Survivor Recommendations for Educating Healthcare Professionals on Human Trafficking

Oct 15, 2019 | by Shaina

Over the last several months, the Healthcare Subcommittee of the Cook County Human Trafficking Task Force has been working to develop a model curriculum to educate current and future healthcare professionals. This is an important endeavor as we know that human trafficking is still a topic that is not commonly covered in the education most healthcare professionals receive prior to starting their careers. There has been increased focus on education for healthcare professionals on human trafficking in an attempt to address the knowledge gap and improve identification and response. 

Survivors of sex and labor trafficking come into contact with a variety of healthcare settings more frequently than professionals think, but they are rarely identified. In a 2017 Polaris survey of 127 sex and labor trafficking survivors, 69% of respondents interviewed by Polaris reported having had access to health services at some time during their exploitation. 85% said they had received treatment for an illness or injury directly related to their work or exploitation. However, only 6% of healthcare workers report treating a victim of human trafficking at some point in their career. 

There are still existing barriers to disclosure. 70% of patients never disclosed sex trade involvement to their medical providers for fear of discrimination or diminished health care. Labor trafficking survivors experience similar barriers for fear of deportation or employment retaliation. Education is therefore all the more important to ensure that healthcare providers are able to provide medical care in a way that is trauma-informed and nonjudgmental. 

The Journal of Human Trafficking recently released a three-part series titled ‘A Framework for the Development of Healthcare Provider Education Programs on Human Trafficking’. Part One focuses on what human trafficking experts suggest be included in education material for healthcare professionals, Part Two focuses on education content recommended by survivors, and Part Three provides recommendations and guidelines for those developing education programs. 

Here we will highlight the survivor recommendations the journal collected through their two-phase study. 38 survivor participants (male, female, and transgender raging in age from 15-60) took part in Phase One which involved answering twelve open-ended questions, allowing them to share their recommendations for content for education and their experiences interacting with healthcare providers. 

Themes from Phase One included:

 - Participant assessments of the “before, during, and after” of their trafficking experience

Survivors shared about the factors that led to their exploitation, abuse endured during their trafficking experiences, and the circumstances that led them to accessing healthcare. A table included in the research article contains a long list of reasons that survivors sought ‘physical healthcare’, headaches, contraception, and sexually transmitted infections being the top three. The top three reasons for seeking mental health care were suicide attempts, depression, and anxiety. A hospital was a safe place for some survivors, a place where they were cared for and provided food. 

- Discussion about barriers to recognition, ineffective and effective actions by HCPs, and appropriate referral in clinical settings

The researchers share that participants in this study “commonly reported feeling negatively judged by clinical staff”. Participants reported a number of “clinician-specific problems” including re-traumatization due to having to tell their stories repeatedly to different providers, lack of identification, receiving treatment for symptoms while providers missed the underlying problem, and an overall failure to provide care in a trauma-informed way.

- Recommendations regarding recognition of trafficked persons

Survivors in this study recommended including the following elements into any  education for healthcare providers who may interact with patients experiencing trafficking:

  • Knowledge of red flags
  • Skilled collaboration and assessment
  • Compassion
  • Advocacy
  • Respect
  • Trust
  • Patience
  • Gentleness
  • Sensitivity
  • Safety
  • Exhibiting a non-judgmental attitude

- Participants in the study made additional recommendations that the researchers summarized as follows: 

- perform true informed consent of all treatments and share realistic time frames.
- do not touch the TP (trafficked patient) without permission, and only when clinically necessary.
- allow the patient as much control as possible, such as allowing the patient to guide HCPs during sensitive examinations.
- listen attentively to patients’ self-identified needs.
- have other survivors be a part of the care team to“…reduce the shame that many [people] feel…”

- Best actions to facilitate safety for the trafficked patient

According to participants, education for healthcare professionals regarding patient safety should cover the following topics: “resource access and preparedness, mandatory and non-mandatory reporting, trust building, HCP and community training, separation from the trafficker, survivor empowerment, follow up, and monitoring.” 

30 of the 38 survivor participants from Phase One took part in Phase Two. Phase Two involved ranking the themes identified in Phase One. Survivor participants in this study reached consensus on 23 topics for education content for healthcare professionals and perfect consensus on five topics in particular: “the dangers of HCP bias and assumptions, how to appropriately refer trafficked persons, when to report to law enforcement, and content on the mind-body connection in HCP educational programs.”

So much rich information was gathered from the participants in this study. Every survivor should have access to quality healthcare from trauma-informed professionals who understand trafficking. Survivor input and consultation is essential for HT curriculum development and any education for healthcare professionals on this issue should be based on the real experiences of trafficked patients. 

Moving forward, the Healthcare Subcommittee plans to make sure that the above information is a part of the model curriculum the task force disseminates and seek input from local survivors who have accessed health care to ensure that our model curriculum touches on what’s most important for healthcare providers to know. 

Sources:

Chisolm-Strakera, M., Miller, C., Duke, G., and Stoklosa, H. A Framework for the Development of Healthcare Provider Education Programs on Human Trafficking Part Two: Survivors. Journal of Human Trafficking, 1-15. 

Polaris. On-Ramps, Intersections, and Exit Routes: A Roadmap for Systems and Industries to Prevent and Disrupt Human Trafficking. Healthcare. (2018).


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