Monday, July 2, 2018

The Joint Commission issues Quick Safety 42: Identifying human trafficking victims

 The Joint Commission issued a safety alert on identifying human trafficking victims on June 18 (see Quick Safety 42: Identifying human trafficking victims). The first paragraph is an attention-getter:

The United States is one of the largest markets and destinations for human trafficking victims in the world. If staff at your health care organization have not yet encountered a human trafficking victim, very likely they will. Knowing how to identify victims of human trafficking, when to involve law enforcement, and what community resources are available to help the individual is important information for all health care professionals.

The alert notes over 40,000 reports of human trafficking in the U.S. over the 10-year period 2007-2017, with the largest number of reports coming from California, Texas, Florida, Ohio and New York, and asserts that “Human trafficking is the fastest growing criminal industry in the world and is the second-largest source of income for organized crime.”

Part of the problem is one of recognition and the challenge seems to be both identifying and knowing how best to help victims.  Most victims or their families have been threatened with harm if they reveal their exploitation, in some cases the victim may not realize his or her rights in the host country, and often times the victim has bonded with his or her exploiter, a condition known as “trauma bonding”.  In addition to fear of physical harm, victims also keep silent due to shame or fear of being humiliated.

The alert provides a technical definition of human trafficking, citing the United Nations Protocol to Prevent and Suppress and Punish Trafficking in Persons, Especially Women and Children and a U.S. law, the Victims of Trafficking and Violence Prevention Act.  But perhaps more helpful, it identifies “at-risk” or the most vulnerable populations for human trafficking which include children involved in foster care, runaway and homeless youth, Native Americans, LGBTQ individuals, undocumented immigrants, among others.  Also particularly useful, the alert highlights health care problems most that may trigger a cause for concern.

So to repeat the stance of The Joint Commission: “Knowing how to identify victims of human trafficking, when to involve law enforcement and what community resources are available to help the individual is important information for all health care professionals.”  The alert provides some metrics for recognizing signs of human trafficking and guidance for when human trafficking is suspected.

In terms of recognizing signs of human trafficking, there are poor mental health or abnormal behavior (such as appearing fearful, avoiding eye contact and refusing treatment) and poor physical health (such as appearing malnourished or signs of physical abuse).  Other signs include not being in control of personal identification, not be allowed to speak for themselves, and inconsistencies in his or her story).

Regarding when human trafficking is suspected, The Joint Commission notes that every situation will be unique and that “it is important to use a victim-centered response.”  While not every victim will be ready to seek help, the Commission notes that “if a victim is a minor (under 18 years of age), the provider is legally obligated to contact Child Protective Services.”  Responses will also depend on whether human trafficking is suspected or if the patient has disclosed that he or she has been trafficked.  The Joint Commission offers options for each of these situations.  For example, the alert notes that if the patient indicates he or she has been trafficked “in situations of immediate, life-threatening  danger,” the provider should follow “institutional policies for reporting to law enforcement.”  Other “safety actions” recommended include providing the patient with options for services, reporting and resources and if your organization has a social worker – “utilize them”. 

What role could Patient Access personnel be expected to play?  Most likely Patient Access would become aware in the Emergency Department – so personnel could be exposed to the common signs and at-risk groups identified in The Joint Commission’s alert to increase general awareness.  Institutional protocols would govern who in the organization would be engaged once human trafficking is suspected or confirmed.  Patient Access personnel should know who to contact within the hospital so appropriate action can be taken. 

As Martin Muratore, CHAM stated, “The role would be interdisciplinary. If and when Patient Access became aware, they would need to ensure that proper notifications were made.  As with all crime and for victims of abuse, any person who has contact with the patient should immediately report to police and social services or the social work department of the organization.”  Muratore notes that in most cases it will be an actual health care provider in the clinical situation who first becomes aware of the abuse or trafficking. Brenda Sauer, RN, MA, CHAM, FHAM agrees: “The Patient Access professional should be able to identify and then report through their usual channels if they suspect abuse.  This is usually  telling a clinician or social worker of their suspicions.”  And Nancy Farrington, CHAM, FHAM confirms that it is most likely going to be a clinician who is in the best position to detect abuse, but that Emergency Department Patient Access may be in a position to notice signs and that reporting to clinicians or social workers is the appropriate response. Patient Access staff may become aware of these situations, especially in the Emergency Department. I would not expect Patient Access staff to report suspicions to outside agencies but rather to follow internal protocols to have providers, clinicians, social workers, etc. make an assessment and take action.”

The Joint Commission’s alert is worth a read and provides some actionable and educational material for staff.  Awareness and response will clearly involve multiple disciplines in the organization and emphasizing internal protocols in addition to the information provided in the alert is a good place to start.

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