View source for Human trafficking

== Background == 
[[File:10 Common Misconceptions of Human Trafficking final (1) Page 1.png|thumb|]]
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* Over 60% of trafficked persons will present to the ED during their time of exploitation <ref>Lederer LJ, Wetzel CA. The health consequences of sex trafficking and their implications for identifying victims in healthcare facilities. Ann Health Law. 2014;23(1):61-91.</ref>
* International Labor Organization has recorded that globally 49.6 million people were living in modern day slavery in 2021
* International definition:  
**UN Protocol to Prevent, Suppress, and Punish Trafficking in Persons (Palermo Protocol) defines “trafficking in persons” as recruitment, transportation, harboring of persons by means of the threat or use of force...or of a position of vulnerability...to achieve the consent of a person having control over another person for the purpose of exploitation 
**Action-Means-Purpose (A-M-P) Model 
***Action: thing trafficker does to trafficked persons 
***Means: method trafficker uses to compel victim 
***Purpose: type of exploitation 

=== Risk Factors ===
* People of color  
* Low socioeconomic status  
* Migrant workers  
* Limited English  
* Children  
* People experiencing homelessness  
* LGBTQ+ 

==Differential Diagnosis==
{{Psychosocial DDX}}

== Encounter Tips == 
* Goal is not to necessarily elicit disclosure, but to create a safe environment for the patient, address immediate health needs, and empower patient to seek help/resources on their terms 
* Use the PEARR Tool 
** Provide privacy: discuss sensitive topics along and in a safe, private setting. Make sure to use professional interpreter if needed. 
** Educate: be sure to normalize the sharing of information when educating patients. 
** Ask: allow time for open discussion with the patient. 
** Respect & Respond: If patient requests assistance, arrange communication with victim advocate/social work and/or provide patient with resources (see below). If the patient declines assistance, please respect the patient’s wishes. 
* Try to have patient alone (if accompanied) to ask safety questions 

=== Questions to ask === 

* Do you feel safe at home/work/school?  

* Has anyone forced you to do something you don’t want to do?  

* Has anyone hurt you?

* Consider using [https://www.acepnow.com/article/recognizing-human-trafficking-victims-as-patients-in-the-emergency-dept/screen-shot-2022-04-18-at-10-16-01-am/ RAFT tool of questions]

== Documentation == 

* Similar to assault cases, only document facts/objective findings  

* Careful documentation of exam findings that might be concerning for abuse  

* Document concerns for trafficking for future providers 

== Hotlines and other resources == 
* 888-373-7888 U.S. National trafficking hotline 
* 800-799-7233 U.S. domestic violence hotline 
* 800-656-4673 U.S. sexual assault hotline 
* Social Work 
* Case Management

== References ==
#Alpert EJ, Ahn R, Albright E  et al. Human Trafficking: Guidebook on Identification, Assessment, and Response in a Healthcare Setting. Boston, MA: MGH Human Trafficking Initiative, Division of Global Health and Human Rights, Department of Emergency Medicine. 
#Canada’s Human Trafficking Laws. British Columbia Public Health Agency. 2014. 
#Global Report on Trafficking in Persons [Internet]. New York; 2014. Available from: https://www.unodc.org/res/cld/bibliography/global-report-on-trafficking-in-persons_html/GLOTIP_2014_full_report.pdf 
#Human Trafficking. Public Safety Canada, Government of Canada. 2019. 
#Identifying Victims of Human Trafficking: What to look for in a healthcare setting. National Human Trafficking Resource Center. The Polaris Project. 
#Lederer L, Wetzel C. The Health Consequences of Sex Trafficking and Their Implications for Identifying Victims in Healthcare Facilities. Ann Heal Law. 2013;23(1):61–91. 
#Macias Konstantopoulos W, Ahn R, Alpert EJ, Cafferty E, McGahan A, Williams TP, et al. An international comparative public health analysis of sex trafficking of women and girls in eight cities: Achieving a more effective health sector response. J Urban Health. 2013. PMID: 24151086 
#Meshkovska B, Siegel M, Stutterheim SE, Bos AER. Female sex trafficking: Conceptual issues, current debates, and future directions. J Sex Res. 2015. PMID: 25897567 
#PEARR Tool Trauma-Informed Approach to Victim Assistance in Health Care Settings. Dignity Health, in partnership with HEAL Trafficking and Pacific Survivor Center. 2019. 
#Shandro J, Chisolm-Straker M, Duber HC, Findlay SL, Munoz J, Schmitz G, et al. Human Trafficking: A Guide to Identification and Approach for the Emergency Physician. Ann Emerg Med. 2016;68(4):501-508.e1. PMID: 27130802 
#Walls NE, Bell S. Correlates of engaging in survival sex among homeless youth and young adults. J Sex Res. 2011. PMID: 20799134 
#What is Human Trafficking? Greater New Orleans Human Trafficking Task Force. Available from: http://www.nolatrafficking.org/what-is-human-trafficking. 
#Zimmerman C BR. Caring for Trafficked Persons: Guidance for Health Providers. Health Providers. Geneva, Switzerland: International Organization for Migration. 2009. 
#2021 Trafficking in Persons Report – United States Department of State [Internet]. U.S. Department of State; 2021. Available from: https://www.state.gov/reports/2021-trafficking-in-persons-report/

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