January is National Human Trafficking Prevention Month.
Instituted in 2010, the United States Department of State dedicates the month of January to raising awareness and equipping the public with resources to identify and prevent trafficking.
Given their unique position, healthcare professionals are often the first to spot signs of human trafficking. They can also provide trauma-informed care and, when able, equip the trafficked individual with resources to leave their abusive situation.
A global issue
While the exact number of those involved may never be known, the Department of State estimates that more than 27.6 million people, including children, are subjected to human trafficking around the world.
Though human trafficking affects all sexes, ages, sexual orientations, ethnicities, and races — and has for millennia — it wasn’t until the 21st century that a full legal definition existed.
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Codified more than two decades ago, the Trafficking Victims Protection Act of 2000 (TVPA) defines “severe forms” of trafficking as:
- sex trafficking in which a trafficker induces a commercial sex act by force, fraud, or coercion, or in which the person performing such an act is not yet 18 years of age; or
- the recruitment, harboring, transportation, provision, or obtaining of a person for labor or services, through the use of force, fraud, or coercion for the purpose of subjection to involuntary servitude, peonage, debt bondage, or slavery.
In general, experts consider a person “trafficked” when a trafficker recruits, transports, transfers, harbors, and/or receives them by force, fraud, or coercion for the purpose of exploitation.
Worth noting: A victim need not be physically transported from one location to another to be trafficked under this definition.
Where does it happen?
The following industries often provide a cover for sex and/or labor trafficking:
- Agriculture, including seasonal harvesting work or caring for animals
- Domestic work, including cooking, cleaning, other household work, and caregiving
- Restaurants and small businesses, including waitstaff, kitchen staff, bussers, or dishwashers
- Traveling sales crews and peddling/begging rings, including selling candy, magazine subscriptions, and other goods or soliciting money
- Health and beauty services, including nail salons, hair salons, spas, or massage parlors
- Escort services through agencies and online sex sites
- Brothels (home-based, lodge-based, truck stop-based, etc.)
The right approach
For healthcare professionals, the goal of every clinical encounter is to provide quality care that minimizes harm to the patient and addresses their health needs. Patients who have been trafficked are at risk for myriad physical and mental health disorders, including depression, post-traumatic stress disorder, suicidal ideation, substance abuse disorders, and sexually transmitted infections (STIs).
Shame, guilt, poor self-esteem, and fear for their family members (based on traffickers’ threats) also create complex psychological stress for trafficked individuals. This can feed into a cycle of victimization and traumatization.
A seemingly benign healthcare visit can become traumatic and leave patients shattered and more vulnerable if the healthcare professional comes across as judgmental. The same is true if part of the examination triggers past traumas, for example, asking the patient to disrobe. These pervasive psychological effects are what drive the need for trauma-informed care.
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What to do if you suspect trafficking
It can be challenging to find balance between asking important questions of the patient while limiting the risk of re-traumatization.
While disclosure of trafficking may occur, it is never the primary goal of the patient encounter. Pressuring patients for a disclosure reduces their agency and could contribute to mistrust in the medical system. Instead, involving survivors of the trauma in meaningful decisions creates survivor-based practices that improve quality of care.
Other critical concepts of trauma-informed care include:
- Safety: This encompasses the physical and psychological safety of the patient who may have been trafficked, as well as the healthcare staff. Patients must be certain they’re not in danger, either from their trafficker or from the authorities.
- Trust and transparency: Those who have been trafficked may fear that they’re in danger, from both their traffickers and the authorities. This fear and history of exploitation may translate to distrust of health professionals. They may distrust both advice from and confidentiality of health professionals. Discussing these issues in a forthright manner will help build and maintain trust. Remember to avoid making promises that can’t be kept.
- Empowerment, voice, and choice: Empowerment means giving an individual or group the ability to make choices and turn these decisions into actions and outcomes.
- Peer support: Sharing experiences with fellow trafficking survivors is a powerful tool toward recovery and healing. Assisting a patient in finding these connections can build trust and hope. Peer support can take the form of peer counseling, either in groups or in mentoring roles from individuals who have graduated from a support program.
Resources for healthcare professionals
One of the most valuable resources for patients and the healthcare professionals who care for them is the National Human Trafficking Hotline (1-888-373-7888). For patients who are unable to freely talk on the phone, the hotline also operates a texting line and website.
- Webpage: www.humantraffickinghotline.org
- Text line: 233733
The hotline is available for patients, providers, or anyone concerned about trafficking. It provides connections to geographically specific resources, as well as tracking geographic patterns of trafficking in the United States.
While healthcare professionals may encourage patients to use this resource, never force patients to accept papers or written phone numbers that may be found by their trafficker, leading to potential retribution.
Instead, patients may want to memorize the number or store it as a different contact in their phone. Likewise, consider providing a secure area and time away from their trafficker in the clinical setting. In this safe space, the patient can call the hotline or utilize a clinic or hospital phone system that their trafficker cannot trace back to them.
Dozens of organizations across the country are working on the front lines in the fight to end human trafficking. Some excellent resources can be found at The Polaris Project and the National Survivor Network.