Missouri Nurse Winter 2022/2023

protective laws (Barnert et al., 2017; CdeBaca & Sigmon, 2014; Moore et al., 2017). Unfortunately, when victims do disclose their trafficked status, they are often treated as criminals, illegal immigrants, prostitutes, or juvenile delinquents. Even when victims are recognized, they may refuse help. This may be due to loyalty to their traffickers or lack of awareness of their own victimization (Chaffee & English, 2015; Greenbaum & Bodrick, 2017). Children have fewer life experiences and lack insight into manipulation methods, as claiming the victim is worthless, or that it is the child’s fault they are in this predicament, all tactics used to increase victim’s dependency on the trafficker (Greenbaum & Bodrick, 2017). A victim’s subsequent To ensure victims are identified during clinical visits, education must go beyond raising awareness and recognizing the signs of human trafficking (CdeBaca & Sigmon, 2014). Training should provide guidance on how to use interviewing techniques to interact with suspected victims and tools to specifically answer questions posed by suspected victims. It is essential providers have knowledge about which community agencies are customized to assist HT victims. Education must include not only HT risk factors (see Table 1), but manifestations of physical and psychological abuse, indications of depression or fearfulness, and signs the victim is being controlled and unable to freely leave the situation (Hornor, 2015; Ronsey & Villano, 2020). It is essential that health care providers are cognizant that victims may present with physical and/ or psychological issues. Ailments stemming from drug use, food and sleep deprivation, physical or sexual feelings of guilt, shame, and hopelessness may also hinder disclosure. Care Implications

Table 1 Risk Factors that Increase Vulnerability to Minor Sex Trafficking (“Family” Mnemonic) Family history of alcohol or drug abuse, violence or mental health illness Adverse experiences for the child such as abuse by either the parents or others

Money issues, underemployment or nonemployment of the parents Involvement of child protective services or law enforcement at any time Lack of support systems or living with people other than the parents Youth with mental health or behavioral issues.

Note. Adapted from Ronsey, L. N. & Villano, C. E. (2020). Recognizing victims of a hidden crime: Human trafficking victims in your pediatric trauma bay. Journal of Trauma Nursing, 27 (1), 37-41. Retrieved from 10.1097/JTN.0000000000000480

violence, high risk sexual activities, or inadequate health care may be clues that the person is being trafficked (see Table 2) (CdeBaca & Sigmon, 2014; Hornor, 2015). Female victims are frequently accompanied by an older male who answer the provider’s questions and is unwilling to leave the victim alone (Hornor, 2015). When concerns arise, it is vital victims are separated from the accompanying person to permit private interviewing. Furthermore, due to indoctrination tactics, victims may lie about their age or present false identification. Victims possessing hotel keys or presenting with branding tattoos are other clues of the trafficking situation. Conclusion Over the last two decades HT has become a global crisis affecting

an estimated 4.5 million sexually exploited victims and generating worldwide over US $30 billion-dollars (Greer et al., 2014; Helton, 2016; Stacey, 2017; Weitzer, 2014). Through a process called grooming, victims are manipulated into becoming cooperating participants in their own abuse (Peterson, 2019). Once trafficked, victims become a renewable commodity who can be bought, sold, and exploited (Helton, 2016). As human trafficking is a closely hidden criminal structure involving many components and players, victims are difficult to identify (Helton, 2016). Oftentimes, victims do not openly disclose their situation, and some may actually take measures to protect their trafficker (Greenbaum & Bodrick, 2017; Moore et al., 2017). Immature victims

Table 2 Health Manifestations Indications that the Victim is being Trafficked

1. 2. 3. 4. 5.

Drug addiction or withdrawal

Pregnancy

Sexually transmitted diseases

Complications from self-induced abortions

Physical injuries

a. Fractures/bruises/contusions b. Cigarettes or other types of burns c. Dental problems such as missing or broken teeth

6. 7.

Depression or post-traumatic stress disorder Suicide ideation or suicide attempts

Note. Adapted from Hornor, G. (2015). Domestic minor sex trafficking: What the PNP needs to know. Journal of Pediatric Health care, 29 (1), 88-94, Box 2. Retrieved from doi: 10.1016/j.pedhc.2014.08.016.

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