SHARING INFORMATION WITH PATIENTS

Healthcare professionals are on the front lines 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.

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 (WHO, 2023a).

The World Health Organization recommends that healthcare institutions implement the following:

  • Remove barriers to care, such as social and financial obstacles, to the degree possible and take measures to increase trafficking providers’ trust in the health care system.
  • Become involved in prevention efforts when possible, supporting programs such as “My Strength” and “My Life” that are offered in the United States.
  • Develop treatment plans based on available resources and ensure that these plans are patient-centered.
  • Use validated screening tools to universally screen all patients for trafficking.
  • Provide trauma-informed and compassionate care.
  • Promote staff education on human trafficking that can be standardized and easily accessed by staff, such as online training, in order to provide better quality care to trafficking survivors.
  • Create policies and programs at local and state levels to address human trafficking.
  • Encourage leadership among health professionals to provide education and intervention.
  • Become involved in research for evidence-based best practices.
    (WHO, 2023b)

When providing direct care for suspected human trafficking patients, the clinician should not focus on eliciting information from them about their trafficking situation. Instead, the clinician should offer comprehensive care services that are unique to the patient’s needs and sensitive to the patient’s circumstances. The aim of the provider is to establish a safe haven in the environment, treat the patient for their medical needs, and offer information and support. It is important that the patient gives consent for any procedures and that the clinician maintains trauma-informed principles (Stoklosa & Beals, 2022).

Survivors who have experienced human trafficking are experts on this topic and understand what healthcare providers need to know in order to create a safe space to interact. According to survivors, it is important that healthcare workers have a working knowledge of resources and mandatory and nonmandatory reporting of human trafficking. When sharing information, healthcare workers should share accurate timeframes, 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 provided to help navigate a complex system. It is important for victims to understand their rights so that they can receive services to address 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 (see box below).

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. 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 they visited the website. The National Human Trafficking Hotline can also be accessed by text.

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.

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 & Johnson, 2021).

(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 (U.S. DHS, 2019).

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. CIS, 2023b). The number of petitioners for the U visa from 2009 to 2020 was 30,900, and USCIS approved 20,400 applications in that same time period (U.S. CIS, 2020a).

Three barriers have been identified that prevent victims from obtaining a T visa:

  • The process is not consolidated, and as a result, victims must tell multiple people and agencies what happened to them and relive the trauma each time.
  • Many victims do not speak English as a first language (if they speak it at all), but the visa application to be completed is in English.
  • The time to process the T visa is lengthy, ranging from 18 months to two and a half years. but the applicant is unable to legally work in the United States during that time.
    (Human Trafficking Search, 2021)
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 (a program that grants sponsors to bring foreign workers into the United States), 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 eventually obtained a T visa for trafficking victims. Today she works as a nanny and earns enough money to send some to her children.