Human trafficking is a grave violation of human rights and a significant public health concern. It involves the exploitation of individuals for labor or commercial sex through force, fraud, or coercion. Health care providers are uniquely positioned to identify victims of human trafficking, as trafficked persons often interact with the healthcare system while being exploited. However, without proper training and readily available tools, these critical opportunities for intervention can be missed. This article focuses on the vital role of screening tools for trafficking in healthcare settings, particularly highlighting resources and initiatives supported by the HHS (U.S. Department of Health and Human Services), to equip health care providers in effectively recognizing and responding to this hidden crime.
The Critical Role of Healthcare Professionals in Identifying Trafficking Victims
Healthcare settings are often a point of contact for individuals experiencing human trafficking. Victims may seek medical attention for injuries, illnesses, or mental health issues directly related to their exploitation. They might present with frequent sexually transmitted infections, injuries from violence, malnutrition, or psychological trauma. Despite these interactions, healthcare providers may unknowingly overlook the signs of trafficking due to a lack of awareness, training, or established protocols.
Recognizing the crucial role of healthcare professionals, organizations like the U.S. Department of Health and Human Services (HHS) have emphasized the need for readily accessible and effective screening tools. These tools are designed to aid healthcare providers in systematically assessing patients for potential indicators of human trafficking in a sensitive and trauma-informed manner. Early identification is paramount, as it opens the door to providing necessary medical care, support services, and pathways to freedom for trafficking victims.
Understanding the Scope of Human Trafficking: Sex and Labor Exploitation
To effectively utilize screening tools for trafficking, healthcare providers must have a foundational understanding of what constitutes human trafficking. The U.S. Department of Justice categorizes human trafficking into two primary forms:
- Sex Trafficking: This involves the recruitment, harboring, transportation, or obtaining of a person for the purpose of a commercial sex act, induced by force, fraud, or coercion, or if the person is under 18 years old.
- Labor Trafficking: This encompasses the recruitment, harboring, transportation, or obtaining of a person through force, fraud, or coercion for involuntary servitude, peonage, debt bondage, or slavery.
Victims of trafficking come from all walks of life, regardless of age, race, gender, nationality, or socioeconomic status. Traffickers can be anyone – from family members and intimate partners to business owners and seemingly ordinary individuals. Exploitation occurs across various industries, including but not limited to hospitality, agriculture, domestic work, and unfortunately, even within healthcare-related settings themselves.
Recognizing the Red Flags: Indicators of Human Trafficking in Patients
While screening tools for trafficking offer a structured approach, healthcare providers should also be aware of potential indicators, often referred to as “red flags,” that may suggest a patient is experiencing trafficking. These indicators span physical health, behavioral health, and other circumstantial factors:
Physical Health Indicators:
- Frequent presentations for sexually transmitted infections (STIs) or injuries, especially in the genital or anal areas.
- Recurrent or unwanted pregnancies, miscarriages, or abortions.
- Unexplained fractures, burns, or bruising in various stages of healing.
- Gastrointestinal problems, potentially due to poor diet or unsanitary living conditions.
- Skin or respiratory issues linked to chemical exposure in agricultural or industrial settings.
- Presence of communicable and non-communicable diseases that may be neglected.
- Oral health problems, including broken or missing teeth, often resulting from violence or neglect.
- Chronic pain conditions without clear etiology.
- Signs of concussions, traumatic brain injuries, or unexplained memory loss.
- Malnutrition, dehydration, or signs of starvation.
Behavioral Health Indicators:
- Reluctance or inability to answer health-related questions directly.
- Difficulty concentrating or providing basic personal information like age, address, or current time.
- Inconsistent or contradictory information provided during interviews.
- Substance abuse or dependence, potentially as a coping mechanism.
- Symptoms of depression, anxiety, or panic disorders.
- Appearing nervous, fearful, or exhibiting avoidance of eye contact.
- Symptoms consistent with post-traumatic stress disorder (PTSD).
Other Potential Indicators of Trafficking:
- Presence of a controlling accompanying person who dominates the conversation and prevents the patient from speaking freely.
- Reports of an unusually high number of sexual partners or encounters.
- Lack of possession of personal identification documents such as driver’s licenses or passports.
- Living in overcrowded conditions or residing at their place of work.
- Tattoos or branding that suggest ownership or control by another person.
- Wearing clothing inappropriate for the weather or clinical setting.
It’s crucial to remember that these indicators are not definitive proof of trafficking but rather signals that should prompt further assessment using validated screening tools.
Essential Screening Tools for Healthcare Practitioners: HHS Resources and Beyond
To assist healthcare providers in effectively identifying trafficking victims, several validated screening tools have been developed. Many of these tools are supported by or aligned with the initiatives of the HHS and its various agencies, ensuring a focus on evidence-based, trauma-informed, and survivor-centered approaches. Here are some key screening tools:
1. Adult Human Trafficking Screening Tool and Guide (Administration for Children and Families, HHS)
Developed by the Administration for Children and Families (ACF), a division of HHS, through the Office on Trafficking in Persons (OTIP), this tool is specifically designed for healthcare providers and other professionals working with adults. It is survivor-centered, trauma-informed, and culturally appropriate, aiming to help assess adult patients for signs of potential exploitation or risk of exploitation. The tool emphasizes creating a safe and supportive environment for disclosure and includes a comprehensive guide for implementation and interpretation.
Learn more: U.S. Office on Trafficking In Persons website
2. Commercial Sexual Exploitation-Identification Tool (CSE-IT)
The Commercial Sexual Exploitation-Identification Tool (CSE-IT) is a research-based screening tool developed by the West Coast Children’s Clinic. While not directly an HHS tool, it is widely recognized and utilized in various sectors, including healthcare, across Texas and other states. CSE-IT is specifically designed to improve the early identification of youth who are commercially sexually exploited. It is valuable for healthcare providers working with adolescent populations and helps to identify potential victims who may not explicitly disclose their exploitation.
Learn more: Office of the Texas Governor Child Sex Trafficking Team website and West Coast Children’s Center website
3. Short Child Sex Trafficking Screen for the Health care Setting
Developed by Dr. Jordan Greenbaum at The Institute on Healthcare and Human Trafficking, this validated screening tool is specifically designed for assessing teenagers in healthcare settings within the United States. While independent of HHS, the Institute on Healthcare and Human Trafficking is a respected organization focused on addressing trafficking from a healthcare perspective, aligning with the broader goals of HHS in combating human trafficking. This short screen is efficient for busy healthcare environments and focuses on key indicators relevant to child sex trafficking.
Learn more: The Institute on Healthcare and Human Trafficking
4. Trafficking Victim Identification Tool and Manual (Vera Institute for Justice)
The Vera Institute for Justice has developed the Trafficking Victim Identification Tool and Manual. While not directly an HHS resource, this tool is highly regarded and utilized by victim service agencies, social service providers, and increasingly, healthcare professionals. It is designed to improve the identification of both adult and child trafficking victims. The manual provides guidance on using the tool effectively, emphasizing the importance of training and mentoring for those conducting screenings.
Learn more and download the tool: Vera Institute for Justice website
Responding with Care: Steps to Take if You Suspect Trafficking
If a healthcare provider suspects a patient is being trafficked, it is crucial to act with sensitivity and follow established protocols. Key steps include:
- Provide Immediate Medical Care: Prioritize addressing the patient’s immediate health needs.
- Private Conversation: Attempt to speak with the patient alone, away from any accompanying individuals, to build trust and create a safe space for disclosure.
- Utilize Screening Tools: Employ appropriate screening tools for trafficking to systematically assess the situation.
- Mandatory Reporting: Be aware of and adhere to state mandatory reporting laws regarding child abuse, elder abuse, or abuse of individuals with disabilities.
- Law Enforcement Involvement (If Immediate Danger): If the patient is in immediate, life-threatening danger, follow institutional policies for reporting to law enforcement. When possible, involve the patient in the decision to contact law enforcement.
- Offer Resources: Provide the National Human Trafficking Hotline number (1-888-373-7888) and text line (233733). Encourage the patient to reach out for help or information.
- Safety Planning: Incorporate safety planning into the discharge process, considering the patient’s immediate safety and ongoing needs.
- Accurate Documentation: Thoroughly and accurately document all findings, injuries, and treatment in the patient’s medical records.
Accessing Further Information and Resources: HHS and National Networks
Numerous resources are available to support healthcare providers in their efforts to combat human trafficking. The HHS and its partner organizations offer extensive information, training materials, and support networks.
- National Human Trafficking Hotline (HHS Supported): A crucial resource for reporting tips, accessing help, and obtaining information. 1-888-373-7888, text 233733, or chat online at https://humantraffickinghotline.org/.
- Office on Trafficking in Persons (OTIP), HHS: Provides federal leadership and resources on anti-trafficking strategies, policies, and programs. https://www.acf.hhs.gov/otip
- HEAL Trafficking: A multidisciplinary network of professionals dedicated to ending human trafficking from a public health perspective. https://healtrafficking.org/
- Office for Victims of Crime (OVC): Supports crime victims, including trafficking survivors, through funding, training, and resources. https://ovc.ojp.gov/program/human-trafficking/overview
- Polaris: Operates the National Human Trafficking Hotline and works to build data-driven strategies to combat trafficking. https://polarisproject.org/
By integrating screening tools for trafficking into routine healthcare practices and leveraging the wealth of resources available through HHS and other organizations, healthcare providers can become powerful allies in the fight against human trafficking, offering hope and help to those who desperately need it.
