Each situation of human trafficking is unique and requires a victim-centered response (NHTH, 2016). First, the victim must be medically stabilized.Priority is given to any signs of trauma, neglect, dehydration, injuries, and unmanaged medical conditions(Gordon et al., 2018). A comprehensive physical work-up is needed including diagnostics (blood work or imaging studies) that correlate with history and physical assessment (Gordon et al., 2018). After the patient is medically stabilized, the psychiatry team needs to evaluate the patient for any possible presence of potentially dangerous thoughts or behaviors directed to oneself or others (Gordon et al., 2018). Additional concerns include signs of intoxication, signs that could indicate potential withdrawal from substances, and the need for admission to an inpatient psychiatric unit for more acute psychiatric assessment and stabilization (Gordon et al., 2018).
After the patients' initial needs are met, additional referrals need to be initiated. A procedure or protocol specific to the needs and safety of human trafficking victims should be in place at each facility. It should include a multidisciplinary approach employing law enforcement, social work, nursing, and hospital administration (NHTH, 2016; Tracy & Macias-Konstantopoulos, 2021; Raker, 2020). The plan should identify potential sources of legal assistance, transportation, vocational training, employment, childcare, and housing and should focus on the importance of being a trusted local network of survivor resources (NHTH, 2016; Tracy & Macias-Konstantopoulos, 2021; Raker, 2020).
Social work can connect victims to community resources for food and housing, mental health specialists can facilitate any required behavioral therapy, and law enforcement can be contacted for safety concerns and to complete a further investigation (Tracy & Macias-Konstantopoulos, 2021; Raker, 2020).
It is important, too, to remind victims that they are not criminals. These victims are protected under the Trafficking Victims Protection Act (TVPA) (U.S. Congress, 2000). Victims can apply for special visas or receive other forms of immigration relief (Raker, 2020). If the victim is under 18, it is mandatory to report sexual exploitation under both state and federal law (U.S. Department of Homeland Security, 2021).
Traffickers can be involved in organized crime, local gangs, or other crime networks; therefore, staff and patient safety are top priorities. Safety measures include(Tracy & Macias-Konstantopoulos, 2021):
- Establish a relationship with the local police force
- Obtain a security audit
- Develop an emergency notification system
- Periodically have emergency drills or review plans
- Restrict after-hours access
- Install lighting
- Security cameras
- Panic buzzers
- Deadbolts or electronic locks
- Preprogram emergency access phone numbers
Confidentiality is critical.Trafficked individuals and their families can be at risk for trying to report or escape the situation(Tracy & Macias-Konstantopoulos, 2021).
If a patient discloses that they have been trafficked (NHTH, 2016):
- Provide the patient with the National Human Trafficking Hotline (NHTH) number and encourage them to call the NHTH hotline (1-888-373-7888) or the text number, BeFree (233733). The NHTH has a tele-interpreting service with at least 200 languages available.
- Do not provide written information if there is a chance that the trafficker will see the documents.
- If there is an immediate, life-threatening danger, follow your institutional policies for reporting to law enforcement.
- Provide the patient with options for services, reporting, and resources. Ensure that safety planning is included in the discharge planning process.
- Accurately document information regarding the patient's injuries or treatment. Written documentation of abuse presented in an unbiased manner may help prove a case against a trafficker; however, information about the victim can also be used against them in court (Tracy & Macias-Konstantopoulos, 2021).
If the patient does not want to leave the trafficking situation, patients should be educated about available resources. Do not give out physical materials unless the patient agrees that the information will not place the patient at risk for retaliation from the trafficker (Tracy & Macias-Konstantopoulos, 2021; NHTH, 2016). Healthcare providers can discuss specific safety plans, including the development of a safe contact system.
Recovery for trafficked persons is long and complex. Victims being repatriated and returned to live with their families is inappropriate and results in returning to a situation where they suffer further harm (Tracy & Macias-Konstantopoulos, 2021; NHTH, 2016).
Every situation of human trafficking is unique; it is important to use a victim-centered response. Not all victims of trafficking will be comfortable disclosing their situation, nor will all victims be ready to seek assistance from service providers, law enforcement, or even medical providers (NHTH, 2016).
Healthcare providers may or may not be required to report human trafficking. Legal requirements differ from state to state. Refer to your local or state requirements regarding mandatory reporting(NHTH, 2016).
For example, Michigan has specific reporting requirements for human trafficking (Michigan Department of Health & Human Services ([MDHHS], 2017; MDHHS, 2021):
- Healthcare professionals are required to report if you suspect that any child or adult is a victim or is at risk of becoming a victim by calling 855-444-3911 at any time.
- If the individual is in imminent danger, immediately call 9-1-1.
- Law enforcement must be contacted immediately through the state's centralized intake system, Children's Protective Services (CPS) MDHHS, if a child is found to be engaged in any commercial sexual activity.
- MDHHS begins investigating the complaint as soon as possible but within 24 hours. The CPS investigation must include a determination as to whether the child is in danger of substantial physical or psychological harm and requires protective intervention, including the initiation of child protective or dependency proceedings.
Michigan Law's definition of Child Labor Trafficking is (MDHHS, 2017):
A child who has been recruited, enticed, harbored, transported, provided, or obtained for forced labor is a victim of labor trafficking. Labor trafficking can include, but is not limited to, domestic servitude, forced labor in restaurants or salons, forced agricultural labor, or debt bondage. Labor trafficking victims must prove that force, fraud, or coercion existed while they were in the care of their trafficker, regardless of whether the victims are children or adults.
In child sex trafficking, proof of force, fraud, or coercion is not required (MDHHS, 2017).
You must have patient consent before disclosing any personal information about adult victims of human trafficking. HIPAA regulations apply. If the patient is a minor, follow mandatory state reporting laws and institutional policies for child abuse or serving unaccompanied youth(NHTH, 2016).
National Human Trafficking Hotline (NHTH) provides help for you to determine if you have encountered a victim of human trafficking, identifies local resources available in your community, and helps you coordinate with local social service organizations. All communications with the NHTH are strictly confidential to the extent permitted by law, and personal information does not have to be disclosed to access services.
Again, you must have the patient consent to share any individual's personal information. Contacting the NHTH does not fulfill mandatory reporting requirements (NHTH, 2016).
Blue Campaign, the United States Department of Homeland Security's sponsored website dedicated to ending human trafficking, provides information on identifying victims and training programs. Anonymous tips regarding possible victims can be reported to Federal law enforcement (Department of Homeland Security [DHS], 2021):