TRAUMA-INFORMED CARE

Trauma is an intense response to a stressful situation that can result in lasting negative effects on an individual that are averse to their health and well-being. Trauma impacts an individual’s worldview, identity, and relationships. These beliefs impact how the individual will respond to available services and the criminal justice system.

Therefore, whenever a clinician is interacting with a potential victim of human trafficking, trauma-informed care and interviewing techniques are important so that the individual is not inadvertently retraumatized. Providers should incorporate the “Four Rs” into their trauma-informed practice:

1. Realize the prevalence of trauma
2. Recognize that trauma affects how an individual responds to interactions with the organization or system
3. Respond by putting knowledge into practice
4. Resist retraumatization of individuals

Any service provider who interfaces with an individual who has a history of trauma—from the receptionist to the physician—should be educated about trauma-informed care and strive to create an environment in which the patient feels safe, believed, and empowered. Nobody should be made to feel like a witness to a crime for which they are the victim (OVC, 2023).

Principles of a Trauma-Informed Approach

Promising practices for a trauma-informed approach to screening rely on caring for each individual as if they have experienced a trauma and being mindful to avoid retraumatizing the patient. There is a focus on physical, psychological, and emotional safety and an emphasis on helping the patient achieve a sense of control, empowerment, and agency.

The six principles of a trauma-informed approach include:

1. Safety. The provider ensures safety for the patient, both physical and emotional, and maximizes the patient’s control. The provider aims to meet the basic needs of the patient, including necessary medications.
2. Trustworthiness and transparency. The provider spells out the limits of confidentiality and ensures that the patient is heard and understood.
3. Peer support. The provider encourages the patient who has survived trauma to implement self-help.
4. Collaboration and mutuality. The provider acknowledges the individual roles of the patient and staff and attempts to even out power discrepancies.
5. Empowerment, voice, and choice. The provider supports the individual’s sense of agency and helps the survivor become empowered.
6. Cultural, historical, and gender issues: The provider recognizes that there may be sources of trauma from cultural, racial, ethnicity, gender, and historical issues, including adverse childhood experiences (ACEs).
   (Human Trafficking Collaborative, UOM, n.d.)

Asking Difficult Questions

Sometimes it is difficult to frame questions in a way that will feel nonjudgmental to a victim. The ability to ask questions in a way that does not cast blame will provide the health professional with better information and is unlikely to cause harm to the patient.

• An opening statement such as “I would like you to tell me everything that you are comfortable sharing” can be very helpful.
• If immigration status might be an issue, it is best to not ask about this initially.
• Asking, “What were you wearing?” could be interpreted by the patient as blaming them for the occurrence based on their dress. Instead, one might ask, “What are you able to remember about what you were wearing?”
• It is important to avoid asking victims of human trafficking “why” questions about any of their actions or responses. Asking “why” may cause the victim to feel or believe that they did something wrong and is likely to negatively impact the interview.

Forensic Experiential Trauma Interview

Principles from the Forensic Experiential Trauma Interview (FETI), developed by Russell Strand, can be utilized by healthcare professionals who work with victims of trauma. The FETI is based on the neurobiology of trauma that entails a shutting down of the prefrontal cortex during the traumatic or stressful event. The prefrontal cortex, when operating efficiently, is the cognitive part of the brain that normally records the memory of an event (who, what, why, where, when, and how). During a traumatic event, less-advanced portions of the brain record the event. Stress and trauma interrupt how memories are stored and may lead to the victim expressing inconsistent or incorrect statements.

• Interviewers make a sincere effort to establish safety, trust, and comfort for the victim. They acknowledge the victim’s trauma and ask nonleading questions such as, “What are you able to tell me about your experience?” or “I would like you to share with me everything that you are comfortable sharing.” Statements such as “Help me understand about the car ride” replace the use of “Why did you get in the car with him?”
• Interviewers do not interrupt, and they pause to allow victims time to think through the question. They may ask, “What were you feeling?” or “What was your thought process during this experience?” instead of “Why did you do that?”
• Interviewers express empathy and understanding and allow the victim to say they “don’t remember” rather than asking the victim to guess.
• Interviewers acknowledge that the victim may remember more after some time has passed.
  (Lonsway & Archambault, 2021)

In Michigan, screening for human trafficking of children may be accomplished by forensic interviews that utilize a multidisciplinary team to assess minor victims. Law enforcement and Child Protective Services professionals coordinate to be present simultaneously. Rapport and safety are essential to eliciting accurate information. If an interpreter is needed, professional services should be obtained rather than use a family member or an acquaintance. The team should be aware of the possibility that a parent or family member may be the child’s trafficker (MDHHS, 2017).