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Part 2: A Clinical Approach to Recognizing Trafficking


How can healthcare professionals recognize and establish protocols for individuals who are being trafficked and provide a safe place?


Today, we will look at part two of this series, which is about recognizing trafficking in a clinical setting. Today’s article in this two-part series of recognizing trafficking helps inform many healthcare professionals to understand the roles and protocols for identifying trafficking that is affecting their patients and help provide a safe, positive space for them. We discuss with certified associated medical providers who consolidate our patients’ information to assess and identify trafficking in the clinic while taking the proper protocols to ensure patient safety. We also inform and guide patients while asking their associated medical provider intricate questions to integrate and provide them with a safe and positive space. Dr. Jimenez, D.C., includes this information as an academic service. Disclaimer.


Health Care Professional’s Role in Identifying Trafficking

Even though they may come across victims of human trafficking and have the chance to step in, many healthcare professionals believe they lack the knowledge and self-assurance needed to recognize these victims and offer them the kind of aid they need. As an illustration:

  • Just 37% of social workers and medical professionals surveyed again had any training in recognizing and supporting victims of human trafficking (Beck et al., 2015).
  • It is extremely hard for processors to identify and aid victims because traffickers move their victims around a lot and employ various strategies to evade discovery. Frequently, it could be your final interaction with the victim (Macy & Graham, 2012).
  • There can be a companion who comes across as very domineering, who won’t let the patient spend time alone with you, or who insists on filling out paperwork or talking on the patient’s behalf.
  • It’s possible that neither the victim nor their friend will have identification or insurance paperwork and will just pay in cash.
  • The victim or their companion may refuse to answer questions.
  • The victim may decline additional testing and follow-up care.
  • The victim may have physical injuries, sexually transmitted diseases, and signs of psychosocial stress.
  • The victim may not know the city and state that they are in.
  • The victim may appear fearful when asked questions or in the presence of their companion.
  • The victim may exhibit feelings of shame, guilt, helplessness, or humiliation.
  • You may notice inconsistencies in basic information, such as age, name, address, work history, or information regarding living status and daily activities.
  • If the patient does not speak English, where are they from, and how did they arrive?
  • If the patient is a minor, who and where is the guardian?
  • The victim may have unusual tattoos to indicate that they are the “property” of their trafficker.


Recognizing the Signs of Trafficking

You can more easily spot possible victims and offer the right help if you are aware of the typical warning indicators of human trafficking. The following are typical signs that someone is being trafficked. Naturally, not all victims or forms of trafficking will exhibit all of the indicators. Work and Living Conditions (National Human Trafficking Hotline, n.d.):

  • The victim may not be able to come and go on their own or leave their current home or work situation.
  • Human trafficking victims are often minors who are forced to engage in commercial sex acts.
  • The individual may work in the commercial sex industry and be under the control of a pimp or manager.
  • The victim may be required to work unusual or excessively long hours.
  • The victim may receive little, if any, pay or may only receive tips.
  • The victim may be subjected to unusual or extreme restrictions at work or may not be allowed to take breaks.
  • The victim may owe a large debt to their “employer.”
  • The victim may have been lured to their current work or living situation through false promises about the nature of their work or living environment.
  • The victim’s home or work location may have unusually high security, such as opaque or boarded-up windows, bars on windows, high fences, and security cameras.
  • The victim may be required to live at their work location.
  • The victim may experience various signs of abuse at the hands of their employer.
  • The victim may not be paid directly. Instead, the money is directed to the supervisor or manager, who deducts a large percentage for living expenses and other debts.
  • The victim may be forced to meet unreasonable daily quotas.
  • The victim may be forced to work in unsafe work environments without the proper safety equipment.


Chiropractic Care for Healing After Trauma-Video

Best Practice Guidelines for Interviewing Trafficking Individuals

As a healthcare provider, you must continuously weigh the different courses of action at every interview process step. To establish trust and ensure safety, practitioners must, above all, put aside preconceived notions and assumptions about the victims and their behavior (Hodge, 2014; DeBoise, 2014; Hemmings, Jakobowitz, & Abas, 2016). Zimmerman and Watts (2003) suggest that the World Health Organization has produced rules for every phase of the interview process, which include the following recommendations:

  • It’s critical to keep in mind that every trafficking scenario and survivor is distinct, making it crucial to pay attention to and accept each person’s account.
  • It could take some time for victims to open up and be willing to talk about their experiences because it can be hard for them to build rapport and trust.
  • You should take precautions to protect both you and the victim because you should anticipate that the victim is at risk of psychological, bodily, social, and legal harm.
  • To prevent further upsetting the victim, you should consider the risks and advantages before beginning the interview process, as it can be a traumatic experience in itself.
  • While you should direct victims to available resources when necessary, you should avoid making unfulfilled promises or pledges.
  • The amount of time it takes for victims of human trafficking to be prepared to embrace change might vary greatly. Some victims can be eager to look for new possibilities and to improve their circumstances. Some people can be less likely to accept assistance because they haven’t developed enough trust issues or because they fear retaliation from their trafficker.
  • Depending on the situation, many service providers or interpreters must be present during the interview. Everyone taking part in the interview process ought to be reasonably knowledgeable about human trafficking, including how traffickers manipulate their victims and how to interact with them in a way that respects their cultural differences. To maintain anonymity and ensure the victim can communicate freely and honestly, you should refrain from using interpreters who are acquainted with the victim or who live in the same neighborhood.
  • Having an emergency safety plan in place is crucial to shielding the victim from harm—both from others and self-harm.
  • Consent must always be obtained voluntarily for all interventions, including interviews. For many victims who have never known autonomy or self-determination, this may be a foreign idea.
  • Avoid using legal or technical jargon.

Furthermore, it’s critical to remember that trauma survivors may suffer after treatment can have a lasting effect on all facets of their lives, making psychological, emotional, and physical safety a top priority. It is reasonable to presume that the person provides the most accurate account of their experience at that time. A person’s guarded, defensive, and belligerent behavior may be only their coping mechanism for their trauma. (V. Greenbaum, 2017)


How to Report Known or Suspected Trafficking

The best way to report suspected trafficking is by calling the National Human Trafficking Hotline or texting the number 711 if the patient responds affirmatively to the evaluation questions if your findings imply that they might be victims of human trafficking. Additionally, you can text 233733. Basic details about the case will be requested from you, such as (National Human Trafficking Hotline, n.d.):

  • the location of the suspected trafficking
  • the name of the alleged trafficker, if possible
  • your city and state
  • how you learned about the hotline

Health care providers who know or believe that a youngster is being abused, neglected, or abandoned should report their concerns to law enforcement or the relevant child welfare agency right away, as they are required reporters under child abuse and neglect statutes. You can report abuse online or by calling the Department of Children and Families Abuse Hotline in the state you are residing in.


Documenting Physical Findings

Physical findings should be meticulously and precisely recorded using written descriptions, freehand sketches that have been identified and annotated, and digital or film photos with the patient’s consent. Regarding photography, the picture should show the patient’s face and the lesion or injury measured using a coin, ruler, or other common object. The photo should include a piece of paper bearing the date the picture was taken. More photos can capture up close shots of every pertinent lesion or injury. Serial follow-up photos over seven to ten days can be used to record the healing or advancement of ecchymoses and other injury-related symptoms. A statement identifying the photographer and attesting to the accuracy and integrity of the images ought to be incorporated into the chart. Before any photos are taken, consent for the photographic documentation should be sought and recorded. Patients should be aware of their rights, which include the ability to decline all photographic documentation or limit it to a limited number of specified locations.


In addition to providing essential medical care, the healthcare professional should work to establish an environment where each patient feels respected, comfortable, cared for, validated, and empowered to reveal if they so choose. If the patient does not feel “ready” to demonstrate in the clinical environment, disclosure may happen later. As a result, for at-risk patients, every single clinical interaction should be seen as a step toward their eventual safety.


Laws & Policies for Human Trafficking

The United States has enacted a variety of laws and policies designed to prevent human trafficking, punish the perpetrators, and protect the survivors. One of these laws and policies is the Trafficking Victims Protection Act law or the TVPA (U.S. Congress).


This is the centerpiece of federal human trafficking legislation. The act focuses on three primary areas:

  • The TVPA seeks to prevent human trafficking through increased training and awareness.
  • The act seeks to protect trafficking victims by providing them access to services using federal funds similar to other refugees.
  • The act establishes trafficking and related crimes as federal offenses subject to stiff penalties.

One way that the legislation protects victims of human trafficking is that it absolves them of consequences for engaging in criminal activities that arise from their trafficking experience, such as entering the nation using fraudulent documents or working without the proper authorization. In addition, families of trafficking victims are qualified for T visas, which let them stay in the nation to support federal law enforcement in their pursuit of the offenders. After three years, victims can then apply to become permanent residents. Depending on the specific circumstances, many individuals may be entitled to assistance and benefits, such as access to the Witness Security Program and reparations. In addition, individuals between 16 and 24 could qualify for the Job Corp program and work permits.


Others criticize the TVPA. Usually, the onus is on the victim to prove their innocence or compulsion first. Second, the act emphasizes sex trafficking more than other types of human trafficking, which ignores how intricate human trafficking is. Only victims and survivors of “severe” types of trafficking who are prepared to cooperate with the investigation and prosecution of their offenders are eligible for the services provided under the act. This ignores the severity of the abuse the victims endured and the degree of mistrust and terror they might harbor toward both the abuser and others in positions of power.


Preventing Trafficking Through Awareness, Interventions, & Resources

In the shadows, human trafficking flourishes. We eradicate the shadows where human traffickers lurk by increasing public and health practitioner awareness of the problem (Hodge, 2008; Gozdziak & MacDonnell, 2007). For instance, putting up signs and pamphlets on human trafficking can not only help to enhance public awareness but also boost the chance that victims may come forward on their own. Brochures and posters are free from the Campaign to Rescue and Restore Victims of Trafficking.


When assisting victims of human trafficking, practitioners and service providers need to be able to engage with a variety of governmental, legal, medical, and social service organizations and institutions. Generally speaking, there are three main categories into which the care and services that a victim falls (Dell et al., 2019; Johnson, 2012; Oram & Domoney, 2018):

  • Immediate Services
  • Services Related to Recovery
  • Services About Reintegration


Resources for Providers

The National Human Trafficking Resource Center’s referral database can be consulted by providers looking to connect with local programs that assist victims of human trafficking or who need assistance for a victim or survivor. Many healthcare providers can check out the website to provide helpful resources in their local area.



Any human trafficking violates fundamental rights. Since human trafficking has many underlying roots, eradicating the issue would need different approaches on various fronts. When it comes to addressing racism, poverty, oppression, prejudice, and other factors that lead to human trafficking, healthcare professionals need to be dedicated to facing this issue both within their patient population and in partnership with colleagues from different disciplines. Physicians, social workers, counselors, and other health care professionals are required by their code of ethics to lead in addressing power abuses and advancing social justice. Practitioners can accomplish this, among other things, by teaching others and themselves about the intricate dynamics and international scope of human trafficking.



Beck, M. E., Lineer, M. M., Melzer-Lange, M., Simpson, P., Nugent, M., & Rabbitt, A. (2015). Medical providers’ understanding of sex trafficking and their experience with at-risk patients. Pediatrics, 135(4), e895-902. doi.org/10.1542/peds.2014-2814

DeBoise, C. (2014). Human Trafficking and Sex Work: Foundational Social-Work Principles. Meridians: Feminism, Race, Transnationalism, 12(1), 227–233. muse.jhu.edu/article/541879/pdf

Dell, N. A., Maynard, B. R., Born, K. R., Wagner, E., Atkins, B., & House, W. (2019). Helping Survivors of Human Trafficking: A Systematic Review of Exit and Postexit Interventions. Trauma Violence Abuse, 20(2), 183-196. doi.org/10.1177/1524838017692553

Gozdziak, E., & MacDonnell, M. (2013, March 4). Closing the Gaps: the Need to Improve Identification and Services to Child Victims of Trafficking by School of Foreign Service – Georgetown University – Issuu. Issuu.com. issuu.com/georgetownsfs/docs/gozdziak-closing-the-gaps

Greenbaum, V. J. (2017). Child sex trafficking in the United States: Challenges for the healthcare provider. PLoS Med, 14(11), e1002439. doi.org/10.1371/journal.pmed.1002439

Hemmings, S., Jakobowitz, S., Abas, M., Bick, D., Howard, L. M., Stanley, N., Zimmerman, C., & Oram, S. (2016). Responding to the health needs of survivors of human trafficking: a systematic review. BMC Health Serv Res, 16, 320. doi.org/10.1186/s12913-016-1538-8

Hodge, D. R. (2008). Sexual trafficking in the United States: a domestic problem with transnational dimensions. Soc Work, 53(2), 143-152. doi.org/10.1093/sw/53.2.143

H.R.3244 – 106th Congress (1999-2000): Victims of Trafficking and Violence Protection Act of 2000. (2019). Congress.gov. www.congress.gov/bill/106th-congress/house-bill/3244

Johnson, B. (2016). Aftercare for Survivors of Human Trafficking. Scribd. www.scribd.com/document/324584925/Aftercare-for-Survivors-of-Human-Trafficking

Macy, R. J., & Graham, L. M. (2012). Identifying domestic and international sex-trafficking victims during human service provision. Trauma Violence Abuse, 13(2), 59-76. doi.org/10.1177/1524838012440340

National Human Trafficking Hotline. (2023). National Statistics. Humantraffickinghotline.org. humantraffickinghotline.org/en/statistics

Oram, S. (2021). Responding to the mental health needs of trafficked women. European Psychiatry, 64(S1), S12-S12. doi.org/10.1192/j.eurpsy.2021.55

Zimmerman, C., & Watts, C. (2003). Ethical and safety recommendations for intervention research on violence against women. Www.who.int. www.who.int/publications/i/item/9789241510189


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Professional Scope of Practice *

The information herein on "Part 2: A Clinical Approach to Recognizing Trafficking" is not intended to replace a one-on-one relationship with a qualified health care professional or licensed physician and is not medical advice. We encourage you to make healthcare decisions based on your research and partnership with a qualified healthcare professional.

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Dr. Alex Jimenez DC, MSACP, RN*, CCST, IFMCP*, CIFM*, ATN*

email: coach@elpasofunctionalmedicine.com

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