Health-care provider challenges to the identification of human trafficking in health-care settings: A qualitative study

ABSTRACT

This study explored health-care providers’ perspectives on practitioner-related factors that can challenge their ability to identify adult victims of labor and sex trafficking seeking medical attention in the U.S. health-care system. Forty-four interviews were conducted with health-care professionals in Houston, Texas, between June 2015 and February 2016. Thematic content analysis was conducted to identify emerging themes. Overall, the number of victims identified by providers was low as was providers’ awareness and knowledge of human trafficking, particularly forced labor. Clinician-related factors inhibiting identification included the following: inadequate community resources for which to refer victims and clinician lack of knowledge of extant resources; the absence of institutional guidance in caring for victims; and clinician-held stereotypes of stigmatized populations. Findings of this study provide support for existing scholarship. They also suggest that health-care settings need to implement protocols for care with mechanisms of referral to vetted community resources for victims who decide to leave their traffickers. Findings also suggest the need for evidenced-based education for health-care providers, which address stereotypes that can impede provider/patient relations. Trainings might draw on established best practices for working with other stigmatized populations such as those with HIV and mental illness.

KEYWORDS:

• health-care provider
• human trafficking
• identification challenges

Acknowledgments

The first author wishes to thank her dissertation committee: Sheryl McCurdy, PhD, Gretchen Gemeinhardt, PhD, MBA, FACHE, Beatrice Selwyn, ScD, and Kerry Ward, PhD. All were vital contributors to this article. I would also like to thank the many members of the Houston health care, public health, and anti-human-trafficking community who participated in my study. Thank you also to members of the HEAL Trafficking Network, with special thanks to Dr. Makini Chisolm-Straker and Dr. Cathy Miller.

Notes

¹ Human trafficking in the United States is defined in the Trafficking Victims Protection Act of 2000 (TVPA, 2000). It is an overarching term used to describe the act of recruiting, harboring, transporting, providing, or obtaining a person for pressed labor or commercial sex. It is a federal crime when it reaches the level of a “severe” form, meaning that force, fraud, or coercion are used to compel the person into labor or commercial sex. With minors, the elements of force, fraud, and coercion do not have to be present for sex trafficking to be considered “severe.” Thus, a male or female not yet 18 years old is considered a victim of sex trafficking if he or she has been induced into a commercial sex act, regardless of the form of inducement. Movement of a person from site to site is not necessary for an act to be considered trafficking. The essence of trafficking is the exploitation of an individual through manipulative, coercive, and sometimes violent behaviors (U.S. Department of State, 2016). The current study focuses on adults only and does not address the trafficking of minors.