Improving Nurse Practitioner Students' Knowledge and Confidence in the Identification and Management of Human Trafficking Victims.

Human trafficking is a global public health problem affecting millions of people worldwide. In the United States, many trafficking victims seek medical care for physical, sexual, and mental health concerns. Unfortunately, many of these individuals go unrecognized by health care providers as being victims of human trafficking and return to their trafficker without interventions for their safety and protection. To provide effective quality care for this patient population, health care providers must be knowledgeable regarding the identification of signs of trafficking, trauma-informed interventions to ensure the safety and protection of the victim(s), and methods to collaborate with interprofessional partners for the provision of appropriate medical and socioeconomic care following the exit from their trafficking situation. The purpose of this pilot study was to evaluate best practices in teaching Family Nurse Practitioner (FNP) students to identify and implement appropriate interventions for victims of human trafficking. The study was conducted in two phases using a mixed-method research design with repeated measures. In the first phase, education was provided through the validated HOPE Training modules produced by the Safe House Project using a pretest, posttest design. In the second phase, the students observed an interprofessional simulation followed by focus groups using a phenomenological approach to explore students' perceptions. Knowledge and confidence increased significantly following the implementation of this study. The results provide essential information regarding incorporating human trafficking education into FNP curricula. This study also contributes to the body of knowledge regarding the vital role that nurse practitioners play in the interprofessional management of human trafficking victims.

How Should Health Care Organizations Limit Roles of Human Trafficking in Their Labor and Supply Chains?

There has been little attention given to roles played by human trafficking in health care organizations' supply chains. Hand sanitizers and gloves, for example, might be produced by forced labor, which tends to increase in prevalence during pandemics, mass violence, migration, or other global crises. This article considers the nature and scope of health care organizations' corporate and social responsibilities to procure products and personnel justly, offers recommendations to minimize possibilities that supplies are produced by forced labor, and advocates for a public health approach to limiting human trafficking in organizations' supply chains.

Detecting orphanage trafficking and exploitation.

BACKGROUND: There is growing awareness that a proportion of children in orphanages have been recruited or transferred into the facility for a purpose of exploitation and/or profit. These children are often falsely presented as orphans to evoke sympathy and solicit funding. This process is known as orphanage trafficking. Although orphanage trafficking can be prosecuted under legal frameworks in some jurisdictions, including Cambodia, there have been limited prosecutions to date. One factor that likely contributes to a lack of prosecution is poor detection, yet the indicators of orphanage trafficking have not been considered by extant research. OBJECTIVE: The current study was conducted as a first step towards providing evidence-based indicators of orphanage trafficking. PARTICIPANTS AND SETTING: Professionals who had identified or responded to cases of orphanage-based exploitation in Cambodia were interviewed. Participants included criminal justice professionals, investigators from civil society organisations, and child protection social workers. METHODS: Professionals' perspectives on how to identify orphanage trafficking were explored via in-depth interviews, and the data were analysed via thematic analysis. RESULTS: The analysis revealed a distinct set of indicators that may be used to detect orphanage trafficking, including the operation of an unauthorised facility, orphanage tourism and volunteering, and an overt focus on fundraising. CONCLUSION: The indicators revealed in this study point to the need for an effective and thorough monitoring system for orphanages, as well as adequate education and training of relevant personnel to aid in the detection of orphanage trafficking.

Healthcare providers' experience of identifying and caring for women subjected to sex trafficking: a qualitative study.

BACKGROUND: Men's violence against women, including human trafficking for sexual exploitation, is a severe threat to global health. Healthcare providers are uniquely positioned to identify and care for women subjected to human trafficking for sexual exploitation. They are among the few professionals the women interact with while being exposed to human trafficking for sexual exploitation. This study aims to describe healthcare workers' experience of identifying and caring for women subjected to human trafficking for sexual exploitation seeking women's healthcare. METHOD: A qualitative design was chosen and nine qualitative interviews with healthcare providers were conducted and analyzed using the content analysis method. RESULTS: Three main categories were revealed: (1) the importance of being attentive, (2) the importance of providing safety, and (3) the importance of collaborating, followed by a number of subcategories: behavioral and physical signs, limited time to interact, security measures, value of confidence building, organizational collaboration, essential external network, and information transmission. CONCLUSIONS: As the women subjected to sex trafficking have limited time in healthcare, it is important for healthcare providers to be attentive and act immediately if suspecting human trafficking for sexual exploitation. It may be the only possibility for the healthcare providers to care for these women and reach them. They must endeavor to provide the women with safety due to their vulnerable position at the hospital. However, these women may leave the healthcare setting unidentified and unaided, which highlights the importance of collaboration on multiple levels.

Coping self-efficacy and social support as predictors of adolescent sex trafficking exit: Results of a secondary analysis.

INTRODUCTION: Social work case management services are increasingly available to youth who want to exit commercial sexual exploitation (CSE). However, few empirical studies investigate the efficacy of such services, particularly whether these services promote an exit from CSE. Guided by ecological systems theory and the Intentions to Exit Prostitution (IEP) model, this study investigates the efficacy of social work case management services for youth CSE survivors. METHODS: Youth survivors of CSE (n = 95) participated in a one-group, quasi-experimental double pre/posttest design study. Measures included the Multidimensional Scale of Perceived Social Support (MSPSS), Coping Self-Efficacy Scale (Cop-SE), and a modified version of the University of Rhode Island Change Assessment (URICA) surveys at zero- and six-months following study commencement. The research team also collected demographic and victimization data, the number and type of social work case management services received, and goal plan data. Analyses included repeated measures tests and linear and multinomial logistic regressions to determine if doses of social work case management are predictive of the positive short-term outcomes that are linked to increased readiness to exit CSE. RESULTS: Youth CSE survivors experienced upward trends in perceived social support and coping self-efficacy scores between zero- and six-months following study commencement. Linear and logistic regressions demonstrated that variables like months of service time, trafficking classification, goal counts, race, and age can predict outcomes like survivor social support, coping self-efficacy, and intention to change behaviors that can lead to revictimization. IMPLICATIONS: Results suggest social work case management services that improve coping self-efficacy and perceived social support can lead to cognitive changes that promote an exit from CSE. Practitioners should target services that adhere to dimensions of the IEP as these improvements are likely to support positive outcomes for youth survivors of CSE.

"He Loves Me Hard and Then He Abuses Me Hard": How Service Providers Define and Explain Trauma Bonds Among Sex Trafficking Survivors.

There is a dearth of research on trauma bonding among victims of sex trafficking. This study aims to fill this gap by seeking to understand how service providers working with survivors of sex trafficking conceptualize and observe trauma bonding in their clients. This qualitative study involved interviews with 10 participants. Purposeful sampling was employed among licensed social workers or counselors. Two themes emerged: defining trauma bonding (with four subthemes: embracing intensity, power imbalance, distortion of love, and inescapability) and the development of trauma bonds (with three subthemes: universality, gendered, and grooming). These findings provide much-needed insight into the complexities of trauma bonding.

Sleep Disturbances and Hygiene of Adolescent Female Survivors of Domestic Minor Sex Trafficking.

INTRODUCTION: This cross-sectional quantitative study investigated the sleep hygiene and disturbances of adolescent female survivors of domestic minor sex trafficking (DMST) compared to an online sample of community-dwelling adolescent females. METHOD: Community-dwelling adolescent females (aged 13-17 years, n = 61) and survivors of DMST housed in residental care (aged 12-17 years, n = 19) completed the Children's Report of Sleep Patterns (adolescent version). Descriptive statistics on sleep health in both samples were computed and compared using chi-square and t-tests. RESULTS: Among the survivors of DMST, the majority reported insufficient sleep duration, okay-to-poor sleep quality, waking thirsty, and frequent nightmares. Compared with community-dwelling adolescents, survivors of DMST had more symptoms of insomnia, sleepiness, nightmares, and waking thirsty (p < .05). DISCUSSION: Sleep disturbances among adolescent female survivors of DMST may be more prevalent than in community-dwelling adolescent females. Further empirical research on appropriate assessment and trauma-informed treatment of sleep in this population is needed.

What is the Impact of Human Trafficking on the Biopsychosocial Health of Victims: A Systematic Review.

The health consequences of human trafficking have been poorly researched compared to other aspects of this crime. A systematic review was carried out to study health from a broader perspective, beyond psychophysical symptoms, to understand the global impact of human trafficking on sexual, social, physical, and psychological health. The search identified many studies focused on the violence of sex trafficking in female samples. This work leads us to conclude that social health is an important dimension of the well-being of trafficking victims. More studies are needed on aspects of social health, especially regarding research gaps related to spirituality and nutrition, thus continuing preventing and combating human trafficking. Many gender biases were also discovered: unlike studies of trafficking in women, the few studies on men did not look at parenting, sexual health, marital status, or sex trafficking.

A state-wide analysis of characteristics and predictors of dual system involvement among child victims of human trafficking.

BACKGROUND: The child welfare system is pivotal in identifying and responding to child (younger than age 18) human trafficking victims. Children who have experienced human trafficking-or are at risk of victimization-are increasingly recognized as also being served in the juvenile justice system. Yet little is known about human trafficking victimization among children in the juvenile justice population or among children with child welfare and juvenile justice involvement. OBJECTIVE: Building on previous research with child welfare-and juvenile justice-involved children, we investigated characteristics and system experiences among children who have experienced a human trafficking abuse allegation in Florida. PARTICIPANTS AND SETTING: The overall study population included all children born on or after January 1, 1993, who had at least one DCF-documented maltreatment allegation before March 1, 2020. This study examined a total of 12,167 allegations in the first set of analyses and the first human trafficking allegation for each child (N = 9300) in the second set of analyses. METHODS: Analyses are based on linked administrative data for a cohort of children involved with Florida's Departments of Juvenile Justice (DJJ) and/or Children and Families (DCF). We used descriptive and multivariate logistic regression analyses to document the characteristics of single and dual system-involved children and examine predictors of child welfare, juvenile justice, and dual system involvement. RESULTS: (1) Nearly half of children with a human trafficking abuse allegation are involved in DCF at the time of the allegation, (2) females who experienced trafficking are more likely to be involved in DCF (with or without DJJ involvement) than involved in no system, (3) Black children with an alleged trafficking incident were more likely than White children to be involved in both systems compared with DCF only, and (4) children who experienced labor trafficking abuse allegations were less likely than those who experienced sex trafficking to be involved with either system. CONCLUSIONS: This study depicts child victims of sex and labor trafficking who are involved with one or both systems in one state.

Dermatology's role in the fight against human trafficking: A report from the AAD Ad Hoc Task Force and call to action.

While the majority of American Academy of Dermatology members have some broad awareness of human trafficking, most are not aware of it in their communities or of the skin signs that could prompt identification of those being exploited, and have requested educational resources to assist patients affected by trafficking. The American Academy of Dermatology Ad Hoc Task Force on Dermatologic Resources for the Intervention and Prevention of Human Trafficking has been working to develop relevant resources, including an online toolkit on the American Academy of Dermatology website: https://www.aad.org/member/clinical-quality/clinical-care/human-trafficking.

Evaluation of a Human Trafficking Educational Intervention for Nursing Professionals.

BACKGROUND: Human trafficking (HT) is a serious public health issue. Survivors of HT seek medical care. Health care professionals may be inadequately trained to identify and support survivors. This study evaluated improvements in nurses' knowledge after a professional development workshop on HT. METHOD: Pre- and postevaluation surveys assessed nurses' self-reported changes in perceived knowledge of HT and its vulnerability factors, the health impact of HT, strategies for identification and assessment of HT, and response to and follow-up of HT. RESULTS: After the workshop, participants showed significant improvement in perceived knowledge of all measures, regardless of hours of previous training and years of practice. CONCLUSION: Perceived knowledge of HT identification and response can be improved through training of nurses, regardless of hours of previous training and years of practice. [J Contin Educ Nurs. 2024;55(1):26-32.].

Streamlining healthcare delivery for sex-trafficked adolescents.

Recent years have elucidated that trafficking in the pediatric population constitutes a broader pattern of child maltreatment. Given the inconsistent engagement with the medical system that trafficked youth can experience, there is growing advocacy promoting streamlined provision of specialized services. One innovative example includes the Adolescent Protection Collaborative (APC) launched at the Children's Hospital of Philadelphia in 2021. The APC was conceptualized to serve the overlapping populations of youth impacted by sex trafficking victimization and child welfare involvement. In an effort to consolidate care and address a range of needs across the biopsychosocial spectrum, the APC brought together a child abuse pediatrician, adolescent medicine physician, and social worker to provide coordinated, real-time care during each clinic visit. It is hoped that the APC may represent a novel approach to balancing the medico-legal aspects of trafficking aftercare with the youth-empowering features of adolescent medicine and social care.

Identifying victims of labor trafficking.

ABSTRACT: Globally, more than 40 million people are victims of human trafficking, exploited as a black-market commodity generating more than $150 billion annually. These people are forced to work in various industries, including domestic work and escort services. Though studies are limited, survivor interviews have indicated that most trafficked persons presented to a healthcare provider at some point during their captivity. No single validated tool exists for screening all victims of human trafficking across all healthcare settings, but several mechanisms are available for immediate implementation, and all have the potential to pierce the veil and spare a life from further abuse.

Human trafficking risk factors, health impacts, and opportunities for intervention in Uganda: a qualitative analysis.

BACKGROUND: Human trafficking is a global public health issue that is associated with serious short- and long-term morbidity. To address and prevent human trafficking, vulnerabilities to human trafficking and forces sustaining it need to be better understood among specific subpopulations. We aimed to explore risk and protective factors for human trafficking, the health impact of exploitation, and barriers and facilitators of seeking help throughout the human trafficking trajectory among forced labor and sex trafficking victims in Kampala, Uganda. METHODS: Between March and November 2020, in-depth, semi-structured qualitative interviews were conducted with 108 victims of forced labor and sex trafficking who had completed a human trafficking survey conducted by the Uganda Youth Development Link (UYDEL). Participants who experienced various forms of exploitation were purposively invited for qualitative interviews and a convenience sample was interviewed. Interviews explored personal history, trafficking recruitment, experiences of exploitation and abuse, and experiences seeking help. Interviews were analyzed using a combination of deductive and inductive thematic analysis. Themes and subthemes were organized using an adapted conceptual framework of human trafficking. RESULTS: Poverty and an abusive home life, frequently triggered by the death of a caretaker, underpinned vulnerability to human trafficking recruitment. Limited education, lack of social support, and survival needs pushed victims into exploitative situations. Victims of human trafficking were systematically exploited and exposed to dangerous working conditions. Victims suffered from sexually transmitted diseases, incontinence, traumatic fistulae, musculoskeletal injuries, and mental health symptoms. Lack of awareness of resources, fear of negative consequences, restrictions on movement, and dependence on the trafficker and exploitation income prevented victims from seeking help. The police and healthcare workers were the few professionals that they interacted with, but these interactions were oftentimes negative experiences. CONCLUSIONS: To address and prevent human trafficking, localized interventions are needed at all stages of the human trafficking trajectory. Health impacts of human trafficking are severe. As some of the few professionals trafficking victims interact with, police and healthcare workers are important targets for anti-trafficking training. Improved understanding of human trafficking drivers and barriers and facilitators to seeking help can inform the design of necessary interventions.

Visit Data and Telehealth in a Clinic for Trafficked Persons: Virtual Care and Human Trafficking During the COVID-19 Pandemic.

BACKGROUND: Human trafficking involves coerced labor or sex. THRIVE, a multidisciplinary University of Miami clinic for trafficked persons, transitioned to a hybrid telehealth model during the COVID-19 pandemic. Th is paper presents appointment data across THRIVE clinic services during this transition. METHODS: A review of appointments for THRIVE patients (n=156) was conducted to compare pre-pandemic (February 2019 to February 2020) and pandemic (March 2020 to December 2021) appointment trends. RESULTS: There were 15% more scheduled (n=51.1 versus n=44) and 8% more completed (n=30.2 versus n=27.9) appointments per month early in the pandemic period with telehealth use compared to the pre-pandemic period. Telehealth was most used within psychiatry. Rescheduled and no-show appointments per month significantly increased during the pandemic period (p=0.010 in pandemic period 1 and and p=0.028 in pandemic period 2). There were few significant differences in appointment trends according to demographic variables. CONCLUSION: Telehealth succeeded in connecting THRIVE patients during the pandemic, highlighting its potential for long-term use amongst trafficked persons.

Victims of human trafficking and exploitation in the healthcare system: a retrospective study using a large multi-state dataset and ICD-10 codes.

Trafficking and exploitation for sex or labor affects millions of persons worldwide. To improve healthcare for these patients, in late 2018 new ICD-10 medical diagnosis codes were implemented in the US. These 13 codes include diagnosis of adult and child sexual exploitation, adult and child labor exploitation, and history of exploitation. Here we report on a database search of a large US health insurer that contained approximately 47.1 million patients and 0.9 million provider organizations, not limited to large medical systems. We reported on any diagnosis with the new codes between 2018-09-01 and 2022-09-01. The dataset was found to contain 5,262 instances of the ICD-10 codes. Regression analysis of the codes found a 5.8% increase in the uptake of these codes per year, representing a decline relative to 6.7% annual increase in the data. The codes were used by 1,810 different providers (0.19% of total) for 2,793 patients. Of the patients, 1,248 were recently trafficked, while the remainder had a personal history of exploitation. Of the recent cases, 86% experienced sexual exploitation, 14% labor exploitation and 0.8% both types. These patients were predominantly female (83%) with a median age of 20 (interquartile range: 15-35). The patients were characterized by persistently high prevalence of mental health conditions (including anxiety: 21%, post-traumatic stress disorder: 20%, major depression: 18%), sexually-transmitted infections, and high utilization of the emergency department (ED). The patients' first report of trafficking occurred most often outside of a hospital or emergency setting (55%), primarily during office and psychiatric visits.

Caring for Domestic Minor Sex Trafficking Patients: Recommendations for Identification, Interventions, and Resources.

Domestic minor sex trafficking has increasingly gained awareness as a social phenomenon that affects adolescent health and safety. Healthcare providers are uniquely positioned to identify and facilitate supportive interventions for adolescents at high risk or involved in trafficking. A growing literature base and clinical experience provide recommendations on how to identify, engage trafficked youth, and provide beneficial linkages with community resources. A coordinated, multidisciplinary, and trauma-informed response that fosters therapeutic alliances promoting agency, safety, and trust are key components of successful care for this vulnerable adolescent population.

Defiance and Strength: A Qualitative Study of Sex Trafficking Survivor-Advocate Coping Strategies.

In the two decades since federal law prohibited the trafficking of humans for sexual or nonsexual services, researchers have generated knowledge related to the mental and physical health consequences of the experience, the individual and environmental factors that facilitate exploitation, and the best practices for prevention and intervention. Despite these advances in knowledge about human trafficking, relatively scant research has explored the resiliencies of survivors, as a deficit-based narrative persists when exploring and contemplating survivor experiences. While the movement increasingly recognizes the need to situate the survivor voice in service delivery, advocacy, and research, an inquiry that values survivor strengths remains nascent. Using the Intersectional-Standpoint Methodology (ISM) and phenomenology, this qualitative study explores the nuances of resiliency during exploitation and exit among seven sex trafficking survivor-advocates in a small midwestern state. Themes related to coping strategies, intrapersonal coping skills, and interpersonal coping skills were revealed and contextualized through the four variables proposed in ISM. Implications for service provision and policy are provided.

Human Trafficking Education: An Asynchronous Approach to Improve Nurses' Knowledge and Application.

Nurses as healthcare professionals are in key positions to identify trafficked persons. Assessment of nurse knowledge shows the benefit of using asynchronous human trafficking education as a means for learning. Recommendations from this study for professional development educators include garnishing nurse executive support and use of case-study, evidence-based approaches. Support for state-mandated human trafficking education requirements for initial and ongoing licensure of nurses is necessary as human trafficking knowledge may decrease over time.