Editor’s Note: The AHA’s Hospitals Against Violence initiative, in partnership with Catholic Health Initiatives and Massachusetts General Hospital’s Human Trafficking Initiative and Freedom Clinic, helped secure 29 diagnostic ICD-10 codes, which became available Oct. 1, allowing hospitals and health systems to better track victim needs and identify solutions to improve the health of their communities. Kathleen Hackett, R.N., pediatric SANE program coordinator for University Hospitals at Rainbow Babies and Children’s Hospital in Cleveland, recently chatted with AHA Today about the new codes and combatting human trafficking. 

Q: What role do nurses play in helping to identify victims of human trafficking? After identification, are there other areas in which health care providers can assist victims?

A: Nurses absolutely help drive these efforts. We train all providers to look for red flags and signs, such as a partner who is very controlling or overbearing at the hospital, someone who refuses to leave the patient alone with a provider, inconsistencies in the patient’s story and others. At Rainbow, we’ve developed a process to identify minors who are missing. In the past, we were simply treating and releasing people who could have been victims of human trafficking. Now, we have a guideline in place where we partner with law enforcement to cross check the missing persons list. We have identified several patients in the emergency department as missing persons, and because of this process, three minors who were seen in Rainbow’s ED had been identified as missing and found to be victims of human trafficking. Identifying patients as possible victims of human trafficking is only the first step for providers; we need to educate patients about our concerns, give them the opportunity to be part of a safety plan, and give them options. Knowing how to appropriately respond when there is a concern for a victim is crucial, and having a pre-established hospital protocol or plan will empower hospital staff to notify the appropriate personnel to maintain the victim’s safety.

Q: Why is it important for health care providers to be educated on this issue?

A: I’m really passionate about this subject because I know I once missed a victim [of human trafficking]. It’s so important to be educated and know what to look for. Nurse practitioners and physicians still have room for improvement in recognizing the signs of human trafficking in patients, which is why we are trying to educate all providers. Now, as part of our onboarding process, University Hospitals requires mandatory training during orientation, and providers are given resources on human trafficking. In addition, clinicians now will be required to complete a human trafficking training as part of yearly mandatory competencies. When I received the new human trafficking ICD-10 codes for data collection and statistics, I sent them out to the providers and coders in our hospital, including all 705 nurse practitioners in our system. The ICD-10 codes are so important because they support human trafficking education in the hospital system. When hospitals and health systems apply the codes, we will have the data to conduct further research on this topic to help create best practices for everyone in the health care setting.    

Q: Can you share some lessons learned from your efforts in detecting human trafficking that may be beneficial to other hospitals and health systems? 

A: I have a lot of takeaways; I have learned on this journey. First, as health care providers, be sure to separate the patient from anyone he or she might have come in with, and assess their safety. When we identify a potential victim and offer services, we need to understand that the patient may not be ready to accept help. As providers, we can assure the patient that our facility is a safe place to return to should he or she feel unsafe and eventually want help. A potential victim of human trafficking has no control over his or her life, so allowing that patient to make decisions about his or her own life may initiate trust and a sense of safety. In my experience, some victims do not accept services on the first visit, or ever. I also found it essential to educate our legal department first, so that is something hospitals and health systems should work to do in integrating the new codes. In addition, it is important for us to understand that many victims of human trafficking were vulnerable previously in their life, which often precipitates the easiness for a trafficker to manipulate and control a person. By using a trauma-informed care approach, we again can initiate trust and a sense of safety for the person we are caring for in the health care setting. This patient population often lives in a state of high alert and faces significant trauma. These patients are doing what they can to survive. 

Lastly, work with your community to improve patient outcomes. We work with Project Star, which gives us access to advocates trained to work with human trafficking victims who quickly respond to the hospital for patients in crisis. In addition, we partner with the Cleveland Rape Crisis Center, which offers ongoing services for all our patients. We want to connect our patients to these resources so that they have choices and access to positive support. Establishing relationships with like-minded organizations is essential for a better patient outcome.      

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