Human Trafficking: Protect Victims and Your Organization

In addition to providing valuable clinical care, healthcare systems monitor and safeguard public health in many other ways. One of these critical areas is protecting vulnerable patients by detecting human trafficking. Human trafficking is the unlawful confinement and exploitation of persons for forcible participation in involuntary sex trafficking, forced labor, or debt collection—and it is a big business. While difficult to quantify, some estimates indicate that at any given time there are 25 million victims worldwide who generate approximately $150 billion in annual revenue for their traffickers.
 
Although traffickers often prey on vulnerable individuals with physical/intellectual/developmental disabilities and mental health diagnoses, their pool of target victims comprises all abilities, ages, genders, nationalities, and socioeconomic groups. Trafficking is a widespread concern, and vigilance in detection and protection for trafficking victims is a vital and lifesaving endeavor.

Trafficked individuals bear unspeakable emotional and physical harm and financial hardship as victims of labor and sexual exploitation. They endure depression, post-traumatic stress, malnutrition, sexually transmitted infection and disease, and substance abuse disorders and addiction, among other physical and mental health conditions. 

Trafficking victims are powerless to escape due to imposed isolation and restrictions on movement and finances. They are intimidated by physical or sexual violence and, in some cases, fall prey to drug or alcohol dependency. Human trafficking is a crime with significant healthcare consequences, including physical, psychological, and social implications for trafficked individuals. This crime also exposes healthcare workers to risk—confrontation with victims and their handlers can be dangerous. 

Risk Management Recommendations 

Healthcare practitioners are in a unique position to identify and intervene in human trafficking cases. Studies have shown that up to 88% of trafficking victims have entered the healthcare system while being trafficked, most often by way of the emergency department. Consider the following when raising awareness about human trafficking at your organization:

• Recognize behavioral/situational indicators. Ensure that all staff, particularly registration and front desk staff, are familiar with the behavioral and situational indicators of human trafficking: 
  • Absence of address, homelessness, incomplete identification, or lack of insurance.
  • Failure to make eye contact.
  • Limited ability to discuss circumstances leading to their healthcare needs.
  • Hesitation to answer questions or provision of an inconsistent clinical history.
  • Deferral of communication to another person.
  • Lack of awareness regarding current location or date.
  • Suspicion that the person accompanying the patient is a “handler” rather than a companion.
  • Fearful, timid, or submissive demeanor.
• Recognize physical indicators. Ensure that all staff, especially clinical staff, are familiar with the physical indicators of human trafficking:
  • Behavioral health or cognitive impairment.
  • Evidence of unmet medical needs, such as old injuries or recurrent or untreated conditions.
  • Exposure to toxic materials or hazardous working conditions.
  • Poor personal hygiene, nutrition, or dentition.
  • Signs of physical abuse, such as bruising, scars, rashes, and burns, including rope burns.
  • Brands or tattoos commonly used by traffickers such as bar codes or currency symbols located on the neck, upper arm, and above the groin area.
• Create written guidelines. Develop written, structured screening and response policies, procedures, and protocols for staff to use when human trafficking is suspected. Include the following key elements:
  • Utilize a structured screening tool. The ideal screening tool is short, inclusive, evidence-based, and minimally invasive. It can help staff recognize the signs of trafficking and respond appropriately. Train staff how to administer the screening tool in a respectful, nonthreatening manner.
  • Provide awareness training for all. Registration and front desk staff are often the first point of contact with trafficking victims. Educate all staff to identify potential human trafficking victims and respond by:
    • Activating a response protocol.
    • Surveilling the environment for potential physical risks.
    • Taking steps to approach a potentially dangerous situation.
  • Encourage restraint. Train staff to refrain from directly confronting a suspected trafficker or alerting a victim to your suspicions. Ensure that staff and patient safety comes first. Contact local law enforcement or local/national hotlines, including the National Human Trafficking Hotline.
• Employ safeguards. Because the trafficker/victim relationship is defined by violence, it is easy to imagine how interactions with these individuals can quickly escalate into dangerous situations for staff and patients. Work with local law enforcement and agencies with expertise to develop appropriate, practical guidelines for staff. Include in these guidelines instructions for alerting security or law enforcement and for providing supportive, nonjudgmental patient care, treatment, and resources.
• Document thoroughly. Accurate documentation of the patient encounter is important to capture the clinical assessment and treatment plan and to objectively recount the interventions taken. If criminal charges are filed against suspected traffickers, the medical record will likely be relevant in subsequent court proceedings.
• Know the law. Mandated reporting obligations vary by state. For example, some states may limit mandatory reporting to minors, persons with disabilities, and seniors at risk, while others may require reporting in other circumstances. Familiarize yourself with mandated reporting responsibilities and limitations at the federal level and in your state. Work with an attorney to ensure your policies, procedures, and protocols are consistent with applicable law. 

Human trafficking has widespread implications for healthcare organizations related to prevention, intervention, and treatment provision to victims. Healthcare workers are in a unique position to recognize and intercede in this pressing public health concern. Prompt recognition of trafficking and decisive intervention could save a life!

Additional Resources:

• National Human Trafficking Training and Technical Assistance Center
• U.S. Department of Health and Human Services
• Polaris  Project
• Administration for Children & Families Office on Trafficking in Persons, Toolkit: Adult Human Trafficking Screening Tool and Guide
• Centers for Disease Control and Prevention, Violence Prevention: Sex Trafficking
• Department of Homeland Security Blue Campaign for Public Awareness
• American Medical Association Journal of Ethics, Mandatory Reporting of Human Trafficking: Potential Benefits and Risks of Harm