Today in the chart
Human Trafficking: Are You Identifying Its Victims in Healthcare?
About 90% of victims are seen while trafficked yet go unidentified. Can you recognize these individuals in the clinical setting?
January is National Human Trafficking Prevention Month. It is a month dedicated to raising awareness on human trafficking (HT) with the ultimate goal of prevention. Although discussed on news networks and social media, as well as being portrayed in Hollywood films, HT is very different from how these outlets depict it. It is not white van abductions nor chains and ropes, but rather psychological manipulation and trauma-bonding.Ā
HT is happening in plain sight, as its victims walk amongst us, yet goes grossly undetected due to a lack of understanding of its true nature and how to identify it. It is a global humanitarian crisis which exploits human vulnerabilities, sparing no age, race, gender, socioeconomic status, or geographic location. HT is an evil that infiltrates all nations and generates hundreds of billions of dollars annuallyāestimated to be the approximate revenue of Google, Nike, and Starbucks combined.Ā Ā
Human Trafficking Defined
Also known as modern-day slavery, HT is an exploitation-based crime against a person for labor or services using force, fraud, or coercion. Although sex and labor trafficking are the two most widely recognized forms of trafficking, there are a number of other forms. These include, but are not limited to: domestic servitude, organ trafficking, forced criminality, forced surrogacy, child soldiering, and forced marriages.Ā
Through technology-driven digital communication and connectedness, perpetrators harness these platforms to perpetrate these crimes. With exposure for a countless number of buyers to an unlimited number of victims, labor or sex can be ordered online as easily as a pizza from Dominos.
VulnerabilitiesĀ
Victims of HT have one commonality: a vulnerability which can be exploited. Preying upon these vulnerabilities, traffickers seek out voids or weaknesses and psychologically manipulate their victims into believing they can fill them. Victims are lured by false promises and, in turn, are exploited. Some of those vulnerabilities include:
- Age, including minors and older adults
- Sexual orientation/LGBTQIA+
- Unstable housing, homelessness, ācouch surfingā
- Involvement with the child welfare or juvenile justice systems
- Lack of education
- Socioeconomic challenges
- Substance use/addiction
- Adverse childhood experiences (ACEs)
- Mental or physical disabilities
- Social media use and online gaming (such as Fortnite, Roblox, and Minecraft)
Human Trafficking and Healthcare
Although HT is primarily viewed as a law enforcement or social services issue, victims of HT are accessing healthcare at exponential rates. The literature shows that approximately 90% of survivors reported being seen by a healthcare professional (HCP) during their exploitation, yet most were never identified nor offered services. These individuals are coming in contact with the healthcare sector for diverse emergent needs and mental health concerns but remain completely invisible to us.Ā
Unlike an illicit drug or arms tradeāin that once that product is sold, itās goneāhumans can be sold over and over again, leading to significant physical ailments and complex trauma. That healthcare encounter is an opportunity to disrupt the cycle of victimization by treating and responding to victims, and mandatory reporting in cases involving minors.Ā
Yet, as victims remain grossly unidentified, these healthcare encounters are missed opportunitiesāan opportunity which we may never get again with that client, if we continue to diagnostically overshadow or label them.
Healthcare Professionalsā HT Preparedness
Studies show that licensed HCPs are not educated on HT and anti-trafficking measures with approximately 80% reporting lack of knowledge on identification skills and lack of confidence in response to these victims.Ā
One study highlights the significant education gap that exists in prelicensure RN programs across America with 91.4% of participants reporting minimal to no HT content being taught.
Red-Flag Indicators of HT
Although there are many diverse clinical findings, the following lists some cues that are most commonly associated with trafficked individuals:
- Suicidality
- Substance use/overdose (mechanism of control used by traffickers and/or a coping mechanism for victims)
- STI/STD, UTIs (especially if occurring frequently)
- Ectopic pregnancy, multiple pregnancies/abortions
- Neonatal abstinence syndrome
- Domestic violence/intimate partner violence
- Signs of abuse (multiple bruises in various stages of healing)
- Delay in seeking treatment
- Nonfatal strangulation
- Multiple cell phones/multiple hotel keysĀ
- No ID or not in possession of ID (when developmentally appropriate)
- Tattoos of $ symbol, crowns, profane language (forms of branding)Ā
- Controlling/domineering companion who is unwilling to leave client alone
Nurses Can Make a Difference
Nurses comprise the largest number of constituents of the healthcare professions. We are ideally situated to identify, treat, respond, and act as mandated reporters in cases involving minorsābut only if we are properly educated. Remaining ill-prepared is causing us to fail an entire vulnerable population.Ā
As nurses, we are voted the most trusted healthcare professionals. It is our ethical duty to become properly educated and ensure that our current and future colleagues do the same. By incorporating HT content into prelicensure programs as well as continuous reinforcement through professional development, not only does this break the cycle of further victimization for that individual once identified, but it prevents other victims from falling prey to exploitation.
Call To Action
- Become comprehensively educated on HT and raise awareness on the pervasiveness and magnitude of these crimes.
- Go to the Nurses United Against Human Trafficking website and become educated, equipped, and empowered with its comprehensive anti-trafficking training. Share what you learned with your colleagues and encourage them to do the same.
- If you are a nurse educator, integrate essential content such as how to identify the red flags of HT and how to appropriately respond using a trauma-informed approach.Ā
- Advocate for the integration of HT content into prelicensure nursing curricula to better prepare our future colleagues for practice. Additionally, advocate for mandatory continuing education and professional development on this topic for all licensed HCPs.Ā
Conclusion
Nurses play a critical role in identifying, treating, and advocating for victims of HT. Unfortunately, this population of victims too often remains unrecognized due to the existing gap in education on this topic.Ā
These victims must be promptly identified and appropriately treated with trauma-informed care, but without proper education these victims will continue to go unidentified. Nurses are ideally positioned to intervene and disrupt the cycle of HTās horrific victimization.
Recommended Resources:
- Nurses United Against Human Trafficking
- https//www.nursesunitedagainsthumantrafficking.org
- https://www.dhs.gov/blue-campaign
- https://endsexualexploitation.org/
- https://www.missingkids.org/home
- https://polarisproject.org/
āFrancine Bono-Neri, PhD, RN, APRN, PNP, FAAN, is a proud member of the nursing profession for over 32 years. She is an academic nurse educator, researcher, published author, invited speaker, and is the Co-founder & President of the professional association, Nurses United Against Human Trafficking (NUAHT).