the rest of society, if only for brief periods. 18 In a study of 98 sex trafficking survivors, 88% had at least one encounter with a health care provider while they were being trafficked, with 63 percent of these encounters happening in an emergency department. 19 One study noted that human trafficking victims in the U.S. may interact with a range of health care personnel, including primary Identifying potential victims of human trafficking Certain patient behaviors and/or companion behaviors can alert health care professionals to a potential human trafficking case. 9,22 One common clue is the presence of a person who seems to control both the patient and the situation. Survivors report that their traffickers completed health-related paperwork for them and communicated with clinic staff and health care providers on their behalf. 9 The physical proximity of the traffickers perpetuated their coercion and control of the victims, preventing them from communicating with health care personnel directly. 9 The presence of an overbearing or controlling companion should trigger concern, and 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. 9 Trained non-clinical workers 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. Non-clinical staff, such as receptionists, security guards, and accounting personnel, who are made sensitive to these matters through training, may observe patterns and know when and how to respond if a potential trafficker repeatedly presents for multiple patients as a companion, translator, or medical bill payer, regardless of whether these personnel interact with the patients themselves. Multilingual non-clinical staff who may share a common language with trafficked persons of limited English proficiency may be able to develop a rapport with trafficked persons that facilitates trust and frank communication based on their language or cultural commonalities. It is recommended, therefore, that health care organizations think broadly about the types of employees who are appropriate to receive training about human trafficking in order to enhance opportunities for identification of and response to potential trafficking situations. 23 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 Responding to victims of human trafficking Victims of trafficking do not often disclose their trafficking situation in clinical settings. 8 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. 2 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.
care providers, sexual and reproductive health care workers, dentists, and providers of traditional or alternative remedies. 9 Trafficking victims may even be found working within health care facilities. Unfortunately, studies have demonstrated that medical care providers are often unprepared to identify trafficking victims. 20,21 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: 2 ● 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: 2 ● 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. ● 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: 2 ● Ensure that safety planning is included in the discharge planning process. ● Provide the patient with options for services, reporting, and resources.
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