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reporting hotline. In this case, it is essential to clearly inform these service providers that the minor is a victim of exploitation (Child Welfare Information Gateway, 2016; Greenbaum & Crawford-Jakubiak, 2015; Todres, 2016). Mandated reporting statutes have explicit language, making suspected “sexual exploitation” or “sexual assault” of minors a reportable offense (Todres, 2016). As mandated reporters, health care providers should discuss these limits of confidentiality with the patient (Greenbaum & Crawford-Jakubiak, 2015). Unless there is imminent danger to an adult patient or others, law enforcement should not be contacted without the patient’s consent (Abas et al., 2013; Alpert et al., 2014; Borland & Zimmerman, 2009). Notifying legal authorities or other service providers without the patient’s authorization is a violation of patient rights and a breach of confidentiality (Alpert et al., 2014). However, state-specific mandated reporting exceptions exist for adult victims in certain situations. Injuries from firearms, sharp weapons, substantial burns, death threats, or threat to a child or adult caretaker of a child and disabled or incompetent adults are examples of these reporting exceptions (Alpert et al., 2014). Practitioners should be familiar with the specific circumstances of state-mandated reporting laws for both children and adults. Consultation with administrators or risk management personnel may provide organization-specific guidance for management and referrals (Greenbaum & Crawford-Jakubiak, 2015). While being trafficked, individuals lose control over every aspect of their life. Each instance that fosters a sense of inclusion, predictability, and choice provides an opportunity to regain control and empowerment (Borland & Zimmerman, 2009; Gibbons & Stoklosa, 2016; Stevens & Berishaj, 2016). If a suspected victim of trafficking declines assistance, provide contact information for the National Human Trafficking Hotline or the Polaris text line “BeFree” (233733). Both services offer information on local resources and recommendations for trafficking victims. Contact information can be discretely provided on a concealed shoe card from the DHS Blue Campaign (U.S. DHS, 2015). Other informational resources are available from both NHTRC and DHS. When referring to service organizations, indicate the patient is a victim of trafficking and avoid disclosing protected health information. CONCLUSION Many individuals in captivity do not selfidentify as “human trafficking victims.” Up to 87% of trafficked victims seek health care while in captivity but are not identified or offered assistance by APRNs or other health care practitioners (Lederer & Wetzel, 2014). Copyright © 2017 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited. Article: AENJ-D-16-00027 Date: January 18, 2017 Time: 0:13 January–March 2017 Vol. 39, No. 1 Human Trafficking Victims in the Emergency Department 47 The first point of contact in the health care system is critical. Each health care encounter provides a window of opportunity for an exploited individual to disclose her or his trafficking situation. A compassionate and respectful environment fosters a sense of safety, empowerment, and control over an individual’s life. This approach is especially critical for those with a history of trauma from trafficking. The clinical presentation and comorbidities of people who are trafficked are complex and varied; however, health care providers can identify victims needing assistance through appropriate assessment and screening tools (Baldwin et al., 2011; Gibbons & Stoklosa, 2016; Peters, 2013). Understanding potential clinical presentations of sex and labor trafficking can assist health care providers in recognizing and responding to the needs of these often marginalized and exploited individuals (Alpert et al., 2014). Advanced practice registered nurses can increase their awareness and ability to identify, treat, and refer victims of human trafficking through continuing education and community outreach programs. When a victim has the courage to disclose her or his trafficking situation, APRNs and other health care providers must have the requisite foundation of education, training, and clinical judgment to act as her or his advocate. U.S. State Laws Addressing Human Trafficking: Education of and Mandatory Reporting by Health Care Providers and Other Professionals Holly G. Atkinson a , Kevin J. Curninb , and Nicole C. Hansonb a Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, USA; b Stroock & Stroock & Lavan LLP, New York, New York, USA ABSTRACT Human trafficking is a global problem and constitutes a grave human rights violation, affecting more than 20 million individuals worldwide. This brutal crime often results in both short- and long-term physical and psychological harm to its victims. We provide a systematic review of U.S. laws that address education about human trafficking and/or mandatory reporting requirements that affect healthcare providers and other professionals across the United States. Thirteen U.S. states now have laws that address education about human trafficking, while seven specifically require mandatory reporting of minors who are victims of trafficking. The findings are instructive to not only practicing physicians and other professionals, who are now mandated reporters of trafficking victims in some states, but also to regulatory and legislative bodies contemplating enacting such laws in an effort to address trafficking. KEYWORDS Child sexual abuse; labor trafficking; legislative review; mandatory education; mandatory reporting; sex trafficking Background Human trafficking, the act of causing a person to be controlled and exploited for sex or labor or services through fraud, force, or coercion, is a grave human rights violation affecting an estimated 20.9 million or more individuals worldwide (International Labor Organization, 2015). Due to the hidden nature of human trafficking and the difficulty in collecting reliable data, accurate statistics on the incidence and prevalence of trafficking currently do not exist. Nevertheless, estimates indicate that, worldwide, women and girls account for the majority of labor-trafficked victims, with 11.4 million victims (55%) compared with 9.5 million (45%) men and boys. Women and girls also account for upwards of 85–90% of victims of sex trafficking (International Labor Organization, 2015). In the United States, trafficking has been reported in cities, suburbs, and rural areas in all 50 states and in Washington, DC (National Human Trafficking Resource Center, 2015). Approximately half of trafficking victims in the United States are believed to be minors (U.S. Department of State, 2007). One study found that the average age of entry into the commercial sex industry for girls is around 12 to 14 years old, while for boys it is younger at 11 to 13 years old (Estes & Weiner, 2001). Another more recent study found the age of entry for young people’s initial sex trade experience ranged from 10 to 17 years of age, with a median age of 15 (Gibbs, Walters, & Lutnick et al., 2014). Many victims have suffered abuse and neglect as children and are runaways or homeless, or have a history of involvement in the juvenile or criminal justice system (Institute of Medicine [IOM] and National Research Council [NRC], 2013). Many victims also have CONTACT Holly G. Atkinson, M.D., FACP, FAMWA holly.atkinson@mssm.edu Program Director of Human Rights, Arnhold Institute for Global Health, Assistant Professor of Medical Education, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA. Holly G. Atkinson, M.D., FACP, FAMWA, is Assistant Professor of Medical Education and Program Director of Human Rights at the Icahn School of Medicine at Mount Sinai. Kevin J. Curnin is the founding director of the Public Service Project at Stroock & Stroock & Lavan LLP, where he is the pro bono partner. He is the president-elect of the Association of Pro Bono Counsel. Nicole C. Hanson is an Associate at Stroock & Stroock & Lavan LLP, and was an Articles Editor for the Boston University Law Review. © 2016 Taylor & Francis JOURNAL OF HUMAN TRAFFICKING 2016, VOL. 2, NO. 2, 111–138 http://dx.doi.org/10.1080/23322705.2016.1175885 histories of past sexual abuse (Smith et al., 2009). Investigations have revealed that the majority of identified trafficked victims have also had some interaction with child protective services.1 Today, human trafficking is a multibillion-