Human trafficking, a modern form of slavery, is a complex problem affecting virtually every aspect of society including the healthcare system. The healthcare industry and medical societies have made great strides in addressing human trafficking. While medical societies and healthcare organizations have created policy statements or guidelines regarding identification and treatment of victims, there are still large gaps.
Major challenges exist in identifying which patients are really victims of human trafficking. While questionnaires and screening instruments exist, little research has been conducted to determine the feasibility and validity of these instruments. Without valid screening instruments to identify victims, it is impossible to fully understand the prevalence of human trafficking in healthcare settings. As demonstrated by all reviewed studies, screening instruments can have a high probability of identifying patients who are truly victims of human trafficking. However, these instruments also have false positive rates that range from 20 to 50 percent of those screened. The high false positive rates make screening programs in healthcare settings more expensive, since as many as half of those who screened positive would have unnecessary follow-ups by social workers or law enforcement.
It was found that human trafficking education for healthcare providers is highly variable and virtually nonexistent for safety and security professionals working in the healthcare system. There is a need to build a body of evidence-based programs for healthcare providers and security professionals working in healthcare settings (Powell, 2017). Training programs and educational resources are critical to changing the way healthcare identifies, assesses, and refers trafficking victims. It is likely, though, that training in and of itself is not sufficient for healthcare organizations to have an impact. Healthcare organizations must develop supportive policies and procedures that are tailored to their context and environment. Safety and security professionals should be an integral partners in the development of these policies.
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. Clear policies can prevent situations that may place the patient or provider in potentially harmful situations. Healthcare organizations can play a critical role in advancing the goal of reducing human trafficking and ending the suffering of victims.
G.A. Tortolero graduated with a Bachelor of Science in epidemiology from The University of Texas at San Antonio in 2018. G.A. Tortolero is currently s graduate student at The University of Texas School of Public Health Houston with a concentration in epidemiology. The author has expertise in geospatial analysis, mental health epidemiology, cancer control disparities, and infectious disease control.
Ahn, R., Alpert, E. J., Purcell, G., Konstantopoulos, W. M., McGahan, A., Cafferty, E., . . . Burke, T. F. (2013). Human trafficking: Review of educational resources for health professionals. American Journal of Preventive Medicine, 44(3), 283-289. doi:10.1016/j.amepre.2012.10.025 [doi]
Anderson, V. R., Kulig, T. C., & Sullivan, C. J. (2019). Estimating the prevalence of human trafficking in Ohio, 2014-2016. American Journal of Public Health, 109(10), 1396. doi:10.2105/AJPH.2019.305203
Baldwin, S. B., Eisenman, D. P., Sayles, J. N., Ryan, G., & Chuang, K. S. (2011). Identification of human trafficking victims in health care settings. Health and Human Rights, 13(1), 36-49.
Beck, M. E., Lineer, M. M., Melzer-Lange, M., Simpson, P., Nugent, M., & Rabbitt, A. (2015). Medical providers’ understanding of sex trafficking and their experience with at-risk patients. Pediatrics, 135(4), e895-902. doi:10.1542/peds.2014-2814 [doi]
Chisolm-Straker, M. (2018). Measured steps: Evidence-based anti-trafficking efforts in the emergency department. Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine, 25(11), 1302-1305. doi:10.1111/acem.13552 [doi]
Chisolm-Straker, M., Baldwin, S., Gaigbe-Togbe, B., Ndukwe, N., Johnson, P. N., & Richardson, L. D. (2016). Health care and human trafficking: We are seeing the unseen. Journal of Health Care for the Poor and Underserved, 27(3), 1220-1233. doi:10.1353/hpu.2016.0131 [doi]
Diaz, A., Clayton, E. W., & Simon, P. (2014). Confronting commercial sexual exploitation and sex trafficking of minors. JAMA Pediatrics, 168(9), 791-792. doi:10.1001/jamapediatrics.2014.1002 [doi]
Egyud, A., Stephens, K., Swanson-Bierman, B., DiCuccio, M., & Whiteman, K. (2017). Implementation of human trafficking education and treatment algorithm in the emergency department. Journal of Emergency Nursing: JEN : Official Publication of the Emergency Department Nurses Association, 43(6), 526-531. doi:S0099-1767(17)30041-7 [pii]
English, A. (2017). Mandatory reporting of human trafficking: potential benefits and risks of harm. AMA journal of ethics, 19(1), 54-62.
Family Violence Prevention Fund. (2005). San Francisco, CA: Turning pain into power: Trafficking survivors’ perspectives on early intervention strategies. Available from, Www.Childhood-Usa.org/upl/files/4109.Pdf,
Goldberg, A., & Moore, J. (2018). Domestic minor sex trafficking. Child and Adolescent Psychiatric Clinics of North America, 27(1), 77-92. doi:S1056-4993(17)30103-7 [pii]
Goldberg, A. P., Moore, J. L., Houck, C., Kaplan, D. M., & Barron, C. E. (2017). Domestic minor sex trafficking patients: A retrospective analysis of medical presentation. Journal of Pediatric and Adolescent Gynecology, 30(1), 109-115. doi:S1083-3188(16)30161-9 [pii]
Grace, A. M., Ahn, R., & Macias Konstantopoulos, W. (2014). Integrating curricula on human trafficking into medical education and residency training. JAMA Pediatrics, 168(9), 793-794. doi:10.1001/jamapediatrics.2014.999 [doi]
Greenbaum, J. (2018). Child sex trafficking and commercial sexual exploitation. Advances in Pediatrics, 65(1), 55-70. doi:S0065-3101(18)30004-5 [pii]
Greenbaum, V. J., Dodd, M., & McCracken, C. (2018a). A short screening tool to identify victims of child sex trafficking in the health care setting. Pediatric Emergency Care, 34(1), 33-37. doi:10.1097/PEC.0000000000000602 [doi]
Grubb, D., & Bennett, K. (2012). The readiness of local law enforcement to engage in US anti-trafficking efforts: An assessment of human trafficking training and awareness of local, county, and state law enforcement agencies in the state of georgia. Police Practice and Research, 13(6), 487-500.
Hickle, K. (2016). A trauma-informed approach: policing responses to child sexual exploitation.
Ijadi-Maghsoodi, R., Cook, M., Barnert, E. S., Gaboian, S., & Bath, E. (2016). Understanding and responding to the needs of commercially sexually exploited youth: Recommendations for the mental health provider. Child and Adolescent Psychiatric Clinics of North America, 25(1), 107-122. doi:10.1016/j.chc.2015.08.007 [doi]
Kaltiso, S. O., Greenbaum, V. J., Agarwal, M., McCracken, C., Zmitrovich, A., Harper, E., & Simon, H. K. (2018). Evaluation of a screening tool for child sex trafficking among patients with high-risk chief complaints in a pediatric emergency department. Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine, 25(11), 1193-1203. doi:10.1111/acem.13497 [doi]
Kiss, L., Pocock, N. S., Naisanguansri, V., Suos, S., Dickson, B., Thuy, D., . . . Zimmerman, C. (2015). Health of men, women, and children in post-trafficking services in Cambodia, Thailand, and Vietnam: An observational cross-sectional study. The Lancet Global Health, 3(3), e154-e161. doi:10.1016/S2214-109X(15)70016-1
Le, P. D., Ryan, N., Rosenstock, Y., & Goldmann, E. (2018). Health issues associated with commercial sexual exploitation and sex trafficking of children in the United States: A systematic review. Behavioral Medicine (Washington, D.C.), 44(3), 219-233. doi:10.1080/08964289.2018.1432554 [doi]
Lederer, L. J., & Wetzel, C. A. (2014). The health consequences of sex trafficking and their implications for identifying victims in healthcare facilities. Annals Health L., 23, 61.
Leslie, J. (2018). Human trafficking: Clinical assessment guideline. Journal of Trauma Nursing : The Official Journal of the Society of Trauma Nurses, 25(5), 282-289. doi:10.1097/JTN.0000000000000389 [doi]
Macias-Konstantopoulos, W. (2016). Human trafficking: The role of medicine in interrupting the cycle of abuse and violence. Annals of Internal Medicine, 165(8), 582-588. doi:10.7326/M16-0094 [doi]
Mapp, S., Hornung, E., D’Almeida, M., & Juhnke, J. (2016). Local law enforcement officers’ knowledge of human trafficking: Ability to define, identify, and assist. Journal of Human Trafficking, 2(4), 329-342.
Mumma, B. E., Scofield, M. E., Mendoza, L. P., Toofan, Y., Youngyunpipatkul, J., & Hernandez, B. (2017). Screening for victims of sex trafficking in the emergency department: A pilot program. The Western Journal of Emergency Medicine, 18(4), 616-620. doi:10.5811/westjem.2017.2.31924 [doi]
National Research Council. (2013). Confronting commercial sexual exploitation and sex trafficking of minors in the United States National Academies Press.
Nichols, A. J., & Heil, E. C. (2015). Challenges to identifying and prosecuting sex trafficking cases in the Midwest United States. Feminist Criminology, 10(1), 7-35.
Oram, S., Stoeckl, H., Busza, J., Howard, L., & Zimmerman, C. (2012). Prevalence and risk of violence and the physical, mental, and sexual health problems associated with human trafficking: Systematic review.9(5) doi:10.1371/journal.pmed.1001224
Ottisova, L., Hemmings, S., Howard, L. M., Zimmerman, C., & Oram, S. (2016). Prevalence and risk of violence and the mental, physical and sexual health problems associated with human trafficking: An updated systematic review. Epidemiology and Psychiatric Sciences, 25(4), 317-341. doi:10.1017/S2045796016000135 [doi]
Ottisova, L., Smith, P., & Oram, S. (2018). Psychological consequences of human trafficking: Complex posttraumatic stress disorder in trafficked children. Behavioral Medicine (Washington, D.C.), 44(3), 234-241. doi:10.1080/08964289.2018.1432555 [doi]
Polaris. (2018). 2018 statistics from the national human trafficking hotline. Retrieved from https://humantraffickinghotline.org/states.
Polaris. (2020). Human trafficking and the health care industry. Retrieved from polarisproject.org/human-trafficking-and-the-health-care-industry.
Powell, C., Dickins, K., & Stoklosa, H. (2017). Training US health care professionals on human trafficking: Where do we go from here? Medical Education Online, 22(1), 1267980. doi:10.1080/10872981.2017.1267980 [doi]
Raj, A., Baird, G. L., Moore, J. L., & Barron, C. E. (2019). Incorporating clinical associations of domestic minor sex trafficking into universal screening of adolescents. Clinical Pediatrics, 58(8), 915-917.
Ravi, A., Pfeiffer, M. R., Rosner, Z., & Shea, J. A. (2017). Trafficking and trauma: Insight and advice for the healthcare system from sex-trafficked women incarcerated on Rikers Island. Medical Care, 55(12), 1017-1022. doi:10.1097/MLR.0000000000000820 [doi]
Strauss, L. (2009). Adult Domestic Trafficking and the William Wilberforce Trafficking Victims Protection Reauthorization Act. Cornell JL & Pub. Pol’y, 19, 495.
Salami, T., Gordon, M., Coverdale, J., & Nguyen, P. T. (2018). What therapies are favored in the treatment of the psychological sequelae of trauma in human trafficking victims? Journal of Psychiatric Practice, 24(2), 87-96. doi:10.1097/PRA.0000000000000288 [doi]
U.S. Department of State. (2016). Trafficking in persons report. 2016. Retrieved from https://www.state.gov/policy-issues/human-trafficking/.
United States, C. (2000). Victims of trafficking and violence protection act of 2000: Conference report (to accompany H.R. 3244) U.S. G.P.O.
United Nations Office on Drugs and Crime. (2003). Human trafficking and migrant smuggling. Retrieved from https://www.unodc.org/unodc/en/human-trafficking/what-is-human-trafficking.html?ref=menuside .
United Nations Office on Drugs and Crime. (2004). United Nations convention against transnational organized crime
and the protocols thereto. New York: Retrieved from https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=2&ved=2ahUKEwju24Ttj_LnAhUBEawKHT8MCOoQFjABegQIBBAB&url=https%3A%2F%2Fwww.unodc.org%2Fdocuments%2Fmiddleeastandnorthafrica%2Forganised-crime%2FUNITED_NATIONS_CONVENTION_AGAINST_TRANSNATIONAL_ORGANIZED_CRIME_AND_THE_PROTOCOLS_THERETO.pdf&usg=AOvVaw1bW9LU4YaGQoTYLgX69HS4
United States Department of Justice (2015). United States Department of Justice Civil Rights Division, trafficking in persons: A guide for non-governmental organizations. Retrieved from https://www.justice.gov/crt/trafficking-persons-guide-non-governmental-organizations
White, J., National Academies of Sciences, Engineering, and Medicine, Division of Behavioral and Social Sciences, and Education, Committee, o. P., & Committee on, N. S. (2019). Estimating the prevalence of human trafficking in the United States: Considerations and complexities: Proceedings of a workshop. National Academies Press. doi:10.17226/25614
World Health Organization. (2012). Understanding and addressing violence against women: Human trafficking. 2012. Retrieved from http://apps.who.int/iris/bitstream/10665/77394/1/WHO_RHR_12.42_eng.pdf.