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following actions to support and help keep the victim safe: 7 • In situations of immediate, life-threatening danger, follow your institutional policies for reporting to law enforcement. Make an effort to partner with the patient in the decision to contact law enforcement. Quick Safety Issue 42, June 2018 Page | 3 Legal disclaimer: This material is meant as an information piece only; it is not a standard or a Sentinel Event Alert. The intent of Quick Safety is to raise awareness and to be helpful to Joint Commission-accredited organizations. The information in this publication is derived from actual events that occur in health care. ©2018 The Joint Commission, Division of Healthcare Improvement National Human Trafficking Resource Center Call: 1-888-373-7888 (24/7) Text: 233733 Email: nhtrc@polarisproject.org Report online or access resources: www.humantraffickinghotline.org • Provide the patient with the NHTRC hotline number. If the patient feels it is dangerous to have something with the number on it, have them memorize it. • Provide the patient with options for services, reporting and resources. Ensure that safety planning is included in the discharge planning process. • If the patient is a minor, follow mandatory state reporting laws and institutional policies for child abuse or serving unaccompanied youth. • Accurately document the patient’s injuries and treatment in the patient’s records. Keep in mind that while documentation of abuse may be helpful in building a case against a trafficker, information about the victim also can be used against them in a court proceeding. Be careful with paraphrasing or summarizing; use patient quotes as much as possible, and stick to the facts. • Gain permission and consent from adult patients who have been trafficked before disclosing any personal information about the patient to others, including service providers. • If your institution has a social worker, utilize them. They can be instrumental in getting the support and resources your patient needs. Health care organizations can take the following safety actions to help prepare staff to be on alert and prepared to identify and help patients who may be victims of human trafficking: • Mitigate language barriers; provide professional interpreters.3 • Incorporate social, work, home history and domestic violence screening questions into routine intake.3 • Ensure that staff know when and how they should alert security and/or local law enforcement. • Train frontline staff on how to identify, refer and report human trafficking victims, and how to connect victims to services and support systems to meet their immediate and longer-term needs.1 Provide staff with the following information to facilitate this: o Local resources to help with suspected trafficking cases (many U.S. metropolitan areas have a Human Trafficking Task Force). 3 o Local or state requirements regarding mandatory reporting of human trafficking. o How HIPAA regulations impact reporting of potential trafficking situations on behalf of a patient. o Confidentiality obligations when contacting the NHTRC or local service providers. o NHTRC resources and services. These can include developing a safety plan that is acceptable to the patient and facilitating a report to specialized law enforcement trained to handle human trafficking cases. 3Identification and Management of Human Trafficking Victims in the Emergency Department Lisa M. Hachey, DNP, CNM Julia C. Phillippi, PhD, CNM Abstract Health care practitioners serve an important role in identification and assistance of human trafficking victims. Advanced practice registered nurses, including certified nurse midwives, clinical nurse specialists, and nurse practitioners, are in a unique position to interact with persons trafficked and seen in the clinical setting, yet they require knowledge to identify the signs of human trafficking. Lack of training and education has been identified as a barrier for health care professionals to recognize human trafficking victims and implement needed health care services (M. Chisolm-Straker, L. D. Richardson, & T. Cossio, 2012; C. Ross et al., 2015). Barriers to identification and management include gap in knowledge about the process to screen for trafficking, to assist victims, and to make referrals. A patient-centered, trauma-informed approach can provide a safe environment to sensitively screen patients for human trafficking. Advanced practice registered nurses should be able to assess for trafficking indicators, collaborate with multidisciplinary service providers, and ensure understanding and availability of federal, state, and local resources to manage the care of victims of trafficking. Key words: health care practitioners, health consequences, human organ trafficking, human trafficking, modern-day slavery, sex trafficking, sexual exploitation HUMAN TRAFFICKING is a human rights violation with global public health implications (United Nations Office on Drugs and Crime [UNODC], 2014). Author Affiliations: Department of Nurse-Midwifery and Women’s Health, University of Cincinnati, Cincinnati, Ohio (Dr Hachey); and Vanderbilt University School of Nursing, Nashville, Tennessee (Dr Phillippi). Dr. Phillippi receives workload support from the VUMC Faculty Research Scholars Program. Disclosure: The authors have no conflict of interests to disclose. Corresponding Author: Lisa M. Hachey, DNP, CNM, Department of Nurse-Midwifery and Women’s Health, University of Cincinnati, 9767 Acton Ct, Cincinnati, OH 45241 (hacheylm@ucmail.uc.edu). DOI: 10.1097/TME.0000000000000138 The Victims of Trafficking and Violence Protection Act of 2000 defines human trafficking as “the recruitment, harboring, transportation, provision or obtaining of a person for labor or services through the use of force, fraud, or coercion for the purpose of involuntary servitude, peonage, debt bondage, or slavery” (Pub. L. 106-386, §2, 103 Stat, 7 [2000]). In addition to sexual exploitation, other forms of trafficking include domestic servitude, organ harvesting, servile marriage, child soldiering, forced criminal activity, and forced labor in a broad range of industries such as construction, hospitality service, street begging, agriculture, and commercial fishing (International Labor Organization [ILO], 2014). Human trafficking has been described as “modern-day Copyright © 2017 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited. 31 Article: AENJ-D-16-00027 Date: January 18, 2017 Time: 0:13 32 Advanced Emergency Nursing Journal slavery,” and victims are exploited for the economic gain of traffickers, isolated from support systems, hidden from mainstream society, and often endure unpredictable physical, psychological, and sexual assaults (Dovydaitis, 2010; Logan, Walker, & Hunt, 2009; Munoz, 2012). Individuals trafficked are deprived of basic human rights, autonomy, freedom, self-esteem, ownership of their body, self-determination, and a sense of safety (Hopper, 2017). Table 1 offers further details on the various forms of human trafficking. BACKGROUND AND INCIDENCE OF HUMAN TRAFFICKING A challenge faced by trafficking advocates, policy makers, law enforcement, and scholars is to define the magnitude of human trafficking because the estimated number of victims varies widely (Weitzer, 2014). It is difficult to determine the exact incidence and prevalence of hidden populations due to the covert nature of the crime, ethical dilemmas, and political considerations (ILO, 2012b; Peters, Table 1. Forms of trafficking in persons Commercial sexual exploitation of children and sex trafficking of minors Sexual exploitation of children and youth under 18 years of age for economic purposes. Forms may include trafficking for sexual purposes, sex tourism, prostitution, pornography, strip clubs, and/or child marriage (bride). These crimes include survival sexual exploitation or the exchange of sex for basic necessities including food, shelter, clothing, or money. Force, deception, or other forms of coercion are not required under the TVPA. Sex trafficking The recruiting, transporting, receiving, harboring, or obtaining of an adult for that purpose commercial sexual exploitation through means of force, fraud, deception, or coercion through the use of physical or psychological threats. Forced labor trafficking The recruiting, transporting, receiving, harboring, or obtaining of individuals for the purpose of labor or involuntary servitude through the use of physical or psychological force, fraud, deception, threats, or coercion. Labor may occur in domestic labor, street