RESPONSE AND FOLLOW UP

Healthcare Professionals’ Role in Intervention and Response

Healthcare professionals are on the frontlines of providing direct patient care to human trafficking survivors and are uniquely positioned to recognize and respond. It is incumbent upon the provider to be aware of indicators of human trafficking, implement trauma-informed care for all patients, and refer individuals to other resources as needed. According to one study, 67% of survivors who were actively being exploited encountered healthcare professionals but their situation was not recognized (U.S. DHHS, 2023).

Survivor-Centered, Multidisciplinary Referrals

Every institution should develop a survivor-centered approach to victims of human trafficking. Providers should be prepared to make an immediate referral of patients to multidisciplinary community partners using a “warm hand-off”(transfer of care between providers in the presence of the patient) and a personal approach when a patient requests assistance. The patient may need an immediate referral for housing, legal assistance, a T visa application, advocacy, or a report to law enforcement. It is essential that the facility provide education and training to providers so that they are well-acquainted with local and state resources.

If the patient does not request immediate help, the treatment plan should still include 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, 2018).

Removing victims from exploitation is only the first step, and recidivism among trafficked individuals is common without multifaceted treatment for recovery and reintegration. Reintegration and recovery require economic and social inclusion, safe housing, a reasonable standard of living, and physical and mental well-being. Survivors also require opportunities to grow personally, socially, and economically and access to justice, education, and training. To succeed, survivors must have an environment that provides access to strong emotional and social support. Unfortunately, many survivors are not identified and, as a result, do not receive assistance. Others may be criminalized, and some decline assistance. The recovery trajectories for survivors are often complex and nonlinear (Surtees, 2021).

Reporting Trafficking in Texas

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. Suspicion of such crimes must be reported within 48 hours to the Department of Family and Protective Services (DFPS). In Texas, any citizen who suspects child abuse must make a report. Reporters who feel that a child is in imminent danger should call emergency services (911) first.

The same is true with suspicion of trafficking among vulnerable adults, such as those who are unable to provide for their own care or protection due to disability or aging. Texas law states that suspected abuse, neglect, or exploitation of a person who is 65 years or older or an adult with disabilities must be reported immediately to DFPS.

• Texas Abuse Hotline: 800-252-5400
• Website: txabusehotline.org
• Texas Relay Service: 7-1-1 or 800-735-2989 (voice or TTY)

Professionals must make a verbal report or online report of suspected abuse but do not need to follow with a written report. The reporter does not need to be certain of abuse and should report if they have a reasonable suspicion (TX DFPS, 2020).

Professional Mandated Reporters

Professional mandated reporters in Texas are defined as persons who are licensed or certified by the state, work for an agency or facility licensed or certified by the state, and have contact with children within the scope of their normal work. The law states that such professionals are required to make a report of abuse or neglect involving a child or a vulnerable adult themselves and may not delegate the duty to another person such as a coworker or family member.

Professional reporters include, but are not limited to:

• Teachers
• Nurses
• Doctors
• Daycare employees
• Employees of a clinic or healthcare facility that provides reproductive services
• Juvenile probation, detention, or correctional officers

Making a Report

It is recommended that the reporting party gather the following information before making the report:

• Names of the involved persons
• Dates of birth
• Social Security numbers
• Home address
• School or daycare
• Employer
• Primary language
• Disability or special needs

Confidentiality and Liability

DFPS is required to keep the reporter’s identity confidential. A person who knowingly files a false report may be subject to civil or criminal liability. If the DFPS determines that there is no abuse or neglect and the report was filed in good faith, the reporting party is protected from liability. In addition, an employer may not suspend, terminate, or discriminate against a professional who makes a suspected child abuse report in good faith (TX DFPS, 2020).

TRAFFICKING IN COMPETENT ADULTS

There are no specific reporting statutes for trafficking that might be applied to competent adult victims due to the assumption that competent adults have the right to privacy and agency. Therefore, the professional must obtain permission from the victim before making a report.

Professional reporters of child and vulnerable adult abuse in Texas are not obligated to report competent adult trafficking victims to law enforcement unless they are treating them for a gunshot wound or an overdose of a controlled substance, per the state’s health and safety codes 161.041 and 161.042 (Texas Statutes, 2020a, 2020b).

Instead, healthcare providers should use a trauma-informed approach to provide adult victims with information, resources, and options. Victim referrals should include direct service providers such as legal assistance, housing, advocacy, law enforcement, and the local or state hotline for human trafficking victims. Professional reporters may also make a confidential report to the National Human Trafficking Hotline (see below).

WHEN TO REPORT SUSPECTED HUMAN TRAFFICKING IN TEXAS

If patient is …	Then …
Minor (under age 18)	Report within 48 hours to law enforcement or the Dept. of Family and Protective Services
Competent adult	Report only with patient consent (but anonymous report to national hotline allowed)
Age 65 or over	Report immediately to law enforcement or the Dept. of Family and Protective Services
Vulnerable/disabled/dependent adult	Report immediately to law enforcement or the Dept. of Family and Protective Services
Being treated for a gunshot wound	Report immediately to law enforcement
Being treated for overdose of controlled substance	Report immediately to the Department of State Health Services (DSHS)

Implications of Law Enforcement Involvement

Involving law enforcement is mandatory in Texas if the human trafficking survivor is a minor or a vulnerable adult, but the arrest and criminalization of trafficked youth for commercial sexual activity typically compounds their trauma. Placement in the juvenile justice system also exposes trafficking victims to other youth detained for criminal acts.

In 2000, the federal Victims of Violence and Trafficking Prevention Act redefined the commercial sexual activity of minors as victimization as opposed to criminal behavior regardless of whether the child’s activity appeared to be voluntary. This law does not protect all minors from arrest under the age of 18 in Texas, however, because the age of consent is 17 according to the state law, and there are other laws that allow for children who are as young as 14 to consent to sexual activity as long as the other party is no more than 3 years older (Human Trafficking Search, 2020).

If the survivor is a competent adult, the healthcare professional must abide by the wishes of the survivor and also consider HIPAA privacy restrictions. Once police are involved, they are limited in their actions by the protections that are available to the survivor. Programs through Trafficking Victims Protection Act, Violence Against Women Act, and Deferred Action for Childhood Arrivals may apply, as may local safe harbor provisions (HEALTrafficking.org, 2018).

Immigrants may be assisted by the U visa or T visa program, but they also run the risk of being deported by Immigration and Customs Enforcement (ICE). If the patient has been charged with a previous crime, the law enforcement officer may be required to arrest the patient based on state or local law (HEALTrafficking.org, 2020).

If law enforcement is called to the clinical setting because of violence or suspicious activity, there is a risk that the patient’s trafficker will not allow the patient to return for care or that the patient may be harmed after leaving. It is important that the care provider and/or institution think carefully before involving law enforcement or security (HEALTrafficking.org, 2020).

Community, Local, and State Resources in Texas

The state of Texas is actively addressing the issue of human trafficking. Several organizations offer a variety of services.

• The Texas Human Trafficking Resource Center is an excellent resource for healthcare providers, Health and Human Services staff, community partners, and victims of human trafficking. The website provides links to local, state, and national resources that assist with human trafficking. It includes the 52-minute video Be the One, which focuses on prevention, recognition, and reporting of human trafficking.
• Polaris, the National Human Trafficking Hotline, provides a link to content specific to Texas and downloadable materials in several languages to print and distribute. Texas information includes statistics, events, and resources for the state.
• The Coalition to Combat Human Trafficking (CCHT) is a nonprofit organization whose focus is to educate, bring awareness, and provide direct assistance to victims of sex and labor trafficking. The organization partners with law enforcement, refugee services, faith-based programs, shelters, and advocacy groups (CCHT, 2022).
• Traffick911 is an organization in Northern Texas that provides direct services including crisis response, advocacy, case management, and mentorship to commercially sexually exploited children. They partner with first responders and are available to offer crisis services to children 24 hours a day.

(See “Resources” at the end of this course for website links/contact information.)

Organizational Protocols

Healthcare institutions are well-situated to address the public health issue of human trafficking. A task force of the Hospitals Against Violence (HAV) urged the Centers for Disease Control and Prevention to create an ICD-10-CM code that classifies human trafficking as a form of abuse, which was implemented in 2019.

Hospitals can establish identification and response protocols within their institutional settings and provide staff education to ensure that victims will be identified. Nurses and other healthcare professionals can work locally with law enforcement to insure a multidisciplinary collaborative response. At the state and national level, nurses can bring public awareness to the issue and lobby legislators to improve programs that assist victims. It is essential that healthcare professionals develop relationships with community partners and local resources as well (Zangerle, 2018).

In order to serve patients who are being exploited or vulnerable, a comprehensive, multidisciplinary approach is necessary. The goal of such a protocol is not to identify victims of labor or sex trafficking and elicit a disclosure. Instead, the purpose of the protocol is to promote the creation of procedures and an environment where victims may be safely treated as well as be supported to seek assistance and become educated about their options.

The protocol toolkit from HEAL Trafficking promotes a trauma-informed approach and defines human trafficking as a public health issue. Protocol aims include:

• Clarifying roles and procedures regarding identification and reporting
• Providing staff education to ensure a survivor-centered approach
• Improving staff ability to refer patients to housing, support, and other needs
• Maximizing safety by utilizing safety planning proactively
• Collaborating with other community partners such as social services, the district attorney, direct service providers, and law enforcement
• Collecting de-identified data for analysis with community partners and state authorities
  (HEALTrafficking.org, 2018).

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.-b).

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