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Jessica Peck, DNP, APRN, CPNP-PC, CNE, CNL, FAANP, FAAN, is a nationally recognized anti-human trafficking advocate who is on a mission to help voiceless victims recover from their abuse. Peck spoke with the American Association of Nurse Practitioners® (AANP), explained her advocacy and highlighted some of the red flags that may help other NPs identify potential victims of human trafficking.
January is National Human Trafficking Prevention Month, and in January 2022, AANP began equipping NPs with the continuing education (CE) needed to help bring an end to the exploitative and abusive practices that take place because of human trafficking.
The prevalence of human trafficking is difficult to measure for many reasons, Peck explained.
“Human trafficking is an illicit criminal enterprise, so it’s difficult to get accurate information because there are very few systems outside of criminal justice, and those are occurring after great harm has already occurred to people,” said Peck. “It can be difficult in that way. Another reason is that because we don’t have standard nomenclature or standardized reporting systems yet, so we’re still working on using the same definitions for terms so that we can study those in a scientifically rigorous way. We’re still working on how to get an accurate database from which to pull data, but having said all of those things, the International Labor Organization estimates trafficking victims to be in the hundreds of thousands.”
Peck said that the numbers in the United States and globally are estimated by the International Labor Association. In 2016, there were about 40 million people in trafficking, including forced labor and forced marriages, said Peck. Work is being done with law enforcement agencies and advocacy organizations to combat the problem.
“People who are exploited and abused through trafficking are accessing health care environments and it is happening anywhere you go,” Peck said.
While it is known that human trafficking is prevalent, stating in exact scientific terms how prevalent is still something experts and officials are working on, Peck said.
“One of the barriers to identifying victims is that they don’t recognize their victimization,” said Peck. “They don’t relate to the term victim, and they are usually people who are exploited and abused during trafficking. They are usually groomed or coerced or defrauded into that situation. So, many times they’ve been victims of their own circumstances or what they perceive to be poor decision-making, but many times it’s very difficult to recognize. They’ll develop trauma bonding with their trafficker and perceive that to be a loving and caring relationship when, in fact, it’s not.”
Victims are often conditioned to believe that the situation they are in is normal and acceptable.
“We know that by the time people are identified by law enforcement great harm has already occurred and there is a unique overlap victimization and criminality,” said Peck. “So, many people who are trafficked are also committing other crimes, many times under force, fraud or coercion.”
“They may be forced to traffic drugs or things like that,” said Peck. “We know that health care workers have a unique opportunity to identify victimization early by identifying risk factors that predispose someone to victimization. Nurses, in particular, are the most trusted professionals, so we have the opportunity to build relationships with patients so that we can identify risks.”
Peck said the goal is to connect victims with appropriate services and resources.
“We should not adopt the narrative of rescuing victims,” said Peck. “That is not our job. It puts too much pressure on nurses and other health care providers, and it takes too much agency away from people who are in that situation. Now, obviously, there’s something different to be said about children who are victimized. We are mandated to report in all 50 states.”
Especially for adults, NPs need to identify risk and connect appropriate services, said Peck.
“We have to remember when they’re accessing the health care system that something has prompted that visit to come, and people who are trafficked are viewed as a commodity, so they’re only going to present for health care when they are no longer able to work,” Peck said. “So, something is that bad. It’s a chronic illness that’s not been managed or an injury that’s not been tended to appropriately. It’s an infection that has not been treated properly. It’s a fracture that is so severe it needs attention. So, we have to remember that they are people in this space, and we have to tend to the health [care issue] for which they presented.
“We can also support them by giving them messages of hope,” Peck said. “It may be the first time that they hear someone say, ‘you know, it’s not okay for someone to treat you like that. There are resources. We can connect you to if this is something you want to consider.’ Those things are really important, but the most important way we can support people who are exploited and abused is through trauma-informed care.”
Peck said providing trauma-informed care is vital for NPs who want to help victims of human trafficking.
“It’s how we should be and it’s really a great thing because trauma-informed care may be implemented for people who are abused, but it’s also going to benefit other people, too,” Peck said. “It’s like a universal precautions approach. Everyone is going to benefit by trauma-informed care. So, that’s really the main way we can do that.”
Peck said that the most important thing for NPs to remember is that they should already know how to behave when treating potential victims of human trafficking.
“So, you need to know what you’re going to do before you have to do it,” said Peck. “That’s the most important thing, because if you are trying to make high stakes decisions in a hectic situation which is already in your clinical environment, then you don’t have a safe situation. It’s not safe for you. It’s not safe for your patient. It’s not safe for your coworkers. It’s not safe for the other families who are in the care environment.
”It’s kind of a serious analogy,” Peck said, “but you think about this like an active shooter situation. No one ever wants to encounter that, but if you’ve ever thought about it and are trying to decide what to do when it’s already happening, your outcome is not going to be good. It is a high-stakes situation, and you need to know what you’re going to do before you do it. Every clinical environment is different, so you have to know what your resources are, what are your policies, what are your protocols. You can start with the core competencies for human trafficking that were published earlier this year by the Department of Health and Human Services, and you can also start a work group in your political environment to make a plan for what you would do.”
Peck said, “Where we are looking at prevention, we are looking at risk factors that predispose people to exploitation and vulnerability. We need to look at that. We can’t talk about eliminating human trafficking without eliminating demand. That is a very complex issue, but without demand for cheap labor or sexual services or sexual abuse, then there would be no trafficking. So, it has to be a multi-pronged approach. We need to look at primary prevention, secondary prevention and tertiary prevention.”
NPs need to remember that many victims will not realize that they are victims, Peck explained. They have accepted their circumstances. “We have to remember,” Peck said, “that experiencing that trauma is going to impact the way they interact.”
It is crucial for NPs to create a place where potential victims feel comfortable disclosing the abuse they’ve faced, Peck stressed. There are evidence-based practices NPs can use in order to obtain the patient’s health history.
“It should be designed with scientific rigor and seek reliability and validity,” said Peck. “Trauma-informed questioning is the most effective way currently to identify potential victimization, and just asking open-ended questions is an effective way to open a conversation. Maybe speaking about adult victims. Maybe they don’t want to disclose anything right then in that moment, but they know that it’s a safe place they can come later for resources.”
You can help prevent human trafficking and treat victims who seek care in your practice setting. Start now by completing Human Trafficking: Nurse Practitioners Leading the Clinical Response in the AANP CE Center and earning two contact hours of CE credit. This compelling course will challenge you to apply a patient-centered, trauma-informed, evidence-based and culturally responsive clinical approach as you interact with patients who may be exploited in the human trafficking trade.