○ 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 if 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. 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/ Refer to your local or state requirements for additional information regarding mandatory reporting. Four fundamental principles have been recommended for healthcare professionals who come into contact with people who have been, or are being, trafficked: 8 1. Use a trauma-informed, resilience-oriented, human rights- focused, and culturally sensitive approach to the care of all patients. 2. Collaborate with and seek advice from colleagues who have been engaged in anti-trafficking or other violence prevention work. 3. 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. 4. Play an active role in self-directed education and training about human trafficking.
USING A TRAUMA-INFORMED APPROACH
At a glance, it is easy to appreciate the trauma of a massive motor vehicle accident, but a patient who is trafficked is experiencing a similarly powerful, but far less visible, traumatic event. The task for clinicians is to recognize trafficking when they see it and respond appropriately. The patient’s experiences can be dehumanizing, shocking or terrifying, can involve singular or multiple compounding events over time, and often include betrayal of a trusted person or institution and a loss of safety. 24 These experiences can mean that ordinary medical procedures, such as asking a patient to undress for an exam, performing a gynecological exam, or even simply checking blood pressure, can be threatening or anxiety-provoking. 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: 24 1. Realizes the widespread impact of trauma and understands potential paths for recovery. Taking a history No evidence-based recommendations guide assessment and evaluation processes in the context of known or suspected human trafficking. Practice-based evidence, however, has been used to generate recommendations for screening and inquiry in these situations. Survivors of trauma report that disclosure may be more likely if health care providers are perceived to be knowledgeable about abuse and violence, nonjudgmental, respectful, supportive, and use a trauma-sensitive approach to evaluation and treatment. 8 Given the impact of adverse childhood experiences and other traumatic exposures on later physical and mental health and well-being, some experts recommend embedding specific questions about trafficking after a trusting relationship has been established. The length of time it takes to establish such a relationship with a victimized individual varies widely—it may take just a few minutes or require multiple separate visits. 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. Enlist the help of a staff member and/or interpreter who has knowledge of the patient’s language and culture after
2. Recognizes the signs and symptoms of trauma in clients, families, staff, and others involved with the system. 3. Responds by fully integrating knowledge about trauma into policies, procedures, and practices. 4. 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. Other trauma-informed approaches support the need for fundamental safety throughout the healthcare system (e.g., the Sanctuary model. Information at http://sanctuaryweb. com/) Additional intervention information can be found in a manual about trauma-informed care published by SAMHSA and available at: https://store.samhsa.gov/product/TIP-57-Trauma- Informed-Care-in-Behavioral-Health-Services/SMA14-4816 confirming there is no conflict of interest. Attempt to interview the patient alone without raising suspicions. You may need to be creative in finding opportunities to interview the patient alone, as traffickers may accompany patients to their visits and insist on staying with the patient 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: 1. Has your identification or documentation been taken from you? 2. What are your working or living conditions like? 3. Where do you sleep and eat? 4. Can you leave your job or situation if you want? 5. Do you sleep in a bed, on a cot or on the floor? 6. Do you have to ask permission to eat, sleep or go to the bathroom? 7. Can you come and go as you please? 8. Have you ever been deprived of food, water, sleep or medical care? 9. Are there locks on your doors and windows? Do you lock them or does someone else? (e.g., so you cannot get out) 10. Have you been threatened if you try to leave?
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Book Code: RPTTX2024
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