Human Trafficking is defined by three things; “a person must be recruited, transported, transferred, harbored, or received. Second, human trafficking influenced use of means such as a threat, force, coercion, abduction, fraud, or deception. Third, human trafficking has a purpose of exploitation (Dols, Beckmann-Mendez, Mcdow, Walker, & Moon, 2019)
In South Texas, an area close to the Mexico boarder, the opportunities for an emergency room nurse to encounter a patient that could be classified as a Human Trafficking Victims (HTV) are relatively high. When those who are trafficked obtain medical care many times it is at an emergency department over other types of medical care. Dols, et al wanted to know what emergency departments in 5 trauma service areas in South Texas were doing to attempt to screen and identify patients in their emergency departments as HTV. They sent out surveys to 99 ED’s and received information back from 27. The surveys asked about the use of a screening tool for both adults and children as well as information on who and when the screening were completed. With a response rate of 27.3% it was found that 40.7% of the ED’s completed a human trafficking screening aimed at adults and 37% use a screening to identify human trafficking victims that are less than 18 years old. Most screenings are completed in the triage area for both adult and child screenings and the greatest percentage is completed by an RN. There were multiple different types of screenings used by each individual department, some adult screenings were modified to be used on children. There are numerous screenings out there for use, however, none of them have been verified with data to show which or even if they are useful for identifying those who could be a HTV.
Those departments who are using the screenings had no identified persons in the year 2017 but had identified HTV in the past. Victims are not known to self-identify so it is up to the nursing staff to identify them so that a chance of providing resources can be completed. However, key changes in education of nursing staff as well as a verified screening tools need to be in place to better equip nursing staff to asses and identify those who could be a victim of human trafficking.
Dols, J. D., Beckmann-Mendez, D., Mcdow, J., Walker, K., & Moon, M. D. (2019). Human Trafficking Victim Identification, Assessment, and Intervention Strategies in South Texas Emergency Departments. Journal of Emergency Nursing, 45(6), 622–633. doi: 10.1016/j.jen.2019.07.002
Cassie, this is a subject that I do not have any official training on or experience with in healthcare. The first place I could imagine that would be a hot spot for human trafficking would be the border between the United States and Mexico, relatively close enough to us even in Kansas for there to be human trafficking victims in our society and healthcare system without even knowing it. Another region or geographical location that I have lived in as a child from my parents careers in the military is South East Asia.The Global Report on Trafficking in Persons 2016, published by the United Nations Office on Drugs and Crimes (UNODC), said China, Japan, Malaysia and Thailand were human traffickers’
destinations from neighboring countries. According to an article in Strait Times from November of 2019 most of the human trafficking victims from Cambodia, Laos, and Myanmar end up in Thailand. Victims from Vietnam, Philippines, and Indonesia end up in Malaysia(New Straits Times 2019). My time spent in the Philippines was the years from 1985 to 1989, ages 8-12 yrs old. Although that was 35 yrs ago and I was just a child, the human trafficking and sex occupation was noticeable, or at least I was aware of the differences around me without being told the harsh truths. To get back to the study you researched from the ENA, I found it quite astonishing that only 27 surveys came back out of the 99. Meaning the percentages provided in the study only came from 27.3% of the overall ED’s. This tells me that there is a need for education on human trafficking and how to detect it in patients presenting in the ER. It’s not just that the only ED’s who responded are the only one’s who are seeing theses type of patients but they may be the only one’s who have any training or education to be able to do so in those areas. If human trafficking is one of the largest criminal organizations in the world according to the U.S. Department of Justice, then we must be missing identifying them in our healthcare system. Candi Bolden of the Wichita Eagle wrote and article and presented a video on human trafficking that identifies Kansas as an originating state in the U.S. of human trafficking(U.S. Department of Justice 2018) Children in vulnerable situations are especially at risk, with 1 in 7 runways victims of human trafficking. 88% of those children victims were in care of social services when they developed as missing. 60% that were recovered were found in foster homes or care homes during FBI raids. DCF has only done 285 assessments on possible human trafficking victims since 2014, and the Kansas Attorney General’s Office reports in 2017 helping 475 trafficking victims of sex and labor. I feel like we may be lagging behind on this fight by more than a little bit. It is time to educate our healthcare system to identify possible victims of human trafficking through out our nation, just as we would and do for chest pain, OB emergencies, stroke, and abuse.
References
Bolden, C. (2018, March 1). Here’s how human trafficking affects Kansas. Retrieved from https://www.kansas.com/news/local/crime/article197925949.html
New Straits Times. (2019, November 30). Human trafficking issue plagues Southeast Asia: New Straits Times. Retrieved from https://www.nst.com.my/world/region/2019/11/543407/human-trafficking-issue-plagues-southeast-asia
Josh, I actually got a little bit of training doing my CE for my NREMT this year. It was interesting to look at how to ID both human and work trafficking individuals on a prehospital basis. I think that a hug baracade in the ED is that there are so many screening tools and so little time. Along with the fact that there is no one screening tool that is the best of the best to help pick out. We know what the initial indicators are for sepsis due to screening tools we use, we do not have a good tool for HTV.
Cassie, I was looking up a study that had a screening survey and I posted it to the other student who is doing human trafficking as well. The study was interesting to say the least. Even though the title says “Sex Trafficking” it dives into work and labor as well. The table referenced Table 2 in the article found @https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5468066/ is a list of survey questions to help identify human trafficking. Here is a copy of the table.
Table 2
Questions and participant responses in a study to determine feasibility of using a brief screening survey to identify sex trafficking victims.
Screening tool items “Yes” answers among true positive screens (n=10) “Yes” answers among false positive screens (n=29)
Do you have to ask permission to eat, sleep, use the bathroom, or go to the doctor? 4 (40%) 2 (7%)
Were you (or anyone you work with) ever beaten, hit, yelled at, raped, threatened or made to feel physical pain for working slowly or for trying to leave? 10 (100%) 18 (62%)
Has anyone threatened your family? 6 (60%) 13 (45%)
Is anyone forcing you to do anything that you do not want to do? 5 (50%) 1 (3%)
Do you owe your employer money? 2 (20%) 1 (3%)
Does anyone force you to have sexual intercourse for your work? 5 (50%) 1 (3%)
Is someone else in control of your money? 4 (40%) 3 (10%)
Are you forced to work in your current job? 1 (10%) 0 (0%)
Does someone else control whether you can leave your house or not? 6 (60%) 1 (3%)
Are you kept from contacting your friends and/or family whenever you would like? 7 (70%) 6 (21%)
Is someone else in control of your identification documents, passports, birth certificate, and other personal papers? 4 (40%) 3 (10%)
Was someone else in control of arrangements for your travel to this country and your identification documents? 1 (10%) 0 (0%)
Do you owe money to someone for travel to this country? 0 (0%) 1 (3%)
Has anyone threatened you with deportation? 0 (0%) 1 (3%)
(Mumma et al., 2017)
This survey of questions was found to help identify victims of human trafficking 60% more than physician concern and one question was answered “Yes” to by all participants in the study by the 10 confirmed victims of human trafficking out of 143, and that was “Were you (or anyone you work with) ever beaten, hit, yelled at, raped, threatened or made to feel physical pain for working slowly or for trying to leave?”(West J Emerg Med., 2017). Physician concern did not positively identify any of the confirmed 10 victims of human trafficking alone.
Reference
Mumma, B., Scofield, M., Mendoza, L., Toofan, Y., Youngyunpipatkul, J., & Hernandez, B. (2017). Screening for Victims of Sex Trafficking in the Emergency Department: A Pilot Program. Western Journal of Emergency Medicine, 18(4), 616–620. https://doi.org/10.5811/westjem.2017.2.31924
Sex trafficking is a growing issue in the United States. In 2017, there were 9,000 cases in the U.S. which were reported to the National Human Trafficking Hotline and BeFree Textline. This was an increase of 13% from the previous year, according to the Polaris Project (Gallucci, 2020).
I do not know very much about sex trafficking as it pertains to screening in emergency departments. Working on a medical surgical unit, I have become aware of some cases in which social workers and case managers must get involved due to concerns of sex trafficking. I do know that our inpatient admission only asks a question related to feeling safe at home or if the patient has ever experienced abuse (sexual, verbal, physical) in the last year or so. I have not had anyone give a response that required following up though. I will be starting my new job in a level one trauma emergency department this upcoming week, so it will be interesting to see what screening tools, if any, they use there to identify and assist victims of sex trafficking.
As for your study, I believe that given that only 27/99 emergency departments that were approached participated, the data could be considered misleading or inconclusive. Given that this study depicts less than 1/3 of the EDs in South Texas, that can really sway the stats. I’d also say that if screening tools are just being modified from adult to child instead of child specific, then that leaves room for error as well. Implementing a nationwide standard screening tool could prove beneficial in identifying victims of sex trafficking more efficiently rather than each facility picking and choosing which, if any, to use.
Gallucci, J. (2020, January 14). Human Trafficking Is an Epidemic in the U.S. It’s Also Big Business. Retrieved from https://fortune.com/2019/04/14/human-sex-trafficking-us-slavery/
I find it interesting that I work both ED and Med/Surg and now that I think about it in my inital interview for patients on the floor that is not in our information collection. I don’t know if its due to an older system being used or not.
It is also scary how far we have come as a county in child protection from early years when children were worked in factories, only to now have this kind of situation.
That is interesting! I know that all we ask are safety questions that do not directly ask about sex trafficking.
It is scary to think that this is happening right under our noses. One other website I looked into discussed how every single state in the United States had reported cases for that particular year-2017, if I remember correctly.
That is a very interesting article. Sex trafficking is not an area I have given much thought about in nursing. I did find an article that found, “Approximately 18,000 people are brought to the United States each year and are forced or coerced into labor or sex work. Raising awareness and providing information to all healthcare workers may be the first steps needed to end sex trafficking.” (Bauer, 2019) That number alone is startling. The article went on to describe giving education to not only to Emergency room nurses but school nurses as well. Are the screening techniques used in the article you found adaptable to be used by school nurses as well?
Bauer, R. (2019). What Health Providers Should Know About Human Sex Trafficking. MEDSURG Nursing, 28(6), 347–351.
In an article with Fox 2 News Detroit, Bastein explained that a large majority of trafficked individuals come into contact with health care workers at some point during their trafficking, but shockingly, very few of them are actually identified by healthcare staff (Brusie, 2019.) This subject is such a scary situation. I myself have not been in contact with a situation like this but this article goes on to give nurses a few pointers on how to help identify a sex trafficking situation.
Brusie, C. (2019, January 31). Nurse Practitioner Student Creates Screening To Identify Human Trafficking Victims. Retrieved from https://nurse.org/articles/nurse-creates-human-trafficking-screening/
This is a topic that I didn’t think a lot about as it’s something that you know is very real but don’t want to think about it going on. I looked into what signs you should look for if you come across a possible sex trafficking victim. It is important to be aware of different signs that you may see. A couple signs that I wasn’t aware of include:Owe money to an employer or another person whom they feel bound to repay,
Describe moving or changing jobs suddenly and often,
Are unfamiliar with the neighborhood where they live or work. These particular ones I didnt think about. This article has a list of signs we should watch out for
Know the Signs. (2020, March 25). Retrieved from https://humantraffickingsearch.org/know-the-signs/