A human trafficking victim may develop a mindset of fear, distrust, denial, and conflicting loyalties. Foreign victims of trafficking are often fearful of being deported or jailed and, therefore, they may distrust authority figures, particularly law enforcement and government officials. Many victims of both sex and labor trafficking fear that if they escape their servitude and initiate investigations against their trafficker, the trafficker and his/her associates will harm the victims, the victims’ family members, or others. Additional patient situations, behaviors, or emotional states may suggest human trafficking: 40 • Paying cash or having no health insurance • Lacking control of identification documents (ID or passport) • Having few or no personal possessions • Being reticent for additional testing or 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 (i.e., “flat affect”) While not all victims of trafficking have physical indicators that aid identification, many victims suffer serious health issues, which may include: 40 • Addiction to drugs and/or alcohol as a way to cope with or “escape” their situation, or as a method of control used by their traffickers • Symptoms of post-traumatic stress disorder, phobias, panic attacks, anxiety, and depression • Sleep or eating disorders • Untreated chronic illnesses, such as diabetes or cardiovascular disease • Signs of physical abuse, such as bruises, broken bones, burns, and scarring • Chronic back, visual, or hearing problems from work in agriculture, construction, or manufacturing • Skin or respiratory problems caused by exposure to agricultural or other chemicals • Infectious diseases, such as tuberculosis and hepatitis, which are spread in overcrowded, unsanitary environments with limited ventilation • Reproductive health problems, including sexually transmitted diseases, urinary tract infections, pelvic pain, and injuries from sexual assault or forced abortions Responding to Victims of Human Trafficking Victims of trafficking do not often disclose their trafficking situation in clinical settings. 31 Health care providers must, therefore, be thoughtful and careful about engaging 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 of the patient. Recognize that the goal of your interaction is not disclosure or rescue, but rather to create a safe, non-judgmental place that will help you identify trafficking indicators and assist the patient. 40 This may be challenging in the context of busy, time-constrained schedules, but it is possible. Clinicians should: • Allow the patient to decide if he or she would feel more comfortable speaking with a male or female practitioner • If the patient requires interpretation, always use professional interpreters who are unrelated to the patient or situation • 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. • Contact the National Human Trafficking Resource Center (NHTRC) hotline (1-888-373- 7888) for assistance. Information available at: https://humantraffickinghotline.org/ If a patient has disclosed that he or she has been trafficked: 40 • Ensure that safety planning is included in the discharge planning process • Provide the patient with options for services, reporting, and resources. • Provide the patient with the NHTRC hotline number. If the patient feels it is dangerous to have something with the number written on it, have them memorize the number or designate someone in your staff that they can call back to in order to provide that number. • In situations of immediate, life-threatening danger, follow your institutional policies for reporting to law enforcement. Whenever possible, try to involve the patient in the decision to contact law enforcement. • If the patient is a minor, follow mandatory state reporting laws and institutional policies for child abuse or serving unaccompanied youth. Most state laws require immediate intervention of the trafficked victim is a minor. • Ensure that any information regarding the patient’s injuries or treatment is accurately
documented in the patient’s records, recognizing that, similar to sexual assault examinations, the medical record serves both medical and legal purposes. BEFORE MOVING ONTO THE NEXT SECTION, PLEASE COMPLETE CASE STUDY 4 ON THE NEXT PAGE. Provisions and Responsibilities for Reporting Suspected Child Abuse Permissive Reporters are persons who are encouraged, but not required, to report suspected child abuse. Any person may make an oral or written report of suspected child abuse (which may be submitted electronically), or report suspected child abuse to a department, county agency or law enforcement, if that person has reasonable cause to suspect that a child is a victim of child abuse. Mandated Reporters are persons required to report suspected child abuse if they have reasonable cause to suspect that a child is a victim of child abuse. Mandated reporters include: 41 • A person licensed or certified to practice in any health-related field under the jurisdiction of the Department of State. • A medical examiner, coroner, or funeral director. • An employee of a health care facility or provider licensed by the Department of Health, who is engaged in the admission, examination, care or treatment of individuals. • A school employee • An employee of a child-care service who has direct contact with children in the course of employment. • A clergy member, priest, rabbi, minister, Christian Science practitioner, religious healer or spiritual leader of any regularly established church or other religious organization. • An individual paid or unpaid, who, on the basis of the individual’s role as an integral part of a regularly scheduled program, activity or service, is a person responsible for the child’s welfare or has direct contact with children. • An employee of a social services agency who has direct contact with children in the course of employment. • A peace officer or law enforcement official. • An emergency medical services provider certified by the Department of Health. • An employee of a public library who has direct contact with children in the course of employment. • An individual supervised or managed by a person listed above, who has direct contact with children in the course of employment. • An independent contractor who has direct contact with children. • An attorney affiliated with an agency, institution, organization or other entity, including a school or regularly established religious organization that is responsible for the care, supervision, guidance or control of children.
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