Individuals experiencing labor and sex trafficking/exploitation have been identified in all 50 U.S. states and the District of Columbia, in urban, suburban, and rural areas. Today, human trafficking is a more urgent issue with the increased use of online communication by children, especially unsupervised use associated with the pandemic.6 Trafficked and exploited children frequently seek care at medical facilities, including emergency departments, urgent care centers, primary care clinics and specialty clinics.1 These interactions with health professionals provide a critical opportunity to offer services to vulnerable patients. However, research indicates that many trafficked persons do not spontaneously disclose their exploitation to medical staff.2-4 In addition, lack of training and facility guidelines/protocols on human trafficking result in many missed opportunities for victim identification and services.
Individuals exploited for sex and/or labor may experience serious physical and mental health adversities, including injury, toxic exposures, malnutrition, dehydration, physical and sexual assault, and sexually transmitted and other communicable infections.5 Post-traumatic stress disorder, major depression and suicidality, substance and alcohol abuse/addiction and anxiety disorders are common.5
While persons experiencing human trafficking may seek health care, they face innumerable barriers to disclosing their exploitation and seeking assistance from staff. Such barriers may originate with the trafficked individual who feels shame, fear, hopelessness, or who lacks awareness of their exploitative situation. Further barriers may arise from a trafficker, who intimidates or threatens the patient to remain silent. Notably, important barriers to human trafficking identification lie within the locus of control of the health professional and the health care organization. Providers may not recognize signs of exploitation due to lack of knowledge of human trafficking or may feel discomfort in broaching the topic with patients. They may misperceive the situation and overlook key indicators of exploitation due to biases about victimization. They may feel unable to address the issue due to lack of screening tools, lack of time, and lack of organizational protocols. Health professionals may be unaware of available community and national resources for trafficked persons. They may feel the health care organization’s priorities are focused on other critical health issues.
The health care professional has an important role to play in recognizing and serving adults and children who experience human trafficking victimization. Many barriers to assistance may be addressed through identification of local victim service organizations and resources, policy and protocol development, and staff training and education. Multiple resources are available to providers and health care organizations seeking to address the issue of human trafficking.
Actions to mitigate risk of similar harm at your hospital
- Identify community and national resources for trafficked persons through a community mapping exercise
- Create a facility policy and protocol for recognizing and responding to suspected labor and sex trafficking
- Train ALL staff on human trafficking, available community resources, the trauma-informed approach to care, mandatory reporting laws, and on the facility protocol
- Monitor and evaluate protocol implementation and effectiveness, and patient satisfaction
What can I do with this alert?
- Forward to the recommended target audiences for evaluation.
- Discuss with organizational leadership; formulate a plan to begin the 4-step process detailed and include in your Daily Safety Brief.
- Let us know what is working and what additional information you need.
- Leverage your PSO membership. Learn from each other to reduce patient harm and Serious Safety Events.
- Allied health care teams
- Ambulatory care
- Ancillary staff
- Call center/advice line
- Case managers
- Child life specialists
- Clinical educators
- Clinical staff and leaders
- Emergency/urgent care
- Legal/risk management
- Medical leaders
- Nursing leaders
- Organizational leaders
- Patient safety
- Primary care
- Quality improvement
- Social workers
- Specialty care service providers
- Surgical leaders
Has a patient experienced an event at your organization that could happen in another hospital?
- Child Health PSO members should submit event details into the Child Health PSO portal.
- Contact Child Health PSO Staff to share risks, issues to assess, and mitigation strategies with member hospitals.
More than 60 children’s hospitals are actively engaged with Child Health PSO. We currently are enrolling new members.
1 Hornor G, Sherfield J. Commercial sexual exploitation of children: Health care use and case characteristics. J Ped Health Care. 2017;32(3):250-262.
2 Lederer L, Wetzel C. The health consequences of sex trafficking and their implications for identifying victims in healthcare facilities. Annals of Health Law. 2014;23:61-91.
3 Lavoie J, Dickerson KL, Redlich AD, Quas JA. Overcoming Disclosure Reluctance in Youth Victims of Sex Trafficking: New Directions for Research, Policy, and Practice. Psychology, public policy, and law : an official law review of the University of Arizona College of Law and the University of Miami School of Law. 2019;25(4):225-238.
4 Chisolm-Straker M, Baldwin S, Gaibe-Togbe B, Ndukwe N, Johnson PN, Richardson LD. Health care and human trafficking: We are seeing the unseen. J Health Care Poor Underserved. 2016;27(3):1220-1233.
5 Le PD, Ryan N, Rosenstock Y, Goldmann E. Health Issues Associated with Commercial Sexual Exploitation and Sex Trafficking of Children in the United States: A Systematic Review. Behavioral medicine (Washington, DC). 2018;44(3):219-233.
6 Europol. (2020). Exploiting isolation: Offenders and victims of online child sexual abuse during the Covid-19 pandemic: June 19, 2020. Available at https://www.europol.europa.eu/publications-documents/exploiting-isolation-offenders-and-victims-of-online-child-sexual-abuse-during-covid-19-pandemic; accessed on 8/28/20.
Jordan Greenbaum, M.D., Medical Director, International Centre for Missing and Exploited Children
Stephanie V. Blank Center for Safe and Healthy Children
Children’s Healthcare of Atlanta
We thank the Helfer Society Child Trafficking Committee for its review of this Alert.