HHSC Human Trafficking Reader Guide

New to Orbit Texas? Read Getting Started: HHSC-Approved Human Trafficking Training

Welcome to the reader guide for the HHSC-required Texas human trafficking training course for health care practitioners, designed by Orbit in collaboration with Free for Life International. This course involves studying and reflecting on three key articles in the field as well as expert criticism of these articles. In order to register credit while completing this course, you will need to be logged into your Orbit account. You will then redeem the reader guide and three articles from your Earn view using the Human Trafficking topic tag. For help getting started, email [e-mail].

Introduction

You might think of slavery as concept for the history books, but human trafficking - the exploitation of humans for labor and sex - is happening now across the world, including in your state. Human trafficking cuts across all demographics - age, gender, socioeconomic status, geographic location. Your role caring for patients, you can be instrumental in detecting and intervening to save a patient from continued devastating exploitation.

The Trafficking Victims Protection Act (TVPA) of 2000 is the first comprehensive federal law to address human trafficking, which includes two categories:

• Sex trafficking is the recruitment, harboring, transportation, provision, obtaining, patronizing, or soliciting of a person for the purpose of a commercial sex act, in which the 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.
• Labor trafficking is the recruitment, harboring, transportation, provision, or obtaining of a person for labor or services, through the use of force, fraud, or coercion for the purpose of subjection to involuntary servitude, peonage, debt bondage, or slavery.

Consensual commercial sex is different from sex trafficking. It involves a good-faith agreement to exchange money or goods for sexual services (Rothman, AMA Journal of Ethics, 2017). The legality of consensual commercial sex is governed by state law.

Human smuggling is different from human trafficking. Smuggling involves the illegal transport of an individual across a national border, and individuals consent to being smuggled. The transaction is mutual and ends upon arrival at desired destination. (US Department of Health & Human Services).

National Human Trafficking Hotline

The National Human Trafficking Hotline helps your patients with the difficult first steps in escaping human trafficking. These resources are confidential, toll-free, and available 24/7.

CALL	1-888-373-7888
TEXT	HELP to BEFREE (233733)
EMAIL	[e-mail]
VISIT	www.humantraffickinghotline.org

Reading assignment

Study each of these three open-access articles selected in collaboration with experts and survivors at Free for Life International, together with the reader guidance generously provided by Texas Health & Human Services. Be sure you're logged into Orbit while reading this reader guide and these three articles, and redeem your articles using the Human Trafficking tag.

Article 1: Child sex trafficking in the United States

Child sex trafficking in the United States: Challenges for the healthcare provider, PLOS Medicine, November 2017

Article 2: Human trafficking and labor exploitation

Human trafficking and labor exploitation: Toward identifying, implementing, and evaluating effective responses, PLOS Medicine, January 2010

Article 3: Human Trafficking

Human Trafficking, StatPearls, 2020.

Guidance:

In the section titled “Essential Elements: AMP Model,” the description on the TVPA definition of labor trafficking is missing the term "recruitment." For comparison, review the formal definition of labor trafficking that we included in the Introduction.

When reading this article, it is important to differentiate between human trafficking and consensual commercial sex, which isn't covered by the article. For comparison, review the definition of consensual commercial sex that we included in the Introduction.

The section called "Financial and Global Statistics” refers to human trafficking as a disease, which is not accurate. For comparison, the formal definition of human trafficking is included in the Introduction.

This section also mentions that human trafficking data is limited, without much explanation. There are various reasons this data is limited. Trafficking is hidden and criminal in nature, which makes it difficult to identify and enroll research subjects. The subjects that are available are frequently survivors, which means they may not be representative of people currently being trafficked. The research literature also varies in the formal definition of trafficking, limiting meta-analyses that would otherwise aggregate data across studies. Ethical and legal standards limit the ways in which data can be obtained, such as covert surveillance.

The section on “Labor Trafficking Red Flags” states, “Healthcare providers must determine if a crime occurred or if all three elements of trafficking in persons exist: force, fraud, and coercion.” This is not accurate. It is not the health care provider’s role to determine whether a crime occurred or which of the three elements the trafficker used to exploit the potential victim.

Instead, the provider’s role in intervention and response includes: (1) addressing the reason for the visit, (2) providing needed resources, and (3) reporting human trafficking situations to law enforcement according to state and local laws.

The section on "Signs of Physical or Psychological Torture" references cupping therapy, without providing a formal definition. Cupping therapy involves the application of suction to the skin, and dates back to 1550 BC. Wet cupping first lacerates the skin before applying suction, which additionally results in blood letting. Dry cupping involves suction without skin laceration.

The section "Sample Messages to Ease Communication" provides example messages that facilitate communication. The words you use to communicate with your patients are critical, but the following messages included in that section may be harmful:

Flawed message from provider to victim	Why this message is flawed
“You can trust me. I will do everything within my power to help you. Assistance is available for you under the law, and there are special visas to allow you to live safely in this country.”	You should provide helpful human trafficking resources but do not imply that certain services are available to victims, since each organization has its own eligibility requirements that some victims may not meet. Also, you could mention that there are U.S. visas available to eligible applicants, but avoid implying that visas ensure victim safety.
“Help us, so this does not happen to anyone else.”	This statement is not victim-centered because it appears coercive. The potential victim may feel pressured into giving information or completing an action so “this does not happen to anyone else.”

The section on "Mandatory Reporting/HIPAA Considerations" provides a general overview of reporting guidelines. When deciding to alert law enforcement, be sure to consider predetermined protocols, local or state laws, and patients’ wishes.

Questions?

Email [e-mail]