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. 2017;22(1):1267980.
doi: 10.1080/10872981.2017.1267980.

Training US health care professionals on human trafficking: where do we go from here?

Affiliations

Training US health care professionals on human trafficking: where do we go from here?

Clydette Powell et al. Med Educ Online. 2017.

Abstract

Some 21 million adults and children are labor-trafficked or sex-trafficked through force, fraud, or coercion. In recognition of the interface between trafficking victims and the healthcare setting, over the last 10 years there has been a notable increase in training of health care professionals (HCPs) on human trafficking (HT) and its health implications. Many organizations have developed curricula and offered training in various clinical settings. However, methods and content of this education on trafficking vary widely, and there is little evaluation of the impact of the training. The goal of this study was to assess the gaps and strengths in HT education of HCPs in the US. This mixed-method study had two components. The first component consisted of structured interviews with experts in human trafficking HCP education. The second portion of the study involved an analysis of data from HCP calls to the National Human Trafficking Resource Center (NHTRC). The interviews captured trainer-specific data on types of HT training, duration and frequency, key content areas, presence of evaluation approaches and indicators, as well as an assessment of barriers and strengths in HT training for HCP. NHTRC call database analysis demonstrated increasing trends since 2008 in calls by HCPs. Overall findings revealed the need for standardization of HT training content to assure correct information, trauma-informed and patient-centered care, and consistent messaging for HCPs. Evaluation metrics for HT training need to be developed to demonstrate behavior change and impact on service delivery and patient-centered outcomes for HT victims, according to our proposed adapted Kirkpatrick's Pyramid model. HT training and evaluation would benefit from an agency or institution at the national level to provide consistency and standardization of HT training content as well as to guide a process that would develop metrics for evaluation and the building of an evidence base.

Abbreviations: AAP: American Academy of Pediatrics; ACF: Administration for Children and Families; CME: Continuing medical education; ED: Emergency department; HCP: Health care professional; HEAL: Health, Education, Advocacy, and Linkage; HHS: United States Department of Health and Human Services; HT: Human trafficking; IOM: United States Institute of Medicine; MH: Mental health; NHTRC: National Human Trafficking Resource Center; SOAR: Stop, Observe, Ask, and Respond to Health and Wellness Training.

Keywords: Violencemedical education; adolescent health; community health; emergency department; free clinics; labor trafficking; migrant health; patient–centered outcomes; sex trafficking; social justice.

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Figures

Figure 1.
Figure 1.
NHTRC calls- general vs. health care provider (HCP).
Figure 2.
Figure 2.
Total health care provider (HCP) calls vs. mental health (MH) provider calls to NHTRC.
Figure 3.
Figure 3.
Reasons for health care provider (HCP) calls to NHTRC. The NHTRC utilizes seven distinct categories to describe a caller’s reason for contacting the NHTRC and track substantive calls received through the hotline. Substantive calls exclude hang ups, wrong numbers, missed calls, and calls where the caller hangs up or is disconnected before the purpose of the call can be determined. General Information Requests: This category includes calls requesting general information on the issue of human trafficking, such as legal definitions, scope, statistics, trends, and prevalence. Direct Services Referral Requests: This call category includes requests for direct service referrals for survivors of human trafficking. Referrals may include contact information for service providers, law enforcement, coalitions and other collaborative efforts, and other relevant agencies or field practitioners. The most commonly requested referrals are for case management services, shelter services, legal services, mental health or medical services. Tips: This category includes calls received from individuals who wish to report tips related to human trafficking victims, suspicious behaviors, and/or locations where human trafficking is suspected to occur. Potential human trafficking tips received by the NHTRC are reviewed by hotline supervisors and regional specialists before being passed on to the appropriate local, state, or federal investigative and/or social service agency equipped to investigate and/or respond to the needs of victims. Not all tips are reported to law enforcement, and any reports made respect callers’ preferences regarding confideniality. Reporting decisions are based on a variety of factors, including the callers’ needs and wishes, and the needs and wishes of victims. Training & Technical Assistance (T&TA): T&TA requests include but are not limited to: specialized information; programmatic and project support; phone consultations; materials reviews; and trainings and presentations. At-Risk: This category refers to calls referencing related forms of abuse and exploitation that may put individuals or specific populations at risk for human trafficking, such as labor exploitation, domestic violence, sexual assault, child abuse, and runaway/homeless youth. Crisis Calls: This category includes calls received from victims of human trafficking in need of immediate assistance or from an individual calling on behalf of a victim in need of immediate assistance or emergency services. The NHTRC has developed extensive crisis protocols and local emergency referral and reporting networks to ensure that NHTRC staff are able to provide an immediate and tailored response to crisis calls. Unrelated: This call category refers to calls that are outside the scope of NHTRC services. NHTRC Call Specialists refer callers to other national hotlines, service providers, or coalitions that are best equipped to fulfill their request.
Figure 4.
Figure 4.
Types of calls by health care provider (HCP) to NHTRC over time.
Figure 5.
Figure 5.
Assessing impact of human trafficking medical education, a hierarchical, patient-centered model. HT = human trafficking; HCP = Health care providers.

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