SHARING INFORMATION WITH PATIENTS

Healthcare professionals are on the frontlines 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 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).

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 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.)

In Michigan, 21.5% of victims needed medical care, 21.5% needed mental health services, 30.8% needed family legal services, and 35.4% needed criminal legal services. The most common need of victims who requested services at the University of Michigan was a T visa (44.6%), and 44.7% of victims requested immigration services (Munro-Kramer, 2019).

Local resources can be identified easily by calling or accessing the National Human Trafficking Hotline website. The National Human Trafficking Hotline website offers an interactive map and search tool to locate specific types of resources in regions throughout the United States, including Michigan. This tool may be accessed by the healthcare provider in the presence of the patient or the patient may use it independently. The website has an escape key to protect victims from repercussions should they be at risk from the trafficker discovering that the visited the website. The National Human Trafficking Hotline can also be accessed by text.

Other resources to consider sharing with human trafficking survivors include:

  • The Michigan Human Trafficking Task Force is a multidisciplinary organization whose focus is to educate, bring awareness, and link trafficking survivors with services. The organization partners with law enforcement, refugee services, faith-based programs, shelters, healthcare services, and advocacy groups. They also maintain a presence on social media.
  • 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.

(See “Resources” at the end of this course.)

U VISA and T VISA

The U visa is a unique visa for undocumented victims of crimes who have suffered substantial mental or physical abuse and are willing to assist law enforcement in the investigation or prosecution of the criminal case. It was developed with the intent to strengthen the ability of law enforcement to investigate and prosecute certain types of cases. Victims who are granted a U visa are given temporary legal status and work eligibility in the United States for up to four years. This program helps law enforcement agencies assist many victims of crimes who would otherwise not be served.

The T visa is similar and addresses victims of trafficking. These victims, along with approved family members, may reside in the United States for approximately four years if they comply with criminal justice system requests (U.S. DHS, 2016).

The number of petitioners for the U visa has diminished from a total of 58,991 in 2018 to 47,225 in 2019 (U.S. CIS, 2020). This decrease in applications is attributed to Immigration and Customs Enforcement (ICE) Directive 11005.1, which allows ICE to deport pending U visa applicants at their discretion (U.S. ICE, 2019).

CASE
Labor Trafficking

Celia entered the United States from the Philippines. Desperate for work to support her three children after her husband suffered a stroke, Celia had been recruited by an organization in Manila that represented itself as an employment agency for catering and hospitality jobs in the United States. When she first arrived in the United States, she owed the recruiter $3,000 for an H-2B visa, airfare, and interest for a loan that had been suggested by the recruiter.

Although her contract stated she would work 40 hours per week for $8.50 per hour, Celia was never paid that much per hour and was never given that number of hours. Her work visa was specific to her contract with a certain hotel, and she was unable to secure additional hours elsewhere to make ends meet. Her rent, which was an inflated amount, and her bus fare were deducted from her paycheck, leaving her about $50 per week to repay her loan, buy food, and send money home to the Philippines to support her children.

Although Celia’s visa status qualified her for Medicaid, she was not aware of this and was reluctant to seek healthcare or establish a professional relationship of trust with a primary care provider or dentist. When she got sick, she relied on home remedies until she became seriously ill, at which point she was forced to visit the local hospital emergency department.

In the emergency department, Celia was diagnosed with bronchitis. As part of a simple screening process, the nurse asked Celia about her living situation and elicited Celia’s response about being forced to share a single room with five other hotel coworkers because that is all she could afford. Through the nurse’s empathetic response, Celia felt encouraged to share more about how she had been promised a well-paying job but instead made $50 a week and was unable to repay her debt to the company that brought her to the United States from the Philippines.

Suspecting that Celia was a victim of labor trafficking, the nurse referred her to a local agency that could help free her from her servitude. Celia learned of her rights, received legal assistance, and obtained a T visa for trafficking victims. Today she works as a nanny and earns enough money to send some to her children.
(Adapted from Schwartz, 2017.)