I Think My Patient Is Being Trafficked

Roxanne Nelson, RN, BSN

Disclosures

September 24, 2019

An encounter with a trafficked victim is generally considered successful if the person discloses and accepts help. But Stoklosa believes that "success" needs to be redefined.

Redefining success is empowering for the clinician, who isn't going to feel like they failed if the patient doesn't disclose, and also for the patient, who doesn't feel pressured into it.

"In my view, the goal of that first encounter is to create an open door," she emphasized. "That the person knows this and when they're ready disclose or seek help, this is where they know they can find it. Redefining success is empowering for the clinician, who isn't going to feel like they failed if the patient doesn't disclose, and also for the patient, who doesn't feel pressured into it."

Without asking the patient directly, the conversation can be opened by discussing abuse. For example, if the patient has a substance abuse problem, Stoklosa explained that the conversation can go something like this: "Some people exchange sex for drugs, and these same people end up getting trafficked and can't leave. The reason I am telling you this is that we have resources to help people like that."

With minors, it may be a little more difficult because many kids don't realize that they are being exploited, explained Greenbaum. "So with a 15-year-old girl with multiple STDs who is a runaway or homeless, the provider should express concern and not try to force a disclosure," she said. "The goal is to identify patients who are either being trafficked or who are at high risk for it."

But with children, it is also very important for the physician to be clear about the limits of confidentiality early in the discussion and acknowledge that information may have to be shared with authorities. In this case, the child can be given a simple description of the conditions under which information would have to be disclosed.

In addition to persons who are actively being victimized, it is also important to recognize those who may be at high risk, according to Gibbs. "Healthcare settings are a key place to identify people, because they are really first responders. But the reality is that patients are often more likely not to disclose than to disclose, and we have to respect their wishes."

Helping Victims Takes Resources and Collaboration

Clinicians may be unprepared if the patient acknowledges the situation and asks for help. Their facility may not have a protocol in place, or even have referral information readily available.

"Developing a response plan preceded trafficking training because we wanted to be able to have resources in place," said Nicole Ensminger, human trafficking response program manager at Ascension Via Christi. "If someone suspects a patient is being trafficked and then activates the response plan, the resources are there."

Also of importance, she emphasized, is to develop community collaboration "because we can't do this alone. We have partnered with resources in the community to make sure that the patient has a safe place to go and can receive services and treatment. And this is going to look different for each individual on their healing path."

If the patient does accept or requests assistance, clinicians should provide the patient with a "warm" or personal introduction to a local advocacy group or other resource, depending on the patient's needs and wishes. Local, state, or national resources, both public and private, that can provide services and support to patients, should ideally be located ahead of time.

Communities, however, may not always be prepared.

Northwell Health, the largest healthcare provider in New York State, recently initiated a program to train ED clinicians and other staff to identify and refer individuals for treatment, or connect them to community resources. Santhosh Paulus, MD, site director of graduate medical education and family physician at Huntington Hospital, Long Island, created and leads the Huntington Hospital Human Trafficking Response Program task force.

They collaborated with Restore NYC, an organization that assists people caught up in sex trafficking, which provided the initial training to key staff, and a hospital task force has now trained other personnel. The program is being rolled out to other Northwell facilities.

"The hard part is hooking patients up to the right resources and getting them the help they need," said Paulus. "For instance, there is no dedicated safe house for trafficking in Suffolk County, where Huntington Hospital is located, although we have them in Queens and Nassau County."

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