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.

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.

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.].

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.

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.

A simulated pedagogical intervention to educate nurse practitioner students about human trafficking.

ABSTRACT: Human trafficking (HT) affects an estimated 40.3 million people globally with 24.9 million people affected in forced labor and 4.8 million in forced sexual exploitation. An estimated 18,000 people are trafficked yearly into the United States. Reports suggest that between 63% and 87% of trafficked persons were seen by health care professionals and were unrecognized while in captivity. The authors designed and implemented an innovative pedagogical intervention for nurse practitioner (NP) students using a 10-min simulation-based education encounter with a standardized patient depicting a potential sex or labor HT clinical presentation. Results demonstrated that simulation-based education is a feasible way to provide HT education to NP students. It is imperative that future NPs receive education/training about HT to recognize potential victims and promote access to appropriate resources.

Reframing human trafficking awareness campaigns in the United States: goals, audience, and content.

Introduction: Human trafficking (HT) awareness campaigns can educate the public and specific professional figures about this crime and ways to prevent it. However, there currently remains a gap in terms of how to best frame such campaigns without stigmatizing groups of individuals or portraying victims in unrealistic ways. Methods: We conducted four focus groups with 22 experts in HT to explore their perspectives and opinions on current challenges in the framing of HT awareness campaigns in the United States. Focus groups were conducted via Zoom and transcribed verbatim. Two independent reviewers analyzed the transcripts to identify themes using an inductive approach. The results of the focus groups analysis were used to structure the guiding questions of a brainstorming technique named Nominal Group Technique (NGT). Fifteen of 22 experts that participated in the focus groups joined the in-person NGT with the intent of generating ideas and achieving consensus on target audiences, goals, and content of human trafficking awareness campaigns. At the end of the NGT participants ranked priority for actions in the development of HT awareness efforts in the United States. Results: During the NGT the experts provided a number of recommendations to improve HT awareness and to empower victims to reach for help. They pointed to the need for: awareness efforts that describe HT on a spectrum of human abuse and exploitation; training for professional figures about trauma-informed care and communication; and efforts that empower trafficked victims to seek support. They also pointed to the need to develop awareness efforts tailored to local needs in close collaborations with the community-based organizations that can champion their dissemination and be the primary point of access for victims seeking help.

The Haven Clinic: The Planning and Implementation of a Medical Home for Child Trafficking Survivors.

The authors describe the planning and implementation of a survivor-informed medical home for child trafficking survivors. Key partnerships necessary for establishing clinical infrastructure are highlighted. The trauma-informed clinical practices are described in detail. An overview of next steps for evaluation of this clinical program is provided.

Human Trafficking and Emergency Medical Services (EMS).

Human trafficking is associated with wide-ranging mental and physical morbidity, as well as mortality, in the United States and globally. Emergency Medical Services (EMS) providers are often first responders to victims of human trafficking. Given their proximity to patients' social and environmental circumstances, these clinicians need to be familiar with the signs and symptoms of human trafficking, as well understand how to best provide care for suspected or confirmed trafficked patients. Evidence from multiple studies indicates that providers who have received formal training may be better able to recognize the signs and symptoms of human trafficking, and thus, can provide better care to potential victims of human trafficking. This review will summarize the relevance of human trafficking to prehospital emergency care, touch on best practices for the care of patients with suspected or confirmed ties to human trafficking, and outline future directions for education and research.

Health care professionals' self-efficacy in identifying and treating human trafficking victims.

BACKGROUND: Human trafficking is characterized as a violation of human rights that exploits males and females of any age for personal or financial gain. Recently, health care professionals have been identified as feasible change agents in this global issue. However, many health care professionals are not trained in identifying and treating human trafficking victims. Through human trafficking education, health care professionals have the potential to be better equipped to recognize and assist trafficking victims and guide them to the specialized care they need. OBJECTIVE: The purpose of this study was to measure the effect of a trauma-informed human trafficking education intervention and the impact of this training on the self-efficacy of health care professionals in identifying and recognizing human trafficking victims in healthcare settings. DESIGN: The study was a quasi-experimental research design with snowball and convenience recruitment SETTING: 100 % virtual, online. PARTICIPANTS: Health care professionals (N = 30) including Nurse Practitioners, Physician Assistants, Registered Nurses, Licensed Practical Nurses, Certified Medical Assistants, Certified Nursing Assistants, Emergency Medical Technicians, and Paramedics from a variety of healthcare settings. METHODS: 30 min total program to include Qualtrics pre-intervention Violence Against Women Health Care Provider survey, 20 min educational intervention on YouTube©, and an identical Qualtrics post-intervention survey. RESULTS: Total of 30 sets of paired data. The results showed statistically significant improvement in self-efficacy in all survey questions pre- and post-human trafficking educational intervention (p < .001). CONCLUSIONS: An increase in health care professionals' self-efficacy in identifying and treating human trafficking victims yields better patient and health care system outcomes. Trauma-informed human trafficking education for all health care professionals is recommended.

Policy and Systems Change in Intimate Partner Violence and Human Trafficking: Evaluation of a Federal Cross-Sector Initiative.

Objectives: This study evaluates Project Catalyst's impact on policies related to Intimate Partner Violence (IV) and Human Trafficking (HT), which contribute to negative health outcomes for survivors. Methods: We utilized continuous evaluation using data from policy assessment tools and interviews with participating state leadership team (SLT) members. Results: Five SLTs reported integration of IPV into state-level initiatives. All implemented clinical practice and organizational policy recommendations. SLTs reported that Project Catalyst increased awareness of IPV/HT and health impacts and established ongoing partnerships between the three organizations. Conclusions: Funding, training, and technical assistance to encourage cross-sector collaboration at the state level can promote policy changes that support comprehensive health center responses to IPV/HT.

Implementation Challenges of T Visa Eligibility for Human Trafficking Survivors: A Role for Social Work.

The passage of the Victims of Trafficking and Violence Protection Act of 2000 (TVPA) and subsequent creation of a residency process for nonresident survivors of human trafficking (the T Visa) are notable milestones in the United States' effort to address the problem of human trafficking and provide essential supports to trafficking survivors. However, current implementation of the statute's eligibility criteria for accessing entitlements and protections contributes to a potential for retraumatization, further traumatization, and other continued harms to survivors. The present article explores the structural and conceptual limitations of current T Visa policy and of recent annual policy guidance materials as important contributors to these policy implementation problems. Resulting problems are identified as an ambiguity of definitions and thresholds, a narrow conceptualization of victimhood, and the contradictory relationship between protection and prosecution. This article then utilizes a trauma-informed social policy framework to identify multisystemic action steps for social workers to address these limitations and improve the T Visa process for trafficking survivors. These actions steps provide an essential road map for closing the gap between the policy goals of the TVPA and its current implementation.

Education Improves Emergency Department Providers' Knowledge of Human Trafficking.

The purpose of this quality improvement (QI) initiative was to implement a human trafficking (HT) education module for the emergency department (ED) staff and providers along with implementation of a policy and protocol for screening, identification, and referral of HT victims in the ED to increase provider knowledge of HT and ensure provider compliance with the HT protocol via documentation of red flags and screening questions in the electronic medical record along with social services referrals. The goal of the social services referral was to connect the HT victim with community resources that facilitated placement, food, and shelter in the event the trafficking victim accepted rescue. HT is a public health concern, globally, nationally, and at the state and local levels. ED providers, which include advanced practice registered nurses such as nurse practitioners and clinical nurse specialists, are positioned to be able to identify and treat victims of HT. Therefore, HT victims are being seen and treated in EDs; however, health care providers are not recognizing them. Project design was a QI initiative, which utilized a convenience sample of ED providers. All ED providers and staff completed the HT Education module in Health Stream with pretest/posttest assessments via the PROTECT instrument, which evaluated ED staff/provider knowledge, perceived, actual, and confidence of HT, demographics, previous contact with HT victims, and participant preference for future HT training. HT Education resulted in improved knowledge of participants' perceived, actual, and confidence of HT as demonstrated by statistical significance from pretest to posttest scores; therefore, the HT educational training proved to be beneficial.

Slipping through the cracks-detection of sex trafficking in the adult emergency department: An integrative review.

INTRODUCTION: Current research estimates that over 24 million individuals experience human trafficking worldwide. There is a growing prevalence of sex trafficking in the United States. An estimated 87% of trafficked persons visit the emergency department during their captivity. Emergency departments across the United States use differing screening methods for sex trafficking. Current screening tools return a high rate of false negatives, and the appropriate use of tools or standardised lists remains unclear. AIMS: To explore best practices for identifying sex trafficking among adults who visit emergency departments. We sought to answer the practice question: How does the implementation of a multifaceted screening model for sex trafficking, versus the use of a list of standardised screening questions, improve the detection of trafficked persons? METHODS: We conducted an integrative review of articles published after 2016 in PubMed, CINAHL, Embase, SCOPUS, and Web of Science databases. PRISMA checklist and guidelines were used. Whittemore and Knafl's method was used to review the literature. RESULTS: A final selection of 11 articles were reviewed and appraised using the Johns Hopkins nursing evidence-based practice model. The synthesis of evidence yielded four themes: (1) Provider and personnel education; (2) Protocol establishment; (3) Legal consultation; and (4) Multidisciplinary teamwork. CONCLUSION: Through this process, we learned the importance of using multifaceted screening tools for identifying persons who are experiencing sex trafficking. In addition to using multifaceted screening tools, detection is improved when all emergency department personnel receive training on sex trafficking. There is a recognised lack of education on sex trafficking recognition nationwide. RELEVANCE TO CLINICAL PRACTICE: Notably, emergency department nurses play an essential role in sex trafficking identification due to their maximised interaction with patients and the increased perception of trust that patients have with nurses. Steps include the development of an education program to improve recognition. NO PATIENT OR PUBLIC CONTRIBUTION: There was no patient or public involvement in the design or drafting of this integrative review.