“The Promise of A Better Life”
Simkhada (2008)
Health Care and Human Trafficking:
Enacting Policy Communication
Dr. Julie L. Taylor
California State University, San Bernardino
Overview
• Public Policies
• Human Trafficking Policies
• Health Care Considerations
• Question & Answer
My
Perspectives
Associate Professor, Communication Studies (CSUSB)
Community Based Research- 14 Years
Organizational Communication
Policy Communication
Why should you care?
Humanity
Globalization Increases Networks
Technology Increases Access
Public Health Concerns
Public Policy Defined
“Public policies are collections of texts,
practices, and decisions articulated by an
institutional system to solve problems
involving people in society.”
(Canary & McPhee, 2009)
Policy-As-Practice
• Perspectives
• Life Experience
• Access to Write Policies
A
Communication-
Centered
Approach to
Policy
LeGreco & Canary, 2011
Policy Enactment
Frame Processes Communicative Outcomes
Orientation Basic Information Dissemination Identifying Policy Priorities
Asking Questions
Group/Online formal training
Amplification Multiple Stakeholders Constructing Meaning Clarifications and explanations
Asking Questions
Posing Potential Consequences
Expressing Differences
Implementation Constructing Meaning in Action Asking Questions
Clarifications and Explanations
Expressing differences
Integration Cross-Context Meaning Construction Identifying Policy Priorities
Seeking External Information
Negotiation of Interpretations
LeGreco & Canary, 2011
Human
Trafficking
Policies
Federal Timeline
State Guidelines
Trafficking Victims
Protection Act
2000
Human Trafficking Defined
The Purpose:
For the purpose of exploitation, which includes exploiting the
prostitution of others, sexual exploitation, forced labor, slavery
or similar practices and the removal of organs.
• Recruitment, transportation, transfer, harboring or receipt of persons
The Act:
• Threat or use of force, coercion, abduction, fraud, deception, abuse of power or
vulnerability, or giving payments or benefits to a person in control of the victim
The Means:
• For the purpose of exploitation, which includes exploiting the prostitution of others,
sexual exploitation, forced labor, slavery or similar practices and the removal of organs.
The Purpose:
Taylor & Isgro, 2018
California
Legislature
• Human Trafficking is "all acts involved in the
recruitment, abduction, transport, harboring,
transfer, sale or receipt of persons, within
national or across international borders,
through force, coercion, fraud or deception,
to place persons in situations of slavery or
slavery-like conditions, forced labor or
services, such as forced prostitution or sexual
services, domestic servitude, bonded
sweatshop labor, or other debt bondage."
Federal Policies
Trafficking Victims Protection Act 2000 (TVPA)
Trafficking in Persons Report (TIP Report)
18 U.S.C.§ 1584: Involuntary Servitude
18 U.S.C. § 1591: Sex Trafficking of child by force, fraud, or
coercion
18 U.S.C. § 1589: Forced Labor
CA Policies
PC 236.1 (a): Human Trafficking
PC 236.1 (c): Human Trafficking of a Minor
PC 266H: Pimping
PC 266I: Pandering
PC 266J: Furnish/Transport Child for Lewd Purposes
PC 267: Abduction of Minor For Prostitution
PC 647B: Prostitution (and SB 1322, amendment)
PC 653.22: Loitering for Prostitution (and AB 1771, amendment)
PC 318: Place of Illegal Prostitution
PC 266a: Abduction for Prostitution
PC 266c: Consent to Sex Act Induced by Fear
PC 181: Slavery
PC 236: False Imprisonment
PC 261.5c: Unlawful Sexual Intercourse
PC 315: Keeping or Residing in Home of Ill-Fame
PC 269: Aggravated Sexual Assault of a Child
PC 288: Sexual Offense or Lewd Act against Child
PC 422: Criminal Threats
PC 207: Simple Kidnap
PC 208: Kidnap of Children
PC 667.61: One Strike Law: Sentence is life if you have a kidnap or multiple victims.
Assembly Bill 629: Crime Victims (2019)
Assembly Bill 1735: Evidence: Privileges Human Trafficking Caseworker-Victim-Privledge (2019)
Senate Bill 970: Employment: Human Trafficking Awareness
Assembly Bill 2034: Human Trafficking Notice (2018)
Assembly Bill 178: Provision of Incident Reports to Victims (2016)
Assembly Bill 2027: Victims of Crime- nonimmigrant status (2016)
Senate Bill 448- Sex Offenders- Internet Identifiers (2016)
Senate Bill 1064: Sexually Exploited Minors (2016)
Senate Bill 1322: Commercial sex acts: minor (2016)
Assembly Bill 1276: Child Witness Human Trafficking (2016)
Assembly Bill 2498: Human Trafficking (2016)
Senate Bill 823: Criminal Procedure (2016)
Assembly Bill 1761: Human Trafficking Victims (2016)
Assembly Bill 2221: Criminal Procedure, Human Trafficking Witnesses (2016)
Assembly Bill 1684: Civil Actions: Human Trafficking (2016)
Assembly Bill 15: Limitations of actions: human rights abuses (2015)
Assembly Bill 418: Tenacy: termination (2015)
Senate Bill 84: State Government (2015)
Key CA Legislation to Protect
and Assist Human Trafficking
Survivors
Questions About
Policy Information?
Case Study
Approach
• Interviewed victims and people who work
closely with victims
• Recounted experiences with health care
• Opportunities for Intervention
Baldwin, Eisenman, Sayles, Ryan, & Chuang, 2011
Health Care Professionals
Play a Vital Role
SOAR
Stop
• Become aware of the scope of human trafficking
Observe
• Recognize the verbal and non-verbal indicators of human
trafficking
Ask
• Identify and interact with a potential victim using a
victim-centered, trauma-informed approach
Respond
• Respond effectively to a potential victim by identifying
needs and available resources to provide critical support
and assistance
Most Recent CA Legislation
AB 2034 Human Trafficking Education- Transit Employees
• At at least 20 min of training (by January 1, 2021).
• Training includes:
• (1) The definition of human trafficking.
• (2) Myths and misconceptions about human trafficking.
• (3) Physical and mental signs to be aware of that may indicate that human trafficking is
occurring.
• (4) Guidance on how to identify individuals who are most at risk for human trafficking.
• (5) Guidance and protocols for reporting human trafficking
SB 970: Hotel and Motel
• Currently through the California Fair Employment and Housing Act (FEHA) requires hotel
and motel employers with 50 + employees to provide 2 + hours of prescribed training and
education on sexual harassment, with the amendment 20 minutes of those two house
would be on human trafficking awareness. This would need to be implemented by January
1, 2020
Health Consequences
• Physical
• Reproductive Health Issues and Infectious Disease
• Psychological
Observing Body Language
Baldwin, Eisenman, Sayles, Ryan, & Chuang, 2011
Identification and Management of
Trafficking Victim
Domestic Violence vs Trafficking
Potential
Warning Signs
Evidence of physical and/or sexual violence
Discrepancy between suspected and reported age
Self-inflicted injuries
Addiction use disorders
Chronic medical conditions
Multiple or recurrent STI’s
Presence of controlling person (partner, employer, family member)
Reponses of PTSD
No access to valid identification
No verifiable residential address
If Warning Signs
are Detected
• Trauma-informed care
• Trust (verbal and nonverbal)
• Most patients don’t identify as being victims
Initial Communicative
Moments
“She [the trafficker] didn’t ask me
anything. She filled out everything,
[when they called my name], she
walked in with me. She called me her
‘auntie.’ [The doctor and nurse talked
to her]. I couldn't even listen. I
didn't speak English" Victim
“[I didn’t tell the nurse about my
situation] because the man was like,
around there, so we couldn’t really
talk about our situation. He was
outside, but he would walk in the
hallway where we were, where we
were at. He would try to find a way to
see if they could listen in.” Victim
Screening and
Physical
Examination
1. Separate the patient from anyone accompanying them
2. Use a certified translator or translator phone service if
t
here is a language barrier.
3. Ask the patient if they prefer male/female provider
4. Consider cultural backgrounds when patient is
an
swering (e.g., the role of eye contact)
5. During sexual history—t
his may be uncomfortable—try
to assess consensual and nonconsensual sexual
experiences
Hachey & Phillippi, 2017
Cultural Pressures
• “I was feeling guilty and shameful. I couldn’t
think…[about running away escaping] because I
kept thinking it would go to my family [and they]
would hear something about this and It's going to
be so shameful, and I was still having to…hoping to
make money…and start to saving money and send
it to my mom.” Victim
Baldwin, Eisenman, Sayles, Ryan, & Chuang, 2011
Sample Screening Questions
Hachey & Phillippi, 2017
Tell me about your living situation
Has anyone ever asked you to have sex in exchange
for money, food, shelter, or other items?
Has anyone every threatened violence if you
attempted to leave?
Has anyone ever threatened your family if you
leave?
Additional Questions
Safety
Is it safe for you to talk to me right now?
Do you feel like you may be in danger for speaking with me?
Is there anything that would help you feel safer?
Fraud
What were you told about the job before you started?
Have you ever felt you were deceived or lied to about your work or relationship?
Coercion
What would happen if you didn’t do what you were told?
Has anyone taken/kept your legal papers or identification?
Monetary
Do you have access to money?
Do you owe money to anyone? Can you spend your money the way you want to?
Force
Are you able to access medical care?
Are you allowed to leave the place you were living/working?
Sex
Has anyone ever pressured you to engage in sexual acts against your will?
Have you ever been required to earn a certain amount of money/meet a quota?
Hachey & Phillippi, 2017
Assisting Victims Vs Management
• Prioritize safety of the patient, practitioner, staff, and other patients
• Speak with the person alone
• Ask questions related to the symptoms to assess situation
Assisting Victims
• Adhere to HIPAA and exercise discretion with private information
• Assess safety risks
• Provide resources
• Know state-mandated reporting laws
• Do not contact the authorities without consent or unless legally mandated
• Avoid making promises
Management
Hachey & Phillippi, 2017
Incident Leading to Visit
• “One time, I was cleaning a restroom, I was cleaning
the wall and I was on a chair. And I slipped and I fell
to the floor. It was a hard fall; it’s a cement floor. I
couldn’t get up. I was very dizzy…for 10 days, I had
some fluid coming from my left ear…I couldn’t hear. I
had a lot of pain…[Then] her [trafficker] sister came
from San Francisco visiting, and she insisted that
they take me to the doctor.” Labor Trafficking Victim
Baldwin, Eisenman, Sayles, Ryan, & Chuang, 2011
Visit Rationale
Service Provider “She had a lot of acne problems and that’s
mostly what she was worried about, mostly what she went to
the doctor about. Because she worked in the front of the shop,
the trafficker was concerned about her appearance. Also, she
has arthritis really bad because of all the work she was doing.
So she had back pain and hand pain, and so she would go in for
pain medicine.”
Sonia “When she [the trafficker] got there, she spoke English
with the doctor. He came in and asked me what was wrong,
and I said my throat. And he started touching my throat and
made me open my mouth and that was it. He only asked me
how long has the pain been present, and I told him it’s been
about a month that I’ve had this pain. And I was not able to say
anything more because the lady was with me.” Victim
Baldwin, Eisenman, Sayles, Ryan, & Chuang, 2011
Potential Exam Findings Associated with Human Trafficking
System Subjective Complaints & Objective Clinical Findings Associated physical and psychological trauma
General Evidence of malnutrition, weight loss, anorexia, fatigue, poor
skin, nausea/vomiting
Poor nutritional status (starvation, malnutrition, dehydration,
eating disorder), sleep deprivation, insomnia, infectious
disease, anxiety, substance use/addition
Dermatological Burns, bites, scratches, tattoos, contusions, scars, lacerations,
ligature marks, track marks
Psychical trauma (slap, beat, kick, punch, burn, restraint),
strangulation, confinement, torture, labor industrial
injury/exposure, branding
Neurological Headache, dizziness, disorientation, memory loss, vertigo,
concentration difficulty
Traumatic brain injury, starvation, frequent relocation,
isolation, anxiety, depression, complex trauma, PTSD
Cardiovascular Cough, arrhythmias, fever, asthma, tuberculosis, hypertension Unsanitary or crowded living conditions, industrial exposure,
trauma, dehydration, infectious disease
Musculoskeletal Fractures, back pain, joint pain, loss of extremities Traumatic injuries (abuse assault), industrial injuries, stress,
repetitive injury, prolonged work hours
Reproductive Pelvic Pain, labial/vulvar/vaginal/cervical trauma, mutilations,
hematomas, untreated or recurrent STI’s, UTI’s, unintended
pregnancies, multiple abortions
Sexual trauma, gang rape, nonconsensual sex, multiple sex
partners, multiple or forced abortions
Hachey & Phillippi, 2017
Debt Bondage
“It hurt so much, but the next day I did
go to the hospital, but the next day I had
to work because they told me the $500
would be a liability to them and that
would be added to my debt.” Victim
”[They took us to get the HIV test] but on
the way there, we had to stop and work,
to be able to pay for that.” Victim
Baldwin, Eisenman, Sayles, Ryan, & Chuang, 2011
Understanding
the Phases for
Intervention
Zimmerman, Hossain, & Watts, 2011
Policy Enactment Applied
Frame Processes Example
Orientation Basic Information Dissemination Human trafficking includes exploitation
which means poor working conditions,
lack of agency, and repeated violence.
Amplification Multiple Stakeholders Constructing Meaning Resources such as law enforcement,
victim service providers, health care
providers must work together to
identify various resources and needs
Implementation Constructing Meaning in Action Questions like “Should we revise intake
processes now?” or “will interpreters
be available as needed?”
Integration Cross-Context Meaning Construction Pulling in external resources or policy
experts to read through new protocols
Understanding
the Phases for
Intervention
Zimmerman, Hossain, & Watts, 2011
Strategies to Improve Identification of Human
Trafficking Victims in Health Care Settings
• Train health care personnel
• Mitigate language barriers (provide interpreters)
• Interview or examine all patients privately at some point
d
uring medical visit
• Add social, work, home history, and domestic violence
s
creening questions into routine intake
• Carefully observe body language and communication of
patients and those who accompany them
• Learn about local resources
Human Trafficking Education
and Referral Resources
Department of Health and Human Services
Local Police Department
Coalition Against Trafficking in Women
Polaris Project
Safe Horizon
Questions?
• Julie.taylor@csusb.edu
Dr. Julie L. Taylor
• 1-888-373-7888
National Human Trafficking Resource Center
Extra Material, if
needed for Q & A
