The red flags are there if healthcare staffers know how to spot them, experts say. Trafficking victims may not know what city they are in. They may have a fearful, submissive demeanor or have tattoos bearing someone's name. A victim may be accompanied by a controlling companion who insists on answering providers' questions. There may be signs of physical abuse and trauma. And for labor-trafficking victims, red flags can also include hearing, vision, cardiovascular or respiratory problems from working in unsafe conditions.
Provider training typically focuses not only on red flags, but also on strategies for intervention, such as interviewing techniques and tips for working collaboratively with law enforcement and other local agencies. Hope for Justice's Barrows said hospitals and clinics should proactively reach out to law enforcement and other groups so they have solid relationships in place when they identify a victim.
Experts say children's hospitals are, in many cases, ahead of the curve when it comes to educating their staff about trafficking. At Children's Healthcare of Atlanta, for instance, all new clinical staff undergo training, and current staff are encouraged to participate. The hospital also has a six-module webinar series on human trafficking.
Demand for those webinars “skyrocketed” in the last half of 2014, said Angie Boy, program manager at the hospital's Stephanie Blank Center for Healthy Children. “We used to see demand from healthcare professionals in Georgia but now we have much more of a national audience,” she said.
Macias-Konstantopoulos serves on a technical working group for an HHS pilot project that trains healthcare workers to identify trafficking victims. Through the program, known as the SOAR—Stop, Observe, Ask and Respond—to Health and Wellness Pilot, HHS hosted training sessions in six cities last September. Attendees were required to take a survey before the training, another immediately afterward, and a third follow-up survey three months later to see how well they retained the information.
HHS is analyzing data from the SOAR pilot and may scale the program up if the results are promising, she said.
In March, Macias-Konstantopoulos spoke at a daylong trafficking training session in Berkeley, Calif., attended by more than 100 healthcare providers. “We had a few physicians who traveled all the way from Texas,” she said.
Even with high-quality training, providers still have to look at all of the signs together and trust their instincts. “There's an array of red flags, and no single one is specific and indicative of trafficking,” Macias-Konstantopoulos said. “We always say you need to put your thinking caps on and put the pieces of the puzzle together.”
It would also help to have a validated and easy-to-use screening tool, especially in a busy emergency department, said Dr. Alan Janssen, director of the emergency medicine residency at Genesys Regional Medical Center, in Clio, Mich. He and his staff are starting to use a six-question tool developed by Dr. Jordan Greenbaum at Children's Healthcare of Atlanta.
It consists of quick and straightforward questions, such as “Have you ever run away from home?” and “Have you had more than five sexual partners?” Those questions successfully detected 92% of trafficking victims in a study, Greenbaum said. The results are encouraging, but the sample size was small and results were from only one site. “We're now trying to pilot and validate the tool in EDs and clinics across the country,” she said.
Michigan State Sen. Rebekah Warren, who sponsored her state's legislation requiring healthcare workers to receive training, said she was drawn to the issue after speaking with one of her constituents, a foster mother of three sons who were trafficked from the African country of Togo to the U.S. as forced laborers. A dentist who treated the three boys recognized that their paperwork did not match their ages and medical histories. He notified authorities and the boys were rescued from their trafficker and placed in the woman's care. “For me, it shined a light on the fact that healthcare professionals can really help if they know the signs,” Warren said.
Some say there's a need for national action to increase healthcare workers' awareness of the problem. In April, U.S. Sen. Gary Peters (D-Mich.) announced he was co-sponsoring the Trafficking Awareness Training for Health Care Act of 2015. The bill would provide federal funding for a medical or nursing school to develop a healthcare professionals training program. That grantee would then select 10 sites to pilot the training program.
The best approach remains to be seen, said Macias-Konstantopoulos, who cautioned that government-mandated training could spark resistance among healthcare providers. But greater awareness can save victims' lives. “As easily as they come through our doors, they walk right back out again,” she said. “We have a window of opportunity that so far we haven't been able to take advantage of. That needs to change.”