Studies estimate that between 30% and 88% of trafficked persons seek medical services at some point during their capture (Schwarz et al., 2016). When you suspect a patient may be the victim of trafficking, having staff properly trained with an assessment tool has the potential to rescue multiple lives.
Numerous universities and community organizations have developed and begun implementing human trafficking assessment tools for their facilities. Because small community hospitals don’t have the same needs or resources as large urban ones, each assessment tool needs to be customized for the organization and its local resources, breaking it down and reconstructing it to fit the needs of the community.
Organizations need to focus on a victim-centered approach. Safety and proper support can help transform the victim into a survivor. When you identify a potential victim you may be overwhelmed with emotion, but proper training will help you to remain professional and stay focused. The first task is to keep everyone safe. If the abuser is present, take care to avoid a confrontation that could turn violent or, at the very least, result in the abuser taking the patient away.
Simply asking patients if they are trafficking victims is fruitless, especially if the abuser is present. Further, many victims do not think of themselves as victims. During the process of grooming, victims are led to believe they are making a good choice for themselves—but as time passes, they come to believe there is no way out (Egyud & Whiteman, 2016). Traffickers are usually very “protective” of their victims because they allow the abuser to live lavishly; traffickers can earn $150,000 to $200,000 per year with only 4 to 6 victims in captivity.
Training staff on signs of trafficking is imperative to the support and survival of the victims. There are a number of ways victims can be trafficked and staff should be aware of them. A trafficker may use one or more of the following to control victims:
- Force: beatings, rape, constraint, confinement
- Fraud: offers of marriage or employment (ex: told they will be brought to the United States as a waitress but be forced into prostitution)
- Coercion: threats of serious harm or bodily injury, physical restraint, or causing victims to believe that failing to perform an act would result in injury or restraint (Trout, 2010)
National Human Trafficking Resource Center
If your agency has a possible trafficking victim and is unsure what to do, the hotline of the National Human Trafficking Resource Center (800 373 7888) can be called to help conduct an assessment. The hotline can be called anonymously if staff are nervous about identifying themselves.
In 2016 there were 7,572 cases of trafficking reported in the United States: 73% as sex trafficking, 14% as labor trafficking, and 3.5% reported as both. The NHTRC provides an assessment tool on its website to assist potential victims of trafficking.
The section below presents the guideline from the NHTRC website that can be adjusted to fit the needs and resources for your organization.
Human Trafficking Assessment Tool for Domestic Violence Programs
Discuss involving law enforcement or calling NHTRC, then notify. Be vigilant of immediate environment: who is watching, listening, calling, etc. You can ask the hotline to assist in assessing level of danger.
Sex Trafficking may include persons who are:
- Forced by a partner or family member to provide sexual favors or commercial sex to others through informal arrangements, online advertisements, escort services and/or street prostitution.
- In the commercial sex industry and have a controller (boyfriend, pimp, manager, or “daddy”) or mentions having to meet a nightly monetary quota.
- Under 18 years of age and providing commercial sex acts.
- Exhibit poor health and/or have multiple untreated sexually transmitted diseases/infections.
- Terminated multiple pregnancies over a short period of time. If pregnant, hesitates to answer who the father may be or seems unsure of who the father is.
- Exhibit signs of branding such as tattoos with the controller’s name, and/or burn marks.
Labor Trafficking may include persons who (are):
- Forced by a partner/family member to work inside the home in a situation of domestic servitude or outside the home and experiences wage confiscation.
- Unable to access earnings and is not allowed access to any family finances.
- Work excessively long hours outside of the home or within the home for little or no compensation.
- Not allowed to take breaks from domestic work and not allowed to eat unless permitted by the controller.
- Owe a debt to a partner/family member that they are unable to pay off.
- Have unexplained injuries or signs of untreated illness or disease.
- Living in a location where they are monitored or confined by the partner/family.
If no perceived danger:
- Consider asking the potential victim the following questions:
- Have you ever been forced to do work you didn’t want to do?
- Have you ever been forced to have sex to pay off a debt?
- Does anyone hold your identity documents (driver’s license/passport) for you? Why?
- Have physical abuse or threats from your boyfriend/controller made you fearful to leave your situation?
- Has anyone lied to you about the type of work you would be doing?
- Were you ever threatened with deportation or jail if you tried to leave your situation?
If perceived danger:
- The Hotline can assist in determining the next steps. You may need to involve law enforcement for victim safety. Hotline can assist in determining appropriate, sensitive law enforcement contacts.
National Human Trafficking Resource Center Hotline:
888 373 7888
(24/7) and access to 170 languages
Ask for assistance with assessment questions, resources, and next steps.
Indicate which questions you used from the previously mentioned steps.
Hotline can help determine appropriate next assessment of potential danger
Consider asking the potential victim the following questions:
- Does someone control/supervise, or look over what you do?
- Is your communication (calls, emails, conversations) ever restricted or monitored?
- Do you have access to all your identification/personal documents?
- What would happen if you left this person/situation or if you didn’t do what this person told you to do?
- How much time can you spend at the current location?
- Do you believe that you or a family member is in danger?
- Do you want assistance in leaving your situation?
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The NHTRC is a first step to assist agencies in identifying and supporting possible victims. The resource center will also help facilities determine and build protocols to respond to trafficking victims.
U.S. Department of Health and Human Services
Another valuable resource is the U.S. Department of Health and Human Services (DHHS). The DHHS lists multiple resources, services, and legal rights information, on their website. The DHHS has built a task force and training services to inform the public about identifying victims and how to contact organizations that provide help. Clinicians or the general public can email firstname.lastname@example.org or call 844 648 8822 to speak with a specialist. Services are free and delivered as needed.
Because human trafficking is a global issue it is difficult to say exactly how and why people are trafficked. Countries trade people in different ways; for example, in Africa or India a family member (usually a young woman) may be traded through family contacts for as little as £300, while in Vietnam and Afghanistan Mafia-type organizations sell and trade human victims (Adams, 2012).
Local hospitals and communities may be able to partner with charity organizations. Depending on the area, some charities offer resources for trafficking victims. Clinicians can contact their local charities to establish a relationship and provide assistance to one another if a trafficking victim is identified in the area.
Once victims are identified, it is necessary to interview them, but it is important that you care for the person’s basic needs first (food, clothing, shelter, safety). Interviewing the victim about a trafficking experience is a very sensitive and stressful process. We must develop trusting relationships with patients in a safe environment for them to feel safe enough to talk openly.
Without cooperation from the victim, prosecution of the trafficker is nearly impossible. Up to 95% of victims experience some form of sexual or physical abuse (Olguin, 2015). Because of the abuse, they may not be able to open up to medical staff or law enforcement during the first interview. You must be careful not to re-traumatize victims by asking questions that stress them. This applies especially when dealing with children; for example, virginity demands a higher price, so children are at higher risk (Adams, 2012). With any victims under 18 years of age, Child Protective Services must be informed.
The Trafficking Victim Identification Tool
The Trafficking Victim Identification Tool (TVIT) provides a guideline and interview questions that have been proven to identify victims of human trafficking. These questions should be asked by a trained healthcare professional and in a secure environment.
The manual, Screening for Human Trafficking: Guidelines for Administering the Trafficking Victim Identification Tool (TVIT), is based on research conducted by the Vera Institute of Justice and was found to be highly reliable in predicting both sex and labor trafficking victims. The screening tool offers both long and short versions, with the short 16-question version as reliable as the long version.
The tool should be used to guide the interview process with potential victims. Effectiveness of the tool will be based on the rapport built between the victim and the clinician and the willingness of the victim to answer honestly and freely. Consent must always be obtained from the patient prior to calling the hotline or beginning the interview process. We need to be honest with the patient about the purpose of the screening and describe the victim’s rights, the interview process, and the roles of everyone involved (TVIT, 2014).
Beginning the TVIT Assessment
Traffickers often use the fear of immigration officials to control their victims. Many victims may be afraid to reveal immigration status to law enforcement because they do not know enough about the protections regarding trafficking. If law enforcement is present during the interview, they need to keep tactical gear, weapons, and badges hidden and convey a caring attitude (TVIT, 2014).
The interviewer can use phrases such as “We are here to help you,” or “Your safety is our priority,” and “You have the right to live without being abused” (TVIT, 2014). These words can help put the victim at ease during the interview process. The discussion and questioning about immigration must be handled carefully so as to not frighten the victim or worry them about legal consequences.
The interviewer should always ask the victim about their country of birth to determine if the migration section of the screening tool will be needed. The screening tool offers the language for the screener to use for foreign-born victims:
Now I am going to ask you some questions about your country of origin. I am not asking you this to find out about your immigration status. I am only trying to understand what your circumstances are so that we can refer you for the right help, if necessary. The questions ask about your emigration to the United States, who was involved, and how it was arranged. (TVIT, 2017)
For children, it can be stated:
We would like you to tell us about what happened to you when you traveled to the United States. (TVIT, 2014)
For best results, the screening tool should not be used until there is trust between the victim and the interviewer; also, it is best to keep the number of people to a minimum when working with these patients to avoid overwhelming them.
During the interview process it is important to take the time to get the full story. Pay attention to the words the victim uses throughout the conversation. The TVIT inquiries about “work or other activities” performed during the capture. This is to solicit information about sexual services and other types of informal work (TVIT, 2014). Victims may not think of rape, forced prostitution, forced shoplifting, or forced drug smuggling as “work” (TVIT, 2014). Screeners should use the same terminology as the victim.
Note: Currently there is no validation tool that has been established for persons with disabilities or LGBTQ victims (TVIT, 2014).
Since every trafficking case is unique, there is no single way to use the screening tool. Victims may have come from anywhere in the world. Many victims may be trafficked to certain areas for specific events. For example, the Super Bowl is the single biggest occasion for human trafficking (Olguin, 2015).
Identification, protection, and safety are the top priorities when working with potential victims. Overall findings during the interview will determine how the facility and law enforcement can proceed. There is not a defined yes or no answer to the assessment tool, but a comprehensive result as to whether the victim has been trafficked based on the victim’s answers and the training and experience of the screening professional.
The TVIT screening tool is best utilized by trained social workers or other healthcare workers who have received adequate training. Human trafficking is everyone’s issue. The more resources we can provide for victims the more we can assist in their safety and—hopefully—prosecute their captures.
The TVIT, both long and short versions, is available online from Vera Institute of Justice (Vera, 2014). The document includes a Post Interview Assessment that is to be filled out by the interviewer. You can find this tool by clicking here.