Via Christi develops protocol to identify, assist those victimized by human trafficking

April 15, 2015


A patient who struggles to provide a home address. Or one accompanied by someone else who seems hesitant to let the patient answer questions and interrupts to provide a medical history for the patient. A patient with a distinctive tattoo, or a severe injury he or she attempted to manage alone before seeking medical care. These are just some of the signs that could indicate a patient is a victim of human trafficking.

Human trafficking is a modern form of slavery. Victims often are used for commercial sex exploitation or forced labor. The health care environment may be the only place where a victim of human trafficking has an opportunity to be alone with a professional who may be able to assist them.

Wichita, Kan.-based Via Christi Health, an Ascension health care system in Kansas and Oklahoma, has developed a four-step protocol to help clinicians identify victims of human trafficking as well as ways to assist them. Two members of the Via Christi human trafficking awareness committee will describe the protocol during an Innovation Forum at the Catholic Health Assembly, June 7-9, in Washington, D.C.

Close to home
MRI technologist Nicole Ensminger, co-chair of the human trafficking awareness committee, said she began learning more about human trafficking when a friend told her about women and children sold into sex slavery in Cambodia. She said she felt heartbroken when she learned of their plight and was motivated to try to help trafficking victims. Ensminger decided to focus her energy close to home after her husband showed her an article from The Wichita Eagle, published in the fall of 2011, about human trafficking in the Kansas region where they live.

It's difficult to get an accurate count on how many people are trafficked domestically or internationally. A 2014 United Nations report said because human trafficking is a crime that relates to hidden populations, "there is no sound estimate of the number of victims" worldwide. In 2013, the Wichita police said they identified 29 people who had been trafficked, and 14 people were charged with trafficking victims under the age of 18.

Via Christi employees say the system already has been able to assist seven victims of human trafficking since early last year when it first began training clinicians on how to identify and assist a possible victim of human trafficking.

William "Skip" Hidlay, Via Christi Health's senior administrator for communications and marketing, and MRI technologist Nicole Ensminger, take part in a Feb. 9 Mass to honor and remember victims of human trafficking. Ensminger and Hidlay created the system's human trafficking awareness committee. The Mass was held at the Chapel of the Sorrowful Mother at Via Christi Hospital St. Francis in Wichita, Kan.

Health care protocol
Ensminger researched human trafficking while pursuing her master's degree. William "Skip" Hidlay, Via Christi's senior administrator for communications and marketing, was studying in the same master's program. He helped Ensminger create the health system's human trafficking awareness committee, which developed the protocol.

Ensminger said Via Christi's protocol is tailored specifically for human trafficking victims in a health care setting.

Via Christi gives its employees the protocol on a pocket card, has it posted on its website and has created a training program available electronically related to the protocol. In 2014, more than 125 Via Christi employees, including senior leaders, nurses, emergency department physicians and physician assistants attended training to learn the protocol. Members of the human trafficking awareness group are organizing training for additional employees, refining the language of the protocol and preparing it to make it available to other systems.

Spotting red flags
Before beginning the protocol, staff are trained to look for a number of physical indicators, and red flags that someone may be a victim of human trafficking, such as reluctance on the part of a patient to explain an injury, or a patient who doesn't know what city or state he or she is in. (Some traffickers move people between locations for prostitution or forced labor.)

Traffickers may delay medical treatment for a victim and may go to an emergency room or medical appointment with a victim, or send another person in with the victim to keep tabs on him or her. Some victims have tattoos used by a particular trafficker to brand his victims. Ensminger said sometimes these tattoos include the words "property of," symbols of money or a pimp's name. Care providers are trained to build rapport with their patients and create a dialogue about suspicious tattoos.

If a care provider finds a red flag present or a physical indication that a patient may be a victim of human trafficking or evidence that a trafficker is attempting to exert control over the patient, the first step of the four-step protocol includes following child abuse or domestic abuse protocols depending on the patient's age. These involve attending to the patient's medical needs and providing a comfortable and safe area for the patient, such as a private room. The clinician may cite patient privacy and ask the suspected trafficker to leave the patient room, or separate the patient from the controlling person by taking the patient to the bathroom or for an X-ray.

The care provider notifies the charge nurse of a potential human trafficking issue and engages a "trauma-informed" nurse or social worker who has gone through training to ask human trafficking assessment questions. If the patient doesn't speak English, an interpreter is called.

Ensminger said, "These questions are different from your typical (medical) history questions. During a trafficking situation, the trafficker has a lot of control on a victim. These questions are designed to extract that controlling factor."

The nurse or social worker asks questions such as: Have you ever exchanged sex for food, shelter, drugs or money? Does anyone hold your identity documents (like a driver's license or a passport) for you? Why?

If the answer is yes to any of the assessment questions and the victim is under 18, the employee who performed the assessment follows child abuse protocol, including mandatory reporting laws, which in Kansas require reporting abuse to the Kansas Department for Children and Families or the appropriate law enforcement agency. If the person being trafficked is 18 or older and wants to notify law enforcement, the clinician should assist the patient in calling 911. In either situation, on-site security should be kept updated for the safety of patients, visitors and staff.

If an adult victim doesn't want to notify law enforcement, the employee should make sure the patient knows how to get help later. Via Christi staff at any hospital are available around the clock to provide assistance; employees want the patient to know he or she can return when ready. The patient is also told he or she can call an area center that assists sexual assault victims, a national human trafficking hotline, or 911 to contact law enforcement.

Role playing
Kelly King, a charge nurse in labor and delivery at Via Christi Hospital St. Joseph in Wichita, went through a three hour training in January. It included overview information about human trafficking, the protocol and exercises where nursing students portrayed patients and traffickers. King said participants practiced having a staff nurse who had concerns about a red flag communicate that worry to a charge nurse. From there, King assessed patients, practicing tactics for how to make sure she could speak with a patient alone, focusing on making eye contact with the patient and reassuring the patient that the hospital is a safe place.

King called the training "fantastic" and said it fit with Via Christi and Ascension's commitment to treat the patient as a whole person with respect for their human dignity. Learning more about human trafficking helps care providers think to look for it. "The reality is it's a problem everywhere," King said.

Assessment tool helps clinicians assist trafficking victims
Via Christi Health's human trafficking assessment protocol instructs care providers to look for red flags such as branding tattoos and physical trauma that indicate a patient may be a victim of human trafficking.

If a warning sign is present, the following steps are taken:

Step one: The attending clinician follows child abuse or domestic abuse protocols, depending on patient's age. This includes attending to the patient's medical needs, separating the patient from the controlling person, including family members, notifying a charge nurse so the patient can be interviewed by a trauma-informed social worker, trauma-informed nurse or forensic nurse.

Step two: The patient answers interview questions set out in the protocol.

Step three: If the patient answers yes to any of the human trafficking assessment questions and is under 18, the hospital follows its child abuse protocol and complies with the state's mandatory reporting statutes. If the patient is 18 or over, the assessor obtains the patient's consent to notify law enforcement, and assists the patient in calling 911. If the patient is a foreign national, the hospital notifies the FBI. The assessor who suspects abuse or trafficking keeps hospital security updated throughout an unfolding situation to alert them to potential security issues.

Step four: If an adult patient does not want to involve law enforcement, hospital staff make sure the patient knows how to get help in the future, including by calling law enforcement agencies, rescue hotlines or by returning to a Via Christi hospital.

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Copyright © 2015 by the Catholic Health Association of the United States
For reprint permission, contact Betty Crosby or call (314) 253-3477.

Copyright © 2015 by the Catholic Health Association of the United States

For reprint permission, contact Betty Crosby or call (314) 253-3490.