Human Trafficking Training for Florida Nurses and Other Healthcare Professionals
Identifying Victims of Human Trafficking
Online Continuing Education Course
Required for FL Nurses, Respiratory Therapists, Occupational Therapists, Physical Therapists. Discusses recognizing human trafficking, assessment tools, trauma-informed approach to screening, and reporting obligations for mandated reporters in Florida. Accepted by the Florida Board of Nursing, Florida Board of Respiratory Therapy, Florida Board of Occupational Therapy, and Florida Board of Physical Therapy Practice.
Course Price: $20.00
Contact Hours: 2
"Thank you for providing an online option to fulfill my licensing obligation. There are limited opportunities for a live seminar in my area." - Denise, RN in Florida
"Enjoyable reading. The course was well presented and easy to follow." - John, RN in Florida
"Excellent read. I already knew the basics, but knowing more will help me identify those minors in our community who may be at risk." - Jacqueline, LPN in Florida
"I preferred to read this article rather than watch a video on the topic. Having a PDF version will be a useful resource if I ever come across a potential victim. Thank you for the very useful information." - Karin, APRN in Florida
Accreditation / Approval Information
This course fulfills the requirement for human trafficking education for nurses, respiratory therapists, occupational therapists, and physical therapists. Accepted by the FL Board of Nursing, FL Board of Respiratory Therapy, FL Board of Occupational Therapy, and FL Board of Physical Therapy Practice. CE Broker Provider #50-2174.
Human Trafficking Prevention Training for Florida Nurses and Other Healthcare Professionals
Copyright © 2021 Wild Iris Medical Education, Inc. All Rights Reserved.
LEARNING OUTCOME AND OBJECTIVES: Upon completion of this course, you will have the current, evidence-based information and tools necessary to accurately recognize and intervene in suspected instances of human trafficking. Specific learning objectives to address potential knowledge gaps include:
- Describe the different types of human trafficking.
- Recognize factors that place persons at risk for human trafficking victimization.
- Articulate the extent to which human trafficking occurs.
- Describe assessment tools for and indicators of human trafficking.
- Discuss the importance of using a trauma-informed approach when screening victims of human trafficking.
- Explain procedures for sharing information with patients related to human trafficking.
- Describe referral options for legal and social services that can assist victims of human trafficking.
- Identify the use of hotlines and other mechanisms for reporting suspected human trafficking in Florida.
TABLE OF CONTENTS
WHAT IS HUMAN TRAFFICKING?
Human trafficking is a crime involving the exploitation of someone through the use of force, fraud, or coercion for the purposes of compelled labor or a commercial sex act. Human trafficking affects individuals across the world, including in Florida. It affects people of all ages, genders, ethnicities, and socioeconomic backgrounds. Human trafficking robs individuals of their basic human rights and can occur across and within state and international borders.
Human trafficking steals freedom for profit. It is a multibillion-dollar criminal industry that victimizes an estimated 29.9 million people around the world. This crime occurs everywhere, and victims may be found in such industries as healthcare, childcare, agriculture, nail salons, trucking, and hotels/motels. All trafficking victims have a common experience: the loss of freedom (Polaris, 2020a).
Since the Thirteenth Amendment to the Constitution was ratified in 1865, involuntary servitude and slavery—such as human trafficking—have been prohibited in the United States (Interactive Constitution, 2020).
The Trafficking Victims Protection Act (TVPA) was first passed in 2000 and has since been amended and reauthorized many times by Congress. The TVPA provides the infrastructure for the federal response to human trafficking. A multi-agency approach is founded on a framework that focuses on the “3 Ps”: prevention, protection, and prosecution. Federal agencies such as the U.S. Department of Homeland Security and the Federal Bureau of Investigation investigate human trafficking cases. The Justice Department prosecutes federal cases and funds the formation of state and local human trafficking task forces. The Department of Health and Human Services is involved in community education and awareness efforts, prevention, and funding the National Human Trafficking Hotline (Polaris, 2020b).
Healthcare workers are in a unique position to aid in prevention and protection of human trafficking victims. Education of healthcare professionals about human trafficking allows them to identify victims of human trafficking and intervene effectively. Human trafficking is associated with complex physical and psychological health consequences that include communicable diseases, substance dependency, and mental illness. A history of abuse, neglect, and exploitation can influence the experience of the victim of trafficking. Healthcare providers must learn to recognize potentially trafficked persons, consider their wishes and vulnerabilities along with their healthcare needs, and be cognizant of pertinent resources that may be offered (Macias-Konstantopoulos, 2017).
Types of Human Trafficking
There are different types of human trafficking, also known as trafficking in persons. Human trafficking may predominantly involve commercial sex, it may be specific to labor, or it may include both sex and labor. Human trafficking can be domestic or international and does not require crossing international or state borders.
Sex trafficking encompasses many sex crimes. The victims may be adults or children of any gender and may be domestic or foreign residents.
According to the TVPA, sex trafficking is the recruitment, harboring, transportation, provision, obtaining, patronizing, or soliciting of a person for the purposes of a commercial sex act, in which the commercial sex act is induced by force, fraud, or coercion, or in which the person induced to perform such an act has not attained 18 years of age. Under federal law, any minor under the age of 18 who is involved in commercial sex is considered to be a trafficking victim.
Force, fraud, or coercion are key elements used to identify trafficking, but they do not need to be present if the trafficking victim is under the age of 18. However, the use of force, fraud, or coercion on adults is what distinguishes sex trafficking from consensual commercial sex.
According to U.S. federal law (22 USC § 7102), labor trafficking is the recruitment, harboring, transportation, provision, or obtaining of a person for labor or services, through the use of force, fraud, or coercion for the purposes of subjection to involuntary servitude, peonage, debt bondage, or slavery. As with sex trafficking, force, fraud, or coercion do not need to exist if the labor trafficking victim is under the age of 18.
Labor trafficking victims include adults and children of all genders. Labor trafficking is often achieved through the control mechanism of debt bondage. Traffickers offer persons outside the United States promises of legitimate jobs in exchange for a legal visa and travel expenses to this country. Once they have arrived, the victims of this scheme may be charged exorbitant fees for food, rent, and material needs and are unable to repay the debt, remaining under the control of the trafficker (Polaris, 2016).
TRAFFICKING OF MINORS
Florida criminalizes sex trafficking of minors (those under the age of 18), and state law does not require proof of force, fraud, or coercion, as with trafficking in adults. Florida criminalizes human trafficking as a first-degree felony for both adult and minor victims. If convicted of commercial sex trafficking of “any child under the age of 18, or any person who is mentally incapacitated or defective,” the perpetrator may face a life sentence per Florida’s statute 787.06 (Online Sunshine, 2020).
The Action-Means-Purpose (AMP) model is one tool that can be used to assess whether a situation meets the federal definition of human trafficking. It asks whether a perpetrator has implemented any of the actions and used any of the means for the purposes of making the victim perform commercial sex acts, services, or labor. The presence of at least one item from each category determines possible human trafficking.
|(Polaris Project, 2020)|
The crime of human smuggling is different from human trafficking, but it is frequently confused with human trafficking, and the two crimes are sometimes related. Unlike trafficking, the definition of smuggling includes transportation across international borders. Smuggling usually involves the consent of a person who is being transported. People who are smuggled generally pay to be transported across a border, but once they have arrived at their destination, they may become victims of trafficking (U.S. DOS, 2017a).
Smuggling is addressed in the Immigration and Nationality Act, Title 8, Section 1324 (a)(1), which provides criminal penalties for acts or attempts to bring unauthorized aliens to or into the United States, transport them within the United States, harbor unlawful aliens, encourage entry of illegal aliens, or conspire to commit these violations, knowingly or in reckless disregard of alien’s legal status (U.S. CIS, n.d.).
Risk Factors for Human Trafficking
Factors that are associated with increased risk for victimization may be viewed using a public health approach according to the socioecological model. This model describes individual, relationship, community, and societal factors that may result in vulnerability to human trafficking (Greenbaum, 2020).
Individual vulnerability factors include:
- History of exposure to homelessness
- Running away from home
- Physical, sexual, or other types of abuse
- Involvement with Child Protective Services, the juvenile justice system, or foster care
- Identification as lesbian, gay, bisexual, transgender, queer, or questioning (LGBTQ+)
- Being marginalized
- Immigration status as an unaccompanied minor
Relationship vulnerability factors include but are not limited to:
- Family violence
- Loss or abandonment
- Peer or family exploitation
Community vulnerability factors are seen in areas where residents are involved in mass migration, corruption prevails, and exploitation is tolerated. Persons who live in a community that is exposed to violence and natural disasters are also vulnerable to human trafficking.
Societal vulnerability factors are seen in groups that subscribe to cultural beliefs that support marginalization and inequality in matters of race, gender, and the rights of children. Individuals in societies that are without human trafficking laws or do not hold exploiters accountable are also at risk (Greenbaum, 2020).
EXTENT OF HUMAN TRAFFICKING
The true prevalence of human trafficking in the United States is unknown because of the concealed nature of the crime. The unofficial estimate is hundreds of thousands when cases among adults, minors, sex, and labor trafficking are combined.
It is believed that more women and children are victims of sex trafficking and domestic servitude and that more boys and men are trafficked for other forms of labor, but it is not possible to present dependable statistics.
Some researchers use reports of missing children to estimate statistics of trafficked children. Children (defined as under 18 years of age) are frequently recruited as runaways, with the likelihood that an estimated 1 in 6 U.S. children who ran away from home in 2014 were victims of sex trafficking (Polaris, 2017). Thirty-three percent of the sex trafficking cases in the United States that were identified in 2015 involved children (U.S. DHHS, 2016).
While it is difficult to know for sure how many people are victims of human trafficking, the National Human Trafficking Hotline gathers data from calls made to their hotline. Calls to the Human Trafficking Hotline for the state of Florida are described in the tables below.
|Sex and labor||46|
MALE TRAFFICKING VICTIMS
Although most published statistics portray victims of trafficking as predominantly female, that information may not be accurate. Labor trafficking of males occurs in almost every type of work, from mining and construction to fishing, hospitality, and healthcare. Sex trafficking of men and boys is underreported, and the sex trafficking industry may have nearly equal numbers of male and female victims.
Initially, male victims may not self-identify as victims. Social values reinforce their perception because society continues to view males as less vulnerable than females. Male victims are at risk for deportation or being charged as criminals rather than being treated as exploited persons. Recovery is much more difficult for male victims, since shelters or recovery programs may not accept men. Clearly, male victims need the same assistance that females receive, including housing, therapy, legal aid, and medical care (U.S. DOS, 2017b).
ASSESSMENT AND INDICATORS OF HUMAN TRAFFICKING IN CLINICAL SETTINGS
The goals of healthcare providers who wish to intervene and assist victims of human trafficking are in direct conflict with those of exploiters. Exploiters hope for the continued vulnerability of their victims and see their victims as merchandise. Exploiters use concealment and misdirection to confuse anyone who they view as a threat to their profits and manipulation, power, and control to discourage victims from disclosing their circumstances.
In order to develop a capacity to listen to patients who have a history of violence, healthcare workers must be willing to extend themselves into areas of malfeasance and human fallibility. Healthcare professionals’ best resource is knowledge. Being aware of warning signs and indicators of human trafficking can alert the clinician to possible victims.
Setting and Presentation
The media often portrays trafficking victims as women who are in chains or have a sign written on their hands that says, “Help Me.” However, this is not what most trafficking victims look like. When victims of human trafficking present in healthcare settings, it is uncommon for them to self-disclose that they are victims. They have significant trust issues, and even when asked directly, they are not likely to disclose that they are victims. The exploiter may also accompany victims, and as with victims of domestic violence, that presence will discourage victims from making any disclosures to a clinician.
A healthcare professional may encounter victims of sex trafficking in a clinic or emergency department setting who are requesting treatment or testing for pregnancy, abortion, sexually transmitted infections, and contraception. They may request a sexual assault forensic exam or treatment for substance abuse. Victims may suffer from broken bones or nonaccidental injury at the hands of exploiters or buyers.
Victims of labor trafficking may have physical injuries, pesticide poisoning, or salmonella from unclean water sources. If their illness or injury is severe, these patients may present in outpatient clinics or in the emergency department.
Behavioral health providers may encounter victims of trafficking who are depressed, cannot sleep, have anxiety, or are suicidal. Dentists may see these victims when dental problems become severe.
When conducting an exam of a patient who may be a victim of human trafficking, documentation should carefully record a written description of any findings, photographs, diagrams, and forensic evidence. It is important that documentation reflect the patient’s perspective and not the suppositions or biases of the clinician (HEALTrafficking.org, 2018).
Human trafficking may be indicated by numerous possible signs. Clinicians may note one or more of the following “red flags” in a healthcare setting.
- Signs or a history of deprivation of food, water, sleep, or medical care
- Physical injuries typical of abuse, such as bruises, burns, cuts, scars, prolonged lack of health or dental care, or other signs of physical abuse
- Brands, scars, clothing, jewelry, or tattoos indicating someone else’s “ownership”
- Presence of sexually transmitted infections
- Possession of cell phones, jewelry, large amounts of cash, or other expensive items that appear inconsistent with the patient’s stated situation
- Substance abuse or dependence signs and symptoms
- Clothing that is inappropriate for the weather or emblematic of commercial sex
INDICATORS IN A VICTIM’S APPEARANCE
The patient’s appearance may include unusual tattoos that signify “branding,” such as “I belong to John,” “Team Zodiac,” “I cum for $,” or barcodes. The patient may dress incongruently for the weather, such as wearing long sleeves to cover bruises or other marks when it is warm, or clothing that is sometimes emblematic of commercial sex, such as skimpy skirts and low-cut tops regardless of when the weather is cool. It is important to remember that the victim may also be dressed as a school child, appear to be very well-dressed, or may be male or transgender.
- Fear, anxiety, depression, nervousness, hostility, flashbacks, avoidance of eye contact
- Restricted or controlled communication, or use of a third party to translate, with no indicator of inability to understand English
- Inconsistencies in the history of the illness or injury
- Denial of victimization
- Attempted suicide, submissiveness, fearfulness, self-harm, or other signs of psychological abuse
- Appearing to be controlled by a third party (e.g., looking for permission to speak, not being left alone)
- Isolation from family or former friends
- Fear of employer
- Described or implied threats to self or family/friends
- History of running away
- Working and living in the same place
- Lacking the freedom to leave their working or living conditions
- Being escorted or kept under surveillance when they are taken somewhere
- Not being in control of their own money
- Having no, or few, personal possessions
- Frequently lacking identifying documents, such as a driver’s license or passport
- Indicators of being a minor in a relationship with a significantly older adult
- Not knowing their own address
- Being in possession of hotel keys
BARRIERS TO RECOGNIZING MALE VICTIMS
Evidence has shown that even those providers who are trained to identify human trafficking victims often miss identifying male victims when they encounter them (U.S. DOS, 2017). Research identifies multiple contributing factors to the lack of recognition of male commercially sexually exploited children, even though half of children who are involved in commercial sex may be male, and why they are not offered services:
- Boys are not likely to self-identify as sexually exploited due to feeling shame, stigmatization from their family or community, and in some cases concerns about being gay.
- Western culture promotes the image of males as strong and self-reliant persons who actively pursue sex.
- Anti-trafficking organizations offer limited outreach to areas that are known for male prostitution.
- There is a general belief that boys are not trafficked but are willing participants, and this fallacy obscures the need for services for male victims.
(Youth Collaboratory, 2018)
INDICATORS AMONG MINORS
Minor victims may present with the same physical findings as adult victims, but it is important to also take note of a youth’s belongings. Trafficked youth generally have a cell phone and may also have in their possession items that seem too costly for their age and occupation, such as expensive jewelry, purses, and large amounts of cash.
A careful social history may elicit that the child is “couch surfing” or “staying with a friend” and not attending school. Homeless youth may engage in “survival sex,” which is sexual exploitation in exchange for food, a place to stay, or cash. Trafficked youth may have a chronic illness such as asthma or diabetes that is neglected. They may be accompanied by an older person whom they call “Daddy” or “Uncle” or refer to as their “boyfriend.”
Screening should take place in a quiet environment free from interruptions. Food, drink, and tissues should be available during the interview, and the interviewer should be prepared to offer clothing and referrals to medical care and other services as indicated. The screener should be sensitive to the fact that formal dress, suits, and uniforms may be emblematic of immigration or enforcement agencies and are not conducive to open communication.
(See also “Trauma-Informed Care” below.)
USE OF INTERPRETERS
If interpreters are needed, in-person services through accredited agencies are preferred. Interpreters should be screened for any conflict of interest, and they should utilize trauma-informed care practices. Patients should be given the option to request a different interpreter if they are uncomfortable. Some patients may prefer the anonymity of using a translator on the phone instead of in person. Trained interviewers are available in 200 languages through the National Human Trafficking Hotline (see “Resources” at the end of this course) (HEALTrafficking.org, 2017).
STRATEGIES TO INTERVIEW THE PATIENT ALONE
In order to provide an opportunity for the patient to communicate freely, the healthcare professional may need to implement a strategy to create privacy when the patient is accompanied by someone else. Strategies include: requesting that patient leave the room with a clinician and without any accompanying person to undergo a procedure such as an X-ray, requesting that any accompanying person step out of the room due to hospital privacy policies, or asking an accompanying party to leave the room in order to provide assistance with registering the patient.
If the person who is accompanying the patient refuses to leave or to allow the patient to be separated, it may not be in the patient’s best interest to insist. If the trafficker feels threatened, there is a risk that the patient will not be allowed to receive treatment or be harmed after leaving the facility. The same is true for involving law enforcement or security. If the trafficker becomes suspicious, it may jeopardize the ability of the patient to return for needed treatment (HEALTrafficking.org, 2017).
When working with human trafficking survivors, safety is a primary concern. Although many emergency departments have metal detectors to screen for weapons, it is important that all healthcare institutions have a response protocol in the event of violence. It is equally important that healthcare professionals are aware of how to keep their patients and themselves safe at work.
When working with crime victims and suspects in particular, the healthcare professional should pay attention to the environment and be prepared to act quickly. Because of the criminal nature of human trafficking, security should be alerted when a patient is suspected of being a human trafficking victim. Personnel should also be cognizant of prevention measures such as registering a high-risk patient under an alias, flagging their chart not to give information to the public, or placing the unit under lockdown if a direct threat occurs (Titler, 2020).
OVERCOMING SURVIVOR BARRIERS TO DISCLOSURE
The goal of the healthcare professional should not be to elicit a disclosure but to create a safe space where patients feel that they can be treated, learn more about their options, and receive support to make informed decisions (HEALTrafficking.org, 2017). There are many barriers to disclosure by human trafficking survivors to healthcare workers:
- Patients who are trafficked are frequently in the presence of their trafficker or another person who is watching what they say and are not free to discuss their situation.
- They may be unable to communicate due to linguistic issues, illness, or trauma.
- Patients do not have any reason to trust healthcare professionals, are fearful of their trafficker, and are concerned that they will not be believed or might be arrested.
Several assessment tools have been developed to assist professionals in identifying victims of trafficking. These tools require training and are available online at no cost.
Florida’s Human Trafficking Screening Tool (HTST) is associated with a protocol that is specific to the Florida Department of Juvenile Justice and is designed to screen for indicators of human trafficking. (See “Resources” at the end of this course for a link to the Florida HTST screening tool.)
Another screening tool used for minors is the Commercial Sexual Exploitation Identification Tool (CSE-IT). The CSE-IT was developed by West Coast Children’s Clinic for social workers to screen at-risk youth who are 10 years of age and up for commercial sexual exploitation. The evidence-based and validated CSE-IT tool uses a weighted scoring system to evaluate observations made by the professional rather than answers given on a questionnaire to the youth (WCCC, 2017a & 2017b).
A more recent tool, Quick Youth Indicators for Trafficking (QYIT), evaluates for both labor and sex trafficking among homeless young adults. The QYIT is validated, brief to administer, and does not require a human trafficking expert to evaluate the results (Chisolm-Straker et al., 2020).
Trauma is an intense response to a stressful situation that can result in lasting negative effects on an individual that are averse to their health and well-being. Victims of trauma become overwhelmed with stressful stimuli, and this interferes with their ability to function or cope effectively (NHTRC, 2016). Victims of trauma may feel ashamed and see themselves as helpless, powerless, or worthless. They may trust no one and feel that no one can protect them. Victims who view life through a traumatic lens will respond accordingly when working with healthcare practitioners or the criminal justice system.
Therefore, whenever a clinician is interacting with a potential victim of human trafficking, trauma-informed care and interviewing techniques are important. The core principles of a trauma-informed system of care integrate safety, trustworthiness, choice, collaboration, and empowerment into all client services.
Any service provider who interfaces with an individual who has a history of trauma—from the receptionist to the physician—should be educated about trauma-informed care and strive to create an environment in which the client feels safe, believed, and empowered. No victim should be made to feel like a witness for his or her own crime.
Professional training in trauma-informed care is strongly encouraged for anyone who works directly with victims. Such training will help prevent retraumatization of victims and help the professional to recognize and mitigate adverse responses when victims begin to feel out of control or threatened, experience unexpected change, or feel vulnerable or ashamed (U.S. DOJ, n.d.).
Approaches to Screening
Promising practices that implement a trauma-informed approach to screening include:
- First meet the basic needs of the individual who is seeking care. Basic needs include food, water, clothing, and shelter. Medication may also be a basic need for individuals who are diabetic or have a major behavioral health issue or other conditions that are mitigated by medication.
- Reassure the individual that they are safe. Victims of human trafficking need to understand that they are not in trouble and that they are safe. They may fear arrest, deportation, or retaliation from their abuser.
- Build trust. A nonjudgmental attitude, kindness, and good listening skills will help to build rapport with the individual. Abusers teach victims to trust no one, especially people who have positions of authority.
- Language is important. Mirror the language that the individual uses to be sure that they understand what you are saying. Ask open-ended questions and avoid any derogatory inferences.
- Be aware of power dynamics. It is important that the individual understands that a disclosure is not required to receive treatment.
- Do no harm. Avoid retraumatization by having a conversation with the individual rather than an interrogation. The presence of an advocate who is trained in human trafficking can be very helpful.
Asking Difficult Questions
Sometimes it is difficult to frame questions in a way that will feel nonjudgmental to a victim. The ability to ask questions in a way that does not cast blame will provide the health professional with better information and is unlikely to cause harm to the patient.
- An opening statement such as “I would like you to tell me everything that you are comfortable sharing” can be very helpful.
- If immigration status might be an issue, it is best to not ask about this initially.
- Asking, “What were you wearing?” could be interpreted by the patient as blaming them for the occurrence based on their dress. Instead, one might ask, “What are you able to remember about what you were wearing?”
- It is important to avoid asking victims of human trafficking “why” about any of their actions or responses. Asking “why” may cause the victim to feel or believe that they did something wrong and is likely to negatively impact the interview.
Forensic Experiential Trauma Interview
Principles from the Forensic Experiential Trauma Interview (FETI), developed by Russell Strand, can be utilized by healthcare professionals who work with victims of trauma. The FETI is based on the neurobiology of trauma that entails a shutting down of the prefrontal cortex during the traumatic or stressful event. The prefrontal cortex, when operating efficiently, is the cognitive part of the brain that normally records the memory of an event (who, what, why, where, when, and how). During a traumatic event, less-advanced portions of the brain record the event. Stress and trauma interrupt how memories are stored and may lead to the victim expressing inconsistent or incorrect statements.
- Interviewers acknowledge the victim’s trauma and ask, “What are you able to tell me about your experience?” or “I would like you to share with me everything that you are comfortable sharing.” Statements such as “Help me understand about the car ride” replace the use of “Why did you get in the car with him?”
- Interviewers ask, “What were you feeling?” or “What was your thought process during this experience?” instead of “Why did you do that?”
- The six senses can be employed, and the interviewer can ask, “What are you able to remember about smell, sound, sight, taste, touch, and body sensations?”
- Interviewers ask how the experience affected the victim, what was the most difficult part of the experience, and if there is anything the victim cannot forget about the experience.
Forensic interviews of children and adolescents utilize a multidisciplinary team approach and generally take place in a child advocacy center. A certified interviewer conducts the interview while law enforcement, social services, behavioral health, and medical representatives observe from another room. These interviews are generally recorded using an audio-visual system, and observers document their observations according to each discipline’s requirements (Childsafe, 2020). Florida Statute 39.303(9) requires a task force to provide oversight to enhance the safety of children (Scott & Philip, 2018).
SHARING INFORMATION WITH PATIENTS
Healthcare professionals are on the front lines of providing direct patient care to human trafficking survivors and are uniquely positioned to recognize and respond. The majority of survivors who are actively being exploited will encounter healthcare professionals. These individuals may be at risk of trafficking, involved but not ready to get out, involved and wanting help to get out, or have been previous victims (HEALTrafficking.org, 2017).
The manner in which information is shared can be as important as the content itself. It is important to remain objective, provide privacy, and provide verbal and written information in a language that the patient can understand. Healthcare providers must also be mindful of maintaining a trauma and survivor-informed environment. Use of a harm-reduction model meets patients where they are and does not subject them to judgment or push them to disclose information if they are not ready to do so (Cox, 2019).
The following recommendations for institutions can augment the quality of the information-sharing experience between the provider and the client:
- Develop treatment plans based on available resources and ensure that these plans are patient-centered
- Utilize “warm hand-offs” for referrals when possible (call the party to which one is referring the patient in front of the patient or introduce the other party in person)
- Employ survivor advocates
- Develop a personalized safety plan (the National HT Hotline can assist)
- Provide guidance on prevention of sexually transmitted infections, pregnancy, and HIV
- Provide resources verbally as well as through discreet messaging, bearing in mind that it may not be safe for patients to leave with written information. Good examples include placing a business card in a sanitary napkin or writing a hotline number on a prescription pad and labeling it “X-ray.”
- Ask the patient the safest way to communicate if a follow-up is possible
(Baldwin et al., 2017)
If the patient does not request immediate help, the information-sharing should include a treatment plan with referrals to comprehensive care services that are unique to the patient’s needs and sensitive to the patient’s circumstances. The goal of the provider is to treat the patient and offer information and support (HEALTrafficking.org, 2017).
Survivors who have experienced human trafficking are experts on this topic and understand what healthcare providers need to know in order to create a safe space to interact. According to survivors, it is important that healthcare workers have a working knowledge of resources and mandatory and nonmandatory reporting of human trafficking. When sharing information, healthcare workers should share accurate timeframes and respond to the needs that patients verbalize and provide opportunities for the patient to be in control when possible (Chisolm-Straker et al., 2020).
Legal and Social Services for Victims of Human Trafficking in Florida
Legal assistance should be accessible for all victims of human trafficking, and advocacy is available to help navigate a complex system. Victims need to understand their rights so that they can receive services to help their situation. Attorneys can help victims who have been detained, prevent them from being deported, and if they are not citizens of the United States, help them apply for a T visa. (The T visa allows victims of trafficking to live and work in the United States and apply for permanent residency.) The greatest barrier for victims of human trafficking to access their due protections from the TVPA is lack of legal assistance (Florida Health, 2020).
A variety of direct legal and social service providers are available to clients in Florida. Religious groups, government agencies, nongovernmental agencies, and community partners such as domestic violence shelters are part of a network of coordinated community care. There are too many direct service providers for the state of Florida to list individually. The National Human Trafficking Hotline website, operated by the Polaris Project, is a robust resource. The website offers an interactive map and search feature to locate the type of service needed in each community of the United States. A provider or client can also inquire about local services by calling the hotline on the phone (Baldwin et al., 2017). (See “Resources” at the end of this course.)
Other resources to consider sharing with human trafficking survivors include:
- The Florida Family Policy Council website. This website offers multiple resources, both national and specific to those in the state of Florida.
- HEAL Trafficking (Health, Education, Advocacy, Linkage) is an organization composed of multidisciplinary professionals who support human trafficking survivors from a public health perspective. The organization provides an array of resources that are available on their website, including a Human Trafficking Protocol Toolkit, literature and publications, a speaker’s bureau, and links to a network of nonprofit groups and academic and government centers pertaining to human trafficking. The website also offers patient resources, information on child labor, COVID-19, and Protocol Consultancy.
- South Florida Human Trafficking Task Force (SFHTTF), an antitrafficking coordination team, provides a unique model of addressing human trafficking that goes beyond the “3 Ps” (prevention, protection, and prosecution). Composed of representatives from the U.S. Department of Justice, U.S. Attorney’s Office, U.S. Immigration and Customs Enforcement (ICE), Homeland Security Investigations, local law enforcement, and state-certified victim advocates, the task force responds in a collaborative manner to assist victims and address and disrupt organized crime that supports human trafficking. By providing victims with services while coordinating investigations, the SFHTTF promotes a victim-centered approach in which the needs of the victim are viewed as equally important as the apprehension and prosecution of the exploiters (SFHTTF, n.d.).
(See “Resources” at the end of this course for website links/contact information.)
REPORTING HUMAN TRAFFICKING IN FLORIDA
Reporting Trafficking in Minors and Vulnerable Adults
Trafficking in minors (under the age of 18), including child sex or labor trafficking, is a form of child abuse and maltreatment, and any citizen who suspects child abuse must make a report to the Department of Children and Families (see “Making a Report” below). Reporters who feel that a child is in imminent danger should call the police first.
The legal definition of vulnerable adult in Florida is “a person age 18 years or older who has a disability or is suffering from the infirmities of aging.” These adults are unable to perform activities of daily living or provide for their own care or protection because they are impaired due to disability, brain damage, or infirmity. Any person who has a reasonable cause to suspect abuse of a vulnerable adult must make a report to the Florida Abuse Hotline (see “Making a Report” below). Reporters who feel that a vulnerable adult is in imminent danger should call the police first (FL DCF, 2019).
PROFESSIONAL MANDATED REPORTERS
Professional mandated reporters in Florida who are required to give their name when they report include:
- Physician, osteopathic physician, medical examiner, chiropractic physician, nurse, or hospital personnel engaged in the admission, examination, care, or treatment of persons
- Health or mental health professional other than one listed above
- Practitioner who relies solely on spiritual means for healing
- School teacher or other school official or personnel
- Social worker, day care center worker, or other professional childcare, foster care, residential, or institutional worker
- Law enforcement officer
Mandated reporters should make a report immediately to the Department of Children and Families if they have a reasonable suspicion that a child or a vulnerable adult is suffering from abuse or neglect, including human trafficking. Although the mandated reporter is required to give their name, all reports are confidential.
Mandated reporters who knowingly and willfully fail to report abuse or neglect may be charged with a third-degree felony and may be sentenced up to 5 years in prison and fined up to $5,000. Educational institutions that fail to report child abuse related to institutional events may be fined up to $1 million for each failure to report abuse or neglect.
MAKING A REPORT
A report of suspected abuse of a child or vulnerable adult is made by immediately calling, faxing, or reporting online to the Florida Abuse Hotline. The hotline screens all reports and will initiate an investigation to determine risk to the victim (FL DCF, 2019).
There are four ways to make a report of suspected human trafficking in Florida:
- Telephone: 800-96-ABUSE (800-962-2873)
- Fax: 800-914-0004
- TDD: 800-955-8771
- Online: See “Florida Abuse Hotline” in the “Resources” section at the end of this course
The following information is included in a report of human trafficking for a child or vulnerable adult:
- Name, occupation, agency, phone, and address of the reporting party (if the reporter is a professionally mandated reporter; all other reporters may choose to remain anonymous)
- Name of the victim
- Complete address and telephone number, including area code, of the victim
- Estimated or actual date of birth of the victim
- Gender, race, and social security number of the victim
- Names and birthdates of other children in the home
- Name, date of birth, gender, race, social security number of a person suspected of abuse or exploitation
- A brief description of the concern and any injuries sustained by the victim, including when and where the incident occurred, frequency of occurrence, and threat of harm
- Names of others who might be aware of the abuse or exploitation of the victim and their relationship to the victim
- The name and contact information of the victim’s parent or guardian, as well as other adults residing in the home
- A brief description of the victim's disability or infirmity (required for vulnerable adults)
- The relationship of the suspect to the victim
Reporting Trafficking in Competent Adults
In Florida, competent adult victims of human trafficking have the rights to privacy and agency. Mandated reporters may not report suspected human trafficking to law enforcement without a victim’s consent, and to do so without their specific consent could lead to civil action against the reporter.
Healthcare providers may counsel competent adult human trafficking victims and refer them to law enforcement and pertinent services. They may also make a confidential report to the National Human Trafficking Resource Center by calling the National Human Trafficking Hotline at 888-373-7888 (see box below) (FL DCF, 2019).
(See also “Resources” at the end of this course.)
REPORTING TO THE NATIONAL HUMAN TRAFFICKING HOTLINE
- Hotline number: 888-373-7888
This organization is not an investigative agency or affiliated with law enforcement. When a report is made to the National Human Trafficking Hotline, consent and safety are the most important elements that are considered. When a call is received, the following actions will occur:
- A skilled advocate will assess the circumstances for potential labor or sex trafficking of a person of any age, nationality, race, or gender. Whenever possible, the hotline personnel will speak directly with victims in order to discuss reporting and referral options and receive consent to act on that person’s behalf.
- If the victim is a child, the hotline advocate will immediately inform the appropriate authorities.
- When the hotline advocate determines that the call concerns a potential case of human trafficking, a supervisor is immediately alerted to begin coordinating a response. Action steps frequently include:
- A follow-up call to the caller (with their consent) for additional information
- A report to the designated law enforcement agency
- Coordination with service providers for emergency assistance or transfer to a service provider
Tips of suspected human trafficking may also be provided anonymously (NHTH, n.d.-d).
The crime of human trafficking creates a ripple effect of trauma that originates with victims and expands steadily in circles that encompass families, communities, and professionals who assist victims. It is a crime associated with serious adverse mental and physical consequences and increased mortality in a cohort of individuals who may not define themselves as victims.
Change can only occur with a coordinated, multidisciplinary response and must include the efforts of professionals to learn to recognize the signs of human trafficking, take action in a trauma-informed manner when working with victims, and comply with mandated reporting laws.
In order to eradicate this form of human exploitation, legislators must continue to redefine our laws to protect the vulnerable; peace officers must enforce these laws; other members of society, such as healthcare practitioners, other mandated reporters, and citizens, must empathize with victims; and prosecutors must hold offenders accountable.
Blue Campaign (Department of Homeland Security)
To report suspected human trafficking: 866-347-2423
Florida Abuse Hotline
National Human Trafficking Hotline - Florida
Text “BeFree” to 233733
24-hour hotline: 800-621-HOPE (4673)
Victim Assistance Program (U.S. Immigration and Customs Enforcement)
NOTE: Complete URLs for references retrieved from online sources are provided in the PDF of this course.
Anthony B. (2018). Onramps, intersections, and exit routes. Polaris. Retrieved from https://polarisproject.org
Baldwin SB, Barrows J, & Stoklosa H. (2017). Protocol toolkit for developing a response to victims of human trafficking. HEAL Trafficking and Hope for Justice. Retrieved from https://iowanaht.org
Centers for Disease Control and Prevention (CDC). (2017). Understanding sex trafficking. Retrieved from https://www.cdc.gov
Childsafe. (2020). The forensic interview. Retrieved from https://www.childsafe-sa.org
Chisolm-Straker M, Miller CL, Duke G, & Stoklosa H. (2020). A framework for the development of healthcare provider education programs on human trafficking, part two: survivors. Journal of Human Trafficking, 6(4), 410–24. doi:10.1080/23322705.2019.1635333
Chilsolm-Straker M, Sze J, Einbond J, White J, & Stoklosa H. (2018). Screening for human trafficking among homeless adults. Children and youth services review, 19, 72–9. doi:10.1016/j.childyouth.2018.12.014
Cox J & Chambers R. (2019). A medical safe haven for survivors of human trafficking. Health Progress,May-June, 33–7. Retrieved from https://www.chausa.org
Finklea K, Fernandes-Alcantara A, & Siskin A. (2015). Sex trafficking in children in the United States: overview and issues for Congress. Congressional Research Service. Retrieved from https://fas.org
Florida Department of Children and Families (FL DCF). (2019). Abuse hotline. Retrieved from https://www.myflfamilies.com
Florida Family Council (FFC). (2020). Human trafficking help and resources. Retrieved from https://www.flfamily.org
Florida Health (2020). Florida Human Trafficking. Retrieved from http://www.flhealthsource.gov
Greenbaum J. (2020). The public health approach to human trafficking prevention. Georgia State University Law Review, 6(4), 1059–74. Retrieved from https://readingroom.law.gsu.edu
Greenbaum J & Crawford-Jakubiak J. (2015). Child sex trafficking and commercial sexual exploitation: healthcare needs of victims. American Academy of Pediatrics, 135(3). doi:10.1542/peds.2014-4138
HEALTrafficking.org. (2020). Health Education Advocacy Linkage. Retrieved from https://healtrafficking.org
HEALTrafficking.org. (2018). Introductory training on human trafficking for U.S. health care professionals. Retrieved from https://healtrafficking.org
HEALTrafficking.org. (2017). HEAL trafficking protocol toolkit. Retrieved from https://healtrafficking.org
Human Trafficking Search. (2020). Safe Harbor: does your state arrest minors for prostitution? Retrieved from https://humantraffickingsearch.org
Hundertmark D. (2016). Seven facts about human trafficking in the United States. The Odyssey. Retrieved from https://www.theodysseyonline.com
Interactive Constitution (2020). The abolition of slavery. Retrieved from https://constitutioncenter.org
Macias-Konstantopoulos W. (2017). Caring for the trafficked patient: challenges and recommendations for the healthcare professional. AMA Journal of Ethics, 19(1), 80–90. doi:10.1001/journalofethics.2017.19.01.msoc2-1701
National Human Trafficking Hotline (NHTH). (n.d.-a). Myths and misconceptions. Retrieved from https://humantraffickinghotline.org
National Human Trafficking Hotline (NHTH). (n.d.-b). The traffickers. Retrieved from https://humantraffickinghotline.org
National Human Trafficking Hotline (NHTH). (n.d.-c). Sales crews, peddling & begging rings. Retrieved from https://humantraffickinghotline.org
National Human Trafficking Hotline (NHTH). (n.d.-d). Hotline FAQs. Retrieved from https://humantraffickinghotline.org
National Human Trafficking Hotline (NHTH). (2020). Hotline statistics: Florida. Retrieved from https://humantraffickinghotline.org
National Human Trafficking Resource Center (NHTRC). (2016). Trauma-informed human trafficking screenings. Retrieved from https://humantraffickinghotline.org
Office for Victims of Crime. (n.d.). Interpreters. Retrieved from https://www.ovcttac.gov
Online Sunshine. (2020). The 2020 Florida Statutes: statute 787.06. Retrieved from http://www.leg.state.fl.us
Polaris. (2020a). Human trafficking. Retrieved from https://polarisproject.org
Polaris. (2020b). Trafficking Victims Protection Act. Retrieved from https://polarisproject.org
Polaris. (2020c). The AMP model. Retrieved from https://polarisproject.org
Polaris. (2017). Children and youth. Retrieved from https://polarisproject.org
Polaris. (2016). Debt vs. debt bondage: what is the difference? Retrieved from https://polarisproject.org
Schwarz C, Unruh E, Cronin K, Evans-Simpson S, Britton H, & Ramaswamy M. (2016). Human trafficking identification and service provision in the medical and social service sectors. Health and Human Rights Journal, 18(1), 181–92.
Scott R & Philip C. (2018). Child forensic interview protocol task force report. Retrieved from http://www.floridahealth.gov
Stoklosa H, MacGibbon M, & Stoklosa J. (2017). Human trafficking, mental illness, and addiction: avoiding diagnostic overshadowing. AMA J Ethics, 19(1), 23–4. doi:10.1001/journalofethics.2017.19.1.ecas3-1701
Stop Violence Against Women. (2020). Health consequences of human trafficking. Retrieved from https://www.stopvaw.org
Strand R. (n.d.). The forensic experiential trauma interview (FETI). Retrieved from https://mncasa.org
Titler J & Reynolds S. (2020). Human trafficking in the emergency department: improving our response to a vulnerable population. Western Journal of Emergency Medicine, 21(3). Retrieved from https://westjem.com
U.S. Citizenship and Immigration Services (U.S. CIS). (n.d.) Unlawful employment of aliens. Retrieved from https://www.uscis.gov
U.S. Citizenship and Immigration Services (U.S. CIS). (2020a). Questions and answers: victims of human trafficking, T nonimmigrant status. Retrieved from https://www.uscis.gov
U.S. Citizenship and Immigration Services (U.S. CIS). (2020b). Number of form I-918, petition for U nonimmigrant status by fiscal year, quarter, and case status, fiscal years 2009–2020. Retrieved from https://www.uscis.gov
U.S. Department of Health and Human Services (U.S. DHHS). (2016). National Human Tracking Resource Center data breakdown 2015. Retrieved from https://humantrackinghotline.org
U.S. Department of Homeland Security (U.S. DHS). (2019). U visa law enforcement guide. Retrieved from https://www.dhs.gov
U.S. Department of Justice (U.S. DOJ), Office of Justice. (n.d.). Using a trauma-informed approach. Retrieved from https://www.ovcttac.gov
U.S. Department of State (U.S. DOS). (2017a). Human trafficking and migrant smuggling: understanding the difference. Retrieved from https://www.state.gov
U.S. Department of State (U.S. DOS). (2017b). Assisting male survivors of human trafficking. Retrieved from https://www.state.gov
Vera Institute for Justice. (2014). Out of the shadows, a tool for the identification of victims of human trafficking. Retrieved from https://www.vera.org
West Coast Children’s Clinic. (2017a). Tools. Retrieved from http://www.westcoastcc.org
West Coast Children’s Clinic (2017b). Commercial sexual exploitation—identification tool (CSE-IT). Retrieved from http://www.westcoastcc.org
Women at Risk International. (2017). Apps that fight human trafficking. Retrieved from https://warinternational.org
Youth Collaboratory. (2018). Boys and CSEC. Retrieved from https://youthcollaboratory.org