By Melinda Young
Case managers can learn skills and tactics for helping patients who have been trafficked.
For example, investigators used an online training module to educate ED staff about human trafficking. Participants reported more confidence in identifying a possible human trafficking victim, noting they were more likely to screen patients for human trafficking.1
Here are some suggestions for what to include in skills training about human trafficking:
• Learn a trauma-focused and victim-centered approach. “The victim-centered approach respects the victim as an equal partner,” says Erica Koegler, PhD, MSW, an assistant professor at the University of Missouri — St. Louis School of Social Work. “You should respect the survivor to know more about their situation and how to keep themselves safe than any healthcare worker could understand.”
Healthcare professionals must respect all of a patient’s experiences, including negative experiences and trauma. Their efforts to help patients should not exacerbate that trauma and should always be offered in a way that respects patients’ autonomy and allows them to make their own decisions, Koegler says.
• Use protocols with specific actions. Every member of the healthcare organization should have a specific action outlined in the protocol for human trafficking victims. Protocols should help clinicians support their patients and address stigma and confidentiality. The important thing is to respond in ways that address patient concerns about discrimination or stigma.
Among the actions outlined in a protocol, one likely point is to ask staff to never confront the victim or survivor. It is important to not ask questions until the patient is in a room that is separate from the trafficker.
“They should be interviewed by well-trained social workers or nurses,” Koegler says. “The protocol would involve calling child protective services if the patient is a child.”
Only the people in roles named in the protocol would be able to approach the individual — even if they were the ones to recognize signs of trafficking.
“You have to ask specific questions to understand what’s going on, and the person asking should be someone who is experienced in delivering that type of questioning,” Koegler explains.
• Keep screening tool short. There are short screening tools validated for EDs, including a five-question tool, Koegler says. There also are specific screening tools for child victims of sex trafficking.2 Other tools are for adult victims of both labor and sex trafficking.
• Be aware of unusual behavior. “Survivors of trafficking have been so traumatized they might be seen as difficult patients: erratic, unstable, using substances, scared, and not looking up,” Koegler explains. “They may say their friend or family member is waiting for them, but that might be the trafficker.”
Providers need to know trauma and victimization could be underlying their negative behaviors.
• Create a care coordination model. “A care coordination model would be very effective for working with [trafficking] patients, who often have multiple morbidities,” says Nathaniel Dell, PhD, LCSW, an assistant professor of psychiatry at Washington University School of Medicine in St. Louis. “I’d like to emphasize the role of peers, who play a huge role in helping with recovery from traumatic experiences.”
Care coordination could include connecting patients to people who have experienced trafficking and who could play a foundational role in supporting victims and survivors. They also could help patients develop survival skills and teach how to address problems in day-to-day life, Dell explains.
• Document cautiously. “Our advocacy is not only on how to be better at documenting trafficking, but we also need to connect it to ethical questions about how we could provide these codes ethically and support patients who have these experiences,” Dell says.
One tactic is a limited data set that cannot be connected to a particular person and medical record. “The tricky issue is how can we have safeguards within healthcare organizations to make sure certain aspects of the electronic health record data are masked, if they are particularly sensitive,” Dell says. “How can clinicians record facts of the case and supporting data in matter-of-fact ways and add nothing extraneous?”
REFERENCES
- Donahue S, Schwien M, LaVallee D. Educating emergency department staff on the identification and treatment of human trafficking victims. J Emerg Nurs 2019;45:16-23.
- Greenbaum VJ, Dodd M, McCracken C. A short screening tool to identify victims of child sex trafficking in the health care setting. Pediatr Emerg Care 2018;34:33-37.
Case managers can learn skills and tactics for helping patients who have been trafficked. For example, investigators used an online training module to educate ED staff about human trafficking. Participants reported more confidence in identifying a possible human trafficking victim, noting they were more likely to screen patients for human trafficking.
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