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Human Trafficking Meets Healthcare: An Opportunity For Intervention

Human Trafficking Meets Healthcare: An Opportunity For Intervention. Jordan Greenbaum, MD Stephanie V. Blank Center for Safe and Healthy Children Children’s Healthcare of Atlanta Institute for Healthcare and Human Trafficking. The Institute on Healthcare and Human Trafficking. Funded by:.

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Human Trafficking Meets Healthcare: An Opportunity For Intervention

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  1. Human Trafficking Meets Healthcare:An Opportunity For Intervention Jordan Greenbaum, MD Stephanie V. Blank Center for Safe and Healthy Children Children’s Healthcare of Atlanta Institute for Healthcare and Human Trafficking

  2. The Institute on Healthcare and Human Trafficking Funded by:

  3. Objectives • Recall the definition of human trafficking and describe which populations are at highest risk • Describe possible indicators of trafficking and be familiar with available screening tools • Recall 3 aspects of a trauma-informed approach to patient care.

  4. A word about words….

  5. What is Human Trafficking? Action Recruits Harbors Entices Transports Provides Obtains or maintains a person OR [patronizes /solicits sex] Means Force OR Fraud OR Coercion Purpose Involuntary servitude OR Debt Bondage OR Slavery OR Sexual exploitation TVPA, 2000; Justice for Victims Trafficking Act, 2015

  6. Sex Trafficking of a Minor Action Recruits Harbors Entices Transports Provides Obtains or maintains a person OR [patronizes /solicits sex] Means Force OR Fraud OR Coercion Purpose Involuntary servitude OR Debt Bondage OR Slavery OR Sexual exploitation TVPA, 2000; Justice for Victims Trafficking Act, 2015

  7. Human Trafficking Is NOT Smuggling Trafficking Smuggling Crime against a country Involves transportation Person voluntarily enters into agreement with smuggler Transaction with smuggler is over after cross border and pay fee • Crime against a person • Transportation is NOT required • Involves exploitation of person for compelled labor or commercial sex • Involves F/F/C (adults) or minor status • Exploitation continues for indefinite time period

  8. Trafficking in the U.S. No reliable estimates of prevalence/incidence 3,000,000? 30? 30,000? 300?

  9. Sex Trafficking • Foreign victims • Girls/Women • Paid sex (‘prostitution’) • Men as traffickers When we think of human trafficking, we think of….. Labor Trafficking • Foreign victims • Boys/Men • Farm work

  10. But What About…..

  11. Trafficking Examples • Hector is a 16 yo male from a small village near Villa Nueva. He decides to come to the U.S. to build a better life for himself and his family, and to escape community violence. He answers an ad for construction workers in Atlanta… • Pat is a 20 yo transgender youth who ran away from home at age 17 to escape mother’s drug addiction and violent BF. She lives on the streets and exchanges sex to pay for food, hormones, and clothing… • Keisha is a 13 yo female who argues with her mother and leaves home. She meets 2 men who offer her a ride and take her to an abandoned house where they have sex…

  12. Who’s at Risk for Human Trafficking?

  13. Individual Societal Community Relationship CDC Individual Hx maltreatment Homeless/runawayLGBTQ+status Substance misuse Hx with JJ, CPS Unaccompanied minor Relationship Family violence Familial poverty Family dysfunction Forced migration Community Tolerance of sexual exploitation High crime rate Lack of community resources/support Transient male populations Societal Gender-based violence & discrimination Cultural attitudes/beliefs Natural disasters Political/social upheaval

  14. Do Trafficked Persons Seek Medical Care? • 82.5% seen at the local children’s hospital within past year 1 • 42.9% had received health care within the 2 months prior to identification2 • Persons seek care in variety of settings3 • 63% Hospital/ED • 57% any type of clinic • 30% Planned Parenthood • 23% Regular doctor 1 Horner 2017; 2 Varma 2015; 3 Lederer & Wetzel, 2014

  15. How might Hector, Pat and Keisha present for care? Hector recruited into construction Pat involved in survival sex Keisha trafficked by strangers she met.

  16. Health Consequences of Labor Trafficking Turner-Moss, 2014; Buller, 2015; Oram 2016 • Untreated chronic medical conditions • Work-related injuries • Acute trauma • Chronic pain, strain • Exposure to chemicals, dust, toxins • Significant weight loss • Infection

  17. Sex and Labor Trafficking Greenbaum, 2015; Lederer, 2014; Turner-Moss, 2014 Dank 2016,

  18. So, how can I recognize a trafficked person?

  19. Challenges to Identification • Trafficked persons don’t self-identify • Do you think Hector, Pat or Keisha will disclose?

  20. Possible Indicators of Trafficking: First Impressions Unfamiliar with city or where staying False Information

  21. Possible Indicators of Trafficking • Consider adverse health effects of trafficking…. • Work-related injuries • Malnutrition • Multiple STI’s • Pregnancies, abortions, or miscarriages • Illicit drug use • Current or past history of: • Sexual assault • Inflicted Injury • Visible signs of physical abuse

  22. How Do I Interact With a Potentially Trafficked Person?

  23. A Trauma-Informed Approach Victim-centered SAMHSA, 2014; Zimmerman, 2003; IOM, 2009, UNHR, 1990

  24. Rights-Based Care UNHR, 1990

  25. Trauma-Informed Approach Understands the impact of trauma on behavior Views of the world and other people Pat Hector What person expects of you Views of self Keisha Way person interprets your words/actions Behaviors Attitudes toward you Things person says SAMHSA, 2014

  26. Trauma-Informed Approach SAMHSA, 2014; Zimmerman, 2003; IOM, 2009

  27. Keep Your Goal in Mind…. Disclosure of trafficking Assessment of risk GOAL?

  28. When Talking About Trauma Experience…

  29. Adolescents: 6-Item Screen • Drug/alcohol use in past 12 months • History running away • History with police • History broken bones, knocked unconscious, cuts needing stitches • History STI • Number of sex partners (>5 is ‘Yes’) > 2 Yes answers = positive screen Greenbaum, 2015; Greenbaum, 2018; Kaltiso, 2018

  30. Questions For Youth About Possible Sex Trafficking 1) Have you ever been in a position where you’ve had to consider exchanging sex for something you wanted or needed (money, food, shelter or other items)? 2) Has anyone ever asked you to have sex with another person? 3) Has anyone ever wanted to take sexual pictures of you or post such pictures on the internet? Think about Keisha….

  31. Universal Education and Resources • Talk about • Healthy relationships • Impact of violence on health • Harm reduction techniques • Human trafficking • Community resources, national resources Futures Without Violence, 2017

  32. What About Tools for Adults? NHTTTAC

  33. Questions About Possible Labor Trafficking • Tell me about your work day • Are you doing the work you expected? • Do you get paid what you expected? • Do you have control over your money? • Can you come and go at will? • Tell me about your living quarters Think about Hector….

  34. Longer Tools….

  35. CSEC-IT

  36. If you are a healthcare provider….

  37. Exam and Diagnostic Evaluation • Assess overall health, nutrition Patient permission is critical!! • Assess and treat acute/chronic conditions • Assess development (+/-) • Obtain sexual assault evidence kit (+/-) • Document injuries, genital/extra-genital • Offer STI and pregnancy testing/prophylaxis • Consider testing for endemic diseases • of home country • Offer drug testing Greenbaum, 2015; IOM, 2009

  38. Tips for the Exam Monitor for Signs of Distress

  39. Reporting and Referrals • Be transparent with person, engage them in the treatment plan • Use information you gathered to identify possible resources/referrals • Typically patient has Many needs! • Know your community resources • Respect right to confidentiality; obtain consent as necessary IOM, 2009; Greenbaum, 2015

  40. Reporting for Adults: Mandatory?? • Know your state laws • May have mandated reporting for… • suspected exploitation of elder or disabled persons • suspected inflicted physical injury • Patient may decline to speak with police • Need permission to make nonmandated referrals

  41. Reports and Referrals: Children Mandated Reporting in Illinois (sex trafficking of children)

  42. A Critical Resource… • National Human Trafficking Resource Center: • Hotline (24/7) • Interpreters for >100 languages • All types of trafficking, all ages Text Hotline: 233733 (BE FREE) Chat hotline: www.humantraffickinghotliine.org/chat Submit a tip online: https://humantraffickinghotline.org/report-trafficking

  43. https://humantraffickinghotline.org/training-resources/referral-directoryhttps://humantraffickinghotline.org/training-resources/referral-directory

  44. Reports/Referrals: Foreign Nationals • Unaccompanied minors • Office of Refugee Resettlement (ORR; https://www.acf.hhs.gov/orr/programs/ucs/about)

  45. Get Legal Assistance for Foreign Nationals

  46. Make Health-Related Referrals For Ongoing Care

  47. What next?

  48. www.vIHHT.org

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