Physicians can help advance care for the uniquely vulnerable and often unidentified population of human trafficking persons by embracing their roles as first responders, viewing each patient in a social context and sharing their practice experience with policymakers.
An article in the January issue of the AMA Journal of Ethics lays out an action plan for physicians who encounter potential victims of human trafficking in a health care setting, focusing on three core activities.
Learn to spot and help victims. A 2014 study found that 88 percent of victims had contact with at least one health care professional during the period in which they were being trafficked, but none were identified or offered help in getting out of bondage during their encounter. In addition, an earlier study of emergency department personnel found that 29 percent thought human trafficking was a problem in their patient population, but only 13 percent felt confident or very confident that they could identify a victim, and fewer than 3 percent had ever been trained to do so.
“When it comes to identification of human trafficking victims, several barriers exist for both health care professionals and patients,” wrote the authors of the AMA Journal of Ethics article. “Professional-related barriers include clinicians’ lack of knowledge regarding human trafficking, failure to apply trauma-informed care and cultural assumptions about the victim. Patient-related barriers include patients’ failure to self-identify as human trafficking victims due to fear, shame and lack of awareness of victim status and rights; lack of knowledge of U.S. laws and contractual obligations in cases of labor trafficking; and language barriers and illiteracy.”
The Department of Health and Human Services’ (HHS) National Human Trafficking Training and Technical Assistance Center offers online and in-person training for health care professionals on identifying and responding to trafficking victims. This includes the “Stop. Observe. Ask. Respond to Human Trafficking” (SOAR) training that helps physicians, health professionals and social service providers recognize the verbal and nonverbal indicators of human trafficking and learn how to use a victim-centered, trauma-informed approach in their interactions.
Note the bigger picture. Physicians should “view human trafficking as part of a spectrum of interrelated violence and systemic inequities that are influenced by the social determinants of health,” the authors said. “Anyone can become a victim of human trafficking. However, social determinants of health make some groups particularly vulnerable to trafficking.”
These populations include:
- People with a history of childhood abuse and neglect
- Children who have been in foster care or spent time within the juvenile justice system
- Runaway and homeless youth
- People with disabilities
- Undocumented immigrants
- People with low incomes
- Lesbian, gay, bisexual, transgender and questioning people
- Migrant workers
- Racial and ethnic minorities
In addition, by adopting evidence-based prevention and intervention strategies, such as a trauma-informed approach and HHS’s Office of Minority Health’s National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care (CLAS), physicians can understand the stressors faced by these groups and maximize healing while minimizing the risk of retraumatization.
Help refine anti-trafficking practice. Both the CLAS standards and trauma-informed approaches are shaped by physicians’ clinical experiences.
“Relative to other problems such as intimate partner violence, anti-trafficking practice-policy feedback loops, in which health care professionals and researchers inform the work of policymakers, are in their infancy,” the authors wrote. “While some researchers have developed and tested appropriate screening tools, little research exists on the evaluation and development of evidence-based practices for identifying and treating victims of trafficking.”
One learning group is the Health, Education, Advocacy, Linkage (HEAL) network which provides a platform for interdisciplinary health professionals to discuss care for victims of human trafficking. Its committees focus on topics such as education and training, prevention and protocol development.
Listen, vote and learn
In the journal’s January podcast, Ranit Mishori, MD, professor of family medicine and director of the Department of Family Medicine’s Global Health Initiatives at Georgetown University School of Medicine, discusses how to spot red flags of trafficking and how to respond to incidents of suspected trafficking in health care settings. The January issue of the journal also features an ethics poll.
Upcoming issues of the AMA Journal of Ethics will focus on legitimacy and authority, language and hierarchy, moral psychology and "difficult" patient-clinician dyads, mental health and oncology, and moral distress. Sign up to receive email alerts when new issues are published, and follow the journal on Twitter at @journalofethics.
