Dignity Health this month released new recommendations detailing how health care organizations can spot and help patients who may be victims of human trafficking.
A growing crime—and a lack of provider training
According to the Department of Defense, human trafficking is the fastest growing crime in the world. The National Human Trafficking Hotline recorded more than 7,500 incidents of human trafficking in 2016—35 percent more than they recorded in 2015 and 130 percent more than they recorded in 2012.
But despite the increasing prevalence of human trafficking, "it's just not something really on doctors' radar," Jacqueline Bhabha, a professor at Harvard University's T.H. Chan School of Public Health, said. In fact, according to a 2015 study in Pediatrics, nearly 60 percent of providers have never been trained to spot potential victims of human trafficking.
That lack of training is particularly worrisome, according to Holly Gibbs, director of Dignity Health's program and a human trafficking survivor, because nearly 88 percent of human trafficking victims say they have had contact with a health care professional while being trafficked. According to Hospitals & Health Network, human trafficking victims are likely to encounter a provider during their exploitation because they often have many health issues stemming from their abuse, such as behavioral health disorders, smoking, and substance misuse.
Yet the majority of victims, Gibbs said, do not get any assistance or needed information during their visit. "Trafficked persons are often overlooked even though most survivors report that they have visited a health care setting at least once while being trafficked," said Gibbs.
Dignity Health's approach
The new recommendations are based on lessons learned from Dignity Health's Human Trafficking Response Program. The program, which involves a continuum of care, includes educational modules and victim response policies that involve the health system's providers, first responders, and the larger community.
Dignity Health originally launched the program in its EDs, and later rolled it out at its labor and delivery and postpartum departments. The health system is now implementing the program in nearly 40 hospitals across three states, and officials plan to eventually roll it out to all of the system's 400 facilities in 21 states.
Dignity Health's recommendations
Dignity Health's manual, which is available at no cost, includes best practices, checklists, and tools that health organizations can use to establish their own response programs.
Specifically, the guidelines detail:
- Potential indicators of human trafficking in patients, such as fearful or submissive behavior, a controlling companion, or more subtle signs, such as a patient who does not know what city he or she is in;
- Policies to respond to those indicators, including assessment questions;
- Advice on how to cultivate trust with a patient and how to offer assistance;
- Guidance on when to contact human trafficking response agencies; and
- Recommendations on identifying relevant community services.
The recommendations also advise providers to assess particularly vulnerable populations for signs of human trafficking, including children, undocumented immigrants, patients who misuse drugs, patients who have behavioral health issues, and those who are homeless.
"Dignity Health has developed a victim-centered, trauma-informed program based on actual cases because we believe that health care providers can provide a critical step in identifying and supporting trafficked persons," Gibbs said. "Our goal is to share our best practices with other systems so that one day human trafficking response programs like ours will be a standard offering at all hospitals and health care facilities across the country."
She continued, "If you suspect any person of being the victim of abuse, I think you always have to keep in the back of your mind that human trafficking is a possibility" (Ross Johnson, Modern Healthcare, 5/16; Durben Hirsch, Hospitals & Health Networks, 5/16; AHA News Now, 5/16; Rosin, Becker's Hospital Review, 5/17).
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