A Safe Haven from Human Trafficking

Kiersten Kelly, MD
Posted on November 27, 2023

Note: Dr. Kelly is a resident physician at Dignity Health Family Medicine Residency in Sacramento, California, and one of AFP’s 2023 Resident Representatives.

Janette was sexually assaulted as she bounced between foster homes, finally running away to her mother who started grooming her for prostitution, where she soon was forced into drug use and trafficking as a teenager.

Human trafficking, defined as “the use of force, fraud, or coercion to compel a person into commercial sex acts or labor against their will,” is prevalent across the globe, with the International Labour Organization estimating that 49.6 million people were living in modern slavery in 2021. Since 2007, nearly 165,000 victims have been identified by the U.S. National Human Trafficking Hotline.

How did Janette finally escape her trafficking situation? She ended up in the hospital because of injuries and learned she was pregnant. Janette was connected with a clinic in Sacramento, California, that offered comprehensive and longitudinal care for victims and survivors of human trafficking—the Medical Safe Haven.

In 2014, Dignity Health created, from an abundance of need, the Human Trafficking Response Program , which included training protocols in trauma-informed care to better identify and care for victims and survivors in clinical settings. From this initiative came the Medical Safe Haven housed in the family medicine residency clinic at Methodist Hospital in Sacramento. A longitudinal approach combined with a wraparound care model was used to address the needs of this vulnerable population. Being situated within a residency program allowed for cost-effective care, as well as a trickle-down effect of training residents who would bring these skills to their future practices.

The Medical Safe Haven is connected to organizations in the community that help victims and survivors by providing resources, including housing, clothing, and meals. When patients are referred to the clinic through these organizations, law enforcement, and other clinical settings in the community, they are more likely to be able to avoid their trafficking situation than if they had never established care. In one study, 86% of women who successfully completed a community-based antitrafficking program had received care at the Medical Safe Haven, with an odds ratio of 5.37 compared with other participants. 

Trafficking can have burdensome health outcomes for patients, including sexually transmitted infections, unplanned pregnancies, and deleterious mental health effects. Most victims and survivors have health care encounters while being trafficked. Victims have often experienced judgment in health care settings based on how they are dressed, history of drug use, and inability to provide linear and cohesive histories. A key factor in the success of the Medical Safe Haven is building trust and providing longitudinal care with these patients who have often felt misunderstood in health care settings. 

Given trafficking’s high prevalence, clinicians must be prepared to recognize and care for these patients in any clinical setting, including the emergency department, labor and delivery, and other inpatient and outpatient settings.

To best care for this population of patients, physicians can do the following.

• Review risk factors, behavioral red flags, and signs/symptoms of trafficking and recognize that this population is most likely recruited into trafficking by someone they know (i.e., family member, caregiver, significant other, employer)
  • Risk factors: recent migration or relocation, substance use, family members in the sex trade, involvement in child welfare systems 
  • Behavioral red flags: not having control of their own money or documents, being unwilling to provide a history, behaving in sexually provocative or submissive ways
    
  • Signs/symptoms: includes genital trauma, inappropriate clothing for weather, poor eye contact, branding tattoos
    
• Review screening questions to assess for trafficking status
  • Can you leave your job if you want to?
  • Do you feel safe where you work?
  • Where do you eat and sleep? 
  • Do you have to ask permission to eat and sleep?
  • Do you believe that you could safely leave your living situation?
  • Could you safely leave your boyfriend?
  • Has anyone forced you to do things you do not want to do?
  • Have you ever been forced to have sex?
  • Do you want resources to help you out of your situation?
• If human trafficking is suspected in any clinical setting, offer judgment-free, trauma-informed care, which is defined as having an emphasis on knowledge of and accommodation for patients’ prior trauma and ways in which that affects their presentation, with the goal of developing trust and a therapeutic relationship
• Connect with local community organizations for resources (e.g., local hotlines, safe houses, and access to food and clothing) that can be provided to patients when human trafficking is suspected
• Review national resources, including the National Human Trafficking Hotline at 1-888-373-7888, to help with next steps if local resources are unavailable
• Increase your organization’s response to human trafficking through the Polaris Project and HEAL (Health, Education, Advocacy, Linkage) Trafficking Toolkit; in the outpatient setting, if your clinic can provide longitudinal services for this vulnerable patient population, connect with and receive referrals through local community organizations

Unfortunately, patients such as Janette live in nearly every community. Since its initiation, the Medical Safe Haven model has expanded to five residency clinics across California, which have cumulatively provided more than 5,000 patient visits and have served 800 unique patients. Family physicians are needed to continue serving as leaders in recognizing and providing care to victims and survivors of human trafficking across the nation.