TJC Quick Safety Issue - Identifying Human Trafficking Victims

PUBLISHED: Jun 22, 2018
Relevant to: Ambulatory Care, Behavioral Health, Community Mental Health Centers, Critical Access Hospitals, Home Health, Hospitals, Long Term Care, Medical Office, Rural Health Clinics

The Joint Commission (TJC) has published Quick Safety Issue 42 addressing the identification of human trafficking victims.

The statistics are jarring:

  • Over a 10-year period (2007-2017), the National Human Trafficking Resource Center (NHTRC) received 40,200 reports of human trafficking cases in the U.S
  • States with the highest number of reported human trafficking cases are California (1,305), Texas (792), Florida (604), Ohio (365) and New York (333)
  • Of the 20.9 million victims of human trafficking globally:
    • 68% are in forced labor
    • 22% are sexually exploited
    • 10% state-imposed forced labor
    • 26% of them are children
    • 55% are women and girls.

Human trafficking is the fastest growing criminal industry in the world and is the second-largest source of income for organized crime. Human trafficking has been reported in every single state in the United States.

The International Labor Organization estimates that forced labor and human trafficking is a $150 billion industry worldwide. The U.S. Department of Labor has identified 139 goods from 75 countries made by forced and child labor. In 2016, an estimated 1 out of 6 endangered runaways reported to the National Center for Missing and Exploited Children were likely child sex trafficking victims.

Even if staff have not yet encountered a human trafficking victim in their organization, it is highly likely that they will – understanding how to identify victims and how to access help and resources is important for all health care professionals.

Human trafficking can be very difficult to recognize. It is important to remember that human trafficking is modern day slavery. The U.S. Victims of Trafficking and Violence Prevention Act of 2000 (TVPA) defines and classifies human trafficking into two categories: sex trafficking and labor trafficking.

Signs of Human Trafficking

Poor mental health or abnormal behavior

  • Appears fearful, anxious, depressed, submissive, tense, nervous or paranoid
  • Avoids eye contact
  • Refuses to change into a gown and/or to cooperate with physical exam
  • Behavior or demeanor does not align with injury or complaint (i.e., acts like it is “no big deal,” even with concerning injuries)
  • Refuses treatment that does not take place during that visit (i.e., refuses to go to specialist)

Poor physical health:

  • Appears malnourished
  • Signs of repeated exposure to harmful chemicals
  • Signs of physical and/or sexual abuse, physical restraint, confinement or torture
  • Patient is not in control of identification (ID or passport)
  • Patient is not allowed or able to speak for themselves (a third party may insist on being present and/or interpreting)
  • Claims of just visiting
  • Unable to clarify address or where he/she is staying
  • Unsure of whereabouts and/or of what city he/she is in
  • Loss of sense of time
  • Inconsistencies in his/her story
  • Tattoo(s), brand(s) or other marking(s)

What to do when human trafficking is suspected:

In their Quick Safety Issue, TJC recommend that when human trafficking is suspected that a “victim-centered response” be implemented. Health care professionals are in a unique position to provide trafficking victims with options, information and connection to resources. TJC recommends that, if human trafficking is suspected providers should:

  • Remain nonjudgmental
  • Observe the body language and communication style of the patient and those who accompany him/her
  • Use plain language; try to use words the patient uses
  • Try to interview and/or examine the patient privately at some point during the visit.
  • Ensure the patient is alone when you discuss sensitive issues.
  • Find an interpreter if necessary
  • Build a trusting rapport with the patient
  • Document concern/suspicions in the medical record to ensure it is not overlooked if the victim returns for care or assistance

If a patient has disclosed that they have been trafficked, providers should do the following:

  • Follow institutional policies for situations that are immediate or life-threatening.
  • Provide the patient with the NHTRC hotline number. If the patient feels it is dangerous to have something with the number on it, have them memorize it.
  • Provide the patient with options for services, reporting and resources. Include safety planning in discharge planning.
  • If the patient is a minor, follow mandatory state reporting laws and institutional policies for child abuse or serving unaccompanied youth.
  • Accurately document the patient’s injuries and treatment in the patient’s records.
  • Gain permission and consent from adult patients who have been trafficked before disclosing any personal information about the patient to others, including service providers.
  • If your institution has a social worker, utilize them. They can be instrumental in getting the support and resources your patient needs.

Health care organizations can also implement safety activities to help staff be prepared to identity and help trafficking victims:

  • Have a comprehensive language translation program to mitigate language barriers
  • Incorporate social, work, home history and domestic violence screening questions into routine intake.
  • Train frontline staff on how to identify, refer and report human trafficking victims, and how to connect victims to services and support systems to meet their immediate and longer-term needs.
  • Ensure staff have the following information available to them:
    • Local resources to help with suspected trafficking cases (many U.S. metropolitan areas have a Human Trafficking Task Force).
    • Local or state requirements regarding mandatory reporting of human trafficking.
    • How HIPAA regulations impact reporting of potential trafficking situations on behalf of a patient.
    • Confidentiality obligations when contacting the NHTRC or local service providers.
    • NHTRC resources and services.

San Francisco-based Dignity Health published information on its Human Trafficking Response Program to help hospitals and health systems implement Human Trafficking Response programs. Dignity Health states that the goal of this program is to ensure trafficked persons are identified in the health care setting and appropriately assisted with victim-centered, trauma-informed care and services. The Response Program contains educational modules and victim response procedures that engage not only hospital staff and physicians, but also first responders and the community to build a strong multi-agency resource network to prevent exploitation, support trafficked persons and empower survivors.

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