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Identifying Human Trafficking Victims in Healthcare Settings

This post is co-written by Brittany Blevins, an MPH Student at the University of Southern California.

The pervasiveness of human trafficking juxtaposed with its concealed nature can often make it difficult for victims to be identified in a clinical setting. There is no single manifestation of symptoms or diagnostic tools available to readily alert providers to a trafficking situation.

Human trafficking victims in healthcare settings

Victims often seek health services in an emergency, for physical injury or assault, gynecological services or prenatal care, mental health or addiction treatment, routine follow-up for chronic conditions, or following workplace injuries—putting the victims in direct contact with Emergency Department staff, nursing staff, physicians/surgeons, psychiatric units, substance use counselors, social workers, and many others within a setting (National Human Trafficking Hotline, 2019).

Studies have shown that upwards of half of victims who interact with healthcare providers remain unidentified. Part of the problem is that most physicians and healthcare providers are under-trained in how to assess this. For example, a study by Chisholm et al. (2016) reports that 55.6 percent of victims had spoken with ED staff, 44 percent interacted with primary care providers, 26 percent were seen by a dentist, and 3 percent were treated by a pediatrician. The significant deficit in physician training can translate into the inability to recognize the often invisible signs of human sex and .

A trafficked person may present with a variety of symptoms that can convolute the differential diagnosis process. Acute medical complaints include malnutrition, lack of sleep, gastrointestinal problems, chronic headaches, and/or mental health complaints that result from the highly stressful environment. Additionally, musculoskeletal pain or trauma can result from physical or sexual violence.

Repeated physical abuse or torture can result in fractures or burns. Often, there will be evidence of burns or injuries that appear to be in different stages of healing and on different parts of the body. Gynecologic complaints such as vaginal bleeding, genital pain, PID, serial STIs, and pregnancy complications are also common complaints experienced by victims. Ultimately, psychological trauma can commonly manifest as PTSD, paranoia, depression, and/or suicidal ideation (Anh et al., 2013; Macias-Konstantopoulos, 2016).

Aside from the physical symptoms of trafficking mentioned above, there are several other red flags that can easily slide under the radar. These symptoms can include dirty or unkempt appearance, unwashed clothing or weather-inappropriate attire, submissive or fearful behavior, withdrawn demeanor or restricted communication, answers that appear to be scripted or rehearsed, lack of identification, being unaware of location or time, and tattoos or branding (Bohnert et al., 2017; Anh et al., 2013).

As patients, victims may display hypervigilance around physical examination or demonstrate general mistrust around the visit in its entirety. Victims are unlikely to speak of their experiences in a linear way. They may even lie. The patients may exhibit irritability or agitation when probed for information or may even become belligerent. It is important to remember that an unclear or inconsistent history does not mean the patient is being obstructionist, but rather this could signify a response or defense mechanism to ongoing trauma and abuse.

THE BASICS

As mandated reporters, physicians are legally required to report , elder abuse, and abuse of the disabled. A suspected human trafficking incident of a person under 18 is considered child abuse and usually requires a report (state laws may vary, and incidents are often considered on a case-by-case basis) (Jones Day, 2022). In most cases, though, physicians and healthcare providers are not required to report adult human trafficking cases. Yet, the healthcare encounter provides an important opportunity to establish trust and let a suspected victim know that help is available.

However, the opportunity to identify victims as well as link them to services is limited by several factors. At the individual level, lack of about what constitutes trafficking, limited opportunity to be alone with a provider, lack of a stable support network or financial , shame and embarrassment, mistrust of strangers, fear of retaliation by the trafficker, and/or criminal records discourage victims from coming forward. Larger-scale barriers include legal issues such as fear of deportation, fear of the police, or cultural beliefs that promote endurance or silence (Ahn et al., 2013; Baldwin et al., 2011).

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How healthcare providers can help

Providers who are competent in recognizing the physical and psychological symptoms of trafficking can address patients’ medical and mental health needs in an integrated way. Providers have a responsibility to incorporate respectful, non-judgemental, trauma-informed care when treating suspected victims. Assessing the patient’s ability or desire to speak freely, as well as being cognizant of the power dynamic, will support the clinician’s ability to provide a secure and comfortable environment that will encourage the victim to offer information. For example, a provider can separate the patient by citing the clinic’s policy of private examination or by saying that tests are needed in a separate exam room.

Sample questions include:

  • Have you been threatened if you try to leave your employer?
  • Do you have your passport or identification? If not, who has it?
  • Has your family been threatened?
  • Are you able to come and go as you please?
  • Do you have a safe space to go?

In cases where English is not the patient’s native language, interpretation services must be provided by a professional interpreter and not the companion, as this introduces the possibility of incorrect information as well as robs the opportunity for confidential patient-provider communication (HHS, 2018).

Truthful answers will likely not be given at an initial consultation because it often takes multiple attempts for the patient to open up and disclose a trafficking situation. Probing deeply too quickly can cause the victim to feel triggered, leading to subsequent unresponsiveness. If the patient declines to share information, the encounter must continue to be respectful, and the patient should be encouraged to return in the future should there be a change of mind or circumstance.

Healthcare providers can help foster feelings of security, self-esteem, and self-determination that may last well beyond the patient visit. Institutions must have a protocol in place in the event that a patient does ask for help. And providers must be made aware of protocols regarding internal hand-offs or external referrals in case a patient chooses to share information (National Human Trafficking Training and Technical Assistance Center, 2018).

Ultimately, healthcare providers have a unique opportunity to speak privately with a victim and serve as a bridge between the trafficking victim and the appropriate resources confidentially and safely. Practitioners can help protect patients from present and future harm by ensuring that their staff and services are sensitive to the vulnerabilities of trafficked persons and that their referral options are safe, appropriate, and convenient.

 

EYES ON TRAFFICKING

This “Eyes on Trafficking” story is reprinted from its original location.

ABOUT

PBJ Learning is a leading provider of online human trafficking training, focusing on awareness and prevention education. Their interactive Human Trafficking Essentials is used worldwide to educate professionals and individuals how to recognize human trafficking and how to respond to potential victims. Learn on any web browser (even your mobile phone) at any time.

More stories like this can be found in your PBJ Learning Knowledge Vault.

 

EYES ON TRAFFICKING

This “Eyes on Trafficking” story is reprinted from its original online location.

ABOUT PBJ LEARNING

PBJ Learning is a leading provider of online human trafficking training, focusing on awareness and prevention education. Their interactive Human Trafficking Essentials online course is used worldwide to educate professionals and individuals how to recognize human trafficking and how to respond to potential victims. Learn on any web browser (even your mobile phone) at any time.

More stories like this can be found in your PBJ Learning Knowledge Vault.