To: Assemblyman Michael DenDekker
From: Gagandeep Munday
Date: January 22, 2020
Re: Addressing hospital/clinic standards for assisting victims of Human Trafficking
Statement of Issue: In 2018 there were an estimated 403,000 trafficked persons in the United States. The Trafficking Victims Protection Act identifies trafficked persons as those utilized for sexual activates and servitude regardless of their age group or gender. Nearly 75% of victims performed sexual acts and 13% performed acts of labor. Minors and women were more likely to be coerced into sex trafficking than men. More US citizens were coerced into sex trafficking than foreign nationals. US and NY law makers have made numerous efforts and cultivated collaborations with enforcement agencies in order to recognize and assist victims. Between 2016-2017 the Department of Justice (DOJ) and the Office for Victims of Crime (OVC) had a total of 8,003 open trafficking victim cases, of which 4,349 were new. In 2019, there were 61,455 migrant workers in North Carolina, 18% of which were victims of human trafficking. In 2015 the National Human Trafficking Resource Center (NHTRC) received 24,757 reports of trafficking, of which 5,544 were unique cases. However, based on the 2018 estimations, this 24-hour NHTRC national hotline appears severely underutilized and hundreds of thousands of people are coerced into a life of victimization. They will not be able to obtain legal assistance from the DOJ or OVC. Surprisingly, 80-88% of survivors indicated that they had at least one health care visit. Unfortunately, trafficking victims can go unnoticed during a healthcare visit. Numerous people are slipping through the safety net that is our healthcare system. Efforts need to be made in New York to standardize protocols for recognizing and assisting victims of Human Trafficking.
- Public health law §2805‐y states that NYS hospitals must have mandated training for employees in order to identify and respond to suspected victims. However, there has been limited effort within NYS to standardize this training and ensure proper procedures are in place. Federal resolutions to standardize training have not passed the house of representatives.
- Literature indicates that medical providers are sometimes the only professional that come into contact with victims of human trafficking. Medical encounters are time limited and often the victim can act overly guarded. Researchers indicate that being admitted to a hospital emergency room is the one of the rarest lifesaving opportunities for a victim.
- According to the OVC, a victim’s inability to obtain assistance can be due to language barriers, fear of harm to themselves or others, and general fear of law enforcement. Some victims are routinely brought into health clinics for STI testing, contraception, and/or injuries.
- Medical providers lack the education and preparation in their schooling, training, and practice. They are often unable to identify the red flags that a victim is presenting. A robust response from the medical staff and its auxiliary support system is mitigated by the lack of universal training.
Policy Options
- A state mandate which standardizes NYS hospital protocols for identifying and assisting suspected human trafficking victims.
- Adaptation of the National Human Resource Center’s method of screening should be adopted as a tool to identify victims. These questions inquire about living situations, the threat of violence against the patient or others, and about instances of exchanging sex for services. This is an advantageous and simple screening tool. Pennsylvania hospital systems utilize a comprehensive yet simple 14 question screening tool. A positive response to any one of the 14 questions was considered suspicious for human trafficking. Adoption of such screening tools in NYS hospital systems would increase response rates to suspected victims. The questionnaires are straightforward enough for all medical staff. However, the caveat is that utilization of such tools can place more of a focus on answers to questions than to the actual physical and emotional signs that are presented by the patient. Often a victim might be reluctant to answer questions. Therefore, medical providers should utilize these tools in conjunction with physical examination. Standardized training can help current medical providers identify signs even when a victim is unresponsive.
- A grant for medical/PA/nursing schools to utilize/develop the best protocols and training methods for health care providers.
- One of the purposes of providing a medical education is to prepare students to deal with societal issues. Researchers indicate that there is a plethora of resources and modules that can educate students about human trafficking. An example of one such curriculum is the Medical Student Instruction in Global Human Trafficking (M-SIGHT), which is a series of instructional modules that utilizes standardized patient simulations. After gaining a core understanding, students practice scenarios in which they take social history, conduct a physical exam, and make attempts to recognize potential warning signs. It provided an overall improvement in a student’s communication and in their cognition. This is just one of many tools available. A federal or state grant could influence schools to adopt or develop similar curricula. This would ensure that the next generation of medical providers are prepared to identify and assist victims. Overall, efforts should be made to ensure that the curricula are standardized. Subsequent grants should be provided based on student scores on post assessments. This is a costly but necessary option.
- Public awareness campaigns to increase recognition of common indicators of human trafficking.
- Most victims are unwilling to share information regarding their personal lives to healthcare providers. This is due to fear and lack of trust. Unfortunately, this is one of the main reasons that many victims go unnoticed in a health care setting. A campaign to help the general public understand the common signs of trafficking would lead to increased assistance and support for victims. This campaign could be similar to the awareness campaigns for smoking. Extensive campaigning and awareness might push susceptible persons to try to get the help they need.
Policy Recommendation:
Hundreds of thousands of people are being subjugated to an oppressive lifestyle and many of these victims will pass through the halls of an emergency room unrecognized. At this time, I would recommend a state mandate that standardizes identification procedures in hospitals. We should all utilize screenings recommended by the National Human Resource Center and also the 14-question screening tool used by Pennsylvania hospitals. This ensures that the mandatory training within each NYS hospital would be universal. This would provide some encouragement that each hospital has similar baseline for recognizing potential victims. However, this is a just starting point. Hopefully in the future we will implement training modules in schools and conduct public awareness campaigns.
Sources
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https://ovc.ncjrs.gov/ncvrw2018/info_flyers/fact_sheets/2018NCVRW_Trafficking_508_QC.pdf
