Human Trafficking: Identification and Response for the School ...

Human Trafficking: Identification and Response for the School ...

Human Trafficking: Identification and Response for the School Nurse KATHLEEN THIMSEN, DRNP, MSN FNS & LINDA NEUMANN RN Expected Outcomes Background & Rationale Health care providers are among the most likely front line providers who may encounter with trafficked victims while they are still under conditions of exploitation [2]. Studies have found that 28 percent to 87 percent of trafficking victims have encountered health care professionals while they are still under conditions of 1. Stoklosa, H., Grace, M., A. & Littenberg, N. (2015). Medical Education on exploitation [1] Human Trafficking. AMA Journal of Ethics. Volume 17 (10: 914-921), 2. Chon, K. , (2014). Testimony before : Committee on Energy & Commerce ,United

States House of Representatives. The recruitments, harboring, transportations, provision, or obtaining a person for sex or labor of services through the use of force, fraud, or coercions for the purpose of subjugation, servitude, peonage, debt bondage, or slavery There is an estimated over trafficked people globally What is trafficking? 40.3 Million Health Care and Human Trafficking

https://vimeo.com/155545532 Filmed by Andrew Baumgarter BSN RN Mercy Healthcare, St Louis, MO The Problem Sexual exploitation (forced prostitution, pornography) Domestic servitude (nannies, housekeepers, foster children ) Forms of trafficking

Organ harvesting (paying for organs or exploiting homeless and mentally ill) Servile marriage Child soldiers (mail order brides or child marriages) (adoptions from orphanages in countries of civil unrest) Force criminal activity

Forced labor door sales) (drug mules, gun runners) (day laborers, undocumented workers, door to Who is trafficked Undocumented immigrants/refugees Non-English speaking people Displaced people

Vulnerable persons with low self-esteem, followers, loners Poor, homeless Prostitutes (survival, forced not selfexploitation) Runaway teenagers Children from wealthy families Persons with addiction LGBTQIA

Populations at risk: St. Louis Metropolitan 3 Domains (Socioeconomic/Education System/ High Risk Venues) Human Trafficking Collaborative Network 2016; Polaris Project 2016 International victims at risk Do not speak or understand the native language Do not understand how the new country works Groomed and told lies about US authorities Made to believe they are criminals Fear of deportation and arrest

Cultural differences Rescue & Restore 2016; Polaris Project 2017 GIS Mapping of the ST Louis Metropolitan Statistical Area for the three domains of risk for Human Trafficking Human Trafficking Collaborative Network By the numbers* St Louis Missouri United States Human trafficking hotline calls (2017) Data not available 240

13,897 Human Trafficking Cases Reported (2017) Data not available 74 4,460 Types of Trafficking (2017) Sex Labor No Organ No child soldiers Sex: 59 Labor: 7 Sex & Labor: 3 Not specified: 5 Sex: 3,186

Labor: 689 Sex & Labor: 174 Not specified: 411 Citizenship of Victim (2017) Data not available US: 16 Foreign National: 11 US; 1,082 Foreign National: 872 Age of Victim (2017) 3 months- 48 years Adult: 44 of age Minor: 28 Adult: 2,812 Minor: 1,438

Gender of Victim (2017) Female Male Trans Female: 3,698 Male: 607 Gender Minority: 53 Missouri Attorney General Data (2017, January25)National Human Trafficking Hotline. Female: 66 Male: 10 Gender Minority: 3 The trafficker Can be a man or a woman

Deconditioning and manipulation of the victim keeps them under the traffickers control Gangs and organized crime are frequently involved because of high profits and low risk Traffickers are able to prey upon a victims desire to be loved & protected Once the victim accepts the perpetrators advances a more direct form of coercion and manipulation are used The perpetrator is able to manipulate and control minors by grooming due to immature development of prefrontal cortex Want the victim to be completely dependent on them

Show me the Money: Sex Trafficking Psychological manipulation Physical abuse Forced sex Punching Beatings

Kicked Strangled Threats of harm to loved ones and or pets Deprivation of food, water, sleep, and clothing Suspects need to maintain constant control over the victim Control of monitory valuables such as all identity and money

Threatened with weapons Adult Human Trafficking Screening Tool and Guide, HHS.gov (2018, Jan) Methods of Control Victim perspectiv e Signs, symptoms & Health Risks Depression, anxiety, social isolation, distrust, disassociations, splitting, PTSD, CPTSD, Stockholm syndrome

Victims rarely see themselves as victims Fearful, scared, substance abuse, mental health issues, signs of abuse, inconsistent stories, signs of sexual abuse, isolation Late presentation of medical concerns Frequents ED, absences Developmental delays, relationship development problems, Physical, educational, intellectual, cultural and spiritual deprivation

Health history Malnourishment Malnourishment Poor Bodily injuries Bloodborne diseases 1) R Bodily injuries 1) Cigarette burns 2) Fractures 3)

Bruises in different stages of healing 4) Contusions Chronic genito-urinary issues 5) Unusual discharge 6) Abnormal menstrual cycles 7) PID 8) Chronic infections 9) Pain during intercourse 10) Odor 11) STD Blood borne diseases TB (respiratory issues that go unresolved) ne Broken bones that do not heal properly

e and genitourinary issues STDs Tuberculosis Malnourishment Poor dental hygiene Broken bones that do not heal properly Traumatic Brain Injury

Pregnancy and abortion related complications Drug and alcohol dependency Chronic vaginal issues Suicide attempts Overdose dental hygiene Broken bones that do not heal properly Traumatic Brain Injury Pregnancy and abortion related complications Drug and alcohol dependency

Chronic vaginal issues Suicide attempts Overdose Poor dental hygiene Broken bones that do not heal properly Traumatic Brain Injury Pregnancy and abortion related complications Drug and alcohol dependency Chronic vaginal issues Suicide attempts Overdose Traffic Victims look like Child has over protective/aggressive/controlling parent/guardian Child may be in a co-parenting situation

Parent or guardian refuses or is hesitant to provide health information Child behaves in a fearful or submissive way Child may be overly friendly or physical- knows more adult vocabulary than typical for stated age Parent or guardian does not have identifying documentation Child is not sure where she/he is OR where they moved from Child has no money or appropriate clothing

Child has excessive money, clothing, electronics Signs of poor health inconsistent with the story Clothing is soiled or stained and a wear pattern may become obvious Signs of physical abuse or neglect Appears frightened, anxious, or distressed Absences are not readily explained

Gap in Knowledge and Skills A study conducted in New York City found that only 4.8 percent of emergency medicine clinicians reported feeling confident about their ability to identify a victim of human trafficking In a survey with trafficking survivors to explore their experience in interacting with health care professionals indicated that in addition to not being identified, Stoklosa, H., Grace, M., A. & Littenberg, N. (2015). Medical Education on Human they had been hurt, humiliated, and, in Trafficking. AMA Journal of Ethics. Volume 17 (10: 914-921), some cases, harmed by the actions of clinicians Next Steps Identify - Healthcare systems stakeholders to collaborate on community wide effort Develop - Standardized training curriculum and tools for - Best Practice Policies, Procedures &

Protocols that apply trauma informed, culturally competent care Research, Evaluate and Disseminate - Care strategies and outcomes Advocacy & Policy Through Collective Human Trafficking Identification & Response Trauma informed care; Advocacy; Collaboration with

community and parents; Myths- School Observed Red Flags Observation Triggers Prevention Strategies Psycho-social aspects

Somatic Complaints Being Prepared for a Safe Response Education ParentsChildren and Community Privacy Risk Assessments Social Media Policies Policies and procedures;

Mandated reporting; Schools strive to create a safety net for students by building healthy environments, ensuring student safety, promoting health, and assuring readiness to learn (Lewallen et al., 2015). A school nurse is an integral part of the school team, partnering with law enforcement and community health agencies, to recognize and respond to suspected human trafficking. School nurses use their assessment skills to provide pro-active surveillance that is critical to help identify risks associated with human trafficking. As school nurses we have the opportunity to interact with children on a daily basis. As mandated reporters, the role of the school nurse is to report suspicion of any child maltreatment

Childrens Division Child Abuse and Neglect Hotline 1-800-392-3738 The role of Child Protective Services and law enforcement is to investigate the suspicion (USDHHS, 2017). MYTH: Trafficking includes some form of travel or transportation across borders. FACT: HT does not require movement or border crossing. If someone is forced to work or engage in commercial sex against their will, it is trafficking. MYTH: Victims must be held against their will using some form of physical restraint or bondage. FACT: Some traffickers physically hold the people more commonly they use psychological means of control. Fear, trauma, drug addiction, threats against families, and a lack of options due to poverty and homelessness can all prevent someone from leaving. https://www.acf.hhs.gov/otip/about/myths-facts-human-trafficking MYTH: Victims will be desperate to escape

their trafficker and ask for help when they need it. FACT: HT victims may not readily seek help due to: shame, self-blame, fear, or even specific instructions from their traffickers. Some victims do not selfidentify and may not realize that they have rights. https://www.acf.hhs.gov/otip/about/myths-facts-human-trafficking MYTH: Only women and children are trafficked. FACT: Anyone can experience human trafficking. Traffickers prey on the vulnerable, often with promises of a better life. https://www.acf.hhs.gov/otip/about/myths-facts-human-trafficking School nurses should Be knowledgeable of local laws, regulations, policies and procedures and protocols for the process of reporting suspected human trafficking (USDHHS, 2017);

Advocate for trauma informed training for school personnel to improve communication with any child who has been or is a suspected victim of human trafficking (Cole, 2014; Wiest-Stevenson & Lee, 2016; Overstreet, S., & Chafouleas, S. M. (2016); Advocate for incorporating sexuality education/health promotion into the curriculum and the importance of healthy and unhealthy relationships (CDC, 2016b; NCMEC, n.d.); Build trust by establishing open, non-judgmental dialog with children (NCMEC, n.d.); Advocate for school health education policies that include personal body safety (NASN, 2016); School Nurses

are well positioned to: Educate the staff on indicators/signs that a student might display & on the nature of trafficking crimes (NASN, 2016); Be alert to those students who have frequent somatic complaints, sudden academic concerns, emotional or behavioral issues of which the underlying cause may be the complex trauma they are experiencing (NASN, 2016); Provide resources that can be posted in school and/ or given to students (hotline number & text, National Runaway hotline; crisis hotline);

Support the victims of human trafficking (NASN, 2016); and Collaborate with parent and community organizations/stakeholders to raise awareness of human trafficking (NASN, 2016). Are these posters still hanging in your school restrooms? MO Statute 160.975, RSMo. Prevention Character Education Internet Safety for students/parents/school staff

Every case is different, the following may be indicators that a child or youth may be involved in human trafficking (U.S. Department of Health and Human Services [USDHHS], 2017; NCMEC, 2017) Frequent, unexplained absences Repeat running away from home Unexplained bruises or scars, withdrawn behavior, or anxiety/fear Knowledge of sexual situations or terms beyond what is normal for the childs age

Signs of drug addiction, e.g. changes in behavior, personality, or mood Sudden changes in clothes, friends, or access to money Having a boyfriend or girlfriend who is noticeably older and/or controlling Coached or rehearsed responses to questions Expressing concern for family members safety if he or she shares too much information

Working unusually long hours and being paid very little More possible indicators that a child or youth may be involved in human trafficking Living at a workplace or with the employer, or living with many people in a small space Gang involvement (especially girls) Childhood sexual abuse

Childhood sexual assault or rape Children who identify as LGBTQ and are not accepted by their family and run away or are kicked out Children who abuse substances or live in a home where someone has a substance abuse problem Involvement with the Juvenile Justice system Withdrawn behavior/poor eye contact Depression/anxiety/sleep problems

Fear/concerned about safety Sudden change in academic performance School District Mandatory Safety Training Education / Advocacy 4th Annual Traffic School for Health care Professionals: Trauma Informed Care for Resilience to Enhance Clinical Outcomes November 1, 2018 Keynote Speaker: Dr Annie Lewis OConnor, ARNP

Goldfarb School of Nursing 4483 Duncan Ave Brigham Womens Hospital & Harvard medical School St Louis, MO 63110 Founder and Director of CARE Clinic 7:30am-4pm Co-Author of Adult Human Trafficking Screening Tool and Guide (HHS.gov) Cost: $30 (lunch, breaks and handouts included) Afternoon Session will be case simulated

scenarios Free Parking Poster Session & For more information or to be put on Eventbrite invite (available August 1, 2018) contact: [email protected] Community Resources and Referral Agency Exhibits Book Signing Dr Andrea Nichols Author of five books on sex trafficking Trauma Informed Care for Nurses Taking Care of Yourself

3 minute mediation Reflection Debriefing Leaving it at Work Taking Care of Each Other Listening Supporting Validating

references references Conclusion healtrafficking.org/ http://www.stoptraffickingmo-il.org/ training.html

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