By Jim Burke and Lindsay Shapiro
Nearly all hospitals in the U.S. have mandatory protocols to recognize and respond to child abuse. Guidelines for dealing with sex-trafficked patients, however, are far less common – instituted at fewer than 2% of hospitals, according to one study.1
There’s good reason to change that and an ongoing push to do so. There’s also a framework for a human trafficking protocol in healthcare settings provided by the National Human Trafficking Resource Center (NHTRC), among others.2 But the healthcare community needs to recognize the problem to act on it more effectively.
The numbers tell the sex trafficking story and how the healthcare system has come up short:
- Between 15,000 to 20,000 women and girls are trafficked in the U.S. annually, two-thirds of whom are believed to be U.S. citizens.3
- Victims are more likely to have interacted with healthcare providers than law enforcement; up to 88% of 106 victims in one survey visited mainly emergency rooms, but also pediatric clinics, orthopedic and OB-GYN departments and dentists.4
- That same survey found 99% of survivors experienced at least one physical health problem while they were being trafficked, 98% developed mental health conditions, and over two-thirds suffered gynecological problems ranging from urinary tract and sexually transmitted infections to unintended pregnancies.
- Fewer than 5% of doctors identified trafficking victims among their patients and fewer than 3% of ER clinicians were trained to do so.5
The numbers tell the sex trafficking story and how the healthcare system has come up short:
The NHTRC provides a comprehensive set of resources and referrals to help healthcare professionals identify trafficking victims. It calls out various red flags in its comprehensive assessment tool, like6:
- Someone else (an “uncle” or “cousin”) speaks for the patient.
- The patient is not aware of his or her location, the date or time.
- The patient can’t accurately verify details on insurance or identification cards, like age or the spelling of the last name.
- The patient seems fearful, anxious and/or or tense, and submissive to his or her handler.
- Signs of physical or sexual abuse, medical neglect or torture; common health issues can range from jaw and neck problems to marks hidden under clothing like stab wounds, bite marks and cigarette burns.
- The patient is reluctant to explain his or her injury.
If any such red flags have been raised, the practitioner should have a private conversation with the patient to ask such questions as whether sexual acts for money or favors have been forced, a passport or identification is being held by others, or if a family member has been threatened. If possible, a social worker should be enlisted to assist. A translator should also be engaged, if necessary.
Assistance for further assessment (including the potential danger to the patient) and next steps is available through the 24-hour NHTRC hotline, 1-888-373-7888. The hotline follows all HIPAA and mandatory reporting regulations and has access to over 200 languages. The protocols developed by individual institutions should include community referral resources like law enforcement and social services, as well.
HUB International’s team is ready to help your organization respond to the opportunities and risks in the changing healthcare environment.
1https://www.tandfonline.com/doi/abs/10.1080/23322705.2016.1187965?journalCode=uhmt20
3https://www.state.gov/policy-issues/human-trafficking/
5https://muse.jhu.edu/article/481724
6https://humantraffickinghotline.org/sites/default/files/Comprehensive%20Trafficking%20Assessment.pdf