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Human Trafficking

Many team partners, such as law enforcement and prosecution, are beginning to understand the significant health needs of victims of human trafficking. At the same time, health care is providing more education regarding the provider’s ability to identify trafficking victims in the health setting. As a result, forensic nurses are being asked to evaluate these victims, identify their health needs, and collect forensic evidence. Many human trafficking responses lack a medical forensic component. The approach commonly used for sexual assault victims in a SANE program are not always effective in working with victims of trafficking. Victims may have been beaten, tortured, exposed to a wide range of violence, confined, and deprived of food, water, and sanitary needs. Victims may also be subjected to narcotics to create addiction and dependence.112  The involvement of mental health professionals in the care of trafficked victims can be critical. Some victims of human trafficking are unable to perceive that they are victims of crime. This can result in a lack of capacity to trust providers. It may be difficult to establish groundwork for the victim to feel safe enough to disclose the details of their victimization.113  Exams may need to be delayed to meet the emergency physical and mental health needs of the survivor, which may be profound. The typical sexual assault victim reporting for an exam usually has one episode with one perpetrator; however, victims of human trafficking, particularly those who are victims of sex trafficking, often have been assaulted multiple times by various perpetrators during their captivity.114  

Challenges to this type of expansion— 

  1. Education for staff: The first challenge in expanding services to meet the need of trafficking victims is the need for additional education required by both the program staff and the larger ED staff. Because trafficking victims can be hidden in the general patient population, it is crucial that all staff know what to suspect so that proper referrals to the program can occur. Legal considerations should be anticipated because there may be issues with obtaining informed consent for the exam, as many victims of human trafficking are minors.
  2. Additional responders: There will be a need to include mental health providers on the response team for this patient population.
  3. SANE and staff safety: Coordinate with law enforcement and hospital security to assure that perpetrators of human trafficking do not have access to victims.
  4. Vicarious trauma management for staff: Victims of human trafficking have often been subjected to multiple forms of victimization and may have been subjected to torture.
  5. Reimbursement for services: The program may need to expand the sources of reimbursement to cover medical costs for services beyond just sexual assault-specific reimbursement.
  6. Civil needs for victims: The program may need to include access to civil resources for legal assistance for patients.
  7. Commercial sexual exploitation of minors is a serious form of child abuse, as indicated in CAPTA (Child Abuse Prevention and Treatment Act), in which case mandatory reporting laws would apply.