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ESSENTIALS OF DIAGNOSIS

ESSENTIALS OF DIAGNOSIS

  • Clinicians in any setting may encounter patients who are or have been subject to human trafficking.

  • Several signs, symptoms, and behaviors may serve as "red flags" for trafficking.

  • Standard practices, such as interviewing all patients alone for a portion of the visit and the consistent use of trained interpreters, can help facilitate patient disclosure.

  • While specific questions may elicit current or past trafficking, clinicians should also use communication skills that support patient trust such as empathic listening techniques, eye contact, and engaged listening.

  • Within the United States, the National Human Trafficking Resource Center, 1-888-373-7888, provides real-time assistance regarding patient safety evaluation and resources to assist clinicians and patients.

General Considerations

Human trafficking is a criminal human rights violation that occurs in nearly all nations and impacts persons in both rural and urban centers. The United Nations defines trafficking as "the recruitment, transportation, transfer, harboring, or receipt of persons, by means of the threat or use of force or other forms of coercion of abduction, of fraud, of deception, of the abuse of power or of a position of vulnerability or of the giving or receiving of payments or benefits to achieve the consent of a person having control over another person, for the purpose of exploitation." While exact numbers are difficult to obtain due to the illegal nature of trafficking, the International Labour Organization estimates that 25 million people worldwide are actively engaged in forced labor, with women accounting for 71% of those impacted. Labor trafficking involves the illegal trade of persons for exploitation or commercial gain; labor trafficking practices occur in several industries, including agriculture, construction, elder care, janitorial work, beauty services, and domestic labor. The United Nations specifically defines sex trafficking as the recruitment, transportation, transfer, or harboring of an individual by means of threat, force, coercion, or deception for the purpose of sexual exploitation. In the United States, it is estimated that 400,000 persons experience trafficking at any given time point.

Trafficking may impact persons of any age or social group. However, poverty and young age (particularly girls) are particular risk factors. Additionally, migrant workers; persons experiencing homelessness; youth who have left their homes; lesbian, gay, bisexual, transgender, or questioning youth; and indigenous people (eg, American Indian or Alaska Native people); or those with a history childhood sexual abuse are at increased risk for exploitation.

Clinicians are likely to encounter patients who are actively experiencing forced labor or commercial sex work. Survivors of trafficking report being evaluated by health providers in a number of settings, including emergency departments, public health clinics, private practice clinics, and hospitals of all types. Several signs, symptoms, and red flags may help clinicians identify patients who are experiencing exploitation and provide resources to impact their health. Clinicians should use trauma-informed care principles with all patients to facilitate trust and increase the possibility of identifying ...

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