San Francisco-based Dignity Health unveiled new guidelines on Tuesday for healthcare organizations to identify and respond to patients suspected of being human trafficking victims.
As human trafficking incidents including prostitution and forced labor continue to rise, the healthcare industry offers a unique opportunity for human trafficking victims to seek help, as they are usually kept hidden as part of their captivity. Dignity Health spent the last three years developing its own human trafficking response program and is sharing the lessons it learned with other providers.
"Being in healthcare I think offers a unique opportunity to connect with a person and to potentially view for red flags that are observable," said Holly Gibbs, director of human trafficking response at Dignity Health. "It can provide a setting where there's more trust between a patient and a provider, and so you may be able to ask certain questions without the threat of authorities getting involved."
Nearly 60% of healthcare professionals have never received training to identify human trafficking victims, according to a 2015 study published in the journal Pediatrics.
Dignity's recommendation includes encouraging healthcare professionals to focus particularly on assessing patients in vulnerable populations—such as children, undocumented immigrants, the homeless and those with substance abuse or behavioral health disorders.
Reported incidents of human trafficking—whether it's in the form of prostitution or forced labor—have increased in recent years. In 2016 the National Human Trafficking Hotline reported more than 7,500 cases of human trafficking in the U.S., a 35% increase over the 5,544 cases reported in 2015 and a 130% rise compared to the number reported in 2012.
"It's just not something really on doctors' radar," said Jacqueline Bhabha, a professor at Harvard University's T.H. Chan School of Public Health.
If patients show fearful or submissive behavior, physical signs of abuse or have a controlling companion with them, those may be indicators they are a human trafficking victim.
Other signs may be more subtle, such as a patient who appears to have never received medical attention before, or someone who does not know what city they are in or their home address.
The manual Dignity introduced Tuesday recommends posing questions such as "Do you feel safe at home?" or "Has anyone ever taken a photo of you that made you feel uncomfortable?"
Human trafficking victims often end up with a multitude of health issues related to their trauma, including behavioral health disorders. They also have high rates of engaging in risky health behaviors such as smoking and substance abuse.
Providers are required by law to report their human trafficking suspicions. Health professionals should try to maintain a normal standard of care to keep a patient at ease until authorities can arrive to investigate.
Dignity began its human trafficking program in 2014 within its emergency departments as a way to train staff. The program is now being implemented in nearly 40 of its hospitals across three states. Plans are underway to further implement the program in all of its facilities, including outpatient sites.
To provide better insight for its program, Dignity brought in Gibbs as director of the program in 2015. Gibbs is a sex trafficking survivor who as a 14-year-old in suburban south New Jersey was lured by a man she met at a local mall and forced into prostitution for two days before she got help to escape.
Any patient who has suffered abuse should raise red flags for healthcare providers, she said.
"If you suspect any person of being the victim of abuse, I think you always have to keep in the back of your mind that human trafficking is a possibility," Gibbs said. "Human trafficking has allowed for us to consider a population that really hasn't been considered to this point—we need to be screening for abuse, neglect and violence."
Bhabha said efforts are now starting to be made to educate medical students on human trafficking issues in the same way issues related to sexual and physical abuse have been incorporated.
She said professionals must be tactful when asking a patient whether they are being exploited since many are fearful of speaking up.
"It does take a skillful clinician to create an atmosphere of trust," Bhabha said.
