses many health risks, including physical injury, death, and/or long-lasting psychological damage. Clinicians who encounter a trafficked person or other exploited individual have a unique opportunity to provide essential medical care and supportive referral options that may be an individual’s first step toward safety and recovery.
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Scan the QR CODE to start online presentation or visit https://uqr.to/trafficking
8
Recognizing and Responding to Human Trafficking in Texas: Summary
F INAL EXAM QUESTIONS
1. Which of the following is not an industry in which people who are trafficked often work? a. Restaurants
5. Which statement best summarizes the finding of several studies about the roles and behaviors of healthcare providers in regards to human trafficking? a. Most providers have been educated about the problem of human trafficking but do not have time to adequately address the needs of trafficked patients b. Many providers are unprepared to identify trafficking victims when they are encountered in clinical settings c. Many providers can identify trafficking victims, but they often do not follow up with appropriate referrals to external sources of support d. Most providers are not exposed to the issue of human trafficking in medical school 6. What is one possible way to increase the identification of people in healthcare settings who are being trafficked? a. Install security cameras in waiting rooms b. Train nonclinical staff (e.g., receptionists, security guards) in ways to identify human trafficking and to communicate with medical personnel c. Require all patients to fill out a questionnaire about human trafficking d. Require that all patients be asked about human trafficking when signing in for their visit 7. If a patient suspected of being trafficked does not speak English, or is not comfortable speaking English, the best approach is to: a. Have the patient’s friend or relative translate for them b. Use printed materials that have been translated into other common languages
b. Education c. Agriculture d. Fisheries
2. Which is a common method used by human traffickers to control and manipulate their victims? a. Exposure to loud music b. Isolation from family members c. Lawsuits d. Large payments for illicit or illegal behaviors 3. Which statement best describes the use of the terms victim and survivor in relation to human trafficking? a. Both terms may be appropriate depending on the circumstances of the person being trafficked b. The term victim is preferred because it emphasizes how much those being trafficked suffer c. The term survivor is preferred because it recognizes that the individual is “surviving” despite their current situation d. Neither term is preferred because both are emotionally loaded—the preferred term is person being trafficked 4. In a study of people involved in sex trafficking, what percentage had at least one encounter with a healthcare provider while they were being trafficked?
a. 18% b. 45% c. 88% d. 95%
c. Use a professional interpreter or someone unrelated to the patient d. Use the language translation phone application on your smartphone to communicate
9 Recognizing and Responding to Human Trafficking in Texas: Summary
8. Before asking a patient questions about human trafficking, it’s best if clinicians: a. Establish rapport with the patient and separate them from anyone who may have accompanied them on the visit b. Use a written questionnaire to screen for potential signs of human trafficking c. Perform a thorough physical examination d. Check the patient’s health insurance status using an online database 9. If a patient discloses that they are a victim of human trafficking: a. Police must be notified b. Any escort accompanying the patient should be detained by the office staff c. Injuries must be carefully documented and detailed in their medical record d. Insist that they take pamphlets and information regarding human trafficking with them at the time of discharge
10. Why is it important, in the context of human trafficking, to train all clinical and nonclinical staff on safety and security procedures? a. Because victims of human trafficking are often violent b. Because traffickers may be involved in various criminal enterprises and present a threat of violence c. Because victims of human trafficking are more likely to be infected with contagious diseases d. To conform with local or state laws related to the treatment of victims of human trafficking
Access the final exam to this course here!
COURSE CODE: PTTX01HT-H
10
Aging Process: What is Happening to the Body and What Does it Mean? Summary
Aging Process: What is Happening to the Body and What Does it Mean? 3 Contact Hours
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Author Suzanne Greenwalt, PT, DPT, CCS, GCS
Licensed physical therapist, Doctor of Physical Therapy degree from A.T. Still University, Master in Physical Therapy from Saint Louis University. Worked in a variety of clinical settings including rehabilitation, skilled nursing facilities, acute care and outpatient rehabilitation. Board certified Geriatric Clinical Specialist, board certified Cardiovascular and Pulmonary Clinical Specialist. Educator in two Doctor of Physical Therapy programs, Educator and mentor in geriatric residency.
LEARNING OUTCOMES • Breakdown two changes that occur to the vertebral column with aging • Analyze two contributing factors to decreased bone density that occurs in older adult • Characterize two changes that occur to the muscular system with aging • Analyze two functional implications of the changes that occur to the muscular system with aging • Classify three changes that occur in the cardiovascular systems with normal aging • Confirm two changes to the respiratory system with aging and explain how they impact the physical functioning of an older adult
• Analyze one way in which the changes that occur with aging in the nervous system affect function • Classify three differences between normal cognitive aging changes and dementia • Describe at least one difference between cataracts, macular degeneration, and glaucoma • Analyze the differences between the four main types of incontinence • Break down at least three changes that occur with aging that result in older adults having an increased fall risk
S ELF-ASSESSMENT QUESTIONS
1. Risk factors of sarcopenia include: a. Advanced age b. Muscle disuse c. Hormonal changes d. All of the above 2. What is a non-modifiable risk factor for bone loss? a. Calcium intake b. Activity level c. Body mass index d. Ethnicity
3. What is true about atherosclerosis: a. Build up of lipid material under the surface of the epithelium of the vessels (i.e., plaque buildup in arteries) b. Increased thickness of connective tissue in the blood vessels c. Results in increased turbulence and resistance to blood flow d. Decreases systolic and diastolic blood pressure
ANSWERS: 1: D
2 : D
3: A
11 Aging Process: What is Happening to the Body and What Does it Mean? Summary
• Any condition affecting sex hormones (prostate cancer, breast cancer) EVIDENCE-BASED PRACTICE
INTRODUCTION Aging brings about significant changes to the skeletal system, impacting overall health and mobility. The fibrocartilaginous cushions that sit between each vertebra, known as intervertebral discs, lose some of their water contents, resulting in compression of the vertebral column and potentially a reduction in height as well as increasing kyphotic posture . This increases a person's risk of spine fractures and contributes to the narrowing of the spinal canal, a condition called spinal stenosis.
A research study conducted in 2017 investigated the effects of back extensor strengthening in postmenopausal women, all of whom had osteoporosis. The study found that this specific type of strengthening improved all but one physical and mental health parameters of quality of life based on a 36-question assessment tool, highlighting the importance of incorporating extension exercises into the treatment of osteoporosis. Much like the decline in bone density, individuals who do not participate in regular exercise tend to experience a 10 to 15% decline in muscle strength with each passing decade. On the flip side, older adults who have adhered to a lifelong regimen of physical activity often exhibit a relatively well-preserved muscle mass and strength– though not to the extent that muscle loss is completely prevented. SARCOPENIA Sarcopenia refers to the gradual loss of muscle mass that happens as we age. It is a prevalent syndrome that contributes to an overall decrease in functional status and mobility, deficits in metabolic function, greater frailty, and an increased risk of falling. EVIDENCE-BASED PRACTICE Approximately 22% of individuals aged 70 and older have sarcopenia, and this figure increases to about 50% for those aged over 80. Regular physical activity is critical when it comes to mitigating this condition. A research study conducted in 2020 demonstrated that physically active older adults tended to have better cardiorespiratory fitness, greater upper and lower body strength, and lower levels of sarcopenia compared to sedentary seniors.
LEARNING TIP! Peak bone density occurs in late 20s – early 30s. However, bone reabsorption begins to outpace bone formation in 50s-60s (osteoblastic activity), resulting in bone loss and an increased risk of fractures.
Modifiable Risk Factors for Bone Loss • Calcium intake: 1200 mg/day or more is required • Cigarette smoking • Excessive alcohol intake • Low body mass index (<18.5) • Inactivity • Drinking soda instead of milk • Use of steroids • Immobilization Non-Modifiable Risk Factors for Bone Loss • Genetics • Having a smaller frame • Caucasian or Hispanic ethnicity • Female older than 50-females loss more bone mass than men and it is accelerated during menopause • Family history of osteoporosis • Premature at birth • Age-related low estrogen levels (women can lose up to 20% of their bone mass during the first 5-7 years of menopause) • Insufficient protein intake • Inadequate vitamin D levels
12
Aging Process: What is Happening to the Body and What Does it Mean? Summary
ATHEROSCLEROSIS VS. ARTERIOSCLEROSIS
Sarcopenia is a result of the natural aging process and the many muscular changes that occur during that time. Overall, aging leads to a loss of muscle mass and an increase in fatty tissue, a loss in number of motor units, a slowing of muscle contractile properties, and muscle necrosis. Moreover, type II (fast-twitch) fibers are replaced by type I (slow-twitch) muscle fibers, making rapid muscle contractions more challenging for older adults. Sarcopenia Risk Factors • Advanced age • Muscle disuse • Hormonal changes • Diminished calorie intake, low protein • Reduced physical activity Sarcopenia and age-related muscular decline have profound implications for postural control, balance, and fall risk in older adults. Therefore, as healthcare providers, it is critical to incorporate a variety of strengthening, progressive resistive, and aerobic exercises to improve strength and counteract some of these detrimental effects. The cardiovascular system also goes through a number of changes as we age. With age, there's a reduction in myocytes (heart cells) and an increase in non-contractile tissues , such as fat and collagen. There's also cross-linking of collagen fibers, which leads to increased stiffness, thickening and reduced compliance of the ventricles . As a result, blood takes longer to fill up in the ventricles, leading to a decreased cardiac output (less blood pumping out). A notable consequence of these changes is an increase in blood pressure , a common concern among older adults that is associated with conditions such as stroke, heart attacks, atherosclerosis and arteriosclerosis, and kidney failure.
Atherosclerosis • Build up of lipid material under the surface of the epithelium of the vessels (i.e., plaque buildup in arteries) • Results in increased turbulence and resistance to blood flow • Raises systolic and diastolic blood pressure Arteriosclerosis • Increased thickness of connective tissue in the blood vessels • Results in increased turbulence and resistance to blood flow • Raises systolic and diastolic blood pressure | HEALTHCARE CONSIDERATION Aerobic and endurance exercises have been shown to minimize age-related changes in arterial compliance; however, even with exercise, aging still makes individuals susceptible to high blood pressure. As healthcare providers, it's essential to monitor blood pressure during therapy sessions to ensure that hyper – or hypotension are adequately managed. Maintaining proper hydration is crucial for older adults. Dehydration can exacerbate low blood pressure, so encouraging patients to drink water is essential. When taking someone's blood pressure, inquire about their recent fluid and medication intake to understand the potential influence on their blood pressure readings. Older adults tend to exhibit reduction in pulmonary compliance, which refers to the ease at which the lungs can inflate during breathing. This can result in a wealth of respiratory problems, such as difficulty breathing. In addition to this, we also see that the lung's vital capacity, or the maximum volume of air a person can inhale and exhale, decreases with age.
LEARNING TIP! Additionally, there is a decrease in heart rate max and decrease in SA node cells with age.
13 Aging Process: What is Happening to the Body and What Does it Mean? Summary
| HEALTHCARE CONSIDERATION As the respiratory system declines, peripheral chemoreceptors stop being as responsive to hypoxemia (low oxygen levels), and central chemoreceptors struggle to respond to hypercapnia (high levels of carbon dioxide). This difficulty in adjusting to changes in blood gas levels can lead to respiratory failure and other complications. MORE AGE-RELATED RESPIRATORY CHANGES • Elastic recoil of alveoli decreases • Calcification of tracheal rings causing resistance to airflow • Calcification of the rib and costal cartilage • Arthritic changes in the joints of the ribs and vertebrae • Increase in thoracic kyphosis • Increase anterior-posterior chest diameter • Increase in mucous thickness • Decrease in diameter of conducting tubules All together, these age-related transformations make it harder for oxygen to be exchanged efficiently, which reduces the lungs' ability to take in and deliver oxygen to the bloodstream, leading to breathing difficulties, among other issues. It's important to remember that these changes are a normal part of aging, and people with lung problems, such as COPD and emphysema, may face even greater challenges. AGE-RELATED COGNITIVE CHANGES Brain weight starts to decline beginning at around age 20, mainly due to a decline in white matter and myelin . One example is the cerebellum. A highly myelinated area, myelin loss in the cerebellum is associated with declines in posture, balance, an increased fall risk, as well as a slowing of motor and sensory nerve conduction velocity that affects reaction time in older adults. Slower reaction time in older adults is due to changes in cognitive processing as well as motor execution .
| HEALTHCARE CONSIDERATION Reaction time is a crucial topic that healthcare providers should address regularly with their patients. Slower reaction times pose a significant safety risk for older individuals, primarily because they find it more challenging to respond swiftly to unexpected events or perturbations. Additionally, the ability to shift their bodies quickly to avoid injury in case of a fall becomes increasingly difficult with age. Older adults who are active have better reaction times. It is important to keep in mind that while some cognitive decline happens naturally with time, dementia is not considered a normal part of aging. As therapists and healthcare providers working with senior populations, we must consider the impact of cognitive changes as it relates to an older person's ability to follow instructions. Oftentimes, verbal instructions alone may not suffice, so written instructions alongside verbal guidance may be more appropriate to ensure better comprehension and recall. CHARACTERISTICS OF NORMAL AGING • Changes in the frontal cortex • No language impairment • No change in implicit memory or learning abilities • Word recall declines • Semantic memory remains stable • List-making is a good memory strategy • Estrogen deficiency speeds aging effects on memory in women CHARACTERISTICS OF DEMENTIA • Changes in association areas: temporal, parietal, and frontal lobes • Neurofibrillary tangles and neuritic plaques in all limbic structures • Loss of word finding, can't remember names • Loss of ability to learn new information • Word recall declines greater than normal • Semantic memory declines • Rehearsal is a good memory strategy • Women have 2-3x greater prevalence of dementia
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