Human Trafficking FACTS. Health Ministries Conference. What is human Trafficking? September 9, 2018

Transcription

1 Human Trafficking Health Ministries Conference September 9, 2018 Scarlet Hudson, Theresa Vietor MSN What is human Trafficking? Human trafficking is not only a human rights issue, it is also a criminal justice issue, a public health issue, a child welfare issue, and a local and community issue that affects us all. Polaris Project The Trafficking Victims Protection Act (TVPA) defined trafficking as (Gallagher, 2012): Sex trafficking in which a commercial sex act is induced by force, fraud, or coercion, or in which the person induced to perform such act has not attained 18 years of age. OR The recruitment, harboring, transportation, provision, or obtaining of a person for labor services, through the use of force, fraud, or coercion for the purpose of subjection to involuntary servitude, peonage, debt bondage, or slavery. End Slavery Cincinnati, 2016 Commercial sex Pornography Forced begging Restaurant work FACTS Drug sales and cultivation Stripping Magazine crews Au pairs / nannies Hair / nail salons Agricultural work

2 59% Women 14% Men GLOBAL STATISTICS 17% Girls 10% Boys 600,000 to 800,000 women, children, and bought and sold across international borders every year (US Government). STATISTICS When internal trafficking victims are added, 2 to 4 million with 50% of this population estimated to be children. 4.5 million of trafficked persons are sexually exploited. Up to 300,000 Americans under the age of 18 are lured into the commercial sex trade every year. 14,500 to 17,500 of those victims are trafficked into the US each year. NEUROBIOLOGY OF TRAUMA One must understand the short and long term consequences of trauma to understand patient presentation.

3 AMYGDALA DETECTS What happens during an assault THREAT THE PATIENTS RESPONSE/ MEMORY OF EVENT ACTIVATES HYPOTHALAMUS RELEASES FLOOD OF HORMONES HPA AXIS KICKS IN MEMORY PROCESS IMPACTED BY TRAUMA: Limbic System HIPPOCAMPUS RESPONSIBLE FOR PROCESSESING INFORMATION INTO MEMORIES ENCODING AND CONSOLIDATING MEMORIES AMYGDALA RESPONSIBLE FOR PROCESSING EMOTIONAL MEMORIES WORKS WITH THE HIPPOCAMPUS BOTH STRUCTURES SENSITIVE TO HORMONAL FLUCTUATIONS 9 VIOLENCE OVER A LIFETIME CHANGES THE WAY THE BRAIN FUNCTIONS DULLS A TYPICAL RESPONSE TO THREAT CREATES GREY AREAS BETWEEN WHAT IS COMMONLY ACCEPTED AS RIGHT OR WRONG

4 Characteristics of the Victim-survivor: Poly -victimization Finkelhor, D., Turner, H., Hamby, S. Ormrod, R.(2011). Polyvictimization: Children s exposure to multiple types of violence, crime, and abuse. Juvenile Justice Bulletin. National Survey of Children s Exposure to Violence. U.S. Department of Justice, Office of Justice Programs. Retrieved 6/14/18 from Adjusted World View From the abusers perspective Idealization of the abuser, strives to please him / her. Marked by both abuse, control, and dependency along with love, admiration, and gratefulness. Shame and Guilt The Apple and the Tree: Family violence

5 Trauma bonding Herman (1992a) All the structures of the self the image of the body, the internalized images of others, and the values and ideals that lend a sense of coherence and purpose are invaded and systemically broken down. One isolated traumatic event: I am not my self anymore. Chronic abuse and repeated traumatic events: I do not have a self. Conditions Facilitating Recruitment Economic desperation Playing on vulnerabilities Coercion and violence Pimps recruit young, vulnerable US women and children by befriending and creating emotional and drug and alcohol dependencies to entrap them. International Sex Trafficking of Women & Children. Understanding the global epidemic. Looseleaf Law Publications, Inc. New York. Retrieved 8/7/17 from Women of Alabaster Ministries Video

6 Characteristics of Sex Trafficking Characteristics: No single profile Adults and minors in rural, suburban, or urban communities across the country Victims diverse socio-economic backgrounds, varied levels of education, and may be documented or undocumented. Risk factors for victims: 1. Runaway and homeless youth 2. Foreign Nationals 3. Individuals that have experienced trauma and violence Case Study 1 A Profile and History Age: 38 Street: 8 years Gender: Female/Caucasin Marital Status: Divorced Religious Status: Believer Current Status: Faith-based Treatment Facility Highest Level of Education: Some College (Medical Assistant) Pimp: Yes Alcohol and Drug Abuse Physical and Mental Abuse Age 6 Rape Victim (not reported) Father not in picture Back Injury triggered addiction Children (3) biological (1) husbands son Case Study 2 W Profile and History Age: 42 Street: 11 years Gender: Female/Caucasin Marital Status: Divorced Religious Status: Believer Current Status: Work Highest Level of Education: 2-year College (Addiction Counselor) Pimp: Yes Alcohol and Drug Abuse Physical and Mental Abuse Left home at 15 after rape Mother and Father addiction issues Trigger: Childhood Trauma Children (3) biological

7 Case Study 3 B Profile and History Age: 32 Street: 17 years Gender: Female/Caucasin Marital Status: Divorced Religious Status: Believer Current Status: Treatment/New Apartment & Job Highest Level of Education: 8 th grade (reading & writing limited) Pimp: Yes Alcohol and Drug Abuse Physical and Mental Abuse Mom had her dancing for boyfriend at 8 (alcohol) at age 12 stripping and heroin addiction began Father not in picture Trigger: childhood trauma Children (3) biological Healthcare Interaction with victimsurvivor Mental and Sexual Trauma = FEAR (Inner child) Emergency Department = Hyper sensitive to ALL stimulus Anxiety and PTSD/ respond to victim with positive body language and vocal tones remain calming = Emphathetic + Trustworthy Encourage doctor to begin anxiety meds immediately Questions must be direct and not repetitive Victim Is Not Drug Seeking (less than 5%) = I came for help Call an Advocate to sit while with victim/survivor Identification within the Healthcare System LACK OF EDUCATION REGARDING HUMAN TRAFFICKING LACK OF A PROTOCOL GUIDING RESPONSE AND INTERVENTIONS

8 CHOICE vs. COERCION The Drug Epidemic Use of drugs and alcohol to cope - 87% of international women - 92% of US women 50% started using drugs and alcohol to cope after they entered the sex industry ADDICTION: SYMPTOMS OF WITHDRAWAL WITHIN 6 TO 12 HOURS Tearing up, muscle aches, agitation, trouble falling and staying asleep, excessive yawning, anxiety, nose running, sweats, racing heart, hypertension, fever, inability to concentrate. WITHIN 72 HOURS Nausea and vomiting, diarrhea, goosebumps, stomach cramps, depression, drug cravings, aggression, paranoia, hyperactivity. REFRAMING TRAUMA-COERCED ATTACHMENT Power imbalance created by coercion may be invisible if there is very little physical violence associated with it. The traumatic entrapment is often not identified by professionals and the public because of the nature of the coercion that may seem invisible. Power imbalance created by abuser should be seen as chronic stress (fear, dread, and obedience) vs. dysfunctional attachment that reflects masochism, weakness, or social vulnerability.

9 IDENTIFICATION: UNDERSTANDING RED FLAGS Screening Documentation of red flags POSSIBLE SCREENING QUESTIONS Have you been forced to engage in sexual acts for money or favors? Is someone holding your passport or identification documents? Has anyone threatened to hurt you or your family if you leave? Has anyone physically or sexually abused you? Do you have a debt to someone you cannot pay off? Does anyone take all or part of the money you earn? NHTH, 2017 Documentation of Red Flags of Trafficking

10 What to say when you think someone is being trafficked? My highest concern is you, and your well-being. I am worried about your safety if you leave and are stuck in a situation you do not want to be in. If someone is making you do ANYTHING you do not want to do, that is not ok. There may be services available to help you. NOTE: Your immigration status does not matter to me. If anyone has threatened your safety, or the safety of someone you care about, or your immigration status, that is not OK. At this point my main concern is your safety. Offer immediate support: Call the National Human Trafficking Hotline with the victim-survivor If an individual refuses services or help, share the NHTH number above with them so they can call and access resources at a later date. RIGHTS: Response Initiative Guiding Human Trafficking Services PROTOCOL DEVELOPMENT Mission and Statement of Purpose Mission: To optimize community response to victim-survivors of human trafficking by utilizing and maintaining an inter-professional approach. Statement of Purpose: The purpose of the protocol is to provide individuals and agencies in the Northern Kentucky Region with comprehensive resources and guidelines for responding to victim-survivors of human trafficking. The use of the protocol and resource manual will not only ensure safety of the victim-survivor of human trafficking but also creates awareness of the issue of human trafficking and promote positive systemic change through a collaborative and transparent process. Best Practices for the Treatment of Victim-Survivors of Human Trafficking

11 Goals: INTER-PROFESSIONAL TASK FORCE DEVELOPMENT Development of a human trafficking team that includes healthcare providers, forensic nurses, law enforcement, case managers, the justice system and community resources. Identification of processes to support healing and promote resilience for victim-survivors. Support for the prosecution of human traffickers. Increase human trafficking identification and community awareness. Forensic Nursing Response Offer opportunity to call case management to assist patient at time of arrival. More in-depth screening provided using Vera Short form screening tool as a guide. Offer opportunity for forensic nursing exam Provide advocacy information and follow up opportunities

12 JOSEPHINE S CLINIC References CDC. The National Intimate Partner and Sexual assault Violence Survey Retrieved 9/8/2016. Alpert, EJ., Ahn, R., Albright, E., Purcell, G., Burke, TF, Macias-Konstantopoulos, WJ. ( September, 2014). Human Trafficking: Guidebook on Identification, Assessment, and Response in the Health Care. Setting MGH Human Trafficking Initiative, Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA and Committee on Violence Intervention and Prevention, Massachusetts Medical Society, Waltham, MA. Centers for Disease Control and Prevention (2012). National center for injury prevention and control. Web-based injury statistics query and reporting system (WISQARS): Cost of injury reports. Retrieved from Decker, MR., McCauley, HL., Phuengsamran, D., Janyam, S., & Silverman, JG. (2011). Sex trafficking, sexual risk, sexually transmitted infection and reproductive health among female sex workers in Thailand. Journal of Epidemiology & Community Health. 65(4), Doi: /jech Felitti, V., Anda, R., Nordenberg, D., Williamson, D., Spitz, A., Edwards, V., Koss, M., Marks, J. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The adverse childhood experiences study (ACE) study. American Journal of Preventive Medicine. 14(4), Gibbons, P., & Stoklosa, H. (2016). Identification and treatment of human trafficking victims in the emergency department: A case report. The Journal of Emergency Medicine, 50(5), doi: Hachey, L.& Phillippe, J. (2017). Identification and management of human trafficking victims in the emergency department. Advanced Emergency Nursing Journal 39(1), Hemmings, S., Jakobiwitz, S., Abas, M., Bick, D., Howard, L., Stanley, N., Zimmerman, C., Oram, S. (2016). Responding to the health needs of survivors of human trafficking: a systemic review. BMC Health Services Research 16:320. DOI /s Hudson, S. (2016). Data collection from Women of Alabaster and Tamar s Place missions. Cincinnati, Ohio. Lederer, LJ., & Wetzel, CA. (2014). The health consequences of sex trafficking and their implications for identifying victims in healthcare facilities. Annals of Health Law, 23,61. Oram, S., Ostrovschi, NV., Gorceag, VI., Hotineanu, MA., Gorceag, L., Trigub, C., & Abas, M. (2012). Physical health symptoms reported by trafficked women receiving post-trafficking support in Moldova: Prevalence, severity, and associated factors. BioMed Central Women s Health, 12, 20. Doi: / Ottisova, L., Hemmings, S., Howard, LM., Simmerman, C., & Oram, S. (2016). Prevalence and risk of violence and the mental, physical and sexual health problems associated with human trafficking: An updated systematic review. Epidemiology and Psychiatric Sciences, 25(4) Doi: /S Peters, K. (2013). The growing business of human trafficking and the power of emergency nurses to stop it. Journal of Emergency Nursing, 39(3) Polaris Project (2016). Human trafficking. Retrieved from Simon T., Hurvitz, K. (2014). Healthy people 2020 objectives for violence prevention and the role of nursing. Online Journal of Issues in Nursing, (4). Cinahl. Siskin, A., & Sun Wyler, L. (2013). Trafficking in persons: U.S. policy and issues for Congress. Washington, DC. Retrieved from Vera Institute of Justice (June 2014). Screening for Human Trafficking: Guidelines for administering the trafficking Victim identification tool (TVIT). NCJ# Retrieved from