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What to do when a human trafficking victim is identified

Warning - Do not approach the trafficker directly

After identifying a victim of human trafficking, the nurse with other healthcare providers should develop a plan of care that addresses the patient's physical, psychosocial and safety needs (Hodge, 2014). It may be necessary to consult with health professionals involved in the treatment of physical injuries and diseases, mental health professionals, and law enforcement officers of the courts.

Health care institutions should have a plan in place for nurses and other front-line healthcare providers with names of contact individuals to assist in executing legal orders of protection and providing shelter for the victims.

Follow any institutional protocols that have been developed for responding to human trafficking victims. Contact your supervisor if you are in doubt.
If you suspect a threat of immediate harm to a victim, notify security or police stationed in your facility. Otherwise, call 911.
If the patient is a minor, carry out mandatory state reporting laws and institutional policies for child abuse.
If there is no immediate danger to victims, call the National Human Trafficking Resource Center (NHTRC) hotline at 888-3737-888. The National Human Trafficking Resource Center hotline has available the names, locations, and contact numbers of local resources.
Talk with the patient about options for services, reporting, and resources.
Provide the patients with the NHTRC hotline number – they may need to memorize it if they feel it is dangerous to have something on their person.
Take extra care in documenting the patient's injuries in the patient's record. This information could be valuable in a court case against the trafficker. Know your state's definition of trafficking.
Also, use the new ICD-10-CM codes for human trafficking

Effective in 2019, unique ICD-10-CM codes are available for data collection on adult or child forced labor or sexual exploitation.

When encounters with human trafficking victims occur, they should be given one of these codes on their records, improving documentation of these victims. Physicians and nurse practitioners who bill for services are responsible for the diagnosis and therefore the proper code assignment. When encounters with human trafficking victims occur, the physician should be alerted to the signs and symptoms of abuse to improve documentation of these victims.

https://www.aha.org/system/files/2018-09/icd-10-code-human-trafficking.pdf

ICD-10-CM Coding for Human Trafficking
T74.51	Adult forced sexual exploitation, confirmed
T74.52	Child sexual exploitation, confirmed
T74.61	Adult forced labor exploitation, confirmed
T74.62	Child forced labor exploitation, confirmed
T76.51	Adult forced sexual exploitation, suspected
T76.52	Child sexual exploitation, suspected
T76.61	Adult forced labor exploitation, suspected
T76.62	Child forced labor exploitation, suspected
Y07.6	Multiple perpetrators of maltreatment and neglect
Z04.81	Encounter for examination and observation of victim following forced sexual exploitation
Z04.82	Encounter for examination and observation of victim following forced labor exploitation
Z62.813	Personal history of forced labor or sexual exploitation in childhood
Z91.42	Personal history of forced labor or sexual exploitation
Include safety planning in the discharge process.

Richie-Zavaleta (2021) reported on a study they carried out with 22 survivors of human trafficking. Those survivors told their stories and describe what type of interventions carried out by healthcare professionals were helpful to them.

The study participants also described answers to questions that could have been taken as a joke when the victims were serious, such as the following:

How many men did you have sex with last month?
Somewhere between 30 and 50.

There were also events where the trafficker disconnected I.V.s and removed the victim from the hospital. The trafficker needs constant observation.

According to Richie-Zavaleta (2021), the following were essential takeaways mentioned by the survivors for the nurses to pay attention:

Nurses should detect the nuances victims share in an inconspicuous manner, which may reveal their trauma without being blunt about it.
Pay attention to the traffickers' controlling and deceptive strategies, such as
- convincing the nurse of their goodness and care
- showing up at the medical setting and interrupting the flow of care
- pretending to be a boyfriend, friend, or close relative
- answering the questions for the patient
- refusing to leave the room
- being a frequent visitor to establish rapport with the care providers
- threatening the victim not to share the factual information with the care provider.
Check the victim's tattoos, such as money signs, and the words give money and traffickers names.
Survivors stated they appreciated entering and interacting with welcoming healthcare providers in a comfortable and safe setting.
Healthcare providers that showed care and concern about the well-being of the victims helped establish a good rapport.
Asking questions or requesting information from the patient must be done in a respectful and caring demeanor without showing judgment or disgust.
Care that showed compassion, even by providing food or something to drink, helped create a positive relationship.
The participants appreciated being provided with information about resources, including an 800 number to call, local resources such as housing information, hotline, and so forth but not pamphlets, which the trafficker could find.
One survivor suggested putting the 800 number in a condom wrapper—another received lip gloss with an 800 number inside the container.

The PEARR Tool - Trauma-Informed Approach to Victim Assistance in Health Care Settings. The CommonSpirit Health and HEAL organizations developed the PEARR tool to provide trauma-informed assistance to victims of human trafficking. Here are the main components:

P Provide Privacy : Discuss sensitive topics alone and in safe, private setting (ideally private room with closed doors).
E Educate: Educate patient in manner that is nonjudgmental and normalizes sharing of information.
A Ask: Allow time for discussion with patient. Example: “Is there anything you’d like to share with me? Would you like to speak with [insert advocate/service provider] to receive additional information for you or someone you know?”
R&R Respect and Respond: If the patient denies victimization or declines assistance, respect patient’s wishes. If you have concerns about patient’s safety, offer hotline card or other information in event of emergency (e.g., local shelter, crisis hotline).

Instant Feedback:

Which of the following are recommending approaches nurses can use when interacting with a patient suspected of being trafficked?

References

Hodge, D.R. (2014). Assisting victims of human trafficking: strategies to facilitate identification, exit from trafficking, and the restoration of wellness. Soc Work. 59(2), 111-8.

Richie-Zavaleta, A.C., Villanueva, A.M., Homicile, L.M. & Urada, L.A. (2021)Compassionate Care—Going the Extra Mile: Sex Trafficking Survivors' Recommendations for Healthcare Best Practices. Sexes 2, 26-49. https://doi.org/10.3390/sexes2010003.