HUMAN TRAFFICKING: HEALTHCARE RESPONSE
Trafficked persons in need of medical attention provide an opportunity to engage with the victim, provide needed medical care and refer the victims to authorities and organizations that might be able to help them. There are several considerations that healthcare providers should be aware of when responding to human trafficking victims, including understanding the risks of disclosure, using trauma-informed approaches, and identifying resources.
Disclosure and Legal Liability
The goal of healthcare personnel in the identification of trafficking victims should be the well-being of the victim and not necessarily an aggressive pursuit of disclosure. A victim’s decision to disclose is influenced by many complex factors that include guilt, shame, fear of being judged, fear of retaliation against family and others, fear of deportation, fear of imprisonment, threats of physical and emotional harm, and fear of being reported. (Macias-Konstantopoulos, 2016). In fact, disclosure could cause more harm to the patient if it is not handled carefully. Providers should focus on building trust and rapport with patients suspected of being trafficked instead of immediately trying to obtain a disclosure.
Once a patient discloses that they are a victim of human trafficking, the legal and ethical reporting requirements are less clear. In 2008, the Trafficking Victims Protection Reauthorization Act (TVPRA of 2008) stipulated that civil lawsuits may be filed against anyone who “knew or should have known” that sex trafficking occurred and financially benefited (United States, 2008) (Strauss, 2009). This law may place providers and healthcare organizations in legal jeopardy. There are also two types of laws that can put healthcare providers and organizations at risk for failing to identify victims: state mandatory reporting laws and conspiracy law. Mandatory reporting laws as they relate to human trafficking, often fall under child abuse reporting laws. Each state has different mandatory reporting laws that generally require a provider to report any minor that is suspected of being a victim of trafficking, or otherwise be in violation of the law. Security professionals and healthcare staff should be aware of the mandatory reporting laws in their respected state and understand how they relate to human trafficking identification and response. Conspiracy laws can also make healthcare providers and hospitals liable. Courts have stated that businesses that have knowingly witnessed or financially benefitted from a crime can be liable. There is little precedent for how these statutes may apply in a healthcare setting (English, 2017).
A Trauma-Informed Approach
Researchers in the area of human trafficking strongly recommend that providers should have training in a trauma-informed approach to care. This type of care recognizes the effect that trauma has had on the victim and acknowledges the vulnerabilities and triggers associated with being a survivor. Trauma-informed approaches seeks to create safety and security, minimize re-traumatization, and foster a physical, psychological, and emotional environment that promotes health and well-being (Macias-Konstantopoulos, 2016). A trauma-informed approach can also assist healthcare providers in managing their own emotions when traumatized patients exhibit negative behaviors. Healthcare providers who are trained in trauma-informed approaches are more likely to build trust and show compassion and respect for the patient. (Macias-Konstantopoulos, 2016).
The Critical Role of Safety & Security in Addressing Human Trafficking
While hospital safety and security professionals have a critical role to play in addressing human trafficking in a healthcare setting, little has been published about their role specific to human trafficking. In fact, few law enforcement professionals have been trained to understand the signs and symptoms of human trafficking, and nothing is known on training for security professionals. National studies show that most local law enforcement officials perceive that human trafficking is not a problem in their community, and fewer than 20% of law enforcement professionals have received training (Grubbs, 2012; Mapp, 2016). One study reported that only one-third of law enforcement officials from the state of Georgia were aware of the definition of human trafficking, one-third were familiar with human trafficking laws, and only 11.2% has received formal training on human trafficking (Grubbs, 2012). Most human trafficking victims are hiding in plain sight, and, therefore, it is important for security professionals to have the tools, resources, and vocabulary to be able to identify victims.
Security professionals should be aware that human trafficking victims themselves often do not want to be identified for reasons that include fear of arrest, threats of bodily harm, threats of financial harm, threats to harm family members, or psychological ties to their trafficker. Trafficking victims may also be illegally in this country and fear deportation (Mapp, 2016). Security professionals are in a unique position to identify signs of human trafficking that healthcare providers may not observe. In addition to screening questionnaires used by healthcare professionals, security officials may be in a unique position to observe evidence of controlling or dominating relationships exhibited in waiting rooms. Signs of a controlling relationship include not being left alone, not being able to speak for themselves, avoidance of eye contact with authority figures such as those in uniform, or adherence to scripted or rehearsed responses in social interactions.
After being trained, security professionals can be more fully integrated into the healthcare team to actively work with clinical staff and patients to address human trafficking. In addition to observing signs of human trafficking that the healthcare team may not observe, it is important for security professionals to assess what situations could lead to violence so they can mitigate these threats before they escalate. Most human trafficking protocols in healthcare settings attempt to separate potential victims from their traffickers so health histories and human screening can be conducted. Perpetrators of human trafficking may become anxious or even violent if they are separated from their victim. Security professionals should be fully trained in crisis intervention and in interacting with patients who have been traumatized. Victims, themselves, may be at higher risk of being violent because they are more likely to abuse substances and be fearful (Hickle, 2016).
Security professionals should be trained to understand and recognize the impact of trauma on survivors of human trafficking. This type of training, called trauma-informed care, emphasizes identifying potential triggers that may retraumatize victims and may also lead to behavioral issues such as aggression, anxiety, appearing adversarial, and being uncooperative. Individuals who have been traumatized may appear hostile, hypervigilant, or in a constant state of arousal especially when they feel threatened. Creating an environment of safety and support is critical when dealing with trauma victims. De-escalation techniques such as being calm, genuine and respectful and building rapport can assist with creating a safe environment and prevent violence (Hickle, 2016).
Security and safety professionals should be involved in the development of guidelines and policies regarding human trafficking identification and referral as well as on-going monitoring of the effectiveness of policies and programs. Policies should clearly articulate the role security professionals have in identification and reporting. The healthcare security industry can play a major role in reducing human trafficking by advocating for the development and implementation of human trafficking policies in healthcare settings that include the role of security. The healthcare and security communities should be on the forefront of developing programs to train safety professionals in human trafficking, trauma-informed care, and crisis management. Finally, programs and policies should be evaluated, and best practices should be disseminated.
Healthcare organizations must have the appropriate resources to respond to the needs of trafficking victims. Trafficked persons have a high prevalence of complex health needs, but they may not have access to insurance or resources. It is important for the organization to have established clear policies, guidelines, and protocols on how to respond to human trafficking. Having clear guidelines and policies provides a sense of safety and confidence to intervene in these situations. Clear policies can prevent situations that may place the patient or provider in potentially harmful situations.
In addition, organizations must identify personal resources that can adequately address this issue, as well as resources for referral and further treatment. Personal resources in the healthcare setting may include security, law enforcement, social work staff, patient advocates, and educational and development staff. Healthcare organizations should be aware of local organizations that assist victims as well as the services provided by the National Human Trafficking Resource Center. Macias has suggested a framework for healthcare preparedness that includes: development of human trafficking response protocols, identification of a multidisciplinary team to guide protocol development and implementation, adoption of a trauma-focused approach to care, implementation of evidence-based practices, understanding of mandatory reporting laws, development of internal and external resource guides and services available to victims, establishment of algorithms for responding to various scenarios, development of communication channels for knowledge dissemination, and implementation of monitoring and evaluation of the impact and effectiveness of these activities (Macias-Konstantopoulos, 2016.)