Social Emergency Medicine Teaching Modules
This work is licensed under the Creative Commons Attribution-No Derivatives 4.0 International License
Shamsher Samra, MD, Phil
Todd Schneberk, MD
1. Understand the nature and scope of human trafficking.
2. Understand how the emergency department can be a unique venue to identify and address cases of human trafficking.
3. Learn how to assess for human trafficking and what resources are available to help victims of human trafficking.
JS is a 39-year-old woman who presents to the emergency department after a syncopal episode while picking fruit on a hot summer day. Her employer is at bedside and volunteers to interpret. She had been feeling lightheaded all day but tried to work through it. Lab work was sent at triage and her creatinine is slightly elevated. After intravenous fluids, the patient begins to feel better but still appears nervous. You try to delve farther into what has been going on in her life recently, but the employer interjects and answers your questions without interpreting them. You tell them that you are taking the patient to radiology for a chest x-ray and ask the employer to wait in the room. In radiology, you have an interpreter waiting and re-interview your patient far away from the employer. She divulges that she lives in a makeshift structure on the edge of the farm where she picks fruit. There isn’t adequate water for all of the workers at the farm or sufficient breaks to access it. When asked if she wants to report this to local authorities, she is afraid of being fired and deported. She was brought into the country by her employer to work in what seemed to be a promise of economic stability so that she could send money back to her family. But when she arrived in the country, the employer confiscated her identification and had severely limited her contact with anyone outside the farm.
The social worker speaks with the patient and calls the police. In addition to referrals help with basic needs, the patient is referred to an immigration focused medical-legal partnership that helps her to obtain a T-Visa.
1. What are the signs that this patient is a victim of trafficking?
2. What is a T-Visa?
3. What are the different forms of immigration relief available for refugees, asylees, victims
of domestic violence, trafficking, and other crimes?
4. Does trafficking only happen to those from outside the U.S.?
1. Globally 12 million people live in conditions of forced labor or sexual servitude generating over 150 billion dollars in profit. According to the U.S. State Department, human trafficking is defined as the recruitment, harboring, transportation, provision, or obtaining of a person for 1 of 3 purposes:
- 1. Labor or services, through use of force, fraud, or coercion for the purpose of subjection to involuntary servitude, peonage, debt bondage, or slavery
- 2. Commercial sex act through the use of force, fraud, or coercion
- 3. Any commercial sex act if the person is younger than 18 years old, regardless of whether coercion was involved.
2. Most labor trafficking victims (67%) and a large percentage of sex-trafficking victims
(13%) are believed to be undocumented, contributing to higher barriers to exit.
3. While challenging, identification of trafficking victims in the emergency department can be a critical health intervention. There is no standard screener to identify victims of trafficking. Maintaining privacy during the interview and using a certified healthcare
interpreter for limited English proficiency patients are critical.
4. Some victims of trafficking may be eligible for immigration relief and legal residence
through the T-VISA or the U-VISA program.
5. Human trafficking can potentially include movement between countries but does not require movement to fit the definition. People can be considered trafficked that were born into servitude, were exploited in their own home town or were transported to the exploited situation which can be between within or outside of their own home country. The common denominator is the traffickers' aim to exploit the victim regardless of the location.
Violence Against Women Act (VAWA)
Special Immigrant Juvenile Status (SIJS)
Asylum and Convention against Torture (CAT)
1. Are your local social workers aware of the T-Visa and U-VISA programs?
2. Who are local legal organizations that can assist patients in cases of human trafficking?
3. What is local law enforcement's perspective on trafficking?
Recommended Screening Question(s)
These are general physical safety questions recommended by the LA County Health Agency SBDOH Workgroup that may reveal labor or sex trafficking concerns. The Workgroup has not yet developed specific questions to screen for labor or sex trafficking.
1. Do you currently feel unsafe? (Yes/No)
2. Have you ever been slapped, kicked, hit or physically hurt by someone in the past year? (Y es/No)
3. Are you currently in or have you ever been in an abusive relationship? (Yes/No)
4. Have you ever been pressured or forced to have sex? (Yes/No)
Shandro, J., et al., Human Trafficking: A Guide to Identification and Approach for the Emergency Physician. Ann Emerg Med, 2016. 68(4): p. 501-508.e1.
Discussion Points from the Reading
1. Traffickers control their victims by coercion and maintain control by using fear, physical, sexual and emotional violence and manipulation. Patients who are trafficked rarely self- identify, and may have no obvious signs of abuse. This makes identifying potential victims even more difficult. Not all victims are ready to leave their exploitive situation or to acknowledge that they are being exploited. The most important focus of a provider is to create an environment of trust and respect so that those victims who are ready to disclose their situation feel comfortable to do so.
2. There is a national trafficking hotline available 24/7 which can be contacted at 1-888-373- 7888. This resource can help victims, will accept tips regarding people being trafficked and has a directory of services available to trafficking victims.
1. Macias-Konstantopoulos, W., Human Trafficking: The Role of Medicine in Interrupting the Cycle of Abuse and Violence. Ann Intern Med, 2016. 165(8): p. 582-588.
2. Victims of Human Trafficking: T Nonimmigrant Status. (n.d.). Retrieved February 21,
2018, from https://www.uscis.gov/humanitarian/victims-human-trafficking-other- crimes/victims-human-trafficking-t-nonimmigrant-status