There are an estimated 21 million victims of human trafficking worldwide. Numbers have exploded since 2000, which is when the U.S. passed the Victims of Trafficking and Violence Protection Act. Many U.S. healthcare professionals have met or treated a trafficking victim at some point in their careers, but they may not have recognized the signs. A new care services initiative aims to change that trend.

  • About 90% of trafficking survivors had some contact with the healthcare system.
  • Dignity Health of San Francisco plans to roll out standard education about trafficking to staff at nearly 40 hospitals.
  • Abuse and language barriers keep people trapped in trafficking.

About nine in 10 survivors of human trafficking say they had some kind of contact with the healthcare system while they were being exploited. But none of the professionals who admitted, treated, and discharged them picked up on the clues and signs that something was wrong.

This is a problem that a major health system in California has decided to tackle with a long-term project to educate all healthcare professionals, including case managers, about what human trafficking is, how to identify its victims, and how to handle suspected trafficking cases.

A 2014 study about human trafficking shows how unprepared healthcare workers are to respond to the problem, says Holly Austin Gibbs, a patient care services program director with San Francisco-based Dignity Health. Gibbs spoke to case managers about human trafficking at the American Case Management Association’s 2016 National Conference, held April 2-6, in Tampa, FL.

“I work with survivors across the country — from both sex and labor trafficking — and I know more survivors who had contact with the healthcare system than those who did not,” Gibbs says.

A Growing Problem

According to the Victims of Trafficking and Violence Protection Act of 2000, trafficking in 2000 was estimated to affect at least 700,000 people around the world and 50,000 in the United States. Now, the International Labor Organization estimates there are 21 million victims of human trafficking, with most of them exploited for labor. While there are no updated estimates of trafficking victims in the U.S., the National Human Trafficking Resource Center hotline receives more than 35,000 calls for help per year.

Trafficking is a growing problem and there’s greater recognition of its existence, says Dean White, LCSW, regional director of social work for Dignity Health, St. Joseph’s Hospital and Medical Center in Stockton, CA.

“We had an educational meeting with the district attorney, and he said this is growing because they’re on the streets and are seeing more and more victims, whether it’s from sex trafficking or abuse, because there’s money to be made,” White says. “Unfortunately, human beings can be taken advantage of again and again, and it doesn’t end so long as someone has control over them.”

Dignity Health plans to roll out standard education about trafficking to staff at nearly 40 hospitals, White says.

“We’re at a pivotal point, and I’m excited to be on a care coordination team with RN case managers and social workers who have been tasked with working with each hospital area and establishing strong relationships with community health, population health, and key stakeholders,” White says. “What’s unique is that this is a system approach.”

Dignity Health began the initiative as a top-down program, Gibbs says.

“It’s important to Dignity Health that patients who are victims are identified and that we respond to them effectively,” she says. “We are focusing hospital systems right now, implementing the program in maternal-child health, labor and delivery, postpartum, and are rolling out the program systemwide.”

The project includes having a community navigator in the ED to identify familiar faces, people who frequent the ED because of mental health issues, poverty, homelessness, or because they are victims of trafficking. It also includes educating all healthcare workers about human trafficking, he says.

Educate, Look for Red Flags

Educational sessions are designed to help healthcare professionals recognize common red flags related to human trafficking. (See story about trafficking red flags in this issue.)

The trouble is that healthcare professionals often will see something about a patient that appears unusual or wrong, but they won’t know how to ask the patient questions that might provide clues to what’s really going on, White says.

“There are some common themes of when victims of trafficking might have had a lifeline opportunity for someone to save them,” he says. “One was being arrested by law enforcement, and the other is hospital emergency rooms.”

Traditionally, hospitals have missed this opportunity because healthcare professionals are focused on finding out where the patient hurt and what the medical problem is, White explains.

“We treat the medical problem, and if they’re stressed or anxious, we help them calm down,” he says. “But we’ve never taken the time, until recently, to say that as a health system if we can save one life, let’s head down that path.”

The new education focuses on teaching people when to get a social worker to meet with a suspected victim and how to separate victims from their perpetrators, who often will be with them during the healthcare visit. Case managers and others need to be aware of community resources for victims of trafficking, and, just as importantly, they need to know how to get this information to victims. (See story on how to handle suspected trafficking victims in this issue.)

For instance, Dignity Health has business cards that case managers and other healthcare professionals can give to patients. These can be split into three pieces and hidden on a person’s body. The cards provide a national human trafficking phone number in which the caller can speak to someone in his or her native language and quickly learn where to find help locally, White says.

Trafficking numbers increasing

In the past decade, there has been a significant increase in the number of people being trafficked in the United States for sexual slavery and forced labor, according to the U.S. National Human Trafficking Hotline, which also is called the Polaris Project.

The tragedy of youth, women, immigrants, and others being terrorized and abused by traffickers within the U.S. is personal history, as well as a professional passion, for Gibbs. She often speaks to healthcare professionals and begins by telling them her own story of being forced into prostitution at age 14. At a shopping mall, she met a man who promised her a glamorous modeling career in Los Angeles. Instead, he took her to Atlantic City, NJ.

“He pretended to be a friend and romantic interest,” Gibbs says. “But once I was away from home, he forced me into prostitution.”

While she was underage and a prisoner of the trafficker, she had numerous interactions with healthcare professionals, but no one recognized the signs of her plight. Finally, she was arrested for solicitation, and that helped her escape, although the experience was traumatizing. Gibbs eventually went to college, majoring in biology, and she began consulting and speaking about human trafficking. Eventually, Gibbs realized she needed to make it a full-time career, and was offered such an opportunity with Dignity Health, she says.

“Human trafficking can be when someone lures a person from another country and then forces them through violence to work against their will,” Gibbs says. “Trafficking can involve a young woman, who is in a new relationship, being lured to another state where the man becomes violent and expects her to engage in prostitution.”

Runaway teenagers and children often are victims of sexual trafficking, she adds.

“The perpetrators terrorize their victims, so when victims visit a healthcare facility, they might be in fear of reaching out for help because of the consequences,” she says. “Perpetrators target vulnerable people, not healthy kids from loving homes.”

Labor traffickers target foreign nationals who do not know English. If they’re assaulted or injured on the job they’ll be brought to a hospital, but they might not know they can reach out for help, Gibbs explains. “This is why it’s important healthcare staff is educated on red flags and the ways to engage patients.”