I decided to review a study regarding human trafficking due to this being a global problem. There is an estimated 40.3 million victims with 25% being children. California, Texas, and Florida are some of the areas with the highest trafficking. Unfortunately, most of the trafficking in the US is sex trafficking (71%), and 65% of victims being women. Medical personnel in the ER are key in identifying victims due to victims rarely receiving medical treatment. This provides a rare opportunity to provide resources to the victim. The ER can be a potential safe haven for victims of human trafficking. Lack of education can contribute to failing to identify human-trafficking victims.
The purpose of this study was to identify the actions currently taken by ED clinicians and providers to identify, assess, and intervene for victims of trafficking. In this study, a survey of 23 questions was provided to 99 emergency department in South Texas and only 27 responded. Survey consisted of the type of emergency department, providers, and clinical staff; methods used to screen adult and child human-trafficking victims; and results, including number of positive screens, characteristics of individuals with positive screens, strategies helpful to identify human trafficking victims, and the actions taken following identification. Unfortunately there was not a high response to the questions but some insightful information was gathered. Results showed:
-Eleven (40.7%) of the responding 27 emergency departments screened adults to identify human-trafficking victims.
-Sixteen (59.3%) of the 27 emergency departments did not screen adults to identify human-trafficking victims.
-Ten (37.0%) of the 27 emergency departments screened children to identify human-trafficking victims.
-Seventeen (63.0%) of the 27 emergency departments did not screen children to identify human-trafficking victims.
There could have easily been missed opportunities in identifying human trafficking victims. That’s why it is imperative that health personnel is able to properly identify a potential human trafficking victim.
Reference:
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.2019.07.00
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I used this exact same article and I found it interesting how many different screening tools their are. We talk really big in the nursing world about using evidence based practice but in this area there is not much evidence on which screening tool is the best, when the screening should be completed, and by whom it is best the screening is completed by. I really think that if we are going to use a screening tool we need to have some markers that make it efficient as we well as backed that it is going to work. We have a sepsis screening we use and markers to help identify and while each location might have a slightly different version its all the same information. Why with something is important as identifying trafficking victims do we not have a better “score card” so to speak to help.
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
I totally agree that we need a better screening tool that can be used throughout the U.S. and can even be customized if needed with still being able to gather the best information. It’s unfortunate to know that there are many missed opportunities for possibly being able to save victims simply because we are not screening.
It is heartbreaking that human trafficking is such a common occurrence in the world. “According to the FBI, human trafficking is the third largest criminal enterprise worldwide (Sutherland, 2019).” We had a detective from the local police department talk to us when I was in nursing school. I was completely unaware until that moment how much of a problem it is in the USA and right here in Kansas. As a mother, I was completely disgusted and horrified. It is amazing that there are screening tools to help medical personnel decide who is at risk or could be in harm. Understanding which populations are at greatest risk is immensely helpful in identifying potential victims.
Sutherland M. E. (2019). Breaking the Chains: Human Trafficking and Health Care Providers. Missouri medicine, 116(6), 454–456.
Yes Kristen, it is sickening to know that this is going around even in our own neighborhood. As health professionals, it is our duty to be vigilant and to express any suspicion and trust our instincts.
Many people like to believe human trafficking is not an issue in there communities but I live in northwest Kansas and we’re not that far from I-80. It was disappointing seeing only 27 out of 99 hospitals replied especially for southern Texas. What I found more alarming is that the emergency rooms screened more adults than children 40.7% compared to 37.0%.
Yes, unfortunately human trafficking is everywhere and that is why it is so important to have a screening tool. Some hospitals simply would ask the patient if they felt “safe” and used that as a screening tool. This is not enough. As health care professionals we have to do better!
jbonilla, I believe you and Cassie Stein in our class our both doing human trafficking which is awesome because the need for education and bringing the problem to the surface is imperative. I can’t say that I have ever been trained on how to identify in a hospital setting a victim of human trafficking, nor have I ran across the opportunity for training on human trafficking like we do ACLS, child abuse, spousal abuse, etc. According to the U.S. Department of Justice, Human Trafficking is one of the world’s largest criminal organizations. We must be missing the identification of these patients in our system. Shockingly enough I found a video from the Wichita Eagle on line that claims that Kansas is an originating state in the United States of Human Trafficking according to the FBI and U.S. Department of Justice. 1 in 7 runaways, meaning children, are in fact victims of human trafficking. When these children go missing 80% of them were already in the care of social services. 60% were recovered during FBI raids and found in foster homes and care homes. I will try to add this short video, but for now here is the link https://www.kansas.com/news/local/crime/article197925949.html
I guess what I am interested now is how to actually identify a victim of human trafficking. Here is a screening survey list of questions used in emergency room setting from a study on human trafficking found @ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5468066/
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%)
(West J Emerg Med., 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.
References
Bolden, C. (2018, March 1). Here’s how human trafficking affects Kansas. Retrieved from https://www.kansas.com/news/local/crime/article197925949.html
West J Emerg Med. 2017 Jun; 18(4): 616–620.
Published online 2017 Apr 17. doi: 10.5811/westjem.2017.2.31924
Thank you for sharing this information. I feel like this is a very tough topic to discuss because it is heart wrenching to know that this is around us and happening to our youth and adults as well. As a parent you hate to think about this ever happening to your children but unfortunately anyone can become a victim of human trafficking. It is easy for traffickers to get in contact with anyone due to social media. They can hide behind a screen and can easily coerce the potential victim.
Its definitely shocking to find out the Kansas is considered the originating state of human trafficking. How scary!
I feel like any type of screening tool is better than no screening tool but there needs to be more studies done on this topic to provide better resources.
I have been fortunate enough to attend two separate trainings at my organization. I work for a Magnet organization and they tend to be on the forefront of all aspects of healthcare. My previous knowledge of human trafficking was the thought of prostitution. Through these education opportunities I learned there is much more to human trafficking than sex trafficking. Profits from human trafficking are estimated globally at $150 billion a year and are flowing through the U.S. financial system (Luttrell, 2020).
Labor trafficking is something I had never really given thought to. We were told in training that run-away children will be approached by a trafficker with 24 hours of running away. They gave some examples of panhandlers, people doing door to door sells, migrant workers, workers in massage parlors and nail salons as be labor trafficked. Sadly, the next time I had a pedicure I realized the men and women working so hard in that salon are probably being trafficked. Through their limited English they will tell you that their family lives in a different state including their young children who they rarely get to see. They work long hours with no breaks and live in the house of their employer. This makes you think twice about returning to that salon. When traveling to a larger city I also noticed some of the people panhandling will have brand new clothes on or name brand clothes. This is something I did not really pay attention to. Much luck a prostitute, trafficked panhandlers have a quota of money to make and give to their traffickers.
The organization that I work for see health care providers as an integral part of identifying victims of trafficking. Health care workers then have a unique opportunity to offer help. Nursing staff in the ED, technicians in x-ray department, lab workers, and floor staff have all been trained in identifying a victim of trafficking. We have the ability to be alone with the victim and possibly see the visual signs such as branding tattoos, bruising, or injuries that they did not want to disclose. I have included a link to a list of signs to help identify a victim of human trafficking. Unfortunately, after becoming educated and how to spot trafficking I am sure you will notice things you never noticed before.
https://humantraffickinghotline.org/sites/default/files/What%20to%20Look%20for%20during%20a%20Medical%20Exam%20-%20FINAL%20-%202-16-16_0.pdf
Reference:
Luttrell, T. (2020). Human Trafficking: Closer to Home Than You Think. Aba Risk and Compliance. Retrieved from https://bankingjournal.aba.com/2020/01/human-trafficking-closer-to-home-than-you-think/
National Human Trafficking Resource Center, (2016). Identifying Victims of Human Trafficking: What to Look for in a Healthcare Setting. Retrieved from https://humantraffickinghotline.org/sites/default/files/What%20to%20Look%20for%20during%20a%20Medical%20Exam%20-%20FINAL%20-%202-16-16_0.pdf
That’s great to hear that you have been able to attend trainings on this difficult topic. I think a lot of us think about sex trafficking and don’t realize there is a lot of labor trafficking as well or a mixture of them.
I was able to attend one training this past year and I remember the speaker had mentioned that Kansas doesn’t have specific regulations when it comes to massage parlors and they are trying to change this quickly. “Kansas is only one of four states to not require statewide licenses for massage operators. All of that is left to the city ordinances, which is one of the reasons it’s so hard to shut down illegal massage.” (Hammill, 2019)
I also remember someone there had shared that she had been approached by a young lady at a truck stop and that she asked for the human trafficking hotline number. She said till this day she regrets not being able to provide that number for the young lady due to not having access to internet on her phone. I think it would be a good idea for everyone to have this number saved on their phone because you never know if one day someone will need your help. I have listed the National Human Trafficking Hotline information:
National Human Trafficking Hotline
1 (888) 373-7888
SMS: 233733 (Text “HELP” or “INFO”)
Hours: 24 hours, 7 days a week
Languages: English, Spanish and 200 more languages
Website: humantraffickinghotline.org
References:
Hammill, R. (2020, February 6). Johnson County activists target illicit massage parlors in efforts to curb sex trafficking. Retrieved from https://shawneemissionpost.com/2019/08/19/johnson-county-activists-target-illicit-massage-parlors-in-efforts-to-curb-sex-trafficking-81896/
National Human Trafficking Hotline. (n.d.). Retrieved from https://humantraffickinghotline.org/
Yes, the last training I attended mention that the labor traffickers were actually now moving the sex trafficked victims.
My father is a truck driver and he has to do annual training on his to spot sex trafficking in truck stops. He also keeps the sex trafficking hotline in his truck to utilize at any time or to give to someone if he was approached.
That’s great that truck drivers are doing training regarding human trafficking and that your dad has that number available. They have a higher chance of running into a possible human trafficking victim since they are on the road so much.
This is such a sad but great topic that you are covering! The statistics of sex trafficking is terrifying! I was able to find some information that may be useful for you. A nurse was able to help create a protocol that is helping other nurses identify sex trafficking early. With these three things they feel as if it helps a nurse identify sex trafficking early. These include: taking credit classes (which is awesome that you’ve been able to do this!), know the statistics in your area many people think human trafficking isn’t a problem in their area—until they actually look at the statistics, and memorize and display the information for the National Human Trafficking Hotline for potential victims: (888) 373-7888 or text “help” to 233733. (Brusie, 2019.) It seems as if you have been able to do a few of these things which should really be able to benefit and help those in need!
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/