HUMAN TRAFFICKING 10/15/18 OBJECTIVES OBJECTIVE: UNDERSTANDING THE TYPES AND VENUES OF HUMAN TRAFFICKING IN MICHIGAN AND THE UNITED STATES.

HUMAN TRAFFICKING DENA NAZER, MD FAAP CHIEF, CHILD PROTECTION TEAM CHILDREN S HOSPITAL OF MICHIGAN WAYNE STATE UNIVERSITY KIDS TALK CHILDREN S ADVOCACY CENTER OBJECTIVES Understanding the types and venues of human trafficking in Michigan and the United States. Identifying victims of human trafficking in health care settings. Identifying the warning signs of human trafficking in health care settings for adults and minors. Resources for reporting when suspecting an adult or child is a victim of human trafficking. Dispelling myths and misconceptions regarding human trafficking 2 OBJECTIVE: UNDERSTANDING THE TYPES AND VENUES OF HUMAN TRAFFICKING IN MICHIGAN AND THE UNITED STATES. 3 1

WHAT IS HUMAN TRAFFICKING? 4 WHAT IS HUMAN TRAFFICKING Human trafficking is a form of modern slavery a multi-billion dollar (150 billion$$) criminal industry that denies freedom to over 20 million people around the world. United Nations: a crime based on exploitation All trafficking victims share one essential experience: the loss of freedom. https://humantraffickinghotline.org/type-trafficking/humantrafficking 5 2

MYTH VS. REALITY Myth : Sex trafficking is the only form of human trafficking. Reality:The federal definition of human trafficking encompasses both sex trafficking and labor trafficking, and the crime can affect men and women, children and adults. 7 Federal Definition of Human Trafficking Sex Trafficking Labor Trafficking Sex Trafficking: Commercial sex act induced by force, fraud or coercion, or in which person performing the act is under age 18. Labor Trafficking: Using force, fraud or coercion to recruit, harbor, transport, or obtain a person for labor or services in involuntary servitude, peonage, debt bondage or slavery. Human trafficking is the exploitation of one person by another for financial or personal gain 8 MYTH VS. REALITY Myth: Human trafficking is essentially a crime that must involve some form of travel, transportation, or movement across state or national borders. Reality: Trafficking does not require transportation. Transportation may be involved as a control mechanism to keep victims in unfamiliar places but is not a required element. https://humantraffickinghotline.org/what-humantrafficking/myths-misconceptions https://humantraffickinghotline.org/what-humantrafficking/myths-misconceptions 9 3

SMUGGLING VS. TRAFFICKING Human Smuggling is transportation based Human Trafficking is exploitation based (as we saw from the legal definition) and does not have to involve movement. Three Elements of Trafficking Action MEANS* Purpose Recruiting OR Harboring OR Moving OR Obtaining a person, by Force OR Fraud OR Coercion Commercial Sex Act OR Labor or Services *No force, fraud, or coercion required when a child (under 18) is induced to perform a commercial sex act. FORCE, FRAUD, & COERCION Force o The use of physical restraint or serious physical harm. o Physical violence, including rape, beatings, and physical confinement, is often employed as a means to control victims Fraud o False promises regarding employment, wages, working conditions, or other matters Coercion o Threats of serious harm to or physical restraint against any person o The abuse or threatened abuse of the legal process. 4

MYTH VS. REALITY Myth : Human trafficking victims always come from situations of poverty or from small rural villages. Reality:Victims can come from a range of income levels, and many may come from families with higher socioeconomic status. Chances are it's happening nearby! From the girl forced into prostitution at a truck stop, to the man in a restaurant kitchen, stripped of his passport and held against his will. https://humantraffickinghotline.org/what-humantrafficking/myths-misconceptions 13 VICTIMS OF HUMAN TRAFFICKING Two types of victims of human trafficking: o Domestic o International (foreign nationals) May be a victim of labor trafficking, sex trafficking or both Victims of labor trafficking are more likely to be international Victims can be male or female May be an adult or a child ANYONE CAN BE A VICTIM Those who are more susceptible are those that are the most vulnerable (women and girls). 55% of the victims are women and girls 5

WHO ARE THE TRAFFICKERS? Immediate Family 36% Boyfriends 27% Emp loye rs Friends of family 14% 14% Strange rs 9% 0% 5% 10 % 15 % 20 % 25 % 30 % 35 % 40 % domestic minor sex trafficking Covenant House (2013). Homelessness, Survival Sex and Human Trafficking: As Experienced by the Youth of Covenant House New York. MYTH VS. REALITY Myth: Human trafficking only occurs in illegal underground industries. Reality: Trafficking can occur in legal and legitimate business settings as well as underground markets. It has been reported in business markets such as restaurants, hotels, and manufacturing plants, as well as underground markets such as commercial sex in residential brothels and street based commercial sex. https://humantraffickinghotline.org/what-humantrafficking/myths-misconceptions 17 WHERE DOES TRAFFICKING OCCUR? Sex Trafficking Massage Parlors Brothels (commercial & residential) Strip Clubs Escort Services Online Exploitation Truck Stops Labor Trafficking Domestic Service (nannies, maids, fiancées ) Sweatshop Factories Janitorial Jobs Construction Sites Beauty Industry Farm Work Restaurants and Hotels Panhandling Traveling Sales Crews 6

WHY AND HOW DOES IT EXIST? Human trafficking is a market-driven criminal industry that is based on the principles of supply and demand demand for cheap labor, services and for commercial sex Vulnerable children and adults High Profits: Individuals are willing to buy commercial sex and products. It is profitable for traffickers to sexually exploit children and adults. Low Risk: Human traffickers perceive there to be little risk or deterrence to affect their criminal operations. DOES HUMAN TRAFFICKING HAPPEN IN MICHIGAN? 20 'OPERATION CROSS COUNTRY XI 2017 In the span of 3 days, the FBI and local authorities across the country say they saved 84 minors from sex trafficking and arrested 120 sex traffickers as part of a nationwide effort to stop underage human trafficking. 12 children were recovered in Michigan alone 8 sex traffickers/ pimps were arrested. 46 adults were arrested who were involved in prostitution. 21 7

NUMBERS IN MICHIGAN Most reliable statistics come from the National Human Trafficking Resource Center (NHTRC) hotline run by Polaris https://humantraffickinghotline.org/states HUMAN TRAFFICKING IN MICHIGAN Human trafficking occurs in every state, including Michigan. The NHTRC works closely with service providers, law enforcement, and other professionals in Michigan to: serve victims and survivors of trafficking respond to human trafficking cases share information and resources. 23 NUMBERS IN MICHIGAN (CALLS AND CASES) 1200 Chart Title 1000 800 Number 600 400 200 0 2012 2013 2014 2015 2016 2017 Calls 255 472 529 717 843 962 Cases 69 118 131 151 246 305 According to statistics from the National Human Trafficking Hotline 8

25 STATE EFFORTS TO ADDRESS HUMAN TRAFFICKING LEGISLATION In 2014, Governor Snyder signed into law a 21-bill legislative package to strengthen the state s efforts to address human trafficking Included in the legislative package: Safe harbor provisions Tools to hold traffickers accountable Training for medical professionals Creation of the Human Trafficking Commission and Human Trafficking Health Advisory Board 9

HUMAN TRAFFICKING TRAINING REQUIREMENT FOR HEALTHCARE PROFESSIONALS Under law passed in 2014, health professions are required to create training standards for identifying victims of human trafficking Understanding the types and venues of human trafficking in Michigan and the United States. Identifying victims of human trafficking in health care settings. Identifying the warning signs of human trafficking in health care settings for adults and minors. Resources for reporting when suspecting an adult or child is a victim of human trafficking. OBJECTIVES: IDENTIFYING VICTIMS OF HUMAN TRAFFICKING IN HEALTH CARE SETTINGS. IDENTIFYING THE WARNING SIGNS OF HUMAN TRAFFICKING IN HEALTH CARE SETTINGS FOR ADULTS AND MINORS. 29 HUMAN TRAFFICKING AND HEALTHCARE 10

HEALTHCARE S UNIQUE OPPORTUNITY Unique opportunity to identify victims and offer assistance 2014 study: 88% of domestic sex trafficking victims had contact with healthcare while being trafficked 2011 study: half of international victims at an organization in CA had seen a healthcare professional None of the victims in either study left their situation as a result of the encounter Baldwin, S.B., Eisenman, D.P., Sayles, J.N., Ryan, G, & Chuang K.S. (2011). Identification of Human Trafficking Victims in Health Care Settings. Health and Human Rights, 13(1), 36-49 Lederer, L. and Wetzel, C.A. (2014). The Health Consequences of Sex Trafficking and Their Implications for Identifying Victims in Healthcare Facilities. Annals of Health Law 23(1), 61-91 AWARENESS AND TRAINING 2012 study: <5% of healthcare professionals are confident in their ability to identify victims & only 2% have received formal training 80% were hesitant to define human trafficking Only 7% confident in ability to treat a victim Chisolm-Straker, M. & Richardson, L. D. & Cossio, T.(2012). Combating Slavery in the 21st Century: The Role of Emergency Medicine. Journal of Health Care for the Poor and Underserved 23(3), 980-987 MYTH VS. REALITY Myth: Victims of human trafficking will immediately ask for help or assistance and will self-identify as a victim of a crime. Reality: Victims of human trafficking often do not immediately seek help or selfidentify as victims of a crime due to a variety of factors including: lack of trust self-blame specific instructions by the traffickers regarding how to behave when talking to law enforcement or social services https://humantraffickinghotline.org/what-humantrafficking/myths-misconceptions 33 11

BARRIERS TO VICTIM SELF- IDENTIFICATION May not understand they are considered victims of crime by law Shame or guilt Fear of retaliation by trafficker Fear of arrest or deportation Lack of transportation or controlled movement Fear of a report to social services Lack of understanding of U.S. health care system LOCATIONS WHERE VICTIMS ACCESS HEALTHCARE Emergency Department Planned Parenthood Family Physician Urgent Care Women's Clinic Neighborhood Clinic 0% 10 % 20 % 30 % 40 % 50 % 60 % 70 % 63% 30% 23% 21% 19% 19% Lederer, L. And W etzel, C.A. (2014). The Health Consequences of Sex Trafficking and Their Implications for Identifying Victims in Healthcare Facilities. Annals Of Health Law 23(1), 61-91 WHEN DO VICTIMS SEEK MEDICAL SERVICES? In an emergency After an assault After a workplace injury Gynecological services Prenatal care Routine checkups Mental health services Addiction treatment Pre-existing conditions Health issues unrelated to trafficking 12

IDENTIFYING VICTIMS OF TRAFFICKING DHALIA Dhalia was sent by her family to live with her cousin in Detroit and pursue her education after her family experienced financial trouble in Mexico. When she arrived, Dhalia was forced to do domestic work at her cousin's home all day, babysit his 3 children, and would work at his corner store late at night. She was not paid for her work and was denied education and medical care. She was kept away from the public s eye and neighbors didn t know she lived there. She was denied contact with her family and was verbally and physically assaulted. One night she had enough and attempted suicide. Her cousin called 911 and she was rushed to the emergency department. 38 DHALIA Her cousin gave the history in the emergency department and would not leave her side. He refused for her to answer questions She appeared malnourished, exhausted, and had multiple bruises on her exam. When questioned about the bruises and strangulation marks, he said she selfinflicted these marks. 39 13

HUMAN TRAFFICKING RED FLAGS Two types of red flags o Indicators of control o Physical Red Flags for sex and labor trafficking RED FLAGS: INDICATORS OF CONTROL Domineering accompanying individual o May be accompanied by trafficker or person working for trafficker o Other person with them may claim or actually be their boyfriend, husband, family member Subordinate, fearful, hyper-vigilant Scripted/inconsistent history RED FLAGS: INDICATORS OF CONTROL (CONT.) Individual cannot give an address/doesn t know city Lack of control over personal documents Paying in cash Clothing inconsistent w/ weather Delayed presentation for medical care 14

RED FLAGS FOR HUMAN TRAFFICKING Common Work and Living Conditions: Is not free to leave or come and go as he/she wishes Is in the commercial sex industry and has a pimp / manager Is unpaid, paid very little, or paid only through tips Works excessively long and/or unusual hours Is not allowed breaks or suffers under unusual restrictions at work Owes a large debt and is unable to pay it off Was recruited through false promises concerning the nature and conditions of his/her work High security measures exist in the work and/or living locations (e.g. opaque windows, boarded up windows, bars on windows, barbed wire, security cameras, etc.) 43 RED FLAGS FOR HUMAN TRAFFICKING Poor Physical Health: Lacks medical care and/or is denied medical services by employer Appears malnourished or shows signs of repeated exposure to harmful chemicals Shows signs of physical and/or sexual abuse, physical restraint, confinement, or torture Lack of Control: Has few or no personal possessions Is not in control of his/her own money, no financial records, or bank account Is not in control of his/her own identification documents (ID or passport) Is not allowed or able to speak for themselves (a third party may insist on being present and/or translating) 44 RED FLAGS FOR HUMAN TRAFFICKING Other: Claims of just visiting and inability to clarify where he/she is staying/address Lack of knowledge of whereabouts and/or of what city he/she is in Loss of sense of time Has numerous inconsistencies in his/her story Note: According to federal law, any minor under the age of 18 engaging in commercial sex is a victim of sex trafficking, regardless of the presence of force, fraud, or coercion. 45 15

SEAN Sean is a 17 year old who ran away from his home in Lansing. He ran out of money and was sleeping and living on the streets. He was introduced to heroine by a group of friends who also introduced him to a group of older men who would pay for him so he could afford the heroine. All he had to do was sexual favors. After a few years of living on the street, he decided to get tested for HIV and presented to your clinic for testing He tested positive for HIV, Hepatitis C 46 MYTH VS. REALITY Myth: If the trafficked person consented to be in their initial situation or was informed about what type of labor they would be doing or that commercial sex would be involved, then it cannot be human trafficking or against their will because they knew better. Reality: Initial consent to commercial sex or a labor setting prior to acts of force, fraud, or coercion (or if the victim is a minor) is not relevant to the crime, nor is payment. https://humantraffickinghotline.org/what-humantrafficking/myths-misconceptions 47 PHYSICAL RED FLAGS: SEX TRAFFICKING Persistent or untreated STIs or UTIs Trauma to vagina or rectum Problems with jaw or neck Repeated abortions or miscarriages Presence of cotton or debris in vagina Unintended pregnancies or fertility problems Pelvic pain Tattoos or marks that may indicate ownership Somatization symptoms (recurring headaches, abdominal pain, etc.) 16

MYTH VS. REALITY Myth: There must be elements of physical restraint, physical force, or physical bondage when identifying a human trafficking situation. Reality: Trafficking does not require physical restraint, bodily harm, or physical force. Psychological means of control, such as threats, fraud, or abuse of the legal process, are sufficient elements of the crime. https://humantraffickinghotline.org/what-humantrafficking/myths-misconceptions 49 CHILDREN AS VICTIMS ROSE Rose is a 13 year old child who presents to the emergency department with vaginal discharge. She missed her last 2 periods. She states she is sexually active with multiple partners including her 30 year old boyfriend and his friends. She ran away from home and her boyfriend is providing her a place to stay. 17

CHILDREN AS VICTIMS OF SEX TRAFFICKING The USE of any child <18 for sexual purposes in exchange for cash or in kind favors. Don t have to show Force Fraud Coercion Minors cannot consent to commercial sex acts 52 YOUTH AT RISK Homeless and runaways Prior abuse or neglect Substance abuse, behavior and mental health problems Poverty Unaccompanied foreign minors Feeling marginalized youth who identify as lesbian, gay, bisexual, transgender, queer, or questioning (LGBTQ) youth with a history of juvenile justice or child protective services (CPS) involvement Associated with gangs Societal attitudes of gender bias and discrimination, sexualization of girls, and glorification of the pimp culture IDENTIFYING CHILD VICTIMS OF TRAFFICKING 18

HOW DO VICTIMS PRESENT? Signs/symptoms of a sexually transmitted infection Injuries related to physical or sexual assault Exacerbation of an untreated chronic disease Suicide attempt Drug ingestion Assistance with contraception, abortion or complications of pregnancy Varma, Gillespie et. al 2015 POTENTIAL INDICATORS OF COMMERCIAL SEXUAL EXPLOITATION OF CHILDREN INITIAL PRESENTATION Child accompanied by domineering adult who does not allow child to answer questions unrelated adult other children and only one adult Child provides changing information regarding demographics Chief complaint is acute sexual assault or acute physical assault Chief complaint is suicide attempt Child is poor historian or disoriented from sleep deprivation or drug intoxication POTENTIAL INDICATORS OF COMMERCIAL SEXUAL EXPLOITATION OF CHILDREN HISTORICAL FACTORS Multiple sexually transmitted infections (STIs) Previous pregnancy/abortion Frequent visits for emergency contraception Chronic runaway behavior Chronic truancy or problems in school History of sexual abuse/physical abuse/neglect Involvement of child protective services (especially foster care/group home) Involvement with department of juvenile justice Significantly older boyfriend Frequent substance use/misuse Lack of medical home and/or frequent emergency department visits 19

POTENTIAL INDICATORS OF COMMERCIAL SEXUAL EXPLOITATION OF CHILDREN PHYSICAL FINDINGS Evidence suggestive of inflicted injury Tattoos (sexually explicit, of man s name, gang affiliation) Child withdrawn, fearful Signs of substance misuse Expensive items, clothing, hotel keys Large amounts of cash Poor dentition or obvious chronic lack of care MEDICAL EVALUATION COMPONENTS OF THE MEDICAL EVALUATION As for other pediatric complaints: History Physical examination Laboratory testing Treatment planning Forensic evidence collection (certain cases) Report suspected child abuse Call the HT hotline 20

FOCUS OF MEDICAL EVALUATION Assessing and treating acute and chronic medical conditions Assessing dental health and care Referral to appropriate sexual assault response team Documenting acute/remote injuries, genital and extragenital (cutaneous, oral, closed head, neck, thoracoabdominal injuries, and skeletal fractures) Assessing overall health, nutritional status (including iron and other mineral or vitamin deficiencies), and hydration FOCUS OF MEDICAL EVALUATION Testing for pregnancy, STIs, and HIV Urine and/or serum screening for alcohol and drug use, as clinically indicated Offering contraceptive options Offering prophylaxis for STIs and pregnancy ADDITIONAL QUESTIONS WHEN YOU SUSPECT CSEC: 1. Has anyone ever asked you to have sex in exchange for something you wanted or needed (money, food, shelter, or other items)? 2. Has anyone ever asked you to have sex with another person? 3. Has anyone ever taken sexual pictures of you or posted such pictures on the Internet? 21

JANUARY, 2018 64 In this cross-sectional study, patients aged 12 to 18 years who presented to 1 of 3 metropolitan pediatric emergency departments or 1 child protection clinic and who were identified as victims of CSEC/CST were compared with similar-aged patients with allegations of acute sexual assault/sexual abuse (ASA) without evidence of CSEC/CST. The 2 groups differed significantly on 16 variables involving reproductive history, high-risk behavior, sexually transmitted infections, and previous experience with violence. A 6-item screen was constructed, and a cutoff score of 2 positive answers had a sensitivity of 92%, specificity of 73%, positive predictive value of 51%, and negative predictive value of 97%. 65 66 22

OBJECTIVES OF THE PHYSICAL EVALUATION Detect signs of STI. Identify injuries outside of the anogenital region Recognize signs of self-injurious behaviors Address patient concerns about physical health that may arise subsequent to abuse. Collect forensic evidence. PHYSICAL EXAMINATION NOT limited to the anogenital region. A comprehensive head to toe examination is indicated. MEDICAL EXAM The child should be offered a medical examination including forensic evidence collection as soon as possible. Investigators must follow CPS policy on medical examinations for suspected cases or child sexual abuse. The medical examination should be completed by a medical practitioner who specializes in medical examinations of child sexual abuse, or a sexual assault nurse examiner. If possible, the medical examination should be conducted at a Children s Advocacy Center 23

EMERGENCY TREATMENT If sexual assault occurred within the last 72 hours, child needs to be assessed for and offered HIV post exposure prophylaxis as soon as possible. An HIV specialist should be consulted LOCATIONS WHERE THE EVALUATION CAN TAKE PLACE ACUTE (URGENT) <120 hrs Wayne County Sexual Assault Forensic Examiner (acute) WC- SAFE NON-ACUTE (NON URGENT) >120 hrs Kids TALK CAC WHAT TO DO NEXT Follow existing protocols for child abuse, sexual abuse, rape, domestic violence, etc IN MICHIGAN THIS IS CASE NEEDS TO BE REPORTED TO CHILD PROTECTIVE SERVICES Explain reporting obligations to the patient Provide options while keeping in mind the patient s age and immigration status Know the local organizations that help survivors of trafficking governmental, non-governmental, international In U.S., provide the National Human Trafficking Resource Center (NHRTC) hotline number: 1-888-3737-888 24

ROSE Rose is a 13 year old child who presents to the emergency department with vaginal discharge. She missed her last 2 periods. She states she is sexually active with multiple partners including her 30 year old boyfriend and his friends. She ran away from home and her boyfriend is providing her a place to stay. WHERE AND WHEN DOES SHE NEED THE MEDICAL EXAM? Depends on the last time the sexual abuse happened? Refer to your state laws (in Michigan it s 120 hours). If <120 hours contact SAFE If >120 hours refer to the CAC or child abuse specialist unless the child has a medical emergency e.g. genital bleeding ROSE Her physical examination reveals a thin child with multiple bruises on her arms and legs Her anogenital examination is normal Her labs are positive for gonorrhea. Pregnancy test is positive 25

HER ANOGENITAL EXAM IS NORMAL!! A Normal Examination Does Not Rule Out Sexual Abuse IT S NORMAL TO BE NORMAL Only a small percentage of children have signs of genital or anal injury upon examination. no injury was sustained due to the nature of the physical contact the contact involved penetration of tissues that stretched without being injured the contact resulted in injuries that healed by the time the child was examined. 78 26

''NORMAL'' DOES NOT MEAN ''NOTHING HAPPENED'' Genital Anatomy in Pregnant Adolescents: ''Normal'' Does Not Mean ''Nothing Happened'' Nancy D. Kellogg, Shirley W. Menard and Annette Santos Pediatrics 2004;113;e67 Only 2 of the 36 subjects had definitive findings of penetration. COMPLEX NEEDS OF VICTIMS Housing: Food, clothing, etc Interpreter services Emotional support Mental health care Legal advocacy Case management COMPLEX NEEDS OF VICTIMS Immigration assistance Language training School enrollment Life skills and job training Family services, potential reunification Transition services Aftercare planning Support, mentoring 27

RECOMMENDED REFERENCE/ AAP OBJECTIVE: RESOURCES FOR REPORTING WHEN SUSPECTING AN ADULT OR CHILD IS A VICTIM OF HUMAN TRAFFICKING. 83 RESPONDING TO TRAFFICKING 28

IMPORTANT TO REMEMBER Not every victim you identify will want or feel safe to leave their situation Let them know your setting is a safe place Equip with resources/hotline Affirm they are not criminals Trauma-informed approach Empowerment vs. Saving TAKE ACTION IDENTIFY: Male and female victims of human trafficking may present for medical care for a variety of reasons Victims rarely self-identify. EVALUATE: Evaluations of victims may be challenging. REPORT: YOU are mandated reporters of suspected child abuse and neglect. Call the Human Trafficking Hotline CONNECT: Connect with SAFE and the Children s Advocacy Center for a forensic interview and medical evaluation ADVOCATE: Educate professionals and families Give anticipatory guidance to parents and children regarding Internet safety as well as common recruitment scenarios. TAKE ACTION IDENTIFY: Male and female victims of human trafficking may present for medical care for a variety of reasons Victims rarely self-identify. EVALUATE: Evaluations of victims may be challenging. REPORT: YOU are mandated reporters of suspected child abuse and neglect. Call the Human Trafficking Hotline CONNECT: Connect with SAFE and the Children s Advocacy Center for a forensic interview and medical evaluation ADVOCATE: Educate professionals and families Give anticipatory guidance to parents and children regarding Internet safety as well as common recruitment scenarios. 29

TAKE ACTION IDENTIFY: Male and female victims of human trafficking may present for medical care for a variety of reasons Victims rarely self-identify. EVALUATE: Evaluations of victims may be challenging. REPORT: YOU are mandated reporters of suspected child abuse and neglect. Call the Human Trafficking Hotline CONNECT: Connect with SAFE and the Children s Advocacy Center for a forensic interview and medical evaluation ADVOCATE: Educate professionals and families Give anticipatory guidance to parents and children regarding Internet safety as well as common recruitment scenarios. TAKE ACTION IDENTIFY: Male and female victims of human trafficking may present for medical care for a variety of reasons Victims rarely self-identify. EVALUATE: Evaluations of victims may be challenging. REPORT: YOU are mandated reporters of suspected child abuse and neglect. Call the Human Trafficking Hotline CONNECT: Connect with SAFE and the Children s Advocacy Center for a forensic interview and medical evaluation ADVOCATE: Educate professionals and families Give anticipatory guidance to parents and children regarding Internet safety as well as common recruitment scenarios. TAKE ACTION IDENTIFY: Male and female victims of human trafficking may present for medical care for a variety of reasons Victims rarely self-identify. EVALUATE: Evaluations of victims may be challenging. REPORT: YOU are mandated reporters of suspected child abuse and neglect. Call the Human Trafficking Hotline CONNECT: Connect with SAFE and the Children s Advocacy Center for a forensic interview and medical evaluation ADVOCATE: Educate professionals and families Give anticipatory guidance to parents and children regarding Internet safety as well as common recruitment scenarios. 30