A critical summary of screening and intervention techniques all health professionals should be aware of.
Human trafficking is often thought of as an issue faced by other countries, but in 2016, human trafficking in the United States rose 35.7% from the previous year, according to data from the National Human Trafficking Hotline. Polaris, which runs the hotline, reported 7,572 cases involving 6,340 females, 978 males and 70 listed as “gender minorities.” A total of 4,890 reported cases involved adults and 2,387 involved minors. In some cases, callers do not provide demographic information.
A 2014 study in the Annals of Health Law found that almost 88% of interviewed survivors of domestic sex trafficking had encountered one or more health care professionals sometime during the period in which they were being trafficked, yet none were identified as a victim during these encounters. While no other sector plays a more critical role in identify trafficking victims, the vast majority of physicians are unprepared. In a survey conducted by Physicians Against the Trafficking of Humans (PATH), more than 70% of physicians claimed they would not know what to do if they encountered a victim of sex trafficking.
Top 10 Screening Techniques
Physicians should be on the look for:
♦ Bruising, scars, burns, cuts, especially those in non-apparent places
♦ Multiple STD or pregnancy tests
♦ Fearful, anxious or depressed mood
♦ Cash payments, no insurance
♦ A third party may speak for the patient and not allow them to speak
♦ Substance addiction or the appearance of withdrawal symptoms
♦ Lying about age
♦ Patient transient or no address (or the patient doesn’t know what city he/she is in)
♦ Tattoo of a name or strange symbol
“Trafficking victims are frequently tattooed with the name of their trafficker, or the trafficker has some sort of tag that’s an identifying tag, so that if the victim tries to run away she can be readily identified by other pimps as the property of her trafficker,” says Lori Cohen, Director, Anti-Trafficking Initiative Sanctuary for Families in a PATH video. “If a healthcare provider asks the right questions in an environment that’s not judgmental and where a message is being communicated that this is being asked to help the individual, in many cases, a victim will be able to disclose what her experience has been.”
Critical Intervention Techniques
If patients are minors, physicians have a legal duty to report these cases. Healthcare professionals are deemed mandatory reporters and must report suspected abuse and neglect of children. And the growing recognition that many healthcare professionals encounter human trafficking should prompt the medical profession to develop guidelines for responding to all forms of human trafficking.
Do not react in the moment or act shocked if a young person decides to disclose their situation. This can be interpreted the wrong way, as a reaction or disgust toward the victim.
Protect the patient’s identity and privacy even before anyone else is called in: the moment the healthcare provider suspects the patient trafficking victim, change the patient’s name in the records, providing alias.
Write the patient a prescription for a follow up for some medical indication, otherwise you may never see that patient again.
Get the patient alone, especially if they are accompanied by a controlling companion who insists on answering providers’ questions.
Ask your patient if s/he’d like the police involved. Patients should be assured that what they are telling physicians will be kept confidential. They should also be aware that there are times when they are a mandatory reporter.
Avoid the rescue fantasy. This impulse is normal and harmful. Intervening prematurely or without patient consent compromises trust. Physicians can’t fix the situation but may be able to provide a stepping stone in a potentially long path.
“Intervening can be very complicated. Trust is key. If a doctor can continue to communicate that they are concerned about you—we want to help you, we’re not going to force you to do anything you don’t want to do—it gives the patient space to believe that this is someone who really cares about her,” says Cohen.
How to Report Human Trafficking
♦ National Human Trafficking Resource Center (888-3737-888)
♦ Text “BeFree” (233733)
Lederer L, Wetzel CA. The health consequences of sex trafficking and their implications for identifying victims in facilities. The Annals of Health Law. 2014; 23(1):61-91.