Person:

Stoklosa, Hanni

ABSTRACT Some 21 million adults and children are labor-trafficked or sex-trafficked through force, fraud, or coercion. In recognition of the interface between trafficking victims and the healthcare setting, over the last 10 years there has been a notable increase in training of health care professionals (HCPs) on human trafficking (HT) and its health implications. Many organizations have developed curricula and offered training in various clinical settings. However, methods and content of this education on trafficking vary widely, and there is little evaluation of the impact of the training. The goal of this study was to assess the gaps and strengths in HT education of HCPs in the US. This mixed-method study had two components. The first component consisted of structured interviews with experts in human trafficking HCP education. The second portion of the study involved an analysis of data from HCP calls to the National Human Trafficking Resource Center (NHTRC). The interviews captured trainer-specific data on types of HT training, duration and frequency, key content areas, presence of evaluation approaches and indicators, as well as an assessment of barriers and strengths in HT training for HCP. NHTRC call database analysis demonstrated increasing trends since 2008 in calls by HCPs. Overall findings revealed the need for standardization of HT training content to assure correct information, trauma-informed and patient-centered care, and consistent messaging for HCPs. Evaluation metrics for HT training need to be developed to demonstrate behavior change and impact on service delivery and patient-centered outcomes for HT victims, according to our proposed adapted Kirkpatrick’s Pyramid model. HT training and evaluation would benefit from an agency or institution at the national level to provide consistency and standardization of HT training content as well as to guide a process that would develop metrics for evaluation and the building of an evidence base. Abbreviations: AAP: American Academy of Pediatrics; ACF: Administration for Children and Families; CME: Continuing medical education; ED: Emergency department; HCP: Health care professional; HEAL: Health, Education, Advocacy, and Linkage; HHS: United States Department of Health and Human Services; HT: Human trafficking; IOM: United States Institute of Medicine; MH: Mental health; NHTRC: National Human Trafficking Resource Center; SOAR: Stop, Observe, Ask, and Respond to Health and Wellness Training

ABSTRACT Healthcare providers have the potential to play a crucial role in human trafficking prevention, identification, and intervention. However, trafficked patients are often unidentified due to lack of education and preparation available to healthcare professionals at all levels of training and practice. To increase victim identification in healthcare settings, providers need to be educated about the issue of trafficking and its clinical presentations in an interactive format that maximizes learning and ultimately patient-centered outcomes. In 2014, University of Louisville School of Medicine created a simulation-based medical education (SBME) curriculum to prepare students to recognize victims and intervene on their behalf. The authors share the factors that influenced the session’s development and incorporation into an already full third year medical curriculum and outline the development process. The process included a needs assessment for the education intervention, development of objectives and corresponding assessment, implementation of the curriculum, and finally the next steps of the module as it develops further. Additional alternatives are provided for other medical educators seeking to implement similar modules at their home institution. It is our hope that the description of this process will help others to create similar interactive educational programs and ultimately help trafficking survivors receive the care they need. Abbreviations: HCP: Healthcare professional; M-SIGHT: Medical student instruction in global human trafficking; SBME: Simulation-based medical education; SP: Standardized patient; TIC: Trauma-informed care

Human trafficking is a global concern resulting in complex, long lasting mental health consequences for survivors. The United States non-governmental sector has emerged as a key service provider in facilitating and directly providing comprehensive services for survivors, including crucial mental health services. This study aimed to better understand barriers to and potential improvements for human trafficking survivor mental health service delivery by applying a deductive framework analysis to semi- structured interviews with 15 United States based non-governmental organizations. Analysis of interview data underscored key challenges, including extensive and complex human trafficking survivor mental health needs, limited service provider capacity, and a fragmented multisector response. Themes for strategies to improve mental health service delivery included improved multisector collaboration, as well as increasing mental health professional capacity through human trafficking specific training. Implications and recommendations to improve comprehensive, trauma- informed, and client-centered human trafficking survivor care, including future research directions, are discussed.

Background: To reach global and national goals for maternal and child mortality, countries must identify vulnerable populations, which includes sex workers and their children. The objective of this study was to identify and describe maternal deaths of female sex workers in Cambodia and causes of death among their children.

Methods: A convenience sample of female sex workers were recruited by local NGOs that provide support to sex workers. We modified the maternal mortality section of the 2010 Cambodia Demographic and Health Survey and collected reports of all deaths of female sex workers. For each death we ask the ‘sisterhood’ methodology questions to identify maternal deaths. For child deaths we asked each mother who reported the death of a child about the cause of death. We also asked all participants about the cause of deaths of children of other female sex workers.

Results: We interviewed 271 female sex workers in the four largest Cambodian cities between May and September 2013. Participants reported 32 deaths of other female sex workers that met criteria for maternal death. The most common reported causes of maternal deaths were abortion (n = 13;40%) and HIV (n = 5;16%). Participants report deaths of 8 of their children and 50 deaths of children of other female sex workers. HIV was the reported cause of death for 13 (36%) children under age five.

Conclusion: This is the first report of maternal deaths of sex workers in Cambodia or any other country. This modification of the sisterhood methodology has not been validated and did not allow us to calculate maternal mortality rates so the results are not generalizable, however these deaths may represent unrecognized maternal deaths in Cambodia. The results also indicate that children of sex workers in Cambodia are at risk of HIV and may not be accessing treatment. These issues require additional studies but in the meantime we must assure that sex workers in Cambodia and their children have access to quality health services.

This article reviews an emergency department-based clinical vignette of a trafficked patient with co-occurring pregnancy-related, mental health, and substance use disorder issues. The authors, including a survivor of human trafficking, draw on their backgrounds in addiction care, human trafficking, emergency medicine, and psychiatry to review the literature on relevant general health and mental health consequences of trafficking and propose an approach to the clinical complexities this case presents. In their discussion, the authors explicate the deleterious role of implicit bias and diagnostic overshadowing in trafficked patients with co-occurring addiction and mental illness. Finally, the authors propose a trauma-informed, multidisciplinary response to potentially trafficked patients.

This clear-sighted reference examines the public health dimensions of labor and sex trafficking in the United States, the scope of the crisis, and possibilities for solutions. Its ecological lifespan approach globally traces risk and protective factors associated with this exploitation, laying a roadmap towards its prevention. Diverse experts, including survivors, describe support and care interventions across domains and disciplines, from the law enforcement and judicial sectors to community health systems and NGOs, with a robust model for collaboration. By focusing on the humanity of trafficked persons, a public health paradigm broadens our understanding of and ability to address trafficking while adding critical direction and resources to the criminal justice and human rights structures currently in place.

Among the topics covered: Children at Risk: Foster Care and Human Trafficking LGBTQ Youth and Vulnerability to Sex Trafficking Physical Health of Human Trafficking Survivors: Unmet Essentials Research Informing Advocacy: An Anti-Human Trafficking Tool Caring for Survivors Using a Trauma-Informed Care Framework

Abstract The healthcare setting is thought to be one of the most promising places to identify victims of human trafficking. The present study was designed to relay the experiences of a sample of 10 healthcare providers and hospital administrators who developed and have used a protocol to identify victims of human trafficking since February 2014. To our knowledge, the protocol was one of the first to be adopted by any healthcare system in the U.S. Three primary themes emerged from the participant interviews. First, developing the protocol was challenging because at the time there were no predecessor examples. Second, providers reported that the protocol is simple to use and victim identification is easier because of it. Third, identifying and serving victims of human trafficking remains challenging, because there is still a deficit of trained providers and a lack of community resources for survivors. The field needs evidence that this and similar protocols improve users’ knowledge and skills, result in the better identification and treatment of trafficking victims, and ultimately improve public safety and public health.

As health-care-professional awareness about human trafficking rises and clinicians recognize their role as first responders to human-trafficking victims, they are thrust into in a unique position at the intersection of health and law. Recent literature indicates that health-care providers have a role to play, but some are reluctant to become engaged. One reason may be a lack of clarity about matters related to patient privacy as delineated by the Health Insurance Portability and Accountability Act. This article lays out key questions and answers, as well as a simple algorithm, to assist the United States-based health-care professional in caring for trafficked patients while complying with the Health Insurance Portability and Accountability Act. The article uses four case scenarios to illustrate real situations faced by clinicians when caring for potential human-trafficking patients followed by questions and answers and, where appropriate, quotes from the Health Insurance Portability and Accountability Act.