Human trafficking and health: a cross-sectional survey of NHS professionals’ contact with victims of human trafficking

Abstract

Objectives(1) To estimate the proportion of National Health Service (NHS) professionals who have come into contact with trafficked people and (2) to measure NHS professionals’ knowledge and confidence to respond to human trafficking.DesignA cross-sectional survey.SettingFace-to-face mandatory child protection and/or vulnerable adults training sessions at 10 secondary healthcare provider organisations in England, and meetings of the UK College of Emergency Medicine.Participants782/892 (84.4%) NHS professionals participated, including from emergency medicine, maternity, mental health, paediatrics and other clinical disciplines.MeasuresSelf-completed questionnaire developed by an expert panel. Questionnaire asks about prior training and contact with potential victims of trafficking, perceived and actual human trafficking knowledge, confidence in responding to human trafficking, and interest in future human trafficking training.Results13% participants reported previous contact with a patient they knew or suspected of having been trafficked; among maternity services professionals this was 20.4%. However, 86.8% (n=679) reported lacking knowledge of what questions to ask to identify potential victims and 78.3% (n=613) reported that they had insufficient training to assist trafficked people. 71% (n=556), 67.5% (n=528) and 53.4% (n=418) lacked confidence in making appropriate referrals for men, women and children, respectively, who had been trafficked. 95.3% (n=746) of respondents were unaware of the scale of human trafficking in the UK, and 76.5% (n=598) were unaware that calling the police could put patients in more danger. Psychometric analysis showed that subscales measuring perceived knowledge, actual knowledge and confidence to respond to human trafficking demonstrated good internal consistency (Cronbach's αs 0.93, 0.63 and 0.64, respectively) and internal correlations.ConclusionsNHS professionals working in secondary care are in contact with potential victims of human trafficking, but lack knowledge and confidence in how to respond appropriately. Training is needed, particularly for maternity staff, on how to identify and respond to victims’ needs, including through making safe referrals.

Health Care Providers’ Experience with a Protocol for the Identification, Treatment, and Referral of Human-Trafficking Victims

“…As others have suggested, contact with the healthcare system may be the only point of contact with a potential source of help that many trafficked individuals have (Sabella, 2011). However, because only a small proportion of US and UK based healthcare professionals (Chisolm-Straker et al, 2012) (Ross et al, 2015), have ever received any training in human trafficking, much more could be done to prepare the healthcare system to assist with human trafficking intervention.…”

“…A similar U.K.-based study surveyed 782 healthcare professionals and found that 20% had received any training on human trafficking (Ross et al, 2015). Perpetrators may present as caring, well-spoken family members or romantic partners when they accompany their victims to healthcare settings, making identification of victims by healthcare professionals that much more challenging (Becker & Bechtel, 2015).…”

“…However, the results of several recent small-scale studies, and the U.S. Federal Strategic Action Plan on Services for Victims of Human Trafficking, have concluded that education, training and guidance for healthcare professionals on the identification and referral of victims of human trafficking is urgently needed (Ahn et al, 2013;Becker & Bechtel, 2015;Chisolm-Straker et al, 2012;Aimee M. Grace et al, 2014;President's Interagency Task Force to Monitor and Combat Trafficking in Persons, 2013;; Ross et al, 2015).…”

Human Trafficking, Mental Illness, and Addiction: Avoiding Diagnostic Overshadowing

“…In addition to enduring abortions and miscarriages with little, if any, clinical attention, trafficking survivors might not have adequate access to prenatal health care and can suffer from pregnancy-complicating sexually transmitted infections, such as HIV [8,10]. Not surprisingly, a study from the United Kingdom showed that the health professional group most likely to encounter trafficked persons is maternity services professionals [11]. And a US-based study of trafficked persons found that approximately one quarter of labor and sex trafficked persons reported that they saw obstetricians during their period of exploitation [12].…”

Shared Decision Making With Vulnerable Populations in the Emergency Department

“…This is particularly true for patients who are being trafficked or are incarcerated or in police custody. [42][43][44] Shared decision making in the ED setting among patients with socioeconomic challenges may be inhibited by a perceived power differential between physicians and their patients, beyond that experienced by more affluent patients. While many patients are able to articulate their view of healthcare as a service, the impact of a perceived inherent power differential may manifest in various modes of patient behavior that create significant barriers to effective communication with the ultimate outcome of decreased participation by the patient in SDM.…”