CEUFast, Inc. is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center's Commission on Accreditation. ANCC Provider number #P0274.
This course satisfies the specific nursing continuing education requirements for Texas (per Texas Occupations Code, Sections 116 and 301, of 2019 and 1999, respectfully).
≥ 92% of participants will know how to identify and appropriately report victims of human trafficking.
After completing this continuing education course, the participant will be able to:
Human Trafficking is modern-day slavery. It is the business of making a profit by stealing others’ freedom (Polaris Project, 2025).
The United States Department of Justice Trafficking Victims Protection Act (TVPA) of 2000 defines trafficking in persons as:
Victims of human trafficking can be of any age, race, sex, or nationality. It happens to Americans and immigrants.
Victims of trafficking are found in both legitimate and illegitimate labor industries. These areas are typically underpaid and under-regulated industries. Forced labor in foreign countries is used to produce the products American's buy (Stoklosa, 2017).
The difference between human trafficking and the existence of consensual commercial sex is the very word "consensual." Human trafficking occurs when a trafficker is using the means of force, fraud, or coercion for the very purpose of compelling the victim to provide the desired commercial sex acts (National Human Trafficking Hotline, n.d.).
These two things are often confused. However, they are very different. Human trafficking involves exploiting men, women, and children for forced labor or sex against the victim's will (U.S. Immigration and Customs Enforcement [ICE], 2017). Human smuggling, however, involves a provided service of typically transportation or fake documentation to an individual who knowingly and consentingly seeks to obtain illegal entry into a foreign country (ICE, 2017).
Because of the clandestine nature of human trafficking, most data are only estimations. The Polaris Project recently published its 2024 Data Report. This report includes the statistics of victims and survivors identified by the U.S. National Human Trafficking Hotline. The most current statistics are as follows, in the year 2024 (Polaris Project, 2024):
According to the International Labor Organization (ILO), Walk Free Foundation, and the International Organization for Migration’s (IOM) 2022 report, an estimated 49.6 million individuals are trapped in modern-day slavery. Of these (International Labor Organization [ILO], 2022):
Sex trafficking among lesbian/gay/bisexual/transgender/queer (LGBTQ) youth is prevalent (Polaris Project, 2019). Youth who identify as LGBTQ are particularly at risk (Polaris Project, 2019). As of 2019, up to 40% of homeless youth are members of the LGBTQ community (Polaris Project, 2019). Of these individuals, 46% ran away because of their family rejecting them. In addition, these individuals are 7.4 times more likely to experience acts of sexual violence than compared heterosexual individuals of the same age group (Polaris Project, 2019).
The victims of human trafficking suffer severe, life-long physical and psychological consequences of being at the mercy of their captors. While under control, these individuals often experience extreme stress levels, deprivation of food, water, and sleep, sexual assault, and hazardous environments (Raker, 2020).
The Trafficking Victims Protection Act (TVPA) (2000) creates a comprehensive federal law to address human trafficking. A three-pronged approach is used in addressing trafficking:
The Federal Bureau of Investigation (FBI) has statutory authority to investigate matters of forced labor, trafficking with respect to peonage, slavery, involuntary servitude, or forced labor and forced sex trafficking (Federal Bureau of Investigation [FBI], 2021).
TVPA gives law enforcement the ability to protect international victims of human trafficking through several forms of immigration relief, including Continued Presence and the T visa (FBI, 2021). TVPA also established a law requiring defendants of human trafficking investigations to pay restitution to the victims (FBI, 2021).
Continued Presence allows law enforcement officers to request temporary legal status in the U.S. for an immigrant whose presence is necessary for the success of an investigation (FBI, 2021). The T visa allows foreign victims of human trafficking to become temporary U.S. residents (FBI, 2021). The victims may become eligible for permanent residency after three years.
Being aware of the most common risk factors of human trafficking enhances one's ability to identify potential victims in the clinical setting. Each patient encounter must be made with a heightened awareness of these warning signs.
It is also important to note that although trafficking victims consist of people of all ages and sexes, the most common victims are women and children (Raker, 2020). Additional risk factors of note are poverty or economic hardship, a history of abuse, involvement with the child welfare system, disability, lack of formal education, living in a rural location, being a member of the LGBTQ+ community, and having limited support systems (Hope for Justice, 2024; Raker, 2020).
Traffickers exploit other people for the profit gained from forcing them to participate in labor or commercial sex (National Human Trafficking Hotline, n.d.). These individuals lure and trap people into these situations by hunting, manipulating, and exploiting their vulnerabilities (National Human Trafficking Hotline, n.d.). They utilize calculated methods to prey on individuals searching for a better life, who need money/jobs, have unstable home lives, or lack an adequate support system (National Human Trafficking Hotline, n.d.). Victims are promised high-paying jobs, an opportunity to move to a new country, a loving relationship, or other exciting opportunities that the victim feels they cannot get elsewhere. They then utilize physical and psychological violence to control them (National Human Trafficking Hotline, n.d.).
Perpetrators often share the same national or cultural background as their victims (Florida State University [FSU], n.d.). Interestingly enough, a recent study found that those who trafficked minors for sex (FSU, n.d.):
Common Sex Trafficking Sites include (FSU, n.d.):
Traffickers have a variety of profiles and recruit their victims with a variety of recruitment tactics. Recruitment tactics that are most common and cited by Florida State University (FSU) include (FSU, n.d.):
As mentioned above, human trafficking victims often present to emergency departments and women's health or family planning clinics. Healthcare providers have an opportunity to identify victims of human trafficking (Bradley & Macias-Konstantopoulos, 2025).
If human trafficking is suspected or confirmed, assess acute healthcare needs and perform a complete physical to identify common medical conditions in trafficked persons. Sex-trafficked and sexually abused labor-trafficked victims should be offered a forensic medical evaluation. Pregnancy testing and emergency contraception should be offered (Bradley & Macias-Konstantopoulos, 2025).
The first, arguably most important, step in assessing a suspected victim of human trafficking is to create a safe environment. It is vital that the patient feel as comfortable and secure as possible. Individuals who might be victims will be more likely to share information and seek future healthcare if they feel that they are not being judged (Raker, 2020). Make the best effort to ensure the conversation is private and be willing to spend the time to build rapport and garner trust with the suspected victim.
Take time to answer the victim's questions and acknowledge and address their fears (Bradley & Macias-Konstantopoulos, 2025). It is important to be sensitive to cultural differences, sex differences, and language barriers and use an interpreter when needed (U.S. Department of Homeland Security, 2021).
Other helpful strategies for interviewing the possible victim alone include (Health, Education, Advocacy, Linkage [HEAL] Trafficking, 2018):
It is best to interview the possible victim alone. Still, if the patient refuses or if the accompanying individual refuses the separation, it might be a safer plan to allow them to remain together (HEAL Trafficking, 2018). If the accompanying individual feels threatened, it may risk the opportunity to provide medical services to this patient or increase the chances that potential harm will fall to the victim after they leave (HEAL Trafficking, 2018).
Communicating with these individuals will often be challenging as many will choose not to share what they are going through or seek any assistance as they are often fearful of authority figures or possible retribution (Raker, 2020). Therefore, communication must be clear, direct, therapeutic, and non-threatening to encourage an authentic patient response (Raker, 2020).
During this patient interaction and as these questions are asked, it is important to notice subtle signs. These signs can include the responses to the questions being asked appearing to be scripted, a hesitancy to answer the questions, and a demonstration of nervous behavior (no eye contact, increased heart and respiratory rate, uncomfortable body language) (Raker, 2020). Each separate sign, if present alone, might not indicate a trafficking situation.
The U.S. Department of Homeland Security developed the Blue Campaign to provide resources to fight human trafficking. Included in their most recent published brochure (2020) are the following questions that have been adapted for clarity to ask yourself to identify common signs of human trafficking:
Behavior or Physical State:
Social Behavior of the Victim:
Social Behavior of the Trafficker:
Work Conditions and Immigration Status:
Minor Victims:
General Indicators of Human Trafficking:
| Labor Trafficking Indicators | Sex Trafficking Indicators |
|---|---|
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Healthcare providers should screen patients for potential trafficking when red flags and indicators are identified in the presentation, history, or physical examination (NHTRC, 2016).
Any victim of human trafficking whose first language is not English or otherwise is not able to communicate fully with staff should necessitate the use of a professional interpreter (Office for Victims of Crimes, n.d.).
There are some important considerations when identifying and selecting a proper interpreter (Office for Victims of Crimes, n.d.):
Once a victim is identified, the primary goal is to remove them from the danger (Raker, 2020). Most victims experience intense fear of their traffickers and of being deported. Therefore, it is important to reassure the victim that they are safe, so they can begin the process of getting protection and assistance to rebuild their lives (Bradley & Macias-Konstantopoulos, 2025; U.S. Department of Homeland Security, 2021).
Gaining the trust of trafficking victims is important. Sample therapeutic massages to help gain trust include (Bradley & Macias-Konstantopoulos, 2025; U.S. Department of Homeland Security, 2021):
The healthcare professional can now focus on the immediate medical needs of this patient and the rest of the medical team. After these needs are met, multidisciplinary services can be solicited to begin prompt referral for additional assistance.
After the patients' initial needs are met, additional referrals need to be initiated.
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 (Bradley & Macias-Konstantopoulos, 2025; 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.
If a patient discloses that they have been trafficked (NHTRC, 2016):
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 (Bradley & Macias-Konstantopoulos, 2025; NHTRC, 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 (Bradley & Macias-Konstantopoulos, 2025; NHTRC, 2016).
Legal and social services resources are provided locally. Healthcare facilities need a list of resources that can be called or shared based on the patient's needs.
As referenced above, the NHTH is an excellent resource for healthcare facilities to help identify and connect with existing local resources.
Many of the services available for victims are time-limited. Such services include domestic violence shelters and runaway and homeless youth programs, where on-site counseling services are offered. These resources generally provide for short stays that do not allow adequate time to establish trusting relationships needed for a victim to open up and begin to address their trauma (Bradley & Macias-Konstantopoulos, 2025; NHTRC, 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 (NHTRC, 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 (NHTRC, 2016).
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 (NHTRC, 2016).
Again, you must have the patient consent to share any individual's personal information. Contacting the NHTRC does not fulfill mandatory reporting requirements (NHTRC, 2016).
Blue Campaign is 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):
Mandated reporting of abuse of older adults and adults with disabilities is typically defined as a legal obligation of a specific profession or individual to report suspected abuse, neglect, or exploitation of another individual meeting that state’s specific definition of an adult eligible for special protection under the law (National Center on Elder Abuse [NCEA] & National Adult Protective Services Association [NAPSA], n.d.). Reports must be made to that specific entity in the state that is required to investigate such allegations. Each state defines who is the mandated reporter, what situations they are required to report on, when they must report, and to whom they are required to report to (NCEA & NAPSA, n.d.). Some states require only certain professions while others require universal reporting, in other words everyone is a mandatory reporter (NCEA & NAPSA, n.d.). The most often named mandated reporters are law enforcement and medical professionals.
Trauma-Informed care (TIC), also called trauma-sensitive care, is a care approach framework that integrates acknowledgment of the impact of traumatic events and the importance of instilling a sense of safety and autonomy in each patient (Bradley & Macias-Konstantopoulos, 2025; Hopper, 2017). Essentially, this patient-centered approach focuses on the basic understanding that the trauma the patient has endured very much impacts their life from now on (Bradley & Macias-Konstantopoulos, 2025; Hopper, 2017).
TIC can be applied to all patients as it simply involves the healthcare personnel's practice modification to be critically aware of the general traumatic events this specific patient has lived through (Bradley & Macias-Konstantopoulos, 2025; Gaillard-Kenney et al., 2020).
If a patient is admitted to an inpatient psychiatric unit following initial medical stabilization and psychiatric assessment, it is crucial that all care should continue to be trauma-informed as well (Gordon et al., 2018).
As mentioned above, the health implications of victims of human trafficking are often very severe and long-lasting.
The healthcare needs of human trafficking victims range from physical abuse to psychological trauma. Unlike other violent crimes, trafficking usually involves prolonged and repeated trauma, including (Bradley & Macias-Konstantopoulos, 2025):
In addition, victims of human trafficking also often suffer significant psychological stress. This stress manifests itself in many mental health conditions. The mental health repercussions of trafficking include (Raker, 2020; Stoklosa, 2017):
The following table lists health-related indicators and consequences of human trafficking published by the National Human Trafficking Resource Center (NHTRC) (2016). This list of physical and mental health indicators of human trafficking is not exhaustive. Trafficking survivors may experience one or more of these indicators, none of these indicators, or health indicators not on this list.
| Mental Health Indicators
Social or Developmental Indicators
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Survivors of human trafficking require a multitude of follow-up services. Due to the repetitive and traumatic nature of most human trafficking cases, a complete psychiatric evaluation of victims of human trafficking is needed to provide the mental health providers with a complete picture of the victim. This evaluation should include prior traumatic experiences, presentation of co-morbidity, assessment of the patients' functioning, and availability of basic resources (Gordon et al., 2018).
Treating the psychological consequences of human trafficking requires long-term, comprehensive, multi-faceted therapy. Mental health therapy usually includes one or more theories of psychological treatment (Gordon et al., 2018).
As previously mentioned, human trafficking victims can have PTSD. The current evidence-based treatments for PTSD include (Gordon et al., 2018; Altun et al., 2017):
Behavioral therapy essentially manipulates the environment to increase desired behaviors and decrease problem behaviors.
Cognitive therapy alters a patient's comprehension and understanding of significant life experiences that change behaviors and feelings.
Psychodynamic therapy explains behavior and personality as being motivated by inner forces and targets patients' unconscious. These inner forces include past experiences, inherited instincts, and biological drives.
In addition to the importance of psychological support and medical care following a trafficking experience, survivors also need financial assistance. In many cases, traffickers have taken complete control of the victim's financial identity or bank accounts, resulting in depletion of funds and annihilation of their credit score (U.S. Department of State, 2021). Financial institutions and the government can help survivors obtain secure financial access, utilize victim support services, work to repair their credit, and receive restitution payments when they are able (U.S. Department of State, 2021).
Human trafficking survivors are the experts of their lived experiences (Chisolm-Straker, 2020). These individuals can have valuable insight into what healthcare professionals should know and ask to help identify other victims in the future (Chisolm-Straker, 2020).
One such survivor study specifically asked survivors of human trafficking what they would recommend being included in human trafficking education provided to healthcare professionals (Chisolm-Straker, 2020). Based on each of the 51 survivor's experiences, the content that the majority felt was necessary includes acceptable physical and psychosocial exam tips and tricks, more guidance for health care professionals in how they are to report victims, and safer discharge planning instructions to get the victim out of the hospital and to a safe and secure place (Chisolm-Straker, 2020).
Understanding the experiences and perspectives of survivors, too, is helpful to inform healthcare personnel further how we can better provide for, advocate for, and support victims of human trafficking (Tsai et al., 2020). Collecting qualitative information from the survivors also assists us in improving anti-human trafficking policy and practice (Tsai et al., 2020).
One study conducted in Cambodia (2020), another key country destination for human trafficking, followed the experiences of 128 survivors from 2010 to 2020 in a post-trafficking shelter (Tsai et al., 2020). The average age of the survivors at the beginning of their involvement in the study (so following their trafficked experience) was 16 years of age, meaning they were trafficked at even younger ages (Tsai et al., 2020). Five major themes of needs while the survivors stayed within a shelter among other survivors were identified in their interviews (Tsai et al., 2020):
These survivor-consulted themes help to communicate the major needs that survivors of human trafficking have following their personal trafficking experiences. While many of the survivors were quite comfortable and felt supported in their stay, others who felt they were being judged or that the staff did not believe what they had gone through felt negatively about their shelter experiences (Tsai et al., 2020). Consistently providing TIC, as described in the section above, will help to eliminate these possible situations of not feeling comfortable or safe (Tsai et al., 2020; Bradley & Macias-Konstantopoulos, 2025).
All healthcare personnel must remember the trauma involved in trafficking experiences and be sensitive to the encounters of survivors to best assist them in their treatment, healing, and reintegration into society (Tsai et al., 2020; Bradley & Macias-Konstantopoulos, 2025). Because TIC also assumes that all individuals have experienced some level of trauma in their lives, the very structure of all organizations should reflect the need for sensitivity surrounding each interaction and conversation (U.S. Department of State, 2021).
Healthcare professionals have a duty to assist in the identification of victims of human trafficking. As widespread as the issue of human trafficking is, we all must do our part in knowing the risk factors and the physical/psychological signs of either a victim or perpetrator of trafficking. Remember that due to the sensitive nature of these situations, it is important to remain calm, respectful, non-judgmental, and private in any patient encounter you suspect might be related to trafficking. Take the time to refresh yourself on the protocols and procedures you must enact in your own workplace/unit so that you are immediately ready to act if you face a potential victim while at work. It is important to be aware that in some situations, much like with abusive relationships, the victim might not be ready to admit the need for help and might not want to leave their trafficking situations due to many reasons cited above. Do not take these decisions made on their part to mean that you have failed. Remember that your sympathetic words, thoughtful actions, and the time you spent with that patient all carry great weight and might contribute to making a difference in their lives in the future.
For more information, please see these additional Human Trafficking resources:
A 40-year-old Hispanic male presents to the ED with severe dehydration. This patient is thin; his skin is very dry with healing wounds on his arms and hands. His clothes are very worn and crusted with accumulated sweat and dirt. The patient is accompanied by a man who identifies himself as the patient's supervisor, presents the patient's identification, and insists on accompanying the patient to his room.
The patient is identified as an agricultural worker. The supervisor is providing interpretation for the Spanish-speaking patient. The supervisor answers most questions without consulting the patient. When the supervisor questions the patient, the patient gives short, abrupt answers. The patient avoids eye contact with the healthcare providers.
There are no previous charts available for review. Today's history is brief and focuses on the patient's symptoms. No questions relating to social history and very few questions relating to past medical history are asked. The physical exam and lab work are performed. Intravenous hydration is started.
The supervisor is impatient and repeatedly tells the nurse they need to leave. After hydration is complete, the patient is discharged with instructions, in Spanish, about how to prevent and identify dehydration.
An independent interpreter should have been used, and the supervisor should have been separated from the patient. A more detailed history of this patient's background, social history, and home situation may have identified some forced labor and abuse indicators.
CEUFast, Inc. is committed to furthering diversity, equity, and inclusion (DEI). While reflecting on this course content, CEUFast, Inc. would like you to consider your individual perspective and question your own biases. Remember, implicit bias is a form of bias that impacts our practice as healthcare professionals. Implicit bias occurs when we have automatic prejudices, judgments, and/or a general attitude towards a person or a group of people based on associated stereotypes we have formed over time. These automatic thoughts occur without our conscious knowledge and without our intentional desire to discriminate. The concern with implicit bias is that this can impact our actions and decisions with our workplace leadership, colleagues, and even our patients. While it is our universal goal to treat everyone equally, our implicit biases can influence our interactions, assessments, communication, prioritization, and decision-making concerning patients, which can ultimately adversely impact health outcomes. It is important to keep this in mind in order to intentionally work to self-identify our own risk areas where our implicit biases might influence our behaviors. Together, we can cease perpetuating stereotypes and remind each other to remain mindful to help avoid reacting according to biases that are contrary to our conscious beliefs and values.
