1. Human Trafficking: It’s Right in Front of Us Deb Fischer-Clemens, RN, BSN, MHA Senior Vice President of Public Policy Avera Health

6. Human Trafficking By law in the U.S. and most countries, human trafficking has the elements of force, fraud or coercion Many times victims are not under lock and key - rather, they are watched and brainwashed with fear and intimidation

7. Myths of Human Trafficking Only involves foreign born nationals Must involve transfer across state / national boundaries There must be physical restraint Sex trafficking is the only form of human trafficking Victims will ask for help and self-identify

9. Identifying Victims of Trafficking in Persons (TIP) While trafficking is largely a hidden social problem, many trafficking victims are in plain site if you know how to identify them You have likely come in contact with a trafficking victim without realizing it and, therefore, missed an opportunity to help this individual escape bondage

10. Identifying Victims Warning signs – Not able to speak for themselves, never allowed to be alone – Lack of control of possessions, money or ID documents – Lack of knowledge of whereabouts – Loss of sense of time

11. Identifying Victims Work / living conditions that raise suspicion – Not being free to leave when one wishes – Being under 18 and providing commercial sex acts – Working excessively long / unusual hours – Owing a large debt and not being able to pay it off – Being unpaid, paid very little or paid only through tips

12. Identifying Victims Behaviors – Fearful, anxious, depressed, submissive or nervous – Avoiding eye contact – Unusual fear about bringing up law enforcement

13. Urgent Health Care Needs Common Urgent Problems – Malnutrition – Dehydration – Chemical exposures – Traumatic injuries – Respiratory problems

14. Urgent Health Care Needs Common Urgent Problems – Infections of skin – Gastrointestinal system – Lung – Reproductive tract – Withdrawal from addictive substances

15. Urgent Health Care Needs Assess mental health status for acute and/or violent manifestation – Anxiety – Post-traumatic stress disorder – Hostility – Depression – Suicidal ideations

16. Violence Examples of violence – Assaults – Beating – Rough sex – Discrimination Head and dental injuries are a common sign of violence Murder of a trafficked person is the ultimate violence, but difficult to investigate

17. Violence Another common consequence of violence is Traumatic Brain Injury

18. Jill’s Story Runaway teen at age 14, escaping sexual and physical abuse Homeless until approached in a suburban mall by a man named Bruce Promised to help and provide work

19. WHAT CAN YOU DO

21. Victims Provide a safe / comfortable area to treat medical needs Assure victim that you are there to HELP and not punish or deport

22. Step 1 As health care professionals, we are routinely gathering information about: – Demographics such as addresses and phone numbers – Past history – Make sure all information is current and accurate; Tell trafficker that it is important in order to reach patient about results of tests

23. Step 1 In addition, try to get the following information: – Phone number of the “family member” – License plate of their vehicle (by surreptitiously finding their vehicle) – Consider even photographing if the victim may be a minor

24. STEP 2 Separate the patient from ANY and ALL “family members / friends”

25. STEP 2: Separate the patient from ANY and ALL “family members / friends” You don’t know that the person claiming to be a family member or friend really is… The victim will never disclose as long as he/she feels threatened by the trafficker… Therefore, interview the victim alone!

26. Step 3 Before questioning potential trafficking victim: – Enlist a trusted translator / interpreter who also understands victim’s cultural needs – Be aware of cultural sensitivities and differences Importance of indirectly and sensitively probing to determine if person is trafficking victim

27. Step 3 Begin asking the patient general questions: – Are you in any physical danger? – Are you being threatened in any way? Consider moving to more direct questions: – Are you being controlled by the person who brought you here? – Are you involved in activities that you would like to stop?

28. Step 3 If possible eventually move to this question: Have you been asked to have sex with men that you don’t want to have sex with?

29. Step 3 Realize that for many reasons, the patient may not be truthful in his/her answer Also be aware that if you find you are dealing with a true victim of trafficking, there may be some danger to you and your staff should you attempt to free the patient

30. Be prepared for the minor patient to give evidence of being trafficked but not be willing to leave the trafficker

31. IF YOUR SUSPICIONS ARE STRONG OR CONFIRMED: As a health care professional, you are a mandated reporter in most states of abuse in minors. Therefore, you must report your suspicions to the proper authorities.

32. Minor Victims If patient is under 18 and has answered yes to ANY screening questions: – Follow child abuse protocol and mandatory reporting statues – Contact Security office/law enforcement regarding security needs – Contact Social Work

33. Victims If the patient is over 18 and does not want to contact anyone – Assess current level of danger – Provide local emergency number – 911 – Provide information so the patient knows where to get help – Provide National Trafficking Hotline: 888-3737-888 – Inform them that hospitals will provide assistance 24/7

34. Why Stay? Six Types of Influence: 1.Reciprocity 2.Scarcity 3.Authority 4.Commitment & Consistency 5.Liking 6.Consensus / Social Proof

35. Bottom Line Do NOT Blame the Victim

36. ASSESSMENT IN MEDITECH

37. Assessment for Every Patient

38. Intervention List

39. The Assessment

42. The Protocol

43. “The health care community must become more engaged in increasing the recognition of trafficked women and girls in health care settings, in provision of appropriate services, and in helping shape public policy to address what is one of the most disturbing health issues of our time.” -Chris Beyrer

44. Deb Fischer-Clemens, RN, BSN, MHA Senior Vice President, Public Policy Avera Health 3900 W. Avera Dr. Sioux Falls, SD 57108 (605) 322-4668 Deb.FischerClemens@Avera.org

45. Additional Resources The helpline center: helplinecenter.org; 211 (across SD)helplinecenter.org The Compass Center: thecompasscenter.org; 877-IN-CRISIS (46-274747thecompasscenter.org S.D. Domestic Violence Hotline: 800-430-SAFE (7233) SDNAFVSA “The Network”: sdnafvsa.comsdnafvsa.com Trafficked: The Exploitation of Women and Girls in the Bakken and Beyond: www.traffickedreport.comwww.traffickedreport.com The Polaris Project: www.polarisproject.org; 888-3737-888; text BeFree (23733)www.polarisproject.org