Identification and Management of Human Trafficking Victims in the Emergency Department

Health care professionals' self-efficacy in identifying and treating human trafficking victims

BACKGROUND

Human trafficking is characterized as a violation of human rights that exploits males and females of any age for personal or financial gain. Recently, health care professionals have been identified as feasible change agents in this global issue. However, many health care professionals are not trained in identifying and treating human trafficking victims. Through human trafficking education, health care professionals have the potential to be better equipped to recognize and assist trafficking victims and guide them to the specialized care they need.

OBJECTIVE

The purpose of this study was to measure the effect of a trauma-informed human trafficking education intervention and the impact of this training on the self-efficacy of health care professionals in identifying and recognizing human trafficking victims in healthcare settings.

DESIGN

The study was a quasi-experimental research design with snowball and convenience recruitment SETTING: 100 % virtual, online.

PARTICIPANTS

Health care professionals (N = 30) including Nurse Practitioners, Physician Assistants, Registered Nurses, Licensed Practical Nurses, Certified Medical Assistants, Certified Nursing Assistants, Emergency Medical Technicians, and Paramedics from a variety of healthcare settings.

METHODS

30 min total program to include Qualtrics pre-intervention Violence Against Women Health Care Provider survey, 20 min educational intervention on YouTube©, and an identical Qualtrics post-intervention survey.

RESULTS

Total of 30 sets of paired data. The results showed statistically significant improvement in self-efficacy in all survey questions pre- and post-human trafficking educational intervention (p < .001).

CONCLUSIONS

An increase in health care professionals' self-efficacy in identifying and treating human trafficking victims yields better patient and health care system outcomes. Trauma-informed human trafficking education for all health care professionals is recommended.

Human Trafficking Education: An Asynchronous Approach to Improve Nurses' Knowledge and Application

Nurses as healthcare professionals are in key positions to identify trafficked persons. Assessment of nurse knowledge shows the benefit of using asynchronous human trafficking education as a means for learning. Recommendations from this study for professional development educators include garnishing nurse executive support and use of case-study, evidence-based approaches. Support for state-mandated human trafficking education requirements for initial and ongoing licensure of nurses is necessary as human trafficking knowledge may decrease over time.

Slipping through the cracks-detection of sex trafficking in the adult emergency department: An integrative review

INTRODUCTION

Current research estimates that over 24 million individuals experience human trafficking worldwide. There is a growing prevalence of sex trafficking in the United States. An estimated 87% of trafficked persons visit the emergency department during their captivity. Emergency departments across the United States use differing screening methods for sex trafficking. Current screening tools return a high rate of false negatives, and the appropriate use of tools or standardised lists remains unclear.

AIMS

To explore best practices for identifying sex trafficking among adults who visit emergency departments. We sought to answer the practice question: How does the implementation of a multifaceted screening model for sex trafficking, versus the use of a list of standardised screening questions, improve the detection of trafficked persons?

METHODS

We conducted an integrative review of articles published after 2016 in PubMed, CINAHL, Embase, SCOPUS, and Web of Science databases. PRISMA checklist and guidelines were used. Whittemore and Knafl's method was used to review the literature.

RESULTS

A final selection of 11 articles were reviewed and appraised using the Johns Hopkins nursing evidence-based practice model. The synthesis of evidence yielded four themes: (1) Provider and personnel education; (2) Protocol establishment; (3) Legal consultation; and (4) Multidisciplinary teamwork.

CONCLUSION

Through this process, we learned the importance of using multifaceted screening tools for identifying persons who are experiencing sex trafficking. In addition to using multifaceted screening tools, detection is improved when all emergency department personnel receive training on sex trafficking. There is a recognised lack of education on sex trafficking recognition nationwide.

RELEVANCE TO CLINICAL PRACTICE

Notably, emergency department nurses play an essential role in sex trafficking identification due to their maximised interaction with patients and the increased perception of trust that patients have with nurses. Steps include the development of an education program to improve recognition.

NO PATIENT OR PUBLIC CONTRIBUTION

There was no patient or public involvement in the design or drafting of this integrative review.

Human Trafficking and Emergency Medical Services (EMS)

Human trafficking is associated with wide-ranging mental and physical morbidity, as well as mortality, in the United States and globally. Emergency Medical Services (EMS) providers are often first responders to victims of human trafficking. Given their proximity to patients' social and environmental circumstances, these clinicians need to be familiar with the signs and symptoms of human trafficking, as well understand how to best provide care for suspected or confirmed trafficked patients. Evidence from multiple studies indicates that providers who have received formal training may be better able to recognize the signs and symptoms of human trafficking, and thus, can provide better care to potential victims of human trafficking. This review will summarize the relevance of human trafficking to prehospital emergency care, touch on best practices for the care of patients with suspected or confirmed ties to human trafficking, and outline future directions for education and research.

A Scoping Review of Human Trafficking Screening and Response

Service providers are increasingly asked to identify individuals who are experiencing trafficking and to connect them with resources and support. Nonetheless, identification is complicated by the reality that those who are experiencing trafficking may rarely self-identify, and providers may fail to identify individuals who are experiencing trafficking due to lack of guidance on how to screen for trafficking capably and sensitively. With the aim of guiding practice, we undertook a scoping review to search for and synthesize trafficking screening tools and response protocols. Following the PRISMA extension for Scoping Reviews (PRISMA-ScR), we located 22 screening tools contained in 26 sources. We included any documents that described or tested human trafficking screening tools, screening or identification protocols, response protocols, or guidelines that were published in any year. All documents were abstracted using a standardized form. Key findings showed that most tools were developed by practice-based and non-governmental organizations located in the U.S. and were administered in the U.S. Few screening tools have been rigorously evaluated. The common types of screening questions and prompts included (a) work conditions; (b) living conditions; (c) physical health; (d) travel, immigration, and movement; (e) appearance and presentation; (f) mental health, trauma, and substance abuse; (g) associations and possessions; and (h) arrests and prior involvement with law enforcement. We were not able to locate specific response protocols that provided step-by-step guidance. Nonetheless, the review revealed available practice-based and research-based evidence to help inform guidance concerning how screening and identification of human trafficking may be administered.

Implementing a Human Trafficking Educational Module and Protocol in the Emergency Department

INTRODUCTION

The purpose of this quality improvement initiative was to educate emergency nurses and social workers about human trafficking and implement a human trafficking screening, management, and referral protocol adapted from the National Human Trafficking Resource Center.

METHODS

A human trafficking educational module was developed and delivered at a suburban community hospital emergency department to 34 emergency nurses and 3 social workers through the hospital's e-learning platform, with learning outcomes evaluated via a pretest/posttest and program evaluation. The emergency department electronic health record was revised to include a human trafficking protocol. Patient assessment, management, and referral documentation were evaluated for protocol adherence.

RESULTS

With established content validity, 85% of nurses and 100% of social workers completed the human trafficking educational program, with posttest scores being significantly higher than pretest scores (mean difference = 7.34, P ≤ .01) along with high (88%-91%) program evaluation scores. Although no human trafficking victims were identified during the 6-month data collection period, nurses and social workers adhered to the documentation parameters in the protocol 100% of the time.

DISCUSSION

The care of human trafficking victims can be improved when emergency nurses and social workers can recognize red flags using a standard screening tool and protocol, thereby identifying and managing potential victims.

Profile of Reported Trafficking in Persons in Brazil Between 2009 and 2017

The objective of this study was to analyze the temporal evolution of the number of human trafficking cases notified by the health system in Brazil, considering the characteristics of the population. This article carries out a descriptive study on reports of trafficking in persons in consultation with the Department of Informatics of the Unified Health System. This is a profile of reported trafficking in persons in Brazil between 2009 and 2017. Incidence rates were calculated with adjustments to the population record for each year and presented on a scale of 1:1,000,000 inhabitants. We developed a Poisson regression model to evaluate the ratio of the incidence rate. According to available data, there were 1,011 victims reported in the health system during the study period. The predominant profile of the population exposed to such violence is female, aged between 20 and 29 years, with low education and brown skin. There was a trend growth of annual reports about 10 percentage points (p < .0001) and all regions had significantly higher incidence rates than the Southeast (p < .0001), mainly Midwest, North and South. This means that the regions with the highest incidence rates have international land borders. Given the predominance of women in young adulthood, it is inferred that the majority were trafficked for sexual exploitation. This research represents a pioneering approach to the use and modeling of human trafficking data available in the Brazilian public health system. There is a probable underreporting of cases of trafficking in persons who transit health services. As such, identification methods for hard-to-reach populations should be integrated into future research on human trafficking to increase the likelihood of capturing victims.

Sex trafficking screening and intervention in the emergency department: A scoping review

INTRODUCTION

Human sex trafficking is a global public health crisis. Emergency departments (EDs) are important access points for trafficked persons who seek medical care. However, because of victims' hesitancy to disclose their situation and health care practitioners' lack of training and institutional protocols, many trafficked persons go unrecognized.

METHODS

We performed a scoping review of current literature. PubMed, SCOPUS, and reference lists were searched to identify articles for inclusion. We aimed to identify gaps in knowledge and shortcomings to assist this vulnerable population. Two reviewers independently screened literature search results and abstracted data from included studies. Descriptive analysis was conducted.

RESULTS

We selected and analyzed 23 studies that focused on adult human sex trafficking identification, screening, interventions, or education in the ED. Eight (35%) of the publications used a survey model to quantitatively assess outcomes. Many of the other publications were descriptive or qualitative in nature, with some using a structured interview approach. We have observed that no validated or consistent screening tool exists for the identification of possible adult trafficked patients in the ED. However, we found that educational interventions and screening tools can improve health care practitioners' confidence, victim identification, and knowledge of "next steps" for victims.

CONCLUSIONS

We found that most ED clinicians and staff have little or no formal training in sex trafficking victim identification, support, institutional protocols, or available local resources. Our review demonstrates a paucity of formal training programs, validated adult screening tools, and standardized institutional protocols to aid in the care of trafficked patients in the ED.

Primary Care Clinician's Knowledge of Trafficking in Persons: A Systematic Review

INTRODUCTION

Human trafficking is an enormous global threat. Primary care clinicians are part of a safety net of professionals who may be able to identify and assist trafficking in persons (TIPs). The purpose of this systematic review was to explore clinicians' knowledge, attitudes, and behaviors in identifying and assisting TIPS in health care settings.

METHODOLOGY

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guided this review. Searches were conducted using PubMed, Medline Plus, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases that yielded 130 articles, of which 10 quantitative articles met eligibility criteria. Eligibility determination, data extraction, synthesis, and evaluation were independently conducted by the authors.

RESULTS

Findings revealed deficits in clinician's knowledge, attitudes, and behaviors on identifying TIPs in clinical settings. In addition, cultural influences affect TIP's decision-making.

DISCUSSION

To support the wide-ranging needs of TIPs, education programs that include clinician trainings on the skills required to identify and assist TIPs across cultures is warranted.

Recognizing and Breaking the Cycle of Trauma and Violence Among Resettled Refugees

Purpose of Review

The number of refugees across the globe continues to grow, leaving a large proportion of the global population in a vulnerable state of health. However, the number of robust clinical interventions has not kept apace. This paper provides a general review of literature on the trauma and violence that refugees face, the impact on health outcomes, and some of the promising models for clinical intervention.

Recent Findings

Refugees experience a cycle of trauma, violence, and distress that begins before migration and continues during migration and after resettlement. It has been challenging to develop robust clinical interventions due to the cumulative and cyclic effects of trauma, as well as the unique experiences of trauma that each refugee community and each refugee individual faces.

Summary

Trauma-informed care is a critical component of health care. Developing stronger guidelines for trauma-informed care will help clinicians better provide inclusive and equitable care for refugee patients.

Nursing students' perceptions of identifying and managing sex trafficking cases: A focus group study

AIM

To explore nursing students' perceptions of the identification and medical care of sex trafficking victims and how to improve the care provided based on the identified barriers.

BACKGROUND

Despite the fact that more than 87% of sex trafficking victims establish contact with health professionals, their lack of awareness and training hinders their ability to assist victims properly.

METHODS

A descriptive qualitative study was carried out using 11 focus groups of nursing students after a simulated case of sex trafficking victim. The analysis of results was conducted through content analysis.

RESULTS

A total of 110 fourth-year nursing students participated in this study. After performing the data analysis, three main categories emerged: (i) making a health issue visible, (ii) identifying sex trafficking victims: resources based on evidence-based practice, and (iii) educational resources on sex trafficking in nursing degree.

CONCLUSIONS

Our results show that through clinical simulation, integrating content regarding the medical care of vulnerable groups can be useful for developing the skills necessary to provide effective care from a trauma-informed approach.

IMPLICATIONS FOR NURSING MANAGEMENT

Health institutions, senior charge nurses, and other health service managers should be aware of the current need for sex trafficking training, structural-level changes, and updated evidence-based guidelines and protocols with other service providers and law enforcement to provide high-quality care.

Compassionate Care-Going the Extra Mile: Sex Trafficking Survivors' Recommendations for Healthcare Best Practices

Human Trafficking (HT) persists in the US, despite multi-level measures designed to mitigate its societal costs. HT instruction for healthcare providers is growing, but there is a dearth of resources and training presenting obstacles for victims accessing suitable healthcare services. Voices of survivors are also scant in the literature, despite the fact that their recommendations would appear essential when designing best practices. This study aimed to methodically gather recommendations from sex trafficking (ST) survivors who sought medical care during their victimization. An exploratory concurrent mixed-methods design was used, and semi-structured interviews (N = 22) were conducted between March 2016 and March 2017, in San Diego, CA, and Philadelphia, PA. Data were analyzed through a coding system to identify meaningful analytical themes. Study participants were recruited through survivor-centered organizations, and their identification was kept anonymous and confidential. Findings included three main themes: (A) Red Flags; (B) supportive healthcare practices; and (C) resources for ST-patient study participants’ recommendations aimed to improve healthcare practice in response to their medical needs in a compassionate and caring manner, with trust building, rapport, and an opportunity to instill hope among ST-patients. Implementing Compassionate Care approaches when caring for ST-patients could positively impact patient–provider interactions, while creating opportunities for intervention.

The Need for a Mandatory Sex Trafficking Component in Physician Assistant Education

PURPOSE

Examine the possible deficit of education, training, and confidence among physician assistants (PAs) for assisting patients who have been victims of sex trafficking and determine if there is support for a nationwide mandatory sex trafficking component in the PA curriculum.

METHODS

This quantitative study examined 184 United States PAs' predictors of confidence in assisting victims of trafficking using a modified PROTECT survey and used bivariable logistic regression to analyze data.

RESULTS

This study identified a significant association between confidence in assisting in the care of sex trafficking patients and a nationwide curriculum requirement (OR = 5.389, p = .016) and past training (OR = .096, p = .000).

CONCLUSION

Due to the majority of PAs not having the confidence or past training to assist in the care of patients who have been victims of sex trafficking, this study supports the need for a curriculum requirement dedicated to this topic in US PA programs.

Treatment considerations for foreign-born victims of human trafficking: Practical applications of an ecological framework

Foreign-born individuals immigrating to or residing in the United States are especially vulnerable to exploitation by traffickers. Being trafficked elevates the risk for a variety of physical and mental health problems; thus, victims will often come into contact with health professionals. Because there is a dearth of literature concerning the treatment of human trafficking victims, and especially foreign-born victims, we set out to describe the practical applications of a model that we use for the mental health treatment of victimization in this population. As has been suggested by leaders in the anti-human trafficking community, we employed a culturally sensitive version of Bronfrenbrenner's Ecological Systems Model to provide recommendations and educational resources for treatment at the individual, interpersonal, community, and societal levels. Our recommendations should serve to inform and improve the provision of care for foreign-born victims of human trafficking.

Human trafficking education: A guide for nurse educators

Human trafficking is a form of modern day slavery involving exploitation, abuse, and suffering of victims. Survivors of human trafficking often seek medical care for severe health issues resulting from psychological and physical abuse. Nurses play a critical role in identifying, advocating for, and assisting victims of human trafficking to safety. Sadly, trafficked patients often remain unrecognized due to health care providers' lack of awareness and understanding of human trafficking. Undergraduate nursing programs are uniquely positioned to address this problem; educating nursing students about human trafficking should help improve graduates' ability to help rescue victims. A dearth of knowledge exists in the literature regarding the implementation of human trafficking as a content area in undergraduate nursing curricula. This manuscript provides suggestions for how to deliver human trafficking education to undergraduate nursing students including optimal courses and timing in which to integrate the topic, a review of four key content areas of human trafficking, and creative teaching strategies to consider for classroom use.

Knowledge Base of Nurses Before and After a Human Trafficking Continuing Education Course

BACKGROUND

Recent research shows up to 88% of human trafficking victims are seen in a health care setting sometime during their coerced servitude. Nurses are in key positions to identify trafficked victims but often lack sufficient information about how to assess and report trafficked victims.

METHOD

This article includes participant data from one presurvey and two postsurveys from a human trafficking continuing education course.

RESULTS

Data demonstrate a precourse knowledge base deficit about human trafficking. The postcourse surveys indicated that participants had increased knowledge and desire to implement the course information to identify trafficked individuals.

CONCLUSION

Nurses learning about human trafficking through continuing education courses can be invaluable in identifying and helping trafficked victims. [J Contin Educ Nurs. 2020;51(7):316-321.].

Child Labor Trafficking Essentials for Forensic Nurses

Human trafficking is a form of modern-day slavery and is a significant pediatric healthcare problem in the United States. The term "human trafficking" encompasses both sex and labor trafficking. Sex trafficking, especially child sex trafficking, has received significant lay and professional attention. However, few efforts have focused on learning more about youth experiencing labor trafficking in the United States. Pediatric healthcare providers, including forensic nurses, are likely to encounter victims of child labor trafficking in their practice. A basic understanding of child labor trafficking will assist forensic nurses in timely identification of and appropriate intervention for victims. In this article child labor trafficking is discussed in terms of definition, epidemiology, history, risk factors, consequences, identification, and implications for practice.

Implementing Evidence-Based Care for Women Who Have Experienced Human Trafficking

Human trafficking is a significant women's health issue in the United States. Clinicians who provide care to women are often unaware of the signs and symptoms of human trafficking and are unprepared to provide appropriate care. Nurses represent one of the few agents of change who women may encounter while they are in captivity; this places nurses at the forefront of their care. To provide safe and effective care, nurses can use the ABCD treatment model, which stands for assessment, buy-in, case management, and diversion programming. Any gaps between recognition of women's health care needs and the provision of appropriate care must be closed. Integrating evidence-based human trafficking education and skill building into nursing curricula, standard nursing orientation, and continuing education is an essential step to help nurses transform care and advocate on behalf of those who have been trafficked.

Identifying Sexual and Labor Exploitation among Sheltered Youth Experiencing Homelessness: A Comparison of Screening Methods

Human trafficking is a significant and growing public health concern. Subgroups of adolescents and young adults are particularly vulnerable to human trafficking, especially youth who are unstably housed or homeless. While youth experiencing trafficking come into contact with the healthcare system, they are often not identified during routine assessment due to lack of specific inquiry and low disclosure. Therefore, we utilized a mixed-methods study design to assess the differences in the identification of human trafficking among youth experiencing homelessness (n = 129) between a standard psychosocial assessment tool and a human trafficking specific assessment tool. Findings indicate that the tool developed to specifically assess for human trafficking was more likely to identify youth experiencing sexual and labor exploitation, as well as the risk factors for human trafficking. Secondly, youth reported that mistrust of the system, fear of involving the police if reported, not wanting to interact with the mental healthcare system, and stigma are barriers to disclosing human trafficking. In conclusion, healthcare providers caring for youth experiencing homelessness should adopt improved screening tools for human trafficking to reduce the risk of missed opportunities for prevention and treatment among this high-risk population of youth.

Human Trafficking: How Nurses Can Make a Difference

Human trafficking is a human rights violation and a global health problem. Victims of human trafficking have medical and mental health sequelae requiring specific healthcare interventions. Healthcare professionals may be the initial contact that these victims make outside the world of trafficking. Healthcare professionals are key agents in the identification of human trafficking, which is essential in eliminating this public health problem. Unfortunately, healthcare professionals are not always able to detect signs of human trafficking. Failure to detect results in missed opportunities to assist victims. This is a case report of a victim of human trafficking who presented to an emergency department with medical and mental health issues. Despite numerous encounters with different healthcare professionals, signs and symptoms of human trafficking were not identified. Skilled assessment made by a forensic nurse alerted the healthcare team to clear features of human trafficking associated with this person. Through this case report we illustrate the key role the nurse played in identifying signs of human trafficking. Improvement of human trafficking educational programs is highlighted as a key adjunct to improving detection and facilitating the proper treatment of victims.